Academic literature on the topic 'Australian hospitals'
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Journal articles on the topic "Australian hospitals"
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Kerr, Rhonda, and Delia V. Hendrie. "Is capital investment in Australian hospitals effectively funding patient access to efficient public hospital care?" Australian Health Review 42, no. 5 (2018): 501. http://dx.doi.org/10.1071/ah17231.
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Objective This study asks ‘Is capital investment in Australian public hospitals effectively funding patient access to efficient hospital care?’ Methods The study drew information from semistructured interviews with senior health infrastructure officials, literature reviews and World Health Organization (WHO) reports. To identify which systems most effectively fund patient access to efficient hospitals, capital allocation systems for 17 Organisation for Economic Cooperation and Development (OECD) countries were assessed. Results Australian government objectives (equitable access to clinically appropriate, efficient, sustainable, innovative, patient-based) for acute health services are not directly addressed within Australian capital allocation systems for hospitals. Instead, Australia retains a prioritised hospital investment system for institutionally based asset replacement and capital planning, aligned with budgetary and political priorities. Australian systems of capital allocation for public hospitals were found not to match health system objectives for allocative, productive and dynamic efficiency. Australia scored below average in funding patient access to efficient hospitals. The OECD countries most effectively funding patient access to efficient hospital care have transitioned to diagnosis-related group (DRG) aligned capital funding. Measures of effective capital allocation for hospitals, patient access and efficiency found mixed government–private–public partnerships performed poorly with inferior access to capital than DRG-aligned systems, with the worst performing systems based on private finance. Conclusion Australian capital allocation systems for hospitals do not meet Australian government standards for the health system. Transition to a diagnosis-based system of capital allocation would align capital allocation with government standards and has been found to improve patient access to efficient hospital care. What is known about the topic? Very little is known about the effectiveness of Australian capital allocation for public hospitals. In Australia, capital is rarely discussed in the context of efficiency, although poor built capital and inappropriate technologies are acknowledged as limitations to improving efficiency. Capital allocated for public hospitals by state and territory is no longer reported by Australian Institute of Health and Welfare due to problems with data reliability. International comparative reviews of capital funding for hospitals have not included Australia. Most comparative efficiency reviews for health avoid considering capital allocation. The national review of hospitals found capital allocation information makes it difficult to determine ’if we have it right’ in terms of investment for health services. Problems with capital allocation systems for public hospitals have been identified within state-based reviews of health service delivery. The Productivity Commission was unable to identify the cost of capital used in treating patients in Australian public hospitals. Instead, building and equipment depreciation plus the user cost of capital (or the cost of using the money invested in the asset) are used to estimate the cost of capital required for patient care, despite concerns about accuracy and comparability. What does this paper add? This is the first study to review capital allocation systems for Australian public hospitals, to evaluate those systems against the contemporary objectives of the health systems and to assess whether prevailing Australian allocation systems deliver funds to facilitate patient access to efficient hospital care. This is the first study to evaluate Australian hospital capital allocation and efficiency. It compares the objectives of the Australian public hospitals system (for universal access to patient-centred, efficient and effective health care) against a range of capital funding mechanisms used in comparable health systems. It is also the first comparative review of international capital funding systems to include Australia. What are the implications for practitioners? Clinical quality and operational efficiency in hospitals require access for all patients to technologically appropriate hospitals. Funding for appropriate public hospital facilities, medical equipment and information and communications technology is not connected to activity-based funding in Australia. This study examines how capital can most effectively be allocated to provide patient access to efficient hospital care for Australian public hospitals. Capital investment for hospitals that is patient based, rather than institutionally focused, aligns with higher efficiency.
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Unnithan, Chandana. "RFID Implementation in Australian Hospitals." International Journal of Enterprise Information Systems 10, no. 2 (April 2014): 40–61. http://dx.doi.org/10.4018/ijeis.2014040103.
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Radio Frequency Identification (RFID) is a mobile technology that was explored in hospitals in the last decade for improving process efficiencies. However, in the Australian context, this technology is still regarded as an innovation that health ICT practitioners and hospitals are reluctant to trial. This technology, although non-intrusive, is perceived as disruptive by hospitals. Information Systems professionals in the ICT sector and Health Informatics practitioners in Australia are exploring best practices for implementation. In this research paper, I report on findings from empirical research that was conducted in Australia, based in two large hospitals1, to better understand the factors involved in the successful implementation of RFID in Australian hospitals. Findings from this study are presented and endorsed by health ICT practitioners and informatics professionals as current implications for the field.
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Dwyer, Judith, and Sandra G. Leggat. "Innovation in Australian hospitals." Australian Health Review 25, no. 5 (2002): 19. http://dx.doi.org/10.1071/ah020019b.
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This paper examines the challenge of innovation,and reports on innovation in the Australian hospital sector. Through review of both published and 'grey' literature,the analysis of the innovative record of Australian hospitals is focused on two key questions: How has the hospital sector made use of opportunities for renewal and improved effectiveness in its ongoing response to the challenges it faces? And are the conditions for effective innovation in place? To be truly innovative,the Australian hospital sector requires greater supporting mechanisms including:a consistent policy and funding framework,greater ability to harness the power of information,and development of innovation skills.The government has an important role to play in stimulating the creative capacities of hospitals and their staff.
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Cheah, Ron, Arjun Rajkhowa, Rodney James, Kym Wangeman, Sonia Koning, Karin Thursky, and Kirsty Buising. "Case for antimicrobial stewardship pharmacy technicians in Australian hospitals." Australian Health Review 44, no. 6 (2020): 941. http://dx.doi.org/10.1071/ah19236.
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The pharmacist’s role in hospital antimicrobial stewardship (AMS) programs is known to improve patient safety and the quality of care. Despite this, many Australian hospitals struggle to provide adequate pharmacy AMS program resourcing and need to explore newer models of care. The Pharmacy Board of Australia’s Guidelines for Dispensing Medicines permit suitably qualified, competent and experienced pharmacy technicians to assist pharmacists in ‘tasks in a pharmacy department’. The pharmacy technician workforce is expanding, and there is growing interest in career advancement and expansion of the pharmacy technician role. We propose that the pharmacy technician, a well-integrated member of many Australian hospital pharmacy departments, can play an important role in hospital AMS programs. To bolster AMS initiatives in Australian hospitals, this paper explores the existing evidence for pharmacy technicians in AMS programs and describes how this role may be better supported in Australia.
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Thompson, Walter R., Garry D. Phillips, and Michael J. Cousins. "Anaesthesia underpins acute patient care in hospitals." Australian Health Review 31, no. 5 (2007): 116. http://dx.doi.org/10.1071/ah07s116.
