Relevant bibliographies by topics / Medical care, Cost of Australia

Academic literature on the topic 'Medical care, Cost of Australia'

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Published: 10 December 2022
Last updated: 29 January 2023

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Journal articles on the topic "Medical care, Cost of Australia"

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Tran, David Minh, and Malcolm P. Forbes. "Addressing cost of unwarranted medical care in the medical curriculum." Australian Health Review 41, no. 2 (2017): 151. http://dx.doi.org/10.1071/ah15172.

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Within the past decade, there has been a significant increase in Australia’s health expenditure, with a concurrent rise in overdiagnosis. Australia has introduced the Choosing Wisely campaign in a bid to identify and reduce commonly used investigations, treatments and procedures that add little benefit to patient care. By catalysing a discussion regarding evidence-based use of medications and medical testing, the Choosing Wisely campaign can minimise risk of harm to patients, as well as reduce expenditure. Internationally, several institutions are considering introducing training regarding cost-effective medical investigations into medical school curricula. The American College of Radiology has found positive results when conducting small-group teaching sessions with medical students regarding appropriate imaging modalities. These results are reflected in a US study that used an educational intervention to improve students’ understanding of investigation costs. In addition, the Academy of Clinical Laboratory Physicians and Scientists has developed a proposed curriculum to further medical students’ training in appropriate ordering of laboratory investigations. Australian medical educators must consider whether introducing evidence-based testing into Australian medical curricula should be part of a wider strategy to prevent unnecessary testing and health expenditure now and into the future.
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Gross, Paul F. "Technology Assessment in Health Care in Australia." International Journal of Technology Assessment in Health Care 5, no. 1 (January 1989): 137–44. http://dx.doi.org/10.1017/s0266462300006024.

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In 1977, in the middle of a protracted debate on the costs and methods of paying for health care, the federal minister for health established a Committee on Applications and Costs of Modern Technology in Medical Practice. In 1978, the committee produced its report, which reviewed a number of cost containment strategies, including the reduction or regulation of fees paid to medical practitioners for specific procedures. It recommended that a national panel be established to collect information on medical technology and advise on its introduction in Australia.In 1982, the National Health Technology Advisory Panel (NHTAP) was created to identify and examine existing and emerging medical technology, to determine methods and priorities for assessment, and to make recommendations to the minister for health with respect to assessment and funding of new technology.
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Loucks, Vernon R. "Home Health Care." International Journal of Technology Assessment in Health Care 1, no. 2 (April 1985): 301–4. http://dx.doi.org/10.1017/s0266462300000076.

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Throughout the industrialized world—from the United States to Japan, from Scandinavia to Australia—the theme of cost containment dominates the discourse on health care. This issue is the offspring of successful past efforts to ensure all patients effective medical care. While many countries have groups with special health disadvantages, the great majority of people in the industrialized nations have access to modern medical care and make ready use of it. The problem now is its cost, as aging populations, increasing in number as the result of advanced techniques that are more effective in prolonging life, place considerable strains on health care budgets.
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Richardson, Jeffrey. "Medical Technology and its Diffusion in Australia." International Journal of Technology Assessment in Health Care 4, no. 3 (July 1988): 407–31. http://dx.doi.org/10.1017/s0266462300000362.

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AbstractThe author examines the Australian health care system by surveying the financing techniques, physical organization, and government activity. He explains the impact of the public and private sectors and comments on the effectiveness of current evaluation procedures. While the author believes that the system is relatively healthy and cost effective, he recognizes a need for more comprehensive and scientific oversight. Using regression analysis and focusing on the installation of medical technology in hospitals, the author attempts to determine the specific factors that influence technology diffusion. He concludes by stressing that further studies analyzing the actual use of specific technologies are vital.
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O’Loughlin, Mary, Caryn West, and Jane Mills. "Medical homes and chronic care: consumer lessons for regional Australia." Australian Journal of Primary Health 28, no. 2 (February 1, 2022): 97–103. http://dx.doi.org/10.1071/py21020.

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Medical home models of care, including Australia’s Health Care Homes, have the potential to improve health service delivery. This qualitative study explored the primary healthcare experience of people living with chronic conditions in a regional community. The study aim was to use consumer perspectives to inform the further development of a medical home-type model for regional Australia. Participants were recruited from the emergency department of a north Queensland hospital. Twenty-one adults (aged ≥18 years) participated in interviews, using a semi-structured schedule. Inductive, deductive and abductive analyses were guided by grounded theory methods. Participants were committed to an individual GP, rather than a practice organisation. This finding has implications for medical homes, as individuals may choose not to access team-based practice care. Most participants perceived they currently received high-quality GP care, although challenges were identified. These challenges included disconnected after-hours care and uncertainty around the cost of care. Those living with complex, uncommon, chronic conditions felt the most disenfranchised from existing care models, and could benefit from increased engagement with a medical home-type model. Strengthening the continuity of care between GPs both within and outside the practice may enhance service delivery. Involving consumers in the design of care models supports health services that are fit-for-purpose.
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Lingaratnam, Senthil, Leon J. Worth, Monica A. Slavin, Craig A. Bennett, Suzanne W. Kirsa, John F. Seymour, Andrew Dalton, et al. "A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment." Australian Health Review 35, no. 4 (2011): 491. http://dx.doi.org/10.1071/ah10951.

