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Bomba, David, Kurt Svardsudd, and Per Kristiansson. "A comparison of patient attitudes towards the use of computerised medical records and unique identifiers in Australia and Sweden." Australian Journal of Primary Health 10, no. 2 (2004): 36. http://dx.doi.org/10.1071/py04024.
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This article compares the attitudes of Australian and Swedish patients towards the use of computerised medical records and unique identifiers in medical practices in Australia and Sweden. A Swedish translation of an Australian survey was conducted and results were compared. Surveys were distributed to patients at a medical practice in Sweden in 2003 and compared to the results of an Australian study by Bomba and Land (2003). Results: Based on the survey samples (Australia N=271 and Sweden N=55), 91% of Swedish respondents and 78% of Australian respondents gave a positive appraisal of the use of computers in health care. Of the Swedish respondents, 93% agreed that the computer-based patient record is an essential technology for health care in the future, while 86% of the Australian respondents agreed. Overwhelmingly, 95% of Swedish respondents and 91% of Australian respondents stated that the use of computers did not interfere with the doctor-patient consultation. Both groups preferred biometric identification as the method for uniquely identifying patients but differed in their preferred method to store medical information - a combination of central database and smart card for Australian respondents and central database for Swedish respondents. This analysis indicates that patient attitudes towards the use of computerised medical records and unique identifiers in Australia and Sweden are positive; however, there are concerns over information privacy and security. These concerns need to be taken into account in any future development of a national computer health network.
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Currie, Jane, Mary Chiarella, and Thomas Buckley. "Collaborative arrangements and privately practising nurse practitioners in Australia: results from a national survey." Australian Health Review 41, no. 5 (2017): 533. http://dx.doi.org/10.1071/ah16051.
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Objective Since the introduction of legislative changes in 2010, services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for subsidisation through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). To provide eligible services, PPNPs must collaborate formally with a medical practitioner or an entity that employs medical practitioners. This paper provides data from a national survey on these collaborative arrangements in Australia. The aim of the study was to evaluate the impact of PPNP services on patient access to care in Australia. Methods PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed using thematic analysis. Seventy-three surveys were completed. Results Ninety-three per cent of participants reported having a collaborative arrangement in place. Frequency of communication ranged from daily (27%) to never (1%). Participants reported that collaborative arrangements facilitate learning, patient care and offer support to PPNPs. However, for some PPNPs, organising a formal collaborative arrangement is demanding because it is dependent on the availability and willingness of medical practitioners and the open interpretation of the arrangement. Only 19% of participants believed that collaborative arrangements should be a prerequisite for PPNPs to access the MBS and PBS. Conclusion Although there are benefits to collaborative arrangements, there is also concern from PPNPs that mandating such arrangements through legislation presents a barrier to establishing PPNP services and potentially reduces patient access to care. Collaboration with medical practitioners is intrinsic to nursing practice. Thus, legislating for collaborative arrangements is unnecessary, because it makes the normal abnormal. What is known about the topic? To access the MBS and PBS, PPNPs are required by law to have a collaborative arrangement with a medical practitioner or entity that employs medical practitioners. To date, the effects of these collaborative arrangements on PPNP services in Australia have not been known. What does the paper add? This paper provides unique data from a national survey on collaborative arrangements between PPNPs and medical practitioners in Australia. What are the implications for practitioners? Although there are benefits to collaborative arrangements, there is also concern that mandating such arrangements presents a barrier to establishing PPNP services and potentially reduces patient access to care.
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Mclean, A. S., and E. J. Egan. "Australian Intensive Care Educational Links with Asian Countries." Anaesthesia and Intensive Care 23, no. 6 (December 1995): 718–20. http://dx.doi.org/10.1177/0310057x9502300612.
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A survey examining the level of Australian Intensive Care Unit involvement in the education of Asian critical care doctors and nurses was performed. Of the 49 hospitals surveyed, 34% have ongoing links. An analysis of countries involved, proportion of medical and nursing numbers, and whether the teaching was performed in Australia or the Asian country was undertaken. The survey revealed that a high proportion of Australian Intensive Care Units are actively involved, or would consider future participation, in educational links with Asian units.
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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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Saha, Sajal K., Karin Thursky, David C. M. Kong, and Danielle Mazza. "A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Community Pharmacists." Antibiotics 11, no. 9 (August 27, 2022): 1158. http://dx.doi.org/10.3390/antibiotics11091158.
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Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programmes in primary care. This study aimed to design a GP/pharmacist antimicrobial stewardship (GPPAS) model for primary care in Australia. An exploratory study design was followed that included seven studies conducted from 2017 to 2021 for the development of the GPPAS model. We generated secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components, and a pilot study of a GPPAS submodel. All study evidence was synthesised, reviewed, merged, and triangulated to design the prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. The secondary evidence provided effective GPPAS interventions, and the primary evidence identified GP/CP interprofessional issues, challenges, and future needs for implementing GPPAS interventions. The framework of the GPPAS model informed five GPPAS implementation submodels to foster implementation of AMS education program, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescriptions, through improved GP–CP collaboration. The GPPAS model could be used globally as a guide for GPs and CPs to collaboratively optimise antimicrobial use in primary care. Implementation studies on the GPPAS model and submodels are required to integrate the GPPAS model into GP/pharmacist interprofessional care models in Australia for improving AMS in routine primary care.
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Watt, Kerrianne, Vivienne C. Tippett, Steven G. Raven, Konrad Jamrozik, Michael Coory, Frank Archer, and Heath A. Kelly. "Attitudes to Living and Working in Pandemic Conditions among Emergency Prehospital Medical Care Personnel." Prehospital and Disaster Medicine 25, no. 1 (February 2010): 13–19. http://dx.doi.org/10.1017/s1049023x00007597.