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The Australian and New Zealand College of Anaesthetists (ANZCA) carried out a review of the roles of anaesthetists in providing acute care services in both public and private hospitals in Europe, North America and South-East Asia. As a result, ANZCA revised its education and training program and its processes relating to overseastrained specialists. The new training program, introduced in 2004, formed the basis for submissions to the Australian Medical Council, and the Australian Competition and Consumer Commission/ Australian Health Workforce Officials? Committee review of medical colleges. A revised continuing professional development program will be in place in 2007. Anaesthetists in Australia and New Zealand play a pivotal role in providing services in both public and private hospitals, as well as supporting intensive care medicine, pain medicine and hyperbaric medicine. Anaesthesia allows surgery, obstetrics, procedural medicine and interventional medical imaging to function optimally, by ensuring that the patient journey is safe and has high quality care. Specialist anaesthetists in Australia now exceed Australian Medical Workforce Advisory Committee recommendations
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Lightfoot, Diane. "The history of Public Health Diagnostic Microbiology in Australia: early days until 1990." Microbiology Australia 38, no. 4 (2017): 156. http://dx.doi.org/10.1071/ma17056.
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The arrival of the First Fleet in Port Jackson in 1788, and the subsequent establishment of the colony of NSW began the history of the Australian public health system. Prior to Federation each state dealt with their own public health issues and much of the microbiological analysis was performed in the early hospitals and medical school departments of universities. Today, as there is no central Laboratory for the Commonwealth of Australia, each Australian state is responsible for the microbiological testing relevant to public health. However, because of various Commonwealth of Australia Department of Health initiatives, the Australian Government Department of Health is responsible for the overall public health of Australians.
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Duckett, S. J. "Australian hospital services: An overview." Australian Health Review 25, no. 1 (2002): 2. http://dx.doi.org/10.1071/ah020002a.
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Hospital services in Australia are provided by public hospitals (about 75% of hospitals, two-thirds of separations) and private hospitals (the balance). Australians use about one bed day per person per year, with an admission rate of about300 admissions per thousand population per annum. Provision rates for public hospitals have declined significantly (by 40%) over the last 20 years but separation rates have increased. Average length of stay for overnight patients has been stable but, because the proportion of same day patients has increased dramatically, overall length of stay has declined from around seven days in the mid 1980s to around four days in the late 1990s. Overall, the Commonwealth and state governments each meet about half the costs of public hospital care, private health insurance meets about two-thirds of the costs of private hospitals.
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L Gilbert, G. "A resistant culture - ?superbugs? in Australian hospitals." Microbiology Australia 28, no. 4 (2007): 184. http://dx.doi.org/10.1071/ma07182.
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Antimicrobial resistance is not new in Australian hospitals. In 1946, shortly after penicillin became available for treatment of civilians, a penicillin resistant Staphylococcus aureus strain caused ~50% of staphylococcal surgical wound infections at the Royal Prince Alfred Hospital (RPAH), in Sydney. During the 1950s, another virulent penicillin resistant S. aureus strain (phage type 80/81) emerged in neonatal units in Sydney and spread to other hospitals in Australia and overseas, to the families of affected infants and to the general community, causing serious soft tissue infections, osteomyelitis, pneumonia and septicaemia.
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Norman, Daniel A., Margie Danchin, Christopher C. Blyth, Pamela Palasanthiran, David Tran, Kristine K. Macartney, Ushma Wadia, Hannah C. Moore, and Holly Seale. "Australian hospital paediatricians and nurses’ perspectives and practices for influenza vaccine delivery in children with medical comorbidities." PLOS ONE 17, no. 12 (December 12, 2022): e0277874. http://dx.doi.org/10.1371/journal.pone.0277874.
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Introduction Influenza vaccination of children with medical comorbidities is critical due their increased risks for severe influenza disease. In Australia, hospitals are an avenue for influenza vaccine delivery to children with comorbidities but are not always effectively utilised. Qualitative enquiry sought to ascertainment the barriers and enablers for influenza vaccination recommendation, delivery, and recording of these children at Australian hospitals. Methods Semi-structured interviews and discussion group sessions were conducted with paediatricians and nurses at four tertiary paediatric specialist hospitals and two general community hospitals in three Australian states. Transcripts from interviews and group sessions were inductively analysed for themes. The Capability, Opportunity, Motivation, and Behaviour (COM-B) model was used to explore the elements of each theme and identify potential interventions to increase influenza vaccination recommendation and delivery behaviours by providers. Results Fifteen discussion sessions with 28 paediatricians and 26 nurses, and nine in-depth interviews (five paediatricians and four nurses) were conducted. Two central thematic domains were identified: 1. The interaction between hospital staff and parents/patients for influenza vaccine recommendation, and 2. Vaccination delivery and recording in the hospital environment. Six themes across these domains emerged detailing the importance of dedicated immunisation services, hospital leadership, paediatricians’ vaccine recommendation role, the impact of comorbidities, vaccination recording, and cocooning vaccinations. Supportive hospital leadership, engaged providers, and dedicated immunisation services were identified as essential for influenza vaccination of children with comorbidities in Australian hospital. Conclusion Recommendation of influenza vaccination for Australian children with comorbidities is impacted by the beliefs of paediatricians and the perceived impact of influenza disease on children’s comorbidities. Dedicated immunisation services and supportive hospital leadership were drivers for influenza vaccine delivery at hospitals. Future interventions targeting hospital-based influenza vaccine delivery for children with comorbidities should take a rounded approach targeting providers’ attitudes, the hospital environment and leadership support.
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Adams, Nicole, and David Tudehope. "Australia’s persistently high rate of early-term prelabour Caesarean delivery." Australian Health Review 45, no. 4 (2021): 463. http://dx.doi.org/10.1071/ah20176.
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ObjectiveTo compare the incidence of prelabour Caesarean delivery (PCD) at early term (37 weeks and 0 days (370) to 38 weeks and 6 days (386) of gestation) between Australian states and hospital sectors over time and to compare these rates with those of England and the United States of America (USA). MethodA population-based descriptive study of 556040 singleton PCDs at term (370−406 weeks) in all public and private hospitals in Australian states, 2005–16, was performed. The primary outcome was the early-term PCD rate, defined as early-term PCDs as a percentage of all term PCDs. ResultsAcross Australian states, the early-term PCD rate fell from 56.4% in 2005 to 52.0% in 2016. Over a similar period, England’s rate fell from 48.2% in 2006–07 to 35.2% in 2016–17, while the USA’s rate fell from 47.4% in 2006 to 34.2% in 2016. Australian public hospitals reduced their rate from 54.2% in 2005 to 44.7% in 2016, but the rate increased in private hospitals from 59.1% in 2005 to 62.5% in 2016. There was considerable variation between states and hospital sectors. ConclusionsThe early-term PCD rate increased in Australian private hospitals from 2005 to 2016. The public hospital rate fell by nearly 10% over the period but remained ~10% above the English and USA national rates. What is known about the topic?Babies born at early term (370−386 weeks) are at greater risk of morbidity than babies born at full term (390−406 weeks). Australia has a persistently high rate of early-term prelabour Caesarean delivery (PCD). What does this paper add?This paper reveals concerning differences in the early-term PCD rate between Australian states and hospital sectors. Further, the paper highlights that both Australian hospital sectors (public and private) have not reduced their rates to levels achieved in England and the USA. What are the implications for practitioners?These results should inform efforts to reduce Australia’s early-term PCD rate to prevent harm to babies.