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Background. Adult febrile neutropenic oncology patients, at low risk of developing medical complications, may be effectively and safely managed in an ambulatory setting, provided they are appropriately selected and adequate supportive facilities and clinical services are available to monitor these patients and respond to any clinical deterioration. Methods. A cost analysis was modelled using decision tree analysis, published cost and effectiveness parameters for ambulatory care strategies and data from the State of Victoria’s hospital morbidity dataset. Two-way sensitivity analyses and Monte Carlo simulation were performed to evaluate the uncertainty of costs and outcomes associated with ambulatory care. Results. The modelled cost analysis showed that cost savings for two ambulatory care strategies were ~30% compared to standard hospital care. The weighted average cost saving per episode of ‘low-risk’ febrile neutropenia using Strategy 1 (outpatient follow-up only) was 35% (range: 7–55%) and that for Strategy 2 (early discharge and outpatient follow-up) was 30% (range: 7–39%). Strategy 2 was more cost-effective than Strategy 1 and was deemed the more clinically favoured approach. Conclusion. This study outlines a cost structure for a safe and comprehensive ambulatory care program comprised of an early discharge pathway with outpatient follow-up, and promotes this as a cost effective approach to managing ‘low-risk’ febrile neutropenic patients. What is known about the topic? Febrile neutropenia is a common complication of chemotherapy for patients with cancer. There is high level evidence supporting the use of ambulatory care strategies to manage patients with febrile neutropenia who are deemed to be at low risk of developing medical complications. What does this paper add? This paper highlights a cost structure for an adequately equipped and cost-effective ambulatory care strategy suitable for Australian hospitals to manage patients with low-risk febrile neutropenia. What are the implications for practitioners? The strategy advocated in this paper affords eligible patients the choice of early discharge from hospital. It advocates for improved resource utilisation and expansion of outpatient services in order to minimise opportunity costs faced by cancer treatment facilities.
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Dineen-Griffin, Sarah, Victoria Garcia-Cardenas, Kris Rogers, Kylie Williams, and Shalom Isaac Benrimoj. "Evaluation of a Collaborative Protocolized Approach by Community Pharmacists and General Medical Practitioners for an Australian Minor Ailments Scheme: Protocol for a Cluster Randomized Controlled Trial." JMIR Research Protocols 8, no. 8 (August 9, 2019): e13973. http://dx.doi.org/10.2196/13973.

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Background Internationally, governments have been investing in supporting pharmacists to take on an expanded role to support self-care for health system efficiency. There is consistent evidence that minor ailment schemes (MASs) promote efficiencies within the health care system. The cost savings and health outcomes demonstrated in the United Kingdom and Canada open up new opportunities for pharmacists to effect sustainable changes through MAS delivery in Australia. Objective This trial aims to evaluate the clinical, economic, and humanistic impact of an Australian Minor Ailments Service (AMAS) compared with usual pharmacy care in a cluster randomized controlled trial (cRCT) in Western Sydney, Australia. Methods The cRCT design has an intervention group and a control group, comparing individuals receiving a structured intervention (AMAS) with those receiving usual care for specific health ailments. Participants will be community pharmacies, general practices, and patients located in Western Sydney Primary Health Network (WSPHN) region. A total of 30 community pharmacies will be randomly assigned to either intervention or control group. Each will recruit 24 patients, aged 18 years or older, presenting to the pharmacy in person with a symptom-based or product-based request for one of the following ailments: reflux, cough, common cold, headache (tension or migraine), primary dysmenorrhea, or low back pain. Intervention pharmacists will deliver protocolized care to patients using clinical treatment pathways with agreed referral points and collaborative systems boosting clinician-pharmacist communication. Patients recruited in control pharmacies will receive usual care. The coprimary outcomes are rates of appropriate recommendation of nonprescription medicines and rates of appropriate medical referral. Secondary outcomes include self-reported symptom resolution, health services resource utilization, and EuroQoL Visual Analogue Scale. Differences in primary outcomes between groups will be analyzed at the individual patient level accounting for correlation within clusters with generalized estimating equations. The economic impact of the model will be evaluated by cost-utility and cost-effectiveness analysis compared with usual care. Results The study began in July 2018. Thirty community pharmacies were recruited. Pharmacists from the 15 intervention pharmacies were trained. A total of 27 general practices consented. Pharmacy patient recruitment began in August 2018 and was completed on March 31, 2019. Conclusions This study may demonstrate the efficacy of a protocolized intervention to manage minor ailments in the community and will assess the clinical, economic, and humanistic impact of this intervention in Australian pharmacy practice. Pharmacists supporting patient self-care and appropriate self-medication may contribute to greater efficiency of health care resources and integration of self-care in the health system. The proposed model and developed educational content may form the basis of a national MAS service in Australia, using a robust framework for management and referral for common ailments. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000286246; http://www.anzctr.org.au/ACTRN12618000286246.aspx International Registered Report Identifier (IRRID) DERR1-10.2196/13973
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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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Faux, Margaret, Jonathan Wardle, Angelica G. Thompson-Butel, and Jon Adams. "Who teaches medical billing? A national cross-sectional survey of Australian medical education stakeholders." BMJ Open 8, no. 7 (July 2018): e020712. http://dx.doi.org/10.1136/bmjopen-2017-020712.