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AbstractIntroduction:Little is known about the risk perceptions and attitudes of healthcare personnel, especially of emergency prehospital medical care personnel, regarding the possibility of an outbreak or epidemic event.Problem:This study was designed to investigate pre-event knowledge and attitudes of a national sample of the emergency prehospital medical care providers in relation to a potential human influenza pandemic, and to determine predictors of these attitudes.Methods:Surveys were distributed to a random, cross-sectional sample of 20% of the Australian emergency prehospital medical care workforce (n = 2,929), stratified by the nine services operating in Australia, as well as by gender and location. The surveys included: (1) demographic information; (2) knowledge of influenza; and (3) attitudes and perceptions related to working during influenza pandemic conditions. Multiple logistic regression models were constructed to identify predictors of pandemic-related risk perceptions.Results:Among the 725 Australian emergency prehospital medical care personnel who responded, 89% were very anxious about working during pandemic conditions, and 85% perceived a high personal risk associated with working in such conditions. In general, respondents demonstrated poor knowledge in relation to avian influenza, influenza generally, and infection transmission methods. Less than 5% of respondents perceived that they had adequate education/training about avian influenza. Logistic regression analyses indicate that, in managing the attitudes and risk perceptions of emergency prehospital medical care staff, particular attention should be directed toward the paid, male workforce (as opposed to volunteers), and on personnel whose relationship partners do not work in the health industry.Conclusions:These results highlight the potentially crucial role of education and training in pandemic preparedness. Organizations that provide emergency prehospital medical care must address this apparent lack of knowledge regarding infection transmission, and procedures for protection and decontamination. Careful management of the perceptions of emergency prehospital medical care personnel during a pandemic is likely to be critical in achieving an effective response to a widespread outbreak of infectious disease.
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Comino, Elizabeth J., Nicholas A. Zwar, and Oshana Hermiz. "The Macarthur GP After-hours Service: a model of after-hours care for Australia." Australian Health Review 31, no. 2 (2007): 223. http://dx.doi.org/10.1071/ah070223.
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Introduction: The Macarthur GP After-hours Service (MGPAS) was established to streamline the provision of after-hours medical care in an outer-urban community. This paper reports on a process evaluation of the MGPAS. Methods: A mixed methods approach involving surveys, stakeholder interviews and analysis of administrative data was used. Results and discussion: This model of care was well accepted and regarded by general practitioners, Macarthur Health Service staff and the community. The MGPAS was found to be an acceptable and efficient model of after-hours medical care. Areas that required further review included the need for telephone triage, home visiting and improved communication and referral to the health service. The financial viability of the MGPAS depends on supplementary funding due to the constraints of the Medicare rebate, and limited opportunities to reduce costs or increase revenue. Further research, including an economic evaluation to identify opportunity costs of the service, is needed.
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Bail, Kasia, Paul Arbon, Marlene Eggert, Anne Gardner, Sonia Hogan, Christine Phillips, Nicole van Dieman, and Gordon Waddington. "Potential scope and impact of a transboundary model of nurse practitioners in aged care." Australian Journal of Primary Health 15, no. 3 (2009): 232. http://dx.doi.org/10.1071/py09009.
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Aged care is a growing issue in Australia and other countries. There are significant barriers to meeting the health needs of this population. Current services have gaps between care and lack communication and integration between care providers. Research was conducted in the Australian Capital Territory to investigate the potential role of the aged care nurse practitioner in health service delivery in aged care settings. A multimethod case study design was utilised, with three student nurse practitioners (SNP) providing care to aged care clients across three sectors of health service delivery (residential aged care facilities, general medical practices and acute care). Data collection consisted of in-depth interviews and journal entries of the SNP, as well as focus groups and surveys of multidisciplinary staff and patients over the age of 65 years in the settings frequented by the SNP. The aged care SNP were found to cross professional and organisational boundaries, cross intra- as well as interorganisational boundaries and to contribute to more seamless patient care as members of a multidisciplinary aged care team. The aged care nurse practitioner role consequently has the potential to function in a networked rather than a hierarchical manner, and this could be a key element in addressing gaps in care across care locales and between disciplines.
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Bittleston, Helen, Jane L. Goller, Meredith Temple-Smith, Jane S. Hocking, and Jacqueline Coombe. "‘I didn’t want to visit a doctor unless it was extremely necessary’: perspectives on delaying access to sexual and reproductive health care during the COVID-19 pandemic in Australia from an online survey." Australian Journal of Primary Health 28, no. 2 (February 3, 2022): 131–36. http://dx.doi.org/10.1071/py21239.
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Australians were subject to a series of COVID-19 lockdown restrictions throughout 2020. Although accessing medical care was allowable, concerns were raised that people were avoiding healthcare services. We explored young Australians’ reasons for delaying seeking sexual and reproductive health (SRH) care during the pandemic, using data from two cross-sectional surveys. The surveys included a question asking whether respondents had delayed accessing care during the pandemic. Free-text responses from young Australians (aged 18–29 years) were analysed using conventional content analysis. In all, 1058 under-30s completed a survey, with 262 (24.8%) reporting they had delayed seeking SRH care. Of these, 228 (87.0%) respondents provided a free-text comment. Participants who commented were predominantly female (86.4%) and had a median age of 23 years (interquartile range 20–26 years). Most commonly, respondents delayed testing for sexually transmissible infections, cervical cancer screening, and contraceptive care. Some delayed accessing care despite experiencing symptoms. Participants avoided seeking care due to concerns about contracting COVID-19, uncertainty about accessing care during restrictions and anxiety relating to accessing SRH care. Although some reported a reduced need for SRH care, others required but did not access care. Young people should be reassured that SRH issues are a valid reason to access services, especially when experiencing symptoms.
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*Raman, Sainath, Georgia *Brown, *Equal first authors, Debbie Long, Ben Gelbart, Carmel Delzoppo, Johnny Millar, Simon Erickson, Marino Festa, and Luregn J. Schlapbach. "Priorities for paediatric critical care research: a modified Delphi study by the Australian and New Zealand Intensive Care Society Paediatric Study Group." Critical Care and Resuscitation 23, no. 2 (June 7, 2021): 194–201. http://dx.doi.org/10.51893/2021.2.oa6.