Dissertations / Theses on the topic "Australian hospitals"
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Nita, Yunita. "Adverse drug reaction reporting in Australian hospitals." Thesis, Curtin University, 2002. http://hdl.handle.net/20.500.11937/1234.
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Adverse drug reactions (ADRs) are known to be a major cause of morbidity and mortality. However, only a small proportion are reported. An increase in the number and quality of reports by improving ADR reporting systems in hospitals, could improve patient outcomes and save healthcare costs. The first part of this project was to review the ADR reporting systems in Australian hospitals and to determine factors contributing to the ADR reporting rate. Data were collected by a postal, self-administered questionnaire. Questionnaires were sent to 299 chief pharmacists of Australian hospitals listed in the Society of Hospital Pharmacists of Australia (SHPA) directory. The response rate was 49.5%. Seventy seven (60%) hospitals had a formal hospital policy for ADR reporting and 110 (85.3%) hospitals targeted all drugs to be reported. ADR reporting rates to ADRAC in 2000 (ADR reports per patient admission) were between zero and 1.09% (median=0.02%) with 7.1% of hospitals having a reporting rate of zero. A centralised ADR system and the existence of an ADR policy was not associated with higher reporting rates. The next part of the project was a survey of 803 Western Australian (WA) doctors and 1323 Australian hospital pharmacists to evaluate involvement in, understanding of and reasons for reporting ADRs. A postal, self-administered, anonymous questionnaire was sent to doctors at two tertiary hospitals in Perth and three regional hospitals in WA. A similar questionnaire was sent to all hospital pharmacists listed in the membership list of SHPA, as well as non-SHPA members in WA. Response rates obtained for the WA doctors survey was 35% (n=277) and 43% (n=574) for hospital pharmacists. Sixty four percent of doctors and 96% of hospital pharmacists knew how to report ADRs within the hospital while 57% and 98% (respectively) knew how to report ADRs to ADRAC.Factors that would encourage respondents to report ADRs included serious reactions, unusual reactions, reaction to a new product and confidence in the diagnosis of the ADR. More than 70% of respondents agreed that an uncertain association between the ADR and the suspected drug, minor reactions and well known reactions were factors that would deter them from reporting ADRs. From a list of 14 hypothetical ADR questions, it was found that respondents were more likely to report serious and uncommon reactions. Finally, the incidence of cross-sensitivity between penicillin and other β-lactam antibiotics among patients experiencing penicillin allergy in Fremantle Hospital and Health Services (FHHS) was assessed, along with the appropriate documentation of penicillin allergy in the medical records. The study was a retrospective audit and review of medical records in FHHS (1994-2000). All medical records of patients experiencing penicillin allergy during admission, or causing admission to FHHS, (n=85) were reviewed and data on reactions to other β-lactams were recorded. The incidence of definite cross-sensitivity between penicillins and cephalosporins was 6%, consistent with the reported rate of cross-sensitivity. The documentation of penicillin allergy in the medical records was less than optimal, with alerts on 89% of medication charts and only 28% of medical records (front cover). Improvement in the documentation of ADRs in patients' medical records would likely decrease the risk of preventable adverse events.
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Nita, Yunita. "Adverse drug reaction reporting in Australian hospitals." Curtin University of Technology, School of Pharmacy, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=14052.
Full textAbstract:
Adverse drug reactions (ADRs) are known to be a major cause of morbidity and mortality. However, only a small proportion are reported. An increase in the number and quality of reports by improving ADR reporting systems in hospitals, could improve patient outcomes and save healthcare costs. The first part of this project was to review the ADR reporting systems in Australian hospitals and to determine factors contributing to the ADR reporting rate. Data were collected by a postal, self-administered questionnaire. Questionnaires were sent to 299 chief pharmacists of Australian hospitals listed in the Society of Hospital Pharmacists of Australia (SHPA) directory. The response rate was 49.5%. Seventy seven (60%) hospitals had a formal hospital policy for ADR reporting and 110 (85.3%) hospitals targeted all drugs to be reported. ADR reporting rates to ADRAC in 2000 (ADR reports per patient admission) were between zero and 1.09% (median=0.02%) with 7.1% of hospitals having a reporting rate of zero. A centralised ADR system and the existence of an ADR policy was not associated with higher reporting rates. The next part of the project was a survey of 803 Western Australian (WA) doctors and 1323 Australian hospital pharmacists to evaluate involvement in, understanding of and reasons for reporting ADRs. A postal, self-administered, anonymous questionnaire was sent to doctors at two tertiary hospitals in Perth and three regional hospitals in WA. A similar questionnaire was sent to all hospital pharmacists listed in the membership list of SHPA, as well as non-SHPA members in WA. Response rates obtained for the WA doctors survey was 35% (n=277) and 43% (n=574) for hospital pharmacists. Sixty four percent of doctors and 96% of hospital pharmacists knew how to report ADRs within the hospital while 57% and 98% (respectively) knew how to report ADRs to ADRAC.Factors that would encourage respondents to report ADRs included serious reactions, unusual reactions, reaction to a new product and confidence in the diagnosis of the ADR. More than 70% of respondents agreed that an uncertain association between the ADR and the suspected drug, minor reactions and well known reactions were factors that would deter them from reporting ADRs. From a list of 14 hypothetical ADR questions, it was found that respondents were more likely to report serious and uncommon reactions. Finally, the incidence of cross-sensitivity between penicillin and other β-lactam antibiotics among patients experiencing penicillin allergy in Fremantle Hospital and Health Services (FHHS) was assessed, along with the appropriate documentation of penicillin allergy in the medical records. The study was a retrospective audit and review of medical records in FHHS (1994-2000). All medical records of patients experiencing penicillin allergy during admission, or causing admission to FHHS, (n=85) were reviewed and data on reactions to other β-lactams were recorded. The incidence of definite cross-sensitivity between penicillins and cephalosporins was 6%, consistent with the reported rate of cross-sensitivity. The documentation of penicillin allergy in the medical records was less than optimal, with alerts on 89% of medication charts and only 28% of medical records (front cover). Improvement in the documentation of ADRs in patients' medical records would likely decrease the risk of preventable adverse events.
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Martin, Geraldine M. "Outsourcing in Western Australian hospitals: Management considerations." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1996. https://ro.ecu.edu.au/theses/961.