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ImportanceBilling errors and healthcare fraud have been described by the WHO as ‘the last great unreduced health-care cost’. Estimates suggest that 7% of global health expenditure (US$487 billion) is wasted from this phenomenon. Irrespective of different payment models, challenges exist at the interface of medical billing and medical practice across the globe. Medical billing education has been cited as an effective preventative strategy, with targeted education saving $A250 million in Australia in 1 year from an estimated $A1–3 billion of waste.ObjectiveThis study attempts to systematically map all avenues of medical practitioner education on medical billing in Australia and explores the perceptions of medical education stakeholders on this topic.DesignNational cross-sectional survey between April 2014 and June 2015. No patient or public involvement. Data analysis—descriptive statistics via frequency distributions.ParticipantsAll stakeholders who educate medical practitioners regarding clinical practice (n=66). 86% responded.ResultsThere is little medical billing education occurring in Australia. The majority of stakeholders (70%, n=40) did not offer/have never offered a medical billing course. 89% thought medical billing should be taught, including 30% (n=17) who were already teaching it. There was no consensus on when medical billing education should occur.ConclusionsTo our knowledge, this is the first attempt of any country to map the ways doctors learn the complex legal and administrative infrastructure in which they work. Consistent with US findings, Australian doctors may not have expected legal and administrative literacy. Rather than reliance on ad hoc training, development of an Australian medical billing curriculum should be encouraged to improve compliance, expedite judicial processes and reduce waste. In the absence of adequate education, disciplinary bodies in all countries must consider pleas of ignorance by doctors under investigation, where appropriate, for incorrect medical billing.
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Mundy, Linda, Tracy L. Merlin, Adriana Parrella, Wendy J. Babidge, Dianne E. Roberts, and Janet E. Hiller. "The Australia and New Zealand Horizon Scanning Network." Australian Health Review 29, no. 4 (2005): 395. http://dx.doi.org/10.1071/ah050395.

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UP UNTIL 1982, new health technologies, procedures or services were introduced into the health system in an uncontrolled, unregulated manner. This had the potential for wide-ranging impact on the public health care system including ballooning costs, a lack of preparedness by training and accreditation organisations, and consequent patient safety concerns. Health technology assessment was introduced into Australia in 1982 when the National Health Technology Assessment Panel was formed. This original panel has undergone numerous name changes and evolved into the Australian Government-funded Medical Services Advisory Committee (MSAC).1 The primary role of the MSAC is to inform the Federal Minister for Health and Ageing on the safety, effectiveness and costeffectiveness of new medical technologies and procedures using the available evidence.2 Assessments of the safety, effectiveness and cost-effectiveness of these technologies may occur only after the technology has diffused and is practised widely.3 Early identification of such technologies may avoid the detrimental consequences of their indiscriminate introduction and could result in the adoption of beneficial and cost-effective technologies and the elimination of technologies that are unsafe or for which there is no evidence of cost-effectiveness.4
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Dissertations / Theses on the topic "Medical care, Cost of Australia"

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McCreanor, Victoria Helen Rarity. "Identifying high-value care for coronary artery disease in Australia." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/130756/1/Victoria_McCreanor_Thesis.pdf.

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This project compared the cost-effectiveness of drug therapy, stents and surgery for Australian patients with heart disease, modelling their long-term treatment trajectories, costs and health outcomes. It showed that drug therapy is high-value and that the health system, and Australians, would benefit from targeted rather than routine use of stents. This research provides policy recommendations to reduce the use of low-value care and increase the use of high-value care for Australian patients with heart disease.
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Carter, Robert C. (Robert Charles) 1950. "The macro economic evaluation model (MEEM) : an approach to priority setting in the health sector." Monash University, Dept. of Management, 2001. http://arrow.monash.edu.au/hdl/1959.1/8672.

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Kelman, Christopher William, and christopher kelman@cmis csiro au. "Monitoring Health Care Using National Administrative Data Collections." The Australian National University. National Centre for Epidemiology and Population Health, 2001. http://thesis.anu.edu.au./public/adt-ANU20020620.151547.

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With the inevitable adoption of information technology into all areas of human pursuit, the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation. ¶ Evaluation of health services has become increasingly important to provide indicators of the benefits, risks and cost-effectiveness of treatments. However, if administrative data are to be used for this purpose, several questions must first be addressed: Are the current data collections accessible? What outcome measures can be derived from these data? Can privacy issues be managed? Could the quality of the data be improved? Is the existing infrastructure adequate to supply data for evaluation purposes? Could the existing system provide a basis for the development of an integrated health information system? ¶ The aims of the project were: · To examine the potential for using administrative data to generate outcome measures and surveillance indicators. · To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework. · To compare the Australian health-service data system with the current international state-of-the-art. · To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity. ¶ The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. The potential to evaluate outcomes was investigated using all national health-service information currently available in electronic form. Record linkage techniques were used to combine and augment the existing data collections. Australia’s national health databases are to varying degrees, amenable to such linkage and cover doctor visits, pharmaceuticals, hospital admissions and deaths. The study focused on medical devices as an illustrative case but the results are applicable to the routine assessment of all medical and surgical interventions. ¶ For the Australian ‘Medical Devices study’, the records of 5,316 patients who had medical device implants in 1993-94 were selected from the archives of a major private health insurer. Five groups of medical implants were studied: heart valves, pacemakers, hips, vascular grafts and intra-optic lenses. Outcomes for these patients, including death, re-operation and health service utilisation, were compared and analysed. ¶ A comparison study was performed using data from the Manitoba Health database in Winnipeg, Canada. Manitoba provides a very similar demographic group to that found in Australia and is an example of a prototype integrated-health-information system. One of the principal advantages for research is that personally identified data about medical and hospital services are collected for all patients. Selection bias is eliminated because individual consent is not required for this type of research and all selected patients could be included in the study. ¶ The two studies revealed many barriers to the use of administrative data for health outcomes research. Service event data for the Australian cohort could be collected but only after long delays and hospital morbidity data were not available for the entire cohort. In contrast to the situation in Australia, the Manitoba data were both accessible and complete, but were lacking in detail in some areas. ¶ Analysis of the collected data demonstrated that without the addition of clinical data only general indications of trends could be deduced. However, with minimal supplementary clinical data, it was possible to examine differences in performance between brands of medical devices thus indicating one of the uses for this type of data collection. ¶ In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). The need for the establishment of a systemic quality management system for health care is discussed. ¶ The study shows that linked administrative data can provide information about health outcomes which is not readily available from other sources. If expanded and integrated, the system that is currently used to collect and manage administrative data, could provide the basis for a national health information system. This system would provide many benefits for health care. Benefits would include the monitoring, surveillance and cost-effectiveness analysis of new and existing treatments involving medical devices, drugs and surgical procedures. An integrated health information system could thus provide for both clinical and administrative needs, while in addition providing data for research. ¶ Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures. ¶ Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.
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D'Arrietta, Louisa, and n/a. "An investigation of the information needs and information-seeking behaviour of general practitioners in their delivery of patient care to the elderly on the Gold Coast." University of Canberra. Information, Language & Culture, 1994. http://erl.canberra.edu.au./public/adt-AUC20060426.164122.

