Clinician-researcher profile: Marika Diamantes
1. Can you please tell us about your background and your current role in SWSLHD?
I have been working as a clinical dietitian at Liverpool Hospital since 2005 and in the last ten years have had the privilege of working with infants/children/teenagers and their families in the hospital newborn care unit, paediatric inpatient and outpatient dietetian service. I have also always been quite interested to learn and dig more deeply on topics to gain understanding and clarity, and undertook research in my undergrade university studies, but it was not until 2017 when I decided to develop these skills more formally by enrolling in a distance Masters coursework degree at the University of Newcastle (after my first year, I transferred into a Masters of Clinical Epidemiology, as this course seemed better suited to my goals to develop research skills). Currently I am working as a Senior Clinic dietitian and provide nutrition care in the two outpatient dietitian services attached to Liverpool Hospital (the General Paediatric Dietetic Clinic and in the multidisciplinary Feeding Clinic service). I am also currently providing cover support for some of the adult inpatient and outpatient clinics.
2. Congratulations on your 2023 publication in Dietetics! Can you tell us a little about the study and your results?
Thank you. This work was the result of the project undertaken by a 4th year student (Araceli Jeri) from the University of Wollongong, conducted in 2021, that was run by Dr May Mak (Head of Department (HoD) of the Dietetics’ Department at Liverpool Hospital), as the lead student project supervisor) and myself, at the hospital end and with Dr Kelly Lambert (from the University of Wollongong). To provide more context, in late 2019/very early in 2020, I started having conversations with May about whether we could consider using telehealth as an adjunct to our standard care because I was noticing more families voicing the burdens that were associated with attendence for their child’s dieitian appointments. Increasingly, families would arrive late to appointments, either apologising (or understandably expressing frustration) and explaining that it took a long time to find parking, or they had to travel a long distance from their car to get to the appointment (and at times in extreme temperatures) or they would need to leave an appointment early, to make sure they had not exceeded their carpark limit or told me they were getting infringement notices because they had inadvertedly or intentionally restored to parking in non-designated spots. At the time, telehealth technology was still novel but we thought it might help ease some of the burdens associated with in-person attendance for hospital dietitian appointments. Then the global Coronavirus (COVID-19) pandemic arrived in Australia and all of Liverpool Hospital Dietetic services swiftly had to move from in-person to remote care. The Paediatric Outpatient Dietetic service adhered to the social distancing recommendations by providing telehealth appointments (either via a virtual platform or phone). A small silver-lining of this time was that it provided an opportunity to evaluate whether there was any clinical or service level outcome differences between standard care for patients attending the Paediatric Dietetics’Outpatient service before the pandemic (using face to face modality of care) compared to during the pandemic (using telehealth). The study also reported on the larnings from the rapid implementation of telehealth in this setting.. The study compared paediatric patient groups from the pre COVID 19 period (1 April 2019 to 31 March (2020) and the post COVID 19 period (1 April 2020 to 31 March 2021). Information collected included: demographic data; anthropometry (weight (kg); length/height (cm); associated growth percentile and growth charts used); source of measurement; compliance to dietitian recommendations; attendance; and modality of care (telehealth, health video or face to face). Overall, this study found that telehealth service delivery in the paediatric dietetics’ context was comparable to that of face to face care. The results indicated that telehealth was not associated with inferior clinical and patient service level outcomes including growth, compliance to dietetic recommendations and attendance rate. However, there were concerns with reliability of the anthropometric measurements, low uptake of virtual telehealth and technical difficulties associated with this mode of care. Despite these challenges, telehealth can be a valuable mode of health care delivery and thus a useful addition to traditional care after the COVID 19 Pandemic.
You can read Marika's publication here and hear more about the study at the Allied Health Grand Rounds on Thursday 15th February at 12pm
3. What QI/research projects are you working on currently?
Currently I am in the initial stage of setting up a follow on project to the original study described above. The study team will also include: Dr May Mak; Dr Caitlin McMaster (Research Officer, South West Sydney Allied Health Research Collaboration, SWSLHD and University of Sydney) and a 4th year student from the Nutrition and Dietetic’s program and the University of Wollongong. To date, few studies have investigated the use of telehealth care for dietetic treatment of these children and adolescents. No studies have explored parent/carers’ views of telehealth and willingness to use telehealth as a standard part of care. This study will aim to explore parents/carers' satisfaction and perceptions of telehealth as part of outpatient paediatric dietetic treatment as well as the willingness of parents/carers to incorporate telehealth into the Paediatric Dietetic Clinic at Liverpool Hospital. This study will involve two components: (1) A survey of parents/carers who have attended the Paediatric Dietetic Clinic at Liverpool Hospital; and (2) interviews with parents/carers who complete the survey and opt-in to also be interviewed. It is hoped that this project will improve dietetic treatment for these families and reduce the burden associated with attending at hospital appointments.
4. What would you like other allied health clinicians to know if they are thinking about conducting QI/research projects?
If you see an issue or problem within your clinical service, and you want to try to make improvements or offer a solution (and at the same time, potentially develop and grow your skills), it is possible to do research while working. For me, the resources that have allowed me to develop skills in this area and pursue research goals have been, having access to the Ingham Research Institute staff and resources. Initially when I started to explore the idea of research, I was keen to undertake any learning opportunity that was available to me. The Institute offered several free research courses to hospital staff, and I eagerly enrolled in a few of these. Another key for me was that once I started to share my interest and goals, conversations led to introductions to researchers (from the Ingham Institute) who were generous with their time to provide guidance about coursework and resources. More recently, I have had the opportunity to participate in a research mentoring program with the Ingham Research Institute and been supported by a mentor for a six month period. I appreciated this opportunity and am thankful for the guidance provided to navigate formalising the project and going through the process for the district ethics. Given this was the first time I had navigated this process, it was reassuring to know I could access support on a regularly monthly basis as well as adhoc. I would have found it too daunting to do the process completely independently. I also appreciate that I have been in a department with a HoD who is very supportive of research and willing to share knowledge and resources as well as intentionally seeking to create a culture within the department with facilitates involvement and interest in research. If other allied health are interested in conducting QI/research projects, I would say, with enough personal motivation, good organisation and determination and a knowledge about the research supports that are available to staff working at Liverpool hospital, this is possible.