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This thesis examines Health Care Managers' considerations with and experiences of outsourcing services in Western Australian hospitals. Support services such as cleaning and maintenance are some of the areas which have been targeted for outsourcing (contracting out) by the state government. These services have traditionally been delivered by permanently employed staff either on a full or part- time basis, usually with active union involvement. Core services such as nursing and medical care which involve direct patient care delivery are not included in the outsourcing debate. Firstly, this thesis reviews the literature on outsourcing and its application to the health care industry. Performance indicators and benchmarking are also explored within the context of contracted out services in a variety of settings. The implicit economic, social and legal implications are discussed. This study involved Health Care Managers in Western Australian hospitals and was conducted between June 1995 and May 1996. Their experiences with outsourcing of services together with the hospitals and the communities they served were key considerations in the final analysis. The research findings support the views of more recent studies which emphasize the importance of the context within which outsourcing is implemented, such as rural versus metropolitan hospitals. Hospital size, location, accessibility to contractors, human resource issues and funding arrangements such as those which affect teaching and non- teaching facilities were identified as major determinants affecting the degree to which outsourcing had been embraced. Finally, the implications of this research for future studies are discussed.
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Tan, Ee Lyn. "Drug and Therapeutics Committees: Studies in Australian hospitals." University of Sydney. Pharmacy Practice, 2005. http://hdl.handle.net/2123/711.
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Australia�s policy on Quality Use of Medicines (QUM) aims to achieve appropriate use of medicines and improved health outcomes. Drug and Therapeutics Committees (DTCs) are educators, policy makers as well as financial gatekeepers in matters relating to medicine use. Increasingly, DTCs are also involved in risk management and clinical governance. As such, DTCs could be considered to be QUM advocates in the institutions in which they function. In a health care arena where there are escalating demands on high standards of clinical practice, quality assessment and improvement is essential in ensuring safe and effective patient care. Given the role DTCs play in safeguarding the interests of the stakeholders of the health care system, research into ways in which DTC performance could be enhanced is required. Although indicators specific to DTCs exist, the literature does not seem to provide straightforward answers to the question of what is currently being done in terms of quality assessment and quality improvement of DTCs. In the absence of such data, an opportunity for research is clearly identified. The first aim of this research project was to gain insight into the current activities undertaken by, and challenges facing Australian DTCs. Following this, the second aim was to explore ways in which DTC performance could be augmented. In addressing the first aim of this project, a national survey of Australian DTCs was conducted. These findings reinforce the evidence in the literature about the roles, structure and stakeholder expectations of DTCs. Our research also documents DTCs� quality improvement initiatives and barriers to DTC activities. It appears that there is little support available to Australian DTCs. Further, a case study was undertaken in order to gain an understanding of the depth and detail of DTC operations. An audit of a DTC in an Australian hospital was conducted. This study revealed that DTC decisions are being implemented in an ad hoc manner. In fact, there were no strategies (or action) planned to implement the majority of their decisions. This could have an impact on DTC performance. In view of this finding, qualitative methods were used to explore stakeholder opinions regarding the implementation of DTC decisions and policies. Stakeholders believed that strategies used to implement DTC policies should be targeted (to the audience as well as the type of decision/policy being implemented), timely, and delivered at the point of care. Face-to-face strategies were perceived to be more effective than printed materials, particularly when an influence on clinical practice was desired. Stakeholders also felt that the lack of resources was a significant barrier to DTC performance augmentation. This probably contributed to a lack of follow-up (or review) of implemented policies. According to stakeholders, other barriers to policy implementation include a lack of ownership of policies, low DTC profile, and an over-reliance on pharmacy to implement DTC decisions. Stakeholders felt one of the ways in which DTC performance could be improved was to prioritise DTC decisions for implementation. In pursuit of a method to prioritise DTC decisions, a survey was conducted. Stakeholders identified patient safety, cost, and the practice of evidence-based medicine as domains of important DTC decisions. The results also suggest that stakeholders recognise the need for the prioritisation of DTC decisions for implementation. Stakeholders implied that higher priority would be assigned to DTC decisions considered to be important. In a follow-up survey, stakeholders (including doctors, nurses, pharmacists, and DTC members) seemed to have agreement of the primary domains of DTC decisions. Higher levels of importance and higher priority were assigned to decisions involving the primary domains of patient safety and cost. However, level of importance and priority assignment were not consistently correlated. The work presented in this thesis suggests that there are ways to improve DTC performance. Although conducted primarily on hospital-based DTCs, it is anticipated that the lessons learnt could be applied to state-based, or even, Area Health-based DTCs. In conclusion, this research found that there was a range of views regarding �importance� and prioritisation for implementation. Social, organisational, as well as environmental factors may contribute to this. Future research should examine other possible factors contributing to the importance and priority of DTC decisions, so that DTC policy could be appropriately implemented into practice.
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Gallego, Gisselle. "Access to High Cost Medicines in Australian Hospitals." Thesis, The University of Sydney, 2006. http://hdl.handle.net/2123/1008.
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In the public hospital sector in Australia there is no dedicated scheme to offset costs associated with high cost medications (HCMs) to the institution or the public. (1) Concerns exist as to the equity of access and appropriate mechanisms to manage access to HCMs in public hospitals. (2) There are gaps in the literature as to how decisions are made, and in particular, decision-making processes by which ethical, clinical and economic considerations maybe taken into account. To date, limited work has been conducted regarding the use and funding of HCMs in public hospitals. There are no published data on perceptions, concerns and attitudes, among health care decision-makers or among the community-at-large about access to HCMs in public hospitals. The research reported in this thesis describes the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. The investigation triangulated quantitative and qualitative methods used to collect and analyse data. Four studies were conducted to describe the decision-making process and explore the perceptions, concerns and attitudes of health care decision-makers and the perceptions of members of the general public regarding access to HCMs in public hospitals. The first study, reported in Chapter Three, was a review of individual patient use (IPU) requests for non-formulary HCMs. This study showed that these requests had a significant impact on the capped expenditure of a public hospital. Subsequent to this review, a new policy and procedure for managing requests for HCMs for IPU was established. A high-cost drugs subcommittee (HCD-SC) operating under the auspices of the Drug and Therapeutics Committee (DTC) was created. The second study, reported in Chapter Four, described the operations of the newly formed HCD-SC. This study also evaluated the decision-making process using the ethical framework “accountability for reasonableness”. (3) Different factors were involved in decisions about access to HCMs and decisions were not solely based on effectiveness and cost. HCD-SC members considered it was important to have consistency in the way decisions were being made. The evaluation of this process allowed identification of good practices and gaps which were considered as opportunities for improvement. The third study, reported in Chapter Five, found that health care decision-makers in an Area Health Service echoed the concerns and agreed about the problems associated with access to HCMs expressed by the HCD-SC members. These studies concluded that the majority of decision-makers wanted an explicit, systematic process to allocate resources to HCMs. These studies also identified tensions between funding systems and hospital decision-making. According to participants there were no mechanisms in place to systematically capture, analyse and share the lessons learned between the macro level (ie. Federal, Pharmaceutical Benefits Scheme - PBS) and the meso level (ie. Institution, public hospital) regarding funding for HCMs. Furthermore, decision-makers considered there are strong incentives for cost-shifting between the Commonwealth and the States. Health care decision-makers also acknowledged the importance of public participation in decision-making regarding allocation of resources to HCMs in public hospitals. However the results of these studies showed that those decisions were not generally made in consultation with the community. Decision-makers perceived that the general public does not have good general knowledge about access to HCMs in public hospitals. A survey of members of the general public, reported in Chapter Six, was then conducted. The survey aimed to gather information about the knowledge and views of members of the general public about access to HCMs in public hospitals. Results of this fourth study showed that respondents had good general knowledge but were poorly informed about the specifics of funding of hospitals and HCMs in private and public hospitals. The results also offered support for the development of a process to involve community members in discussion on policy on the provision of treatment and services within health care institutions and specifically, to seek the views of members of the public on the provision of HCMs and expensive services within public hospitals. In summary, the research reported in this thesis has addressed the gaps in the literature as to how decisions are made, and in particular, the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. In a move towards more explicitness in decision-making regarding the allocation of scarce health care resources, the findings from these studies provide an evidence base for developing strategies to improve decision-making processes regarding access to HCMs the public sector.