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The study investigated the self-reported information needs and information-seeking behaviour of 143 general practitioners in their delivery of patient care to the elderly on the Gold Coast. The study sought to obtain an information profile in order to begin discussion on the need for possible infrastructures that may need to be considered in any planning strategies concerned with access to and provision of relevant, accurate and timely information to general practitioners which affects their delivery of patient care to the growing number of elderly patients. A ten-page questionnaire utilising both structured and unstructured questions was returned by 61.9 percent of the survey population. Demographic characteristics indicated that respondents were representative of general practitioners in Australia. Respondents frequently needed information with 40 percent requiring it '1 - 4 times a week' and 78 percent 'once a month or more often'. Information on medical fact was required most frequently, 29 percent, medical opinion 27 percent, and non-medical information 23 percent. The study found support for the proposition that computerised information systems need to be enhanced and made widely known and available to general practitioners to assist them in obtaining information that they need in delivery of patient care to the elderly. There is a great need by these general practitioners for non-medical information as well as medical information. Therefore, the development of a database of non-medical information containing information on local agencies and services is of high priority. Library information delivery services should also be de-institutionalised in terms of lifting restrictions to services provided to enable general practitioners greater access to information. Library services should aim to provide remote access to information via telephone, fax and modem with emphasis on value added services aimed at solving a particular specific information need as well as straight-out bibliographic search services and document delivery services. Continuing medical education in the form of CME courses, conferences and meetings should focus on specific information needs of general practitioners in this area of patient care to the elderly. The need for information on cardiology, orthopaedics, dermatology, physiotherapy, podiatry, pharmaceutical benefits, home help, Meals-on-Wheels and nursing home placement were areas of particular interest identified by respondents in this study.
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O'Driscoll, Catherine T. "A study to determine the quality of life and experiences for liver and kidney transplant recipients and living kidney donors in Western Australia : the economic implications." University of Western Australia. School of Surgery, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0077.

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The use of quality-of-life as an outcome measure provides detailed information about the effectiveness of medical treatments than morbidity or mortality rates alone. The use of quality-of-life data in the clinical setting can inform patients regarding treatment options, treatment benefits and costs. In competing health care markets, outcome measurement is regarded as important as it is concerned with the impact of health care practice and affects health policy decisions. Doessel (1978) conducted the first Australian study on the cost-effectiveness analysis of renal replacement therapies. The study was based on Klarman, Francis & Rosenthal's (1968) the study, where the output was measured in terms of the number of life years gained from kidney transplantation, and a twenty-five percent weight was allocated in an attempt to capture quality-of-life from kidney transplantation. Doessel (1978) used two sources of data: Australian data (Disney 1974) and European data (Gurland et al. 1973; Shiel et al. 1974). The study measured life years gained, and agreed with the Klarman et al. (1974) findings that transplantation is the most effective way to increase life expectancy of persons with chronic renal disease (Butler & Doessel 1989). The outputs of the alternative treatments were not reported in monetary terms; the study focused on life years gained as the output measure. Hence the importance of this current study, which includes a cost-effectiveness analysis for cadaver liver, and living kidney transplantation for end-stage liver and kidney disease patients. Calls to respect patient autonomy and to produce patient-centered outcomes have recently brought the patient’s point of view back into the center of clinical medicine (Sullivan 2003). Survival rates indicate one measure of outcome however they do not reflect patients’ perceptions of health benefit or experiences. Noting that patients’ psychosocial effect on functioning is of more concern to them than their physical Thesis Preamble iii ability, that more accurate knowledge of patients’ conditions be measured prior to transplantation (Tarter et al. 1991). Recently researchers advocated investigating transplant patients' states of health to assess the social benefit of these expensive health care services from their perspective (Joralemon & Fujinaga 1997). The current study's mixed method, bridges the gaps in treatment outcome measurements, as the mixed method applied (Creswell 1994; Sim & Sharp 1998) prospectively measured quality-oflife, determined health utility, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). The study reported the living donors experience of the donation process, described their needs; expressed using a new psychosocial model supporting future living kidney donor's during the donation process.
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Patterson, Jan. "Consumers and complaints systems in health care /." Title page, contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09php3174.pdf.

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Cheng, Qinglu. "Cost-effectiveness of guideline-based care for venous leg ulcers in Australia." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134462/1/Qinglu_Cheng_Thesis.pdf.

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This thesis investigated the cost-effectiveness of guideline-based care to manage patients with venous leg ulcers in the Australian setting. It showed that both the healthcare system and patients affected by venous leg ulcers would benefit from implementing and funding guideline-based care. This research provided important evidence to policy makers on the most efficient use of scarce health resources to manage venous leg ulcers. It is expected that these results will support changes to the reimbursement structure to increase access to guideline-based care for venous leg ulcers in Australia.
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Sinclair, Andrew James, and n/a. "The primary health care experiences of gay men in Australia." Swinburne University of Technology, 2006. http://adt.lib.swin.edu.au./public/adt-VSWT20060713.084655.