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OBJECTIVE: Most interventions in paediatric critical care lack high grade evidence. We aimed to identify the key research priorities and key clinical outcome measures pertinent to research in paediatric intensive care patients. DESIGN: Modified three-stage Delphi study combining staged online surveys, followed by a face-to-face discussion and final voting. SETTING: Paediatric intensive care units in Australia and New Zealand. PARTICIPANTS: Medical and nursing staff working in intensive care. MAIN OUTCOME MEASUREMENTS: Self-reported priorities for research. RESULTS: 193 respondents provided a total of 267 research questions and 234 outcomes. In Stage 3, the top 56 research questions and 50 outcomes were discussed face to face, which allowed the identification of the top 20 research questions with the Hanlon prioritisation score and the top 20 outcomes. Topics centred on the use of intravenous fluids (restrictive v liberal fluids, use of fluid resuscitation bolus, early inotrope use, type of intravenous fluid, and assessment of fluid responsiveness), and patient- and family-centred outcomes (health-related quality of life, liberation) emerged as priorities. While mortality, length of stay, and organ support/organ dysfunction were considered important and the most feasible outcomes, long term quality of life and neurodevelopmental measures were rated highly in terms of their importance. CONCLUSIONS: Using a modified Delphi method, this study provides guidance towards prioritisation of research topics in paediatric critical care in Australia and New Zealand, and identifies study outcomes of key relevance to clinicians and experts in the field.
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Freed, Gary L., Erin Turbitt, and Amy Allen. "Public or private care: where do specialists spend their time?" Australian Health Review 41, no. 5 (2017): 541. http://dx.doi.org/10.1071/ah15228.
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Objectives The aim of the present study was to provide data to help clarify the public–private division of clinical care provision by doctors in Australia. Methods A secondary analysis was performed of data from the workforce survey administered by the Australian Health Practitioner Regulation Agency. The questionnaire included demographic and employment questions. Analysis included frequency distributions of demographic variables and mean and median calculations of employment data. Data were analysed from those currently employed in eight adult specialities chosen to provide a mix of surgical and medical fields. The specialties were orthopaedic surgery, otolaryngology, ophthalmology, cardiology, neurology, nephrology, gastroenterology and rheumatology. Results For the specialities analysed in the present study, a large majority of the time spent in patient care was provided in the private sector. For the surgical specialties studied, on average less than 30% of clinical time was spent in the public sector. There was considerable variation among specialties in whether a greater proportion of time was spent in out-patient versus in-patient care and how that was divided between the public and private sectors. Conclusions Ensuring Australians have a medical workforce that meets the needs of the population will require assessments of the public and private medical markets, the needs of each market and the adequacy with which current physician clinical time allocation meets those requirements. By appreciating this nuance, Australia can develop policies and strategies for the current and future speciality workforce to meet the nation’s needs. What is known about the topic? Australian medical specialists can split their clinical practice time between the public (e.g. public hospitals, public clinics) and private (e.g. private hospitals, private consulting rooms) sectors. For all medical specialists combined, working hours have been reported to be similar in the public and private sectors. In aggregate, 48% of specialists work across both sectors, 33% work only in public practice and 19% work only in private practice. What does this paper add? Because of the potential for significant variability across specialties, these consolidated figures may be problematic in assessing the public and private allocation of the physician workforce. Herein we provide the first speciality-specific data on the public–private mix of practice in Australia. Among the most important findings from the present study is that, for many specialists in Australia, a large majority of time is spent providing care to patients in the private sector. For the surgical specialties studied, on average less than 30% of clinical time is spent in the public sector. What are the implications for practitioners? Public policies that are designed to ensure an adequate medical workforce will need to take into account the division of time providing care in the public vs. the private sector. Public perceptions of shortages in the public sector may increase the availability of public sector positions.
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Marshall, Ric, David Grayson, Anthony Jorm, and Brian O'Toole. "Are survey measures of medical careutilisation misleading?" Australian Health Review 24, no. 3 (2001): 91. http://dx.doi.org/10.1071/ah010091.
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found when estimates from self-report data from anepidemiolgical study were compared to actual cost data extracted from administrative records. Even though the fewsubjects who were actually provided with two or more services in the two-week self-report period substantially under-reportedtheir medical care consumption, a large net over-estimate of medical care consumption was produced by theself-report data. This finding has important implications for use of self-report data from surveys such as the AustralianBureau of Statistics (ABS) National Health Survey for estimating health service consumption.By combining epidemiological survey data from the Australian Vietnam Veterans Health Study (AVVHS), with dataon actual medical care for which the Health Insurance Commission (HIC) or the Department of Veterans' Affairs (DVA)paid benefits, we were able to directly compare self-reported medical care consumption with actual medical careutilisation. The comparison revealed that veterans' self-reports were a valid measure of relative medical careconsumption because those who reported care over the past two weeks were much more likely to have been recentconsumers than those who did not. This relationship became even stronger if the comparison of self-report was extendedto data on benefits paid beyond the two-week self-report period. However, the HIC and DVA data confirmed only 51%of veterans self-reporting medical care consumption during the past two weeks actually received a service.
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Noblet, Timothy David, John F. Marriott, Taryn Jones, Catherine Dean, and Alison B. Rushton. "Perceptions of Australian physiotherapy students about the potential implementation of physiotherapist prescribing in Australia: a national survey." BMJ Open 9, no. 5 (May 17, 2019): e026327. http://dx.doi.org/10.1136/bmjopen-2018-026327.
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ObjectivesTo explore the perceptions of Australian physiotherapy students about (1) the potential implementation and use of non-medical prescribing by physiotherapists in Australia and (2) how physiotherapist prescribing might impact the care that the physiotherapy profession can provide in the future.DesignA cross-sectional descriptive survey of physiotherapy students across Australia was completed using an online questionnaire developed by subject-experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all students enrolled in any accredited, entry-level Australian university physiotherapy programme. A reminder email was sent 4 weeks later.SettingParticipants completed an online questionnaire.Participants526 physiotherapy students from universities across all states with entry-level programmes.Outcome measuresQuantitative data underwent primary descriptive analysis. Thematic analysis was used to synthesise qualitative data.Results87% of participants supported the introduction of physiotherapist prescribing in Australia. 91% of participants stated that they would train to prescribe following introduction. Participants identified improvements in clinical and cost effectiveness, timely access to appropriate prescription medicines and optimisation of quality healthcare as key drivers for the introduction.ConclusionsStudent physiotherapists support the introduction of physiotherapist prescribing in Australia, reporting potential benefits for patients, health services and the physiotherapy profession. Stakeholders should use the results of this study in conjunction with supporting literature to inform future decisions regarding physiotherapist prescribing in Australia.