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Gallego, Gisselle. "Access to High Cost Medicines in Australian Hospitals." University of Sydney, 2006. http://hdl.handle.net/2123/1008.
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Doctor of Philosophy(PhD)In the public hospital sector in Australia there is no dedicated scheme to offset costs associated with high cost medications (HCMs) to the institution or the public. (1) Concerns exist as to the equity of access and appropriate mechanisms to manage access to HCMs in public hospitals. (2) There are gaps in the literature as to how decisions are made, and in particular, decision-making processes by which ethical, clinical and economic considerations maybe taken into account. To date, limited work has been conducted regarding the use and funding of HCMs in public hospitals. There are no published data on perceptions, concerns and attitudes, among health care decision-makers or among the community-at-large about access to HCMs in public hospitals. The research reported in this thesis describes the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. The investigation triangulated quantitative and qualitative methods used to collect and analyse data. Four studies were conducted to describe the decision-making process and explore the perceptions, concerns and attitudes of health care decision-makers and the perceptions of members of the general public regarding access to HCMs in public hospitals. The first study, reported in Chapter Three, was a review of individual patient use (IPU) requests for non-formulary HCMs. This study showed that these requests had a significant impact on the capped expenditure of a public hospital. Subsequent to this review, a new policy and procedure for managing requests for HCMs for IPU was established. A high-cost drugs subcommittee (HCD-SC) operating under the auspices of the Drug and Therapeutics Committee (DTC) was created. The second study, reported in Chapter Four, described the operations of the newly formed HCD-SC. This study also evaluated the decision-making process using the ethical framework “accountability for reasonableness”. (3) Different factors were involved in decisions about access to HCMs and decisions were not solely based on effectiveness and cost. HCD-SC members considered it was important to have consistency in the way decisions were being made. The evaluation of this process allowed identification of good practices and gaps which were considered as opportunities for improvement. The third study, reported in Chapter Five, found that health care decision-makers in an Area Health Service echoed the concerns and agreed about the problems associated with access to HCMs expressed by the HCD-SC members. These studies concluded that the majority of decision-makers wanted an explicit, systematic process to allocate resources to HCMs. These studies also identified tensions between funding systems and hospital decision-making. According to participants there were no mechanisms in place to systematically capture, analyse and share the lessons learned between the macro level (ie. Federal, Pharmaceutical Benefits Scheme - PBS) and the meso level (ie. Institution, public hospital) regarding funding for HCMs. Furthermore, decision-makers considered there are strong incentives for cost-shifting between the Commonwealth and the States. Health care decision-makers also acknowledged the importance of public participation in decision-making regarding allocation of resources to HCMs in public hospitals. However the results of these studies showed that those decisions were not generally made in consultation with the community. Decision-makers perceived that the general public does not have good general knowledge about access to HCMs in public hospitals. A survey of members of the general public, reported in Chapter Six, was then conducted. The survey aimed to gather information about the knowledge and views of members of the general public about access to HCMs in public hospitals. Results of this fourth study showed that respondents had good general knowledge but were poorly informed about the specifics of funding of hospitals and HCMs in private and public hospitals. The results also offered support for the development of a process to involve community members in discussion on policy on the provision of treatment and services within health care institutions and specifically, to seek the views of members of the public on the provision of HCMs and expensive services within public hospitals. In summary, the research reported in this thesis has addressed the gaps in the literature as to how decisions are made, and in particular, the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. In a move towards more explicitness in decision-making regarding the allocation of scarce health care resources, the findings from these studies provide an evidence base for developing strategies to improve decision-making processes regarding access to HCMs the public sector.
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Boyce, Rosalie A. "The organisation of allied health professionals in Australian general hospitals." Thesis, Queensland University of Technology, 1996. https://eprints.qut.edu.au/107083/1/T%28BS%29%20134%20The%20organisation%20of%20allied%20health%20professionals%20in%20Australian%20general%20hospitals.pdf.
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This research is a case study in the sociology of professions. It reports on the Australian allied health professions, a group that has rarely been the subject
of sustained research. The central purpose of the research is to examine the impact of local workplace organisation in Australian general hospitals in the public sector on the position of the allied health professions and their
autonomy. Further, the research seeks to unbundle the competing claims about the utility of alternative organisational approaches and to examine how the allied health professions negotiate inter-professional relationships as a consequence of particular organisational approaches. The research draws on Eliot Freidson's professional dominance theory (medical dominance theory) as the underpinning theoretical framework. Medical dominance theory portrays the allied health professions as inevitably subject to medical dominance and subordination, a proposition which is critically appraised through a contemporary analysis of local workplace arrangements.
To address these issues three models of allied health profession organisation were identified; the classical medical model, division of allied health model and
the unit dispersement model. The research method involved a comparative case study approach and included fifty-three interviews, document analysis, observation strategies and key informants over a two year period. Data collection was guided by seventeen themes of inquiry which were identified
from a multiple methods approach as likely to be important in a comparative analysis of the organisation of the allied health professions.
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Sukkar, Malak, and sukkarm@stvmph org au. "Executives' Decision Making in Australian Private Hospitals: Margin or Mission?" RMIT University. Graduate School of Business, 2008. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20081031.162754.