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The present research, consisting of two studies, was designed to examine the primary health care experiences of gay men in Australia and assess doctors? attitudes and training with regard to gay men and their health care. In the first study, 195 gay men were surveyed regarding their health issues and their primary health care experiences. The most important health concerns of gay men were stress and depression followed by HIV/AIDS, body image disorder and other sexually transmissible infections. Including those participants who were unsure, approximately one-half reported experiencing homophobia and almost one?quarter reported experiencing discrimination in the provision of health care. Despite this, respondents were generally satisfied with their primary health care, although respondents felt that all GPs should receive additional undergraduate medical education regarding gay men?s health. In the second study, 25 doctors (13 gay specialists and 12 non-gay specialists) were surveyed regarding their knowledge of gay men?s health and their comfort working with gay men. Non-gay specialist GPs were less comfortable treating gay men, reported poorer communication and were more homophobic than their gay specialist counterparts. Further, doctors perceived their medical education regarding gay men?s health has been inadequate. Together, the results of the two current studies suggest that disclosure of sexuality is an important issue for both gay men and doctors, and has the potential to impact on the quality of health care that gay men receive. In order to improve the level of disclosure, the pervasiveness of homophobia and discrimination in primary health care must be reduced. Finally, the results indicate that medical education must be updated to reflect current knowledge regarding the health issues of gay men. Failure to address these issues will condemn gay men to continued health inequality.
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Ho, Chi-hang Bruce. "Health care financing options for Hong Kong." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25139526.

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Willis, Susan Beth. "Cost-benefit and cost-effectiveness of case management for a teen pregnancy and parenting program." CSUSB ScholarWorks, 1993. https://scholarworks.lib.csusb.edu/etd-project/630.

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Books on the topic "Medical care, Cost of Australia"

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Welfare, Australian Institute of Health and. Health system expenditures on cancer and other neoplasms in Australia, 2000-01. Canberra: Australian Institute of Health and Welfare, 2005.

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Islam, Sardar M. N. Normative health economics: A new pragmatic approach to cost benefit analysis, mathematical models and applications. Basingstoke [England]: Palgrave Macmillan, 2006.

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McLeod, Ross H. Empty bed blues: Australian health-care policy. Perth, W.A: Australian Institute for Public Policy, 1987.

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Hospital morbidity patterns and costs of immigrants in Australia. Canberra: The National Centre for Epidemiology and Population Health, The Australian National University, 1995.

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Mathers, Colin. Health system costs of injury, poisoning and musculoskeletal disorders in Australia, 1993-94. Canberra: Australian Institute of Health and Welfare, 1999.

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Australian Conference of Health Economists (7th 1985). Economics and health 1985: Proceedings of the Seventh Australian Conference of Health Economists. Edited by Butler, J. R. G. 1952-, Doessel D. P, and University of New South Wales. School of Health Administration. [Kensington, N.S.W., Australia]: University of New South Wales, School of Health Administration, 1986.

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Gray, M. C. Health expenditure, income and health status among indigenous and other Australians. Canberra: Centre for Aboriginal Economic Policy Research, Australian National University, 2002.

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Welfare, Australian Institute of Health and. Expenditures on health for Aboriginal and Torres Strait Islander peoples, 2001-02. Canberra: Australian Institute of Health and Welfare, 2005.

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1942-, Davis Karen, ed. Health care cost containment. Baltimore: Johns Hopkins University Press, 1990.

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Health Care Cost Containment Seminar (4th 1984 Miami, Fla.). Health care cost containment, 1984. Brookfield, Wis: International Foundation of Employee Benefit Plans, 1985.

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Book chapters on the topic "Medical care, Cost of Australia"

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Kezelman, Cathy. "Childhood trauma – the long-term impact and the human cost." In Humanising Mental Health Care in Australia, 43–55. Abingdon, Oxon; New York, NY: Routledge, 2018.: Routledge, 2019. http://dx.doi.org/10.4324/9780429021923-3.

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Yusuf, Farhat, and Stephen R. Leeder. "Household Expenditure on Medical Care and Health in Australia." In Emerging Techniques in Applied Demography, 189–210. Dordrecht: Springer Netherlands, 2014. http://dx.doi.org/10.1007/978-94-017-8990-5_13.

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Dutta, Meghamala, Sourav Dutta, Swati Sikdar, Deepneha Dutta, Gayatri Sharma, and Ashika Sharma. "Reliable, Real-Time, Low Cost Cardiac Health Monitoring System for Affordable Patient Care." In Advancements of Medical Electronics, 281–89. New Delhi: Springer India, 2015. http://dx.doi.org/10.1007/978-81-322-2256-9_26.

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Crane, D. Russell, and Jacob Christenson. "A Summary Report of Cost-Effectiveness: Recognizing the Value of Family Therapy in Health Care." In Medical Family Therapy, 419–36. Cham: Springer International Publishing, 2014. http://dx.doi.org/10.1007/978-3-319-03482-9_22.

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Birch, Stephen, and Amiram Gafni. "Cost-Effectiveness and Cost Utility Analyses: Methods for the Non-Economic Evaluation of Health Care Programmes and How We Can Do Better." In Management of Medical Technology, 51–67. Boston, MA: Springer US, 1996. http://dx.doi.org/10.1007/978-1-4613-1415-8_4.

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Senagore, Anthony J. "Cost of Medical Care: Whose Money Are We Talking About?" In Pelvic Cancer Surgery, 647–52. London: Springer London, 2015. http://dx.doi.org/10.1007/978-1-4471-4258-4_58.