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Reilly, Jennifer R., Carolyn Deng, Wendy A. Brown, Dianne Brown, Belinda J. Gabbe, Carol L. Hodgson, and Paul S. Myles. "Towards a national perioperative outcomes registry: A survey of perioperative electronic medical record utilisation to support quality assurance and research at Australian and New Zealand College of Anaesthetists Clinical Trials Network hospitals in Australia." Anaesthesia and Intensive Care 50, no. 3 (January 18, 2022): 189–96. http://dx.doi.org/10.1177/0310057x211030284.
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In Australia, 2.7 million surgical procedures are performed annually. Historically, a lack of perioperative data standardisation and infrastructure has limited pooling of routinely collected data across institutions. We surveyed Australian and New Zealand College of Anaesthetists (ANZCA) Clinical Trials Network hospitals to investigate current and potential uses of perioperative electronic medical record data for research and quality assurance. A targeted survey was sent to 131 ANZCA Clinical Trials Network–affiliated hospitals in Australia. The primary aim was to map current electronic data collection methods and data utilisation in six domains of the perioperative pathway. The survey response rate was 32%. Electronic data recording in the six domains ranged from 19% to 85%. Where electronic data exist, the ability of anaesthesiology departments to export them for analysis ranged from 27% to 100%. The proportion of departments with access to data exports that are regularly exporting the data for quality assurance or research ranged from 13% to 58%. The existence of a perioperative electronic medical record does not automatically lead to the data being used to measure and improve clinical outcomes. The first barrier is clinician access to data exports. Even when this barrier is overcome, a large gap remains between the proportion of departments able to access data exports and those using the data regularly to inform and improve clinical practice. We believe this gap can be addressed by establishing a national perioperative outcomes registry to lead high-quality multicentre registry research and quality assurance in Australia.
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Mueller, Evelyn, Georg Bollig, Gerhild Becker, and Christopher Boehlke. "Lessons Learned from Introducing Last Aid Courses at a University Hospital in Germany." Healthcare 9, no. 7 (July 16, 2021): 906. http://dx.doi.org/10.3390/healthcare9070906.
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In recent years, so called “Last Aid courses”, concerning end-of-life care for people dying, have successfully been established in community settings in several European countries, Australia, and South-America. To date, they have not been evaluated in hospital settings, where educational needs (concerning care of the dying) are especially high, and may differ from the general population. To evaluate if Last Aid courses are feasible in hospital settings, and if informational needs of hospital staff are met by the curriculum, we introduced Last Aid courses at a university hospital. Five courses were offered; participants of courses 1 and 2 completed surveys with open-ended questions; the answers were used to develop the evaluation questionnaire employed in courses 3–5. In these three courses, 55 of the 56 participants completed an evaluation survey to explore their learning goals and obtain feedback. Courses were fully booked; participants were heterogeneous with regard to their professional background. The most prevalent learning goals were “preparation for emotional aspects in care of dying” (65.5% ratings “very important”), “preparation for medical/care aspects in care of dying” (60.0%), and “knowledge of supportive services and facilities” (54.5%). Overall, the evaluation showed that Last Aid courses were more suitable to educate non-medical hospital staff about care of the dying. Medical staff, in contrast to non-medical staff, more often requested courses with an extended curriculum in order to meet their learning goals. Last Aid courses were well accepted and helped to reduce information deficits on care of the dying in a heterogeneous population of hospital staff.
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Albsoul, Rania Ali, Gerard FitzGerald, and Muhammad Ahmed Alshyyab. "Missed nursing care: a snapshot case study in a medical ward in Australia." British Journal of Nursing 31, no. 13 (July 7, 2022): 710–16. http://dx.doi.org/10.12968/bjon.2022.31.13.710.
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Background: Missed nursing care is a global issue in acute healthcare settings. It is a complex phenomenon that refers to nursing care that is required by patients but left undone or significantly delayed. Aim: To investigate the nature of missed nursing care and influencing factors in a general medical ward in an acute care hospital in Brisbane, Australia. Method: This is a descriptive case study. The study was carried out in a 29-bed inpatient general medical/cardiology/telemetry ward in an acute care tertiary hospital. Results: The study ward has been identified as a high complexity unit. The survey data found that the most frequent nursing care elements missed, as reported by the patients, were oral care, response to machine beep, and response to call light. The most frequent nurse-reported missed care items were ambulation, monitoring fluid intake/output and attendance at interdisciplinary conferences. Conclusion: Despite mandating nurse-to-patient ratios in the study ward, inadequate staffing was still perceived as being problematic and one of the most frequent reasons leading to missed nursing care. This possible disconnect between mandated staffing ratios and the persistence of perceived missed care suggests a more complex relationship than can be managed by macro (large-scale) resourcing formulas alone.
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Lakra, V. "Telehealth in Australia." European Psychiatry 65, S1 (June 2022): S569. http://dx.doi.org/10.1192/j.eurpsy.2022.1457.
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Introduction There is a significant psychiatry workforce shortage in Australia, particularly in rural and remote communities. Given the large distances involved, telehealth – providing consultation via videoconference – has been widely accepted. Psychiatrists were among the highest users of telehealth services in Australia before the COVID-19 pandemic. However, the outbreak of COVID-19 resulted in a major transformation to service delivery across Australia. Private psychiatrists and state public mental health services had to rapidly transition to largely telehealth delivery to ensure continuity of care for consumers. In March 2020, additional telehealth item numbers were added to the Australian Medicare Benefits Schedule (MBS) to encourage physical distancing for those accessing medical services during the pandemic. Objectives To provide an overview of the increase in telehealth activity since the COVID-19 pandemic. Methods The MBS is the list of services for which the Australian Government will pay a rebate. Key data on MBS telehealth activity since March 2020 was examined. Results The use of telehealth has increased during the pandemic. A survey of Royal Australian and New College of Psychiatrists (RANZCP) psychiatrists found that 93% supported retention of telehealth MBS item number numbers following the COVID-19 pandemic, noting increased accessibility for consumers. Positive feedback has been received from consumers. Conclusions During 2020 and 2021, the RANZCP worked with the Australian Government to ensure there were appropriate MBS telehealth services available for consumers. The RANZCP continues to work with the Government as they plan for a longer-term transformation of telehealth services beyond 2021. Disclosure No significant relationships.