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This thesis examines decision making at executive level in Australian private hospitals as a social phenomenon, since individuals draw meaning from their own biographical and social environmental experiences. The researcher interpreted the constructed realities of the factors influencing executives' decisions within the context of private hospitals - a field that is rarely examined through the lens of social research. Using an Interpretivist research paradigm, the researcher conducted semi- structured and in-depth interviews with sixteen executive members who are experts in their field and represent both sectors of the private hospital industry: private for-profit and private not-for-profit. The data generated was transformed into technical accounts using an abductive research strategy and adopting Schütz's notion of first-order and second-order constructs. Using Giddens' Structuration Theory, that stressed the fundamental role of the human agent, the structure and their mutual dependence, the researcher moved beyond the interpretation of individuals' meanings, to incorporate the structure as an entity that can be formed and reformed. The researcher interpreted social actors' constructed meanings of these social phenomena in their work environment to form the elements of a two-dimensional decision making model at organisational level, incorporating the present with the future and the internal with the external factors. On an individual level, three different approaches to decision making were identified, based on whether executives perceived the decision making phenomenon as intuition, as a reasoned process or as an expected outcome. While being from a limited research sample, the findings of this study suggest that the paradox of mission / economic decisions restrained executives in the not-for-profit sector from strengthening their hospitals' financial performance, putting at risk, therefore, their ability to achieve social dividends as a way to proclaim their mission. On the other hand, in the for-profit sector, shareholders' dividends appeared to be a strong catalyst for attaining profit maximisation when making decisions. In both settings, the findings suggest that the role of stakeholder theory is questionable, particularly when executives remained hesitant to involve medical specialists, whom they considered to be major stakeholders and profit generators for private hospitals. This attitude appeared to be constant, despite the changes identified in executives' individual approaches to decision making. However, early signs of shifts towards adopting more commercially and socially accountable decisions were apparent in not-for-p rofit and for-profit sectors respectively. The thesis sets out recommendations to assist executives in managing the different factors that interplay to form executives' decisions. The importance of having a mission in business longevity and the integration, as opposed to alignment, of strategic goals with business operations when making executive decisions in private hospitals was highlighted. The implications for both sectors are described and recommendations for further research are suggested.
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Fry, Margaret Mary. "Triage nursing practice in Australian emergency departments 2002-2004 an ethnography /." Connect to full text, 2004. http://hdl.handle.net/2123/701.
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Thesis (Ph. D.)--University of Sydney, 2005.Title from title screen (viewed 19 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Family and Community Health Nursing, Faculty of Nursing. Degree awarded 2005; thesis submitted 2004. Includes bibliographical references. Also available in print form.
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Coulter, Sonali A. "An economic evaluation of antimicrobial stewardship programs in metropolitan Australian hospitals." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/116505/9/Sonali_Coulter_Thesis.pdf.
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This thesis provides the first economic evaluation of Antimicrobial Stewardship (AMS) interventions in two Metropolitan Australian Hospitals. AMS interventions are cost-saving from a hospital perspective and are cost-effective particularly if teamed with rapid diagnostics in the microbiology laboratory. The uncertainty in the mortality estimates does not allow for a high level of confidence in the cost-effectiveness decision for policy makers. While mortality is a useful metric, morbidity associated with bloodstream infections due to inappropriate prescribing needs to be collected over a longer period of time to capture the true benefits of AMS interventions.
Books on the topic "Australian hospitals"
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Colin, Grant, ed. Australian hospitals, operation and management. 2nd ed. Melbourne: Churchill Livingstone, 1985.
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Grant, Colin. Australian hospitals: Operation and management. 2nd ed. Melbourne: Churchill Livingstone, 1985.
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Dickenson, Mary. Hospitals and politics: The Australian Hospital Association 1946-1986. Canberra: Australian Hospital Association, 1986.
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Australian Institute of Health and Welfare. Trends in palliative care in Australian hospitals. Canberra: Australian Institute of Health and Welfare, 2011.
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1890-1967, Stephenson Arthur Sir, and Stephenson & Turner Sydney/Hong Kong Group., eds. Sir Arthur Stephenson, Australian architect. Sydney: Stephenson & Turner, 1987.
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Moon, Lynelle. Waiting for elective surgery in Australian public hospitals, 1995. Canberra: Australian Institute of Health and Welfare, 1996.
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The Australian health care system. 4th ed. South Melbourne, Vic: Oxford University Press, 2011.
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The Australian health care system. 2nd ed. South Melbourne, Vic: Oxford University Press, 2004.
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Western Australia. Office of the Auditor General. Under wraps!: Performance indicators of Western Australian public hospitals : special report. West Perth, W.A: Office of the Auditor General, 1996.
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Patient 12. Strawberry Hills, NSW, Australia: Currency Press, 2014.
Find full textBook chapters on the topic "Australian hospitals"
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Woods, Nic, and Monica Trujillo. "Health Information Technology and Its Evolution in Australian Hospitals." In Textbook of Medical Administration and Leadership, 255–80. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-10-5454-9_15.
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Bray, Mark, Pauline Stanton, Nadine White, and Eileen Willis. "The Structure of Bargaining in Public Hospitals in Three Australian States." In Workplace Reform in the Healthcare Industry, 63–90. London: Palgrave Macmillan UK, 2005. http://dx.doi.org/10.1057/9780230596009_4.
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Churruca, Kate, Chiara Pomare, Louise A. Ellis, Janet C. Long, and Jeffrey Braithwaite. "The Rights and Wrongs, Ups and Downs, and Ins and Outs of Organisational Cultures in Australian Public Hospitals." In Managing Healthcare Organisations in Challenging Policy Contexts, 175–99. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-81093-1_9.
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Maddern, Guy. "Hospital-Based HTA: The Australian Experience." In Hospital-Based Health Technology Assessment, 295–303. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-39205-9_25.
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Simpson, Daniel. "The Naval Hospital." In The Royal Navy in Indigenous Australia, 1795–1855, 219–50. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-60097-6_9.
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Nguyen, Bao Hoang, and Valentin Zelenyuk. "Robust Efficiency Analysis of Public Hospitals in Queensland, Australia." In Advances in Contemporary Statistics and Econometrics, 221–42. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-73249-3_12.
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Stroud, D. B., D. J. Borovnicar, J. R. Lambert, K. G. McNeill, S. J. Marks, R. P. Rassool, H. C. Rayner, et al. "Clinical Studies of Total Body Nitrogen in an Australian Hospital." In In Vivo Body Composition Studies, 177–82. Boston, MA: Springer US, 1990. http://dx.doi.org/10.1007/978-1-4613-1473-8_25.
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Al Aukidy, Mustafa, Saeb Al Chalabi, and Paola Verlicchi. "Hospital Wastewater Treatments Adopted in Asia, Africa, and Australia." In The Handbook of Environmental Chemistry, 171–88. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/698_2017_5.