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Brock, Stan, and Amanda Wilson. "Remote Area Medical®: Pioneers of No-Cost Health Care." In Healthcare Disparities at the Crossroads with Healthcare Reform, 413–20. Boston, MA: Springer US, 2011. http://dx.doi.org/10.1007/978-1-4419-7136-4_22.

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Viskoper, J. R., S. Oren, L. Bregman, J. Mishal, and G. M. Ginsberg. "The Ashkelon Hypertension Detection and Control Program Medical and Cost Implications." In Costs and Benefits in Health Care and Prevention, 72–78. Berlin, Heidelberg: Springer Berlin Heidelberg, 1990. http://dx.doi.org/10.1007/978-3-642-75781-5_9.

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Alexandre, Pierre Kébreau, M. Christopher Roebuck, Michael T. French, Dale D. Chitwood, and Clyde B. McCoy. "Problem Drinking, Health Services Utilization, and the Cost of Medical Care." In Alcoholism, 285–98. Boston, MA: Springer US, 2002. http://dx.doi.org/10.1007/978-0-306-47193-3_16.

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Rushing, William A. "Insurance, Social Relations, Moral Community, and the Cost of Medical Care." In Social Functions and Economic Aspects of Health Insurance, 17–42. Dordrecht: Springer Netherlands, 1986. http://dx.doi.org/10.1007/978-94-009-4231-8_2.

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Conference papers on the topic "Medical care, Cost of Australia"

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Gruber, W. H. "Cost Shifting In The Current Medical Environment." In Health Care Technology Policy I: The Role of Technology in the Cost of Health Care. IEEE, 1994. http://dx.doi.org/10.1109/hctp.1994.721299.

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Langlotz, Curtis P., Bridget Cleff, Orit Even-Shoshan, Mary T. Bozzo, Regina O. Redfern, Inna Brikman, Sridhar B. Seshadri, Steven C. Horii, and Harold L. Kundel. "Incremental cost of PACS in a medical intensive care unit." In Medical Imaging 1995, edited by R. Gilbert Jost and Samuel J. Dwyer III. SPIE, 1995. http://dx.doi.org/10.1117/12.208788.

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Scherer, Laura, Victoria Shaffer, Jeffrey DeWitt, Tanner Caverly, and Brian Zikmund-Fisher. "77 Medical maximizing-minimizing and patient preferences for high and low-benefit care, perceived acceptability of recommendations against low-benefit care, and patient satisfaction." In Preventing Overdiagnosis Abstracts, December 2019, Sydney, Australia. BMJ Publishing Group Ltd, 2019. http://dx.doi.org/10.1136/bmjebm-2019-pod.89.

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Langlotz, Curtis P., Harold L. Kundel, Inna Brikman, Hugh M. Pratt, Regina O. Redfern, Steven C. Horii, and J. Sanford Schwartz. "Effect of PACS/CR on cost of care and length of stay in a medical intensive care unit." In Medical Imaging 1996, edited by R. Gilbert Jost and Samuel J. Dwyer III. SPIE, 1996. http://dx.doi.org/10.1117/12.239258.

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Grzegorz Broda, Lukasz, Taiwo Oseni, Andrew Stranieri, Rodrigo Marino, Jodie Robinson, and Mark Yates. "The Design of a Smartbrush Oral Health Installation for Aged Care Centres in Australia." In ICMHI 2021: 2021 5th International Conference on Medical and Health Informatics. New York, NY, USA: ACM, 2021. http://dx.doi.org/10.1145/3472813.3473186.

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Fitch, J. Patrick. "Testing a potential national strategy for cost-effective medical technology." In Health Care Technology Policy II: The Role of Technology in the Cost of Health Care: Providing the Solutions, edited by Warren S. Grundfest. SPIE, 1995. http://dx.doi.org/10.1117/12.225321.

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Hawking, Paul, Andrew Stein, and Susan Foster. "e-HR and Employee Self Service: A Case Study of a Victorian Public Sector Organisation." In InSITE 2004: Informing Science + IT Education Conference. Informing Science Institute, 2004. http://dx.doi.org/10.28945/2757.

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The application of the internet to the Human Resource function (e-HR) combines two elements: one is the use of electronic media whilst the other is the active participation of employees in the process. These two elements drive the technology that helps organisations lower administration costs, improve employee communication and satisfaction, provide real time access to information while at the same time reducing processing time. This technology holds out the promise of challenging the past role of HR as one of payroll processing and manual administrative processes to one where cost efficiencies can be gained, enabling more time and energy to be devoted to strategic business issues. The relative quick gains with low associated risk have prompted many Australian companies to realise what can be achieved through the implementation of a business to employee (B2E) model. Employee Self Service (ESS), a solution based on the B2E model enables employees to access the corporate human resource information system 24x7. This paper adopts a case study approach with a view to investigating the benefits and associated issues obtained from an implementation of an ESS in an Australian public sector organisation.Keywords: Employee Self Service, e-Human Resources, B2E, HRMIS, ERP Systems, Australian Case Study
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Kumar, M. Rajendra, Manjunatha Mahadevappa, and Dharitri Goswami. "Low cost point of care estimation of Hemoglobin levels." In 2014 International Conference on Medical Imaging, m-Health and Emerging Communication Systems (MedCom). IEEE, 2014. http://dx.doi.org/10.1109/medcom.2014.7006007.

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Fitzmaurice, J. M. "Developing and sharing medical effectiveness information." In Health Care Technology Policy II: The Role of Technology in the Cost of Health Care: Providing the Solutions, edited by Warren S. Grundfest. SPIE, 1995. http://dx.doi.org/10.1117/12.225302.