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Lynch, Elizabeth, Kate Laver, Tamina Levy, and Timothy Schultz. "‘The way that we are collecting and using data has evolved’ evaluating the Australian National Stroke Audit programme to inform strategic direction." BMJ Open Quality 12, no. 1 (January 2023): e002136. http://dx.doi.org/10.1136/bmjoq-2022-002136.
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BackgroundThe National Stroke Audit has been used to audit and provide feedback to health professionals and stroke care services in Australia since 2007. The Australian Stroke Clinical Registry was piloted in 2009 and numbers of hospitals participating in the registry are increasing. Considering the changing data landscape in Australia, we designed this study to evaluate the stroke audit and to inform strategic direction.MethodsWe conducted a rapid review of published literature to map features of successful data programmes, followed by a mixed-methods study, comprising national surveys and interviews with clinicians and administrators about the stroke audit. We analysed quantitative data descriptively and analysed open-ended survey responses and interview data using qualitative content analysis. We integrated data from the two sources.ResultsWe identified 47 Australian data programs, successful programs were usually funded by government sources or professional associations and typically provided twice yearly or yearly reports.106 survey participants, 14 clinician and 5 health administrator interview participants were included in the evaluation. The Stroke Audit was consistently perceived as useful for benchmarking, but there were mixed views about its value for local quality improvement. Time to enter data was the most frequently reported barrier to participation (88% of survey participants), due to the large number of datapoints and features of the audit software.Opportunities to improve the Stroke Audit included refining Audit questions, developing ways to automatically export data from electronic medical records and capturing accurate data for patients who transferred between hospitals.ConclusionWhile the Stroke Audit was not perceived by all users to be beneficial for traditional quality improvement purposes, the ability to benchmark national stroke services and use these data in advocacy activities was a consistently reported benefit. Modifications were suggested to improve usability and usefulness for participating sites.
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Braithwaite, Jeffrey, Robyn Clay-Williams, Natalie Taylor, Hsuen P. Ting, Teresa Winata, Emily Hogden, Zhicheng Li, et al. "Deepening our Understanding of Quality in Australia (DUQuA): An overview of a nation-wide, multi-level analysis of relationships between quality management systems and patient factors in 32 hospitals." International Journal for Quality in Health Care 32, Supplement_1 (December 3, 2019): 8–21. http://dx.doi.org/10.1093/intqhc/mzz103.
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Abstract Objective The Deepening our Understanding of Quality in Australia (DUQuA) project is a multisite, multi-level, cross-sectional study of 32 of the largest hospitals in Australia. This overview examines relationships between (i) organization-level quality management systems and department-level quality management strategies and (ii) patient-level measures (clinical treatment processes, patient-reported perceptions of care and clinical outcomes) within Australian hospitals. Design We examined hospital quality improvement structures, processes and outcomes, collecting data at organization, department and patient levels for acute myocardial infarction (AMI), hip fracture and stroke. Data sources included surveys of quality managers, clinicians and patients, hospital visits, medical record reviews and national databases. Outcomes data and patient admissions data were analysed. Relationships between measures were evaluated using multi-level models. We based the methods on the Deepening our Understanding of Quality Improvement in Europe (DUQuE) framework, extending that work in parts and customizing the design to Australian circumstances. Setting, participants and outcome measures The 32 hospitals, containing 119 participating departments, provided wide representation across metropolitan, inner and outer regional Australia. We obtained 31 quality management, 1334 clinician and 857 patient questionnaires, and conducted 2401 medical record reviews and 151 external assessments. External data via a secondary source comprised 14 460 index patient admissions across 14 031 individual patients. Associations between hospital, Emergency Department (ED) and department-level systems and strategies and five patient-level outcomes were assessed: 19 of 165 associations (11.5%) were statistically significant, 12 of 79 positive associations (15.2%) and 7 of 85 negative associations (8.2%). Results We did not find clear relationships between hospital-level quality management systems, ED or department quality strategies and patient-level outcomes. ED-level clinical reviews were related to adherence to clinical practice guidelines for AMI, hip fracture and stroke, but in different directions. The results, when considered alongside the DUQuE results, are suggestive that front line interventions may be more influential than department-level interventions when shaping quality of care and that multi-pronged strategies are needed. Benchmark reports were sent to each participating hospital, stimulating targeted quality improvement activities. Conclusions We found no compelling relationships between the way care is organized and the quality of care across three targeted patient-level outcome conditions. The study was cross-sectional, and thus we recommend that the relationships studied should be assessed for changes across time. Tracking care longitudinally so that quality improvement activities are monitored and fed back to participants is an important initiative that should be given priority as health systems strive to develop their capacity for quality improvement over time.
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Gasper, Harry, Elizabeth Ahern, Natasha Roberts, Bryan Chan, Brett Hughes, Glen Kennedy, David Wyld, Melissa Eastgate, and Zarnie Lwin. "Semiqualitative research protocol to explore cancer care workforce perceptions of the health system response to COVID-19 preparations in Southeast Queensland, Australia." BMJ Open 11, no. 5 (May 2021): e044655. http://dx.doi.org/10.1136/bmjopen-2020-044655.