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Crowe, B. "Implementation of RIS/PACS at Princess Alexandra Hospital Brisbane, Australia." In CARS 2002 Computer Assisted Radiology and Surgery, 485–90. Berlin, Heidelberg: Springer Berlin Heidelberg, 2002. http://dx.doi.org/10.1007/978-3-642-56168-9_81.
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Haskins, Victoria K. "Australian Nurses and the 1918 Deolali Inquiry: Transcolonial Racial and Gendered Anxieties in a British Indian War Hospital." In Australians and the First World War, 67–83. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-51520-5_5.
Full textConference papers on the topic "Australian hospitals"
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Collaro, Andrew, Anne B. Chang, Julie Marchant, Ian Brent Masters, Leanne Rodwell, Mark Chatfield, and Margaret McElrea. "Spirometry improvement is similar for Australian children treated at outreach clinics and tertiary hospitals." In ERS International Congress 2020 abstracts. European Respiratory Society, 2020. http://dx.doi.org/10.1183/13993003.congress-2020.1169.
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Gloria, Chrismatovanie. "Compliance with Complete Filling of Patient's Medical Record at Hospital: A Systematic Review." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.04.29.
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ABSTRACT Background: The health information system, especially medical records in hospitals must be carried out accurately and completely. Medical records are important as evidence for the courts, education, research, and policy makers. This study aimed to investigate the factors affecting the compliance with completeness of filling patient’s medical records at hospitals. Subjects and Methods: A systematic review was conducted by searching from ProQuest, Scopus, and National journals using keywords medical records, filling of medical records, and non- compliance filling medical records. The abstracts and full-text articles published between 2014 to 2019 were selected for this review. A total of 62,355 articles were conducted screening of eligibility criteria. The data were reported using PRISMA flow chart. Results: Eleven articles consisting of eight articles using observational studies and three articles using experimental studies met the eligible criteria. There were two articles analyzed systematically from the United States and India, two articles reviewed literature from the United States and England, and seven articles were analyzed statistically from Indonesia, America, Australia, and Europe. Six articles showed the significant results of the factors affecting non-compliance on the medical records filling at the Hospitals. Conclusion: Non-compliance with medical record filling was found in the hospitals under study. Health professionals are suggested to fill out the medical record completely. The hospital should enforce compliance with complete medical record filling by health professionals. Keywords: medical record, compliance, hospital Correspondence: Chrismatovanie Gloria. Hospital Administration Department, Faculty Of Public Health, Universitas Indonesia, Depok, West Java. Email: chrismatovaniegloria@gmail.com. Mobile: +6281321161896 DOI: https://doi.org/10.26911/the7thicph.04.29
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Fernando, Tharanga, Angela Clapperton, and Janneke Berecki-Gisolf. "134 Suicide following hospital admission in Victoria, Australia." In 14th World Conference on Injury Prevention and Safety Promotion (Safety 2022) abstracts. BMJ Publishing Group Ltd, 2022. http://dx.doi.org/10.1136/injuryprev-2022-safety2022.60.
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Su, Kevin, Krishna Bajee Sriram, and Parham Afrasyabi. "THU0481 SLEEP DISTURBANCES IN FIBROMYALGIA – AN AUSTRALIAN TERTIARY HOSPITAL EXPERIENCE." In Annual European Congress of Rheumatology, EULAR 2019, Madrid, 12–15 June 2019. BMJ Publishing Group Ltd and European League Against Rheumatism, 2019. http://dx.doi.org/10.1136/annrheumdis-2019-eular.2534.
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Wani, Tafheem Ahmad, Antonette Mendoza, and Kathleen Gray. "BYOD in Hospitals-Security Issues and Mitigation Strategies." In ACSW 2019: Australasian Computer Science Week 2019. New York, NY, USA: ACM, 2019. http://dx.doi.org/10.1145/3290688.3290729.
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Pickrell, Michelle, Elise van den Hoven, and Bert Bongers. "Exploring in-hospital rehabilitation exercises for stroke patients." In OzCHI '17: 29th Australian Conference on Human-Computer Interaction. New York, NY, USA: ACM, 2017. http://dx.doi.org/10.1145/3152771.3152796.
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Ploderer, Bernd, Jonathon Stuart, Vivian Tran, Theresa L. Green, and Jennifer Muller. "The transition of stroke survivors from hospital to home." In OzCHI '17: 29th Australian Conference on Human-Computer Interaction. New York, NY, USA: ACM, 2017. http://dx.doi.org/10.1145/3152771.3152772.
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Suominen, Hanna, and Leif Hanlen. "Visual summarisation of text for surveillance and situational awareness in hospitals." In the 18th Australasian Document Computing Symposium. New York, New York, USA: ACM Press, 2013. http://dx.doi.org/10.1145/2537734.2537739.
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Thapa, Nischay Bikram, Sattar Seifollahi, and Sona Taheri. "Hospital Readmission Prediction Using Clinical Admission Notes." In ACSW 2022: Australasian Computer Science Week 2022. New York, NY, USA: ACM, 2022. http://dx.doi.org/10.1145/3511616.3513115.
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Warwick, G., E. O'Lone, and DH Yates. "Investigation and Management of Community Acquired Pneumonia in an Australian Teaching Hospital." In American Thoracic Society 2009 International Conference, May 15-20, 2009 • San Diego, California. American Thoracic Society, 2009. http://dx.doi.org/10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a1695.
Full textReports on the topic "Australian hospitals"
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Lichtenberg, Frank. The Impact of Therapeutic Procedure Innovation on Hospital Patient Longevity: Evidence from Western Australia, 2000-2007. Cambridge, MA: National Bureau of Economic Research, September 2011. http://dx.doi.org/10.3386/w17414.
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Toloo, Sam, Ruvini Hettiarachchi, David Lim, and Katie Wilson. Reducing Emergency Department demand through expanded primary healthcare practice: Full report of the research and findings. Queensland University of Technology, January 2022. http://dx.doi.org/10.5204/rep.eprints.227473.
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Demand for public hospital emergency departments’ services and care is increasing, placing considerable restraint on their performance and threatens patient safety. Many factors influence such demand including individual characteristics (e.g. perceptions, knowledge, values and norms), healthcare availability, affordability and accessibility, population aging, and internal health system factors (e.g patient flow, discharge process). To alleviate demand, many initiatives have been trialled or suggested, including early identification of at-risk patients, better management of chronic disease to reduce avoidable ED presentation, expanded capacity of front-line clinician to manage sub-acute and non-urgent care, improved hospital flow to reduce access block, and diversion to alternate site for care. However, none have had any major or sustained impact on the growth in ED demand. A major focus of the public discourse on ED demand has been the use and integration of primary healthcare and ED, based on the assumption that between 10%–25% of ED presentations are potentially avoidable if patients’ access to appropriate primary healthcare (PHC) services were enhanced. However, this requires not only improved access but also appropriateness in terms of the patients’ preference and PHC providers’ capacity to address the needs. What is not known at the moment is the extent of the potential for diversion of non-urgent ED patients to PHC and the cost-benefits of such policy and funding changes required, particularly in the Australian context. There is a need to better understand ED patients’ needs and capacity constraint so as to effect delivery of accessible, affordable, efficient and responsive services. Jennie Money Doug Morel
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.