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Delorenzo, A., St T. Clair, E. Andrew, S. Bernard, and K. Smith. "33 Characteristics of patients undergoing pre-hospital rapid sequence intubation by intensive care flight paramedics in victoria, australia." In Meeting abstracts from the second European Emergency Medical Services Congress (EMS2017). British Medical Journal Publishing Group, 2017. http://dx.doi.org/10.1136/bmjopen-2017-emsabstracts.33.

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Reports on the topic "Medical care, Cost of Australia"

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Cicala, Steve, Ethan M. J. Lieber, and Victoria Marone. Cost of Service Regulation in U.S. Health Care: Minimum Medical Loss Ratios. Cambridge, MA: National Bureau of Economic Research, April 2017. http://dx.doi.org/10.3386/w23353.

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Kessler, Daniel, and Jeffrey Geppert. The Effects of Competition on Variation in the Quality and Cost of Medical Care. Cambridge, MA: National Bureau of Economic Research, March 2005. http://dx.doi.org/10.3386/w11226.

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Barro, Jason, Robert Huckman, and Daniel Kessler. The Effects of Cardiac Specialty Hospitals on the Cost and Quality of Medical Care. Cambridge, MA: National Bureau of Economic Research, October 2005. http://dx.doi.org/10.3386/w11707.

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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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Rheney, Chris. The Rising Cost of Civilian Trauma Care at Brooke Army Medical Center: Strategies and Solutions. Fort Belvoir, VA: Defense Technical Information Center, June 2003. http://dx.doi.org/10.21236/ada421273.

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Burgess, Scott A. Active Duty Access to Specialty Care Within the Great Plains Regional Medical Command: A Cost Benefit Analysis. Fort Belvoir, VA: Defense Technical Information Center, June 1998. http://dx.doi.org/10.21236/ada372404.

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Smit, Amelia, Kate Dunlop, Nehal Singh, Diona Damian, Kylie Vuong, and Anne Cust. Primary prevention of skin cancer in primary care settings. The Sax Institute, August 2022. http://dx.doi.org/10.57022/qpsm1481.

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Overview Skin cancer prevention is a component of the new Cancer Plan 2022–27, which guides the work of the Cancer Institute NSW. To lessen the impact of skin cancer on the community, the Cancer Institute NSW works closely with the NSW Skin Cancer Prevention Advisory Committee, comprising governmental and non-governmental organisation representatives, to develop and implement the NSW Skin Cancer Prevention Strategy. Primary Health Networks and primary care providers are seen as important stakeholders in this work. To guide improvements in skin cancer prevention and inform the development of the next NSW Skin Cancer Prevention Strategy, an up-to-date review of the evidence on the effectiveness and feasibility of skin cancer prevention activities in primary care is required. A research team led by the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, was contracted to undertake an Evidence Check review to address the questions below. Evidence Check questions This Evidence Check aimed to address the following questions: Question 1: What skin cancer primary prevention activities can be effectively administered in primary care settings? As part of this, identify the key components of such messages, strategies, programs or initiatives that have been effectively implemented and their feasibility in the NSW/Australian context. Question 2: What are the main barriers and enablers for primary care providers in delivering skin cancer primary prevention activities within their setting? Summary of methods The research team conducted a detailed analysis of the published and grey literature, based on a comprehensive search. We developed the search strategy in consultation with a medical librarian at the University of Sydney and the Cancer Institute NSW team, and implemented it across the databases Embase, MEDLINE, PsycInfo, Scopus, Cochrane Central and CINAHL. Results were exported and uploaded to Covidence for screening and further selection. The search strategy was designed according to the SPIDER tool for Qualitative and Mixed-Methods Evidence Synthesis, which is a systematic strategy for searching qualitative and mixed-methods research studies. The SPIDER tool facilitates rigour in research by defining key elements of non-quantitative research questions. We included peer-reviewed and grey literature that included skin cancer primary prevention strategies/ interventions/ techniques/ programs within primary care settings, e.g. involving general practitioners and primary care nurses. The literature was limited to publications since 2014, and for studies or programs conducted in Australia, the UK, New Zealand, Canada, Ireland, Western Europe and Scandinavia. We also included relevant systematic reviews and evidence syntheses based on a range of international evidence where also relevant to the Australian context. To address Question 1, about the effectiveness of skin cancer prevention activities in primary care settings, we summarised findings from the Evidence Check according to different skin cancer prevention activities. To address Question 2, about the barriers and enablers of skin cancer prevention activities in primary care settings, we summarised findings according to the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework for identifying important implementation considerations for novel interventions in healthcare settings and provides a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing a new activity or program. We assessed study quality using the National Health and Medical Research Council (NHMRC) levels of evidence. Key findings We identified 25 peer-reviewed journal articles that met the eligibility criteria and we included these in the Evidence Check. Eight of the studies were conducted in Australia, six in the UK, and the others elsewhere (mainly other European countries). In addition, the grey literature search identified four relevant guidelines, 12 education/training resources, two Cancer Care pathways, two position statements, three reports and five other resources that we included in the Evidence Check. Question 1 (related to effectiveness) We categorised the studies into different types of skin cancer prevention activities: behavioural counselling (n=3); risk assessment and delivering risk-tailored information (n=10); new technologies for early detection and accompanying prevention advice (n=4); and education and training programs for general practitioners (GPs) and primary care nurses regarding skin cancer prevention (n=3). There was good evidence that behavioural counselling interventions can result in a small improvement in sun protection behaviours among adults with fair skin types (defined as ivory or pale skin, light hair and eye colour, freckles, or those who sunburn easily), which would include the majority of Australians. It was found that clinicians play an important role in counselling patients about sun-protective behaviours, and recommended tailoring messages to the age and demographics of target groups (e.g. high-risk groups) to have maximal influence on behaviours. Several web-based melanoma risk prediction tools are now available in Australia, mainly designed for health professionals to identify patients’ risk of a new or subsequent primary melanoma and guide discussions with patients about primary prevention and early detection. Intervention studies have demonstrated that use of these melanoma risk prediction tools is feasible and acceptable to participants in primary care settings, and there is some evidence, including from Australian studies, that using these risk prediction tools to tailor primary prevention and early detection messages can improve sun-related behaviours. Some studies examined novel technologies, such as apps, to support early detection through skin examinations, including a very limited focus on the provision of preventive advice. These novel technologies are still largely in the research domain rather than recommended for routine use but provide a potential future opportunity to incorporate more primary prevention tailored advice. There are a number of online short courses available for primary healthcare professionals specifically focusing on skin cancer prevention. Most education and training programs for GPs and primary care nurses in the field of skin cancer focus on treatment and early detection, though some programs have specifically incorporated primary prevention education and training. A notable example is the Dermoscopy for Victorian General Practice Program, in which 93% of participating GPs reported that they had increased preventive information provided to high-risk patients and during skin examinations. Question 2 (related to barriers and enablers) Key enablers of performing skin cancer prevention activities in primary care settings included: • Easy access and availability of guidelines and point-of-care tools and resources • A fit with existing workflows and systems, so there is minimal disruption to flow of care • Easy-to-understand patient information • Using the waiting room for collection of risk assessment information on an electronic device such as an iPad/tablet where possible • Pairing with early detection activities • Sharing of successful programs across jurisdictions. Key barriers to performing skin cancer prevention activities in primary care settings included: • Unclear requirements and lack of confidence (self-efficacy) about prevention counselling • Limited availability of GP services especially in regional and remote areas • Competing demands, low priority, lack of time • Lack of incentives.
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Boyle, Maxwell, and Elizabeth Rico. Terrestrial vegetation monitoring at Cape Hatteras National Seashore: 2019 data summary. National Park Service, January 2022. http://dx.doi.org/10.36967/nrr-2290019.