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IntroductionSars-CoV-2 is a novel coronavirus responsible for COVID-19 officially declared pandemic in March 2020. Health systems worldwide responded with swift changes to increase workflow capacity while protecting the vulnerable, including those with cancer. This led to unprecedented and rapid restructuring of health service provision. Published data from the 2003 SARS pandemic focuses on medical and nursing staff, overlooking other departmental employees such as administration officers or food service workers. Our protocol aims to document directives and adjustments communicated to staff in two cancer care departments and correlate this with measures of distress and perceived preparedness across the spectrum of all staff involved in cancer care.Methods and analysisWe use a semiqualitative approach comprising weekly diarising of events and simultaneous staff surveys. Principal investigators will document changes at a metropolitan quaternary cancer centre and a regional cancer centre. Communications, directives and changes will be diarised in real time in four executional domains. Simultaneously, prospective voluntary self-administered online surveys will be conducted at regular intervals by staff. The survey assesses the perceived institutional preparedness and personal well-being, with a combination of Likert scaled and open response questions. A semiquantitative self-assessment of distress adapted from National Comprehensive Cancer Network distress thermometer is incorporated. Additionally, open-text personal reflections on themes including difficult decisions will be invited. Survey participants will be drawn from various work areas of the cancer care departments: administrative staff, health professionals, for example, allied health, ancillary workers, nursing and medical.Ethics and disseminationThe study has been reviewed and approved by the Human Research Ethics Committee (LNR/2020/QRBW/62982). Published literature on domains of distress neglects categories of healthcare worker who form an essential part of the care delivery team. Our study hopes to gather insights about psychosocial impact and adjustment which could direct responses in future emergencies.
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Saha, Sajal K., David C. M. Kong, Karin Thursky, and Danielle Mazza. "Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study." Antibiotics 10, no. 1 (January 5, 2021): 47. http://dx.doi.org/10.3390/antibiotics10010047.
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Setting up an interprofessional team for antimicrobial stewardship (AMS) to improve the quality and safety of antimicrobial use in primary care is essential but challenging. This study aimed to investigate the convergent and divergent attitudes and views of general practitioners (GPs) and community pharmacists (CPs) about AMS implementation and their perceived challenges of collaboration to design a GP–pharmacist collaborative AMS (GPPAS) model. Nationwide surveys of GPs and CPs across Australia were conducted January-October 2019. Chi square statistics and a theoretical framework were used for comparative analyses of quantitative and qualitative data, respectively. In total, 999 participants responded to the surveys with 15.4% (n = 386) response rates for GPs and 30.7% (n = 613) for CPs. GPs and CPs were aware about AMS however their interprofessional perceptions varied to the benefits of AMS programs. CPs indicated that they would need AMS training; significantly higher than GPs (GP vs. CP; 46.4% vs. 76.5%; p < 0.0001). GPs’ use of the Therapeutic Guideline Antibiotic was much higher than CPs (83.2% vs. 45.5%; p < 0.0001). No interprofessional difference was found in the very-limited use of patient information leaflets (p < 0.1162) and point-of-care tests (p < 0.7848). While CPs were more willing (p < 0.0001) to collaborate with GPs, both groups were convergent in views that policies that support GP–CP collaboration are needed to implement GPPAS strategies. GP–pharmacist collaborative group meetings (54.9% vs. 82.5%) and antimicrobial audit (46.1% vs. 86.5%) models were inter-professionally supported to optimise antimicrobial therapy, but an attitudinal divergence was significant (p < 0.001). The challenges towards GP–CP collaboration in AMS were identified by both at personal, logistical and organisational environment level. There are opportunities for GP–CP collaboration to improve AMS in Australian primary care. However, strengthening GP–pharmacy collaborative system structure and practice agreements is a priority to improve interprofessional trust, competencies, and communications for AMS and to establish a GPPAS model in future.
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Meadows, Graham, Bruce Singh, Philip Burgess, and Irene Bobevski. "Psychiatry and the Need for Mental Health Care in Australia: Findings from the National Survey of Mental Health and Wellbeing." Australian & New Zealand Journal of Psychiatry 36, no. 2 (April 2002): 210–16. http://dx.doi.org/10.1046/j.1440-1614.2002.00990.x.
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Objective: This paper describes the pattern of consultations reported with psychiatrists and primary mental health care providers in the Australian adult population. It explores whether inequalities found in utilization of psychiatric services according to area are different in degree from inequalities in utilization of medical and surgical specialists, and describes the meeting of perceived needs for mental health care within those seen by psychiatrists. Method: The National Survey of Mental Health and Wellbeing (NSMHW) was a community survey employing clustered probability sampling, with a computerized field questionnaire which included sections of the composite international diagnostic interview (CIDI), as well as self-reported service utilization and perceived needs for care. Results: By survey estimates, 1.8% of the Australian population consulted a psychiatrist in the last year. Among people with an ICD 10-diagnosed mental disorder, 7.3% consulted a psychiatrist. Only about one in five people seen by a psychiatrist report the psychiatrist as the only mental health care provider. Disadvantaged areas of the cities and remote areas, when compared with the least deprived areas of the cities, showed lower rates of utilization. This effect is stronger in psychiatry than in other specialities. Patients seeing psychiatrists seem to be a more satisfied group than those seeing only other providers; nonetheless, some needs are not well met, and the role of the psychiatrist cannot be isolated as the cause of this satisfaction. Conclusions: Most care delivered by psychiatrists is de facto shared care. Psychiatrists as clinical professionals need to be continually mindful of the need to communicate with others providing care. Psychiatric services in Australia are not delivered in an equitable manner, and the inequalities are greater for psychiatric services than for other medical specialities.
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Arora, Maansi, Kaete Walker, Judy Luu, Robbert J. Duvivier, Tinashe Dune, and Katie Wynne. "Education of the medical profession to facilitate delivery of transgender health care in an Australian health district." Australian Journal of Primary Health 26, no. 1 (2020): 17. http://dx.doi.org/10.1071/py19102.
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Transgender individuals who desire medical transition need to access care through their local healthcare system. This is the first study to explore the perceptions of the community and attitudes of healthcare providers towards the delivery of transgender health care in an Australian context. An anonymous survey was conducted of trans and gender-diverse community members; and physicians and trainees in the Hunter New England Local Health District of New South Wales, Australia. Community members were surveyed about their healthcare experiences. Medical students, GPs and hospital physicians were surveyed on their attitudes towards the delivery of transgender health care before and after a 1-h education session that included the lived experience of a community member. Community members expressed a need for increased education for healthcare providers in transgender medicine. Following the intervention, significantly more healthcare providers felt confident to facilitate transgender health care for adults, adolescents and children; and more healthcare providers agreed that medical and surgical treatment should be offered to transgender patients if desired. The positive safety profile of treatment was felt to be the most persuasive factor for the provision of care. Healthcare providers identified a need for health education in transgender medicine; easy access to evidence-based resources; and local referral pathways as key strategies to improving transgender health care.