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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.
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Hajarizadeh, Behzad, Jennifer MacLachlan, Benjamin Cowie, and Gregory J. Dore. Population-level interventions to improve the health outcomes of people living with hepatitis B: an Evidence Check brokered by the Sax Institute for the NSW Ministry of Health, 2022. The Sax Institute, August 2022. http://dx.doi.org/10.57022/pxwj3682.
Full textAbstract:
Background An estimated 292 million people are living with chronic hepatitis B virus (HBV) infection globally, including 223,000 people in Australia. HBV diagnosis and linkage of people living with HBV to clinical care is suboptimal in Australia, with 27% of people living with HBV undiagnosed and 77% not receiving regular HBV clinical care. This systematic review aimed to characterize population-level interventions implemented to enhance all components of HBV care cascade and analyse the effectiveness of interventions. Review questions Question 1: What population-level interventions, programs or policy approaches have been shown to be effective in reducing the incidence of hepatitis B; and that may not yet be fully rolled out or evaluated in Australia demonstrate early effectiveness, or promise, in reducing the incidence of hepatitis B? Question 2: What population-level interventions and/or programs are effective at reducing disease burden for people in the community with hepatitis B? Methods Four bibliographic databases and 21 grey literature sources were searched. Studies were eligible for inclusion if the study population included people with or at risk of chronic HBV, and the study conducted a population-level interventions to decrease HBV incidence or disease burden or to enhance any components of HBV care cascade (i.e., diagnosis, linkage to care, treatment initiation, adherence to clinical care), or HBV vaccination coverage. Studies published in the past 10 years (since January 2012), with or without comparison groups were eligible for inclusion. Studies conducting an HBV screening intervention were eligible if they reported proportion of people participating in screening, proportion of newly diagnosed HBV (participant was unaware of their HBV status), proportion of people received HBV vaccination following screening, or proportion of participants diagnosed with chronic HBV infection who were linked to HBV clinical care. Studies were excluded if study population was less than 20 participants, intervention included a pharmaceutical intervention or a hospital-based intervention, or study was implemented in limited clinical services. The records were initially screened by title and abstract. The full texts of potentially eligible records were reviewed, and eligible studies were selected for inclusion. For each study included in analysis, the study outcome and corresponding 95% confidence intervals (95%CIs) were calculated. For studies including a comparison group, odds ratio (OR) and corresponding 95%CIs were calculated. Random effect meta-analysis models were used to calculate the pooled study outcome estimates. Stratified analyses were conducted by study setting, study population, and intervention-specific characteristics. Key findings A total of 61 studies were included in the analysis. A large majority of studies (study n=48, 79%) included single-arm studies with no concurrent control, with seven (12%) randomised controlled trials, and six (10%) non-randomised controlled studies. A total of 109 interventions were evaluated in 61 included studies. On-site or outreach HBV screening and linkage to HBV clinical care coordination were the most frequent interventions, conducted in 27 and 26 studies, respectively. Question 1 We found no studies reporting HBV incidence as the study outcome. One study conducted in remote area demonstrated that an intervention including education of pregnant women and training village health volunteers enhanced coverage of HBV birth dose vaccination (93% post-intervention, vs. 81% pre-intervention), but no data of HBV incidence among infants were reported. Question 2 Study outcomes most relevant to the HBV burden for people in the community with HBV included, HBV diagnosis, linkage to HBV care, and HBV vaccination coverage. Among randomised controlled trials aimed at enhancing HBV screening, a meta-analysis was conducted including three studies which implemented an intervention including community face-to-face education focused on HBV and/or liver cancer among migrants from high HBV prevalence areas. This analysis demonstrated a significantly higher HBV testing uptake in intervention groups with the likelihood of HBV testing 3.6 times higher among those participating in education programs compared to the control groups (OR: 3.62, 95% CI 2.72, 4.88). In another analysis, including 25 studies evaluating an intervention to enhance HBV screening, a pooled estimate of 66% of participants received HBV testing following the study intervention (95%CI: 58-75%), with high heterogeneity across studies (range: 17-98%; I-square: 99.9%). A stratified analysis by HBV screening strategy demonstrated that in the studies providing participants with on-site HBV testing, the proportion receiving HBV testing (80%, 95%CI: 72-87%) was significantly higher compared to the studies referring participants to an external site for HBV testing (54%, 95%CI: 37-71%). In the studies implementing an intervention to enhance linkage of people diagnosed with HBV infection to clinical care, the interventions included different components and varied across studies. The most common component was post-test counselling followed by assistance with scheduling clinical appointments, conducted in 52% and 38% of the studies, respectively. In meta-analysis, a pooled estimate of 73% of people with HBV infection were linked to HBV clinical care (95%CI: 64-81%), with high heterogeneity across studies (range: 28-100%; I-square: 99.2%). A stratified analysis by study population demonstrated that in the studies among general population in high prevalence countries, 94% of people (95%CI: 88-100%) who received the study intervention were linked to care, significantly higher than 72% (95%CI: 61-83%) in studies among migrants from high prevalence area living in a country with low prevalence. In 19 studies, HBV vaccination uptake was assessed after an intervention, among which one study assessed birth dose vaccination among infants, one study assessed vaccination in elementary school children and 17 studies assessed vaccination in adults. Among studies assessing adult vaccination, a pooled estimate of 38% (95%CI: 21-56%) of people initiated vaccination, with high heterogeneity across studies (range: 0.5-93%; I square: 99.9%). A stratified analysis by HBV vaccination strategy demonstrated that in the studies providing on-site vaccination, the uptake was 78% (95%CI: 62-94%), significantly higher compared to 27% (95%CI: 13-42%) in studies referring participants to an external site for vaccination. Conclusion This systematic review identified a wide variety of interventions, mostly multi-component interventions, to enhance HBV screening, linkage to HBV clinical care, and HBV vaccination coverage. High heterogeneity was observed in effectiveness of interventions in all three domains of screening, linkage to care, and vaccination. Strategies identified to boost the effectiveness of interventions included providing on-site HBV testing and vaccination (versus referral for testing and vaccination) and including community education focussed on HBV or liver cancer in an HBV screening program. Further studies are needed to evaluate the effectiveness of more novel interventions (e.g., point of care testing) and interventions specifically including Indigenous populations, people who inject drugs, men who have sex with men, and people incarcerated.