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The Southeast Coast Network (SECN) conducts long-term terrestrial vegetation monitoring as part of the nationwide Inventory and Monitoring Program of the National Park Service (NPS). The vegetation community vital sign is one of the primary-tier resources identified by SECN park managers, and monitoring is currently conducted at 15 network parks (DeVivo et al. 2008). Monitoring plants and their associated communities over time allows for targeted understanding of ecosystems within the SECN geography, which provides managers information about the degree of change within their parks’ natural vegetation. The first year of conducting this monitoring effort at four SECN parks, including 52 plots on Cape Hatteras National Seashore (CAHA), was 2019. Twelve vegetation plots were established at Cape Hatteras NS in July and August. Data collected in each plot included species richness across multiple spatial scales, species-specific cover and constancy, species-specific woody stem seedling/sapling counts and adult tree (greater than 10 centimeters [3.9 inches {in}]) diameter at breast height (DBH), overall tree health, landform, soil, observed disturbance, and woody biomass (i.e., fuel load) estimates. This report summarizes the baseline (year 1) terrestrial vegetation data collected at Cape Hatteras National Seashore in 2019. Data were stratified across four dominant broadly defined habitats within the park (Maritime Tidal Wetlands, Maritime Nontidal Wetlands, Maritime Open Uplands, and Maritime Upland Forests and Shrublands) and four land parcels (Bodie Island, Buxton, Hatteras Island, and Ocracoke Island). Noteworthy findings include: A total of 265 vascular plant taxa (species or lower) were observed across 52 vegetation plots, including 13 species not previously documented within the park. The most frequently encountered species in each broadly defined habitat included: Maritime Tidal Wetlands: saltmeadow cordgrass Spartina patens), swallow-wort (Pattalias palustre), and marsh fimbry (Fimbristylis castanea) Maritime Nontidal Wetlands: common wax-myrtle (Morella cerifera), saltmeadow cordgrass, eastern poison ivy (Toxicodendron radicans var. radicans), and saw greenbriar (Smilax bona-nox) Maritime Open Uplands: sea oats (Uniola paniculata), dune camphorweed (Heterotheca subaxillaris), and seabeach evening-primrose (Oenothera humifusa) Maritime Upland Forests and Shrublands: : loblolly pine (Pinus taeda), southern/eastern red cedar (Juniperus silicicola + virginiana), common wax-myrtle, and live oak (Quercus virginiana). Five invasive species identified as either a Severe Threat (Rank 1) or Significant Threat (Rank 2) to native plants by the North Carolina Native Plant Society (Buchanan 2010) were found during this monitoring effort. These species (and their overall frequency of occurrence within all plots) included: alligatorweed (Alternanthera philoxeroides; 2%), Japanese honeysuckle (Lonicera japonica; 10%), Japanese stilt-grass (Microstegium vimineum; 2%), European common reed (Phragmites australis; 8%), and common chickweed (Stellaria media; 2%). Eighteen rare species tracked by the North Carolina Natural Heritage Program (Robinson 2018) were found during this monitoring effort, including two species—cypress panicgrass (Dichanthelium caerulescens) and Gulf Coast spikerush (Eleocharis cellulosa)—listed as State Endangered by the Plant Conservation Program of the North Carolina Department of Agriculture and Consumer Services (NCPCP 2010). Southern/eastern red cedar was a dominant species within the tree stratum of both Maritime Nontidal Wetland and Maritime Upland Forest and Shrubland habitat types. Other dominant tree species within CAHA forests included loblolly pine, live oak, and Darlington oak (Quercus hemisphaerica). One hundred percent of the live swamp bay (Persea palustris) trees measured in these plots were experiencing declining vigor and observed with symptoms like those caused by laurel wilt......less
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