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Agarwal, Anupriya, Deme J. Karikios, Martin R. Stockler, and Rachael L. Morton. "Discussion of costs and financial burden in clinical practice: A survey of medical oncologists in Australia." PLOS ONE 17, no. 10 (October 21, 2022): e0273620. http://dx.doi.org/10.1371/journal.pone.0273620.
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Background A diagnosis of cancer is associated with significant physical, psychological and financial burden. Including costs of cancer is an important component of shared decision making. Doctors bear a responsibility towards educating patients about the financial aspects of care. Multiple organisations have advocated for price transparency and implementing Informed Financial Consent in the clinic. However, few studies have evaluated the perspectives of oncologists on the current state of this discussion. Aims The aim of this study is to determine the views and perspectives of medical oncologists regarding communication of costs and financial burden in patients with cancer. Methods We conducted a prospective cross-sectional online survey via REDCap. The survey was distributed to medical oncologists and advanced trainees currently registered with Medical Oncology Group of Australia (MOGA). Data was collected using the online survey comprising socio-demographic characteristics, discussion of costs and financial burden, and facilitators and barriers to these discussions. Results 547 members of MOGA were invited to participate in the study, and 106 of 547 MOGA members (19%) completed the survey. Most oncologists (66%) felt that it was their responsibility to discuss costs of care, however a majority of oncologists (59.3%) reported discussing costs with less than half of their patients. Only 25% of oncologists discussed financial concerns with more than half of their patients, and most oncologists were unfamiliar with cancer-related financial burden. Most Oncologists with greater clinical experience and those working in private practice were more likely to discuss costs with a majority of their patients. Conclusions Certain characteristics of medical oncologists and their practices were associated with reported prevalence of discussing costs of care and financial burden with their patients. In the context of rising costs of cancer care, interventions targeting modifiable factors such as raising oncologist awareness of costs of care and financial burden, screening for financial toxicity and availability of costs information in an easily accessible manner, may help increase the frequency of patient-doctor discussions about costs of care, contributing to informed decision-making and higher-quality cancer care.
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Harris, Mark F., Jane Lloyd, Yordanka Krastev, Mahnaz Fanaian, Gawaine Powell Davies, Nick Zwar, and Siaw-Teng Liaw. "Routine use of clinical management guidelines in Australian general practice." Australian Journal of Primary Health 20, no. 1 (2014): 41. http://dx.doi.org/10.1071/py12078.
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Significant gaps remain between recommendations of evidence-based guidelines and primary health care practice in Australia. This paper aims to evaluate factors associated with the use of guidelines reported by Australian GPs. Secondary analysis was performed on a survey of primary care practitioners which was conducted by the Commonwealth Fund in 2009: 1016 general practitioners responded in Australia (response rate 52%). Two-thirds of Australian GPs reported that they routinely used evidence-based treatment guidelines for the management of four conditions: diabetes, depression, asthma or chronic obstructive pulmonary disease and hypertension – a higher proportion than in most other countries. Having non-medical staff educating patients about self-management, and a system of GP reminders to provide patients with test results or guideline-based intervention or screening tests, were associated with a higher probability of guidelines use. Older GP age was associated with lower probability of guideline usage. The negative association with age of the doctor may reflect a tendency to rely on experience rather than evidence-based guidelines. The association with greater use of reminders and self-management is consistent with the chronic illness model.
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Ogden, Kathryn, Emily Ingram, Joanna Levis, Georgia Roberts, and Iain Robertson. "Termination of pregnancy in Tasmania: access and service provision from the perspective of GPs." Australian Journal of Primary Health 27, no. 4 (2021): 297. http://dx.doi.org/10.1071/py20288.
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Termination of pregnancy (TOP) is considered an important component of sexual and reproductive health internationally, but there are known barriers in Australia and countries worldwide. This study investigated the issues for GPs regarding aiding access to TOP and providing early medical abortion (EMA) services for Tasmanian women. Specifically, the aims of the study were to identify the knowledge and attitudes of Tasmanian GPs regarding TOP services and to determine which known barriers to providing EMA are most significant for GPs in Tasmania, Australia. A survey was developed and piloted based on previous qualitative research that identified known barriers to accessing TOP. Surveys were posted to all identified GPs in Tasmania with a reply-paid envelope. In all, 211 (27.4%) responses were returned. GPs identified difficulty accessing TOP services, particularly for rural women and those on a low income. Almost half the GPs, excluding conscientious objectors, indicated they would be interested in providing EMA services, but perceived barriers were significant. The most significant barriers related to accessing appropriate training and support. There was uncertainty around financial reward, support services, medical indemnity and access to the medical abortifacient medications mifepristone and misoprostol. In conclusion, accessing TOP remains an issue for Tasmanian women. Many Tasmanian GPs are interested in providing EMA services if barriers are addressed, but there is a lack of knowledge about the practicalities of implementing EMA. Providing practical support to GPs and increasing knowledge pertaining to EMA provision in general practice could improve access in primary care.
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Long, Janet C., Helena M. Williams, Shefali Jani, Gaston Arnolda, Hsuen P. Ting, Charlotte J. Molloy, Peter D. Hibbert, Kate Churruca, Louise A. Ellis, and Jeffrey Braithwaite. "Assessing the appropriateness of the management of upper respiratory tract infection in Australian children: a population-based sample survey." BMJ Open 9, no. 5 (May 2019): e026915. http://dx.doi.org/10.1136/bmjopen-2018-026915.
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ObjectiveTo assess the proportion of Australian children aged 0–15 years that received care in line with clinical practice guidelines (CPGs) for upper respiratory tract infections (URTIs).DesignRetrospective medical record review using a multistage sampling strategy.SettingGeneral practices, hospital emergency departments and hospital inpatient service providers in three Australian states.ParticipantsChildren aged up to 15 years who received care for URTI in 2012 and 2013.Primary and secondary outcome measuresThe primary assessment was estimated adherence with 14 indicators of appropriate care as documented in medical records. Indicators were extracted from national and international CPGs and ratified by experts. Secondary assessment was adherence to two bundles of indicators (diagnostic symptoms and medical history taking), where all indicators must be adherent for the bundle to be scored as adherent.ResultsThere were 1653 children with one or more assessments of URTI care to CPG adherence. Over half of the children were under 3 years of age, with roughly equal numbers of males and females. Three indicators had fewer than 25 visits so were not reported. Overall adherence ranged from 0.5% for ‘documented advice around antibiotics’ to 88.3% for ‘documentation of medical history’. Adherence with Bundle A (documentation of all three definitive symptoms) was 43.1% (95% CI 32.8% to 54.0%) and Bundle B (documentation of all four indicators of medical history) was 30.2% (95% CI 20.9% to 40.9%).ConclusionsURTIs in children are common, usually self-limiting, conditions that are allocated considerable resources. The results suggest that there may be a need for more thorough holistic assessment of the patient and improved documentation. Since inappropriate prescription of antibiotics for URTIs is still a known problem in Australia, there is a need for consistent, clear communication around antibiotics’ lack of impact on symptoms and a high association with undesirable side effects.
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MacAndrew, Margaret, Elizabeth Beattie, Dubhglas Taylor, Jim Whitehead, and John Quinn. "Health Professionals' Knowledge of how to Report a Missing Person With Dementia: A National Survey." Innovation in Aging 4, Supplement_1 (December 1, 2020): 62–63. http://dx.doi.org/10.1093/geroni/igaa057.204.
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Abstract In Australia one in five land searches conducted by Police involve a person with dementia. Over a third of these people go missing from a health care service and 15% are not found alive. Delays in commencing a specialised search for the missing person with dementia contributes to the risk of death. Delays in Police searching may result from ambiguity in current policies about how to report a missing patient/client. This study aimed to explore health professional’s knowledge about how to report a missing person with dementia and reasons for delayed reports to Police. 246 Australian health professionals completed an online survey. Most were registered nurses (n=124), allied health professionals (n=69) and medical practitioners (n=22) who worked in a range of settings including acute care (n=111), community care (n=59) and residential aged care (n=44). Over a third (n=81) did not know their care service policy for reporting a missing patient/client and did not know if their health service had a policy specific to reporting a missing person with dementia. 20% did not know how long they needed to wait before reporting a missing person to Police and fear of calling Police too soon or wasting their time were common reasons for delaying a report. These findings confirm a degree of misunderstanding about current policy and procedures for reporting a missing person with dementia. Addressing knowledge deficits and standardising approaches to reporting a missing person with dementia in Australia would be recommended as a step toward improving their health outcomes.
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McArthur, Katherine, Darcy Jorgensen, Mike Climstein, and James Furness. "Epidemiology of Acute Injuries in Surfing: Type, Location, Mechanism, Severity, and Incidence: A Systematic Review." Sports 8, no. 2 (February 20, 2020): 25. http://dx.doi.org/10.3390/sports8020025.
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Prospective and retrospective studies have examined traumatic injuries within competitive and recreational surfers worldwide using online surveys and health care facility (HCF; e.g., hospital, emergency department, medical record) data. However, few studies have provided a synthesis of all available literature. The purpose of this study was to obtain, critique and synthesise all literature specific to acute surfing injuries, and evaluate differences in injury type, mechanism and location between HCF and survey data. A systematic literature review design was used to identify relevant articles from three major databases. Peer-reviewed epidemiological studies of musculoskeletal surfing injuries were included. A modified AXIS tool was used for critical appraisal, and objective data was extracted and synthesized by lead researchers. Overall frequencies for injury location, type and mechanism were calculated from raw injury data. A total of 19 cross-sectional articles of fair to good quality (Modified AXIS 54.2–83.3%) were included in this study; 17 were National Health and Medical Research Council (NHMRC) level III-2 (retrospective) and two were level II (prospective). Articles examined competitive, recreational and combined populations. Injury data from Australia, Brazil, UK, USA, Portugal, Japan, Norway, and worldwide were represented. Skin (46.0%; HCF 50.1%, survey 43.8%) and being struck by own surfboard (38.6%; HCF 73.4%, survey 36.7%) were the most common injury type and mechanism. Head, face and neck injuries were most common in HCF (43.1%) versus lower limb injuries (36.4%) in survey data. Incidence proportion was highest in aerialists (0.48). Incidence rate (number of injuries per 1000 h) ranged from 0.74 in Australian surfers (Melbourne) to 6.6 in international contest surfers from medical record data. This review highlights the prevalence of skin, board-related, head, face and neck, and lower limb surfing injuries across available literature. Proposed use of protective equipment and foam-based surfboards in dangerous or crowded surf locations may reduce injury risk.
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McHugh, Matthew D., Linda H. Aiken, Carol Windsor, Clint Douglas, and Patsy Yates. "Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study." BMJ Open 10, no. 9 (September 2020): e036264. http://dx.doi.org/10.1136/bmjopen-2019-036264.
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ObjectivesTo determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses.DesignAnalysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.SettingPublic hospitals in Queensland.Participants4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.Main outcome measures30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.ResultsMedical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57).ConclusionsBefore ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent.
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Whereat, Sarah E., and Anthony S. McLean. "Survey of the current status of teaching intensive care medicine in Australia and New Zealand medical schools." Critical Care Medicine 40, no. 2 (February 2012): 430–34. http://dx.doi.org/10.1097/ccm.0b013e31823295fe.
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Baker, A. B. "Anaesthesia Workforce in Australia and New Zealand." Anaesthesia and Intensive Care 25, no. 1 (February 1997): 60–67. http://dx.doi.org/10.1177/0310057x9702500111.
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A survey of anaesthetic workforce was undertaken in departments in Australia and New Zealand approved for specialist training by the Australian and New Zealand College of Anaesthetists. When compared to a previous survey 17 years before, the results showed that the number of anaesthetics administered rose, the number of operating theatres (OTs) remained the same, but the surgical beds were reduced. There was a small increase (20%) in full-time specialists with a number of vacancies in establishment. There was, however, a large increase (80%) in Visiting Medical Officer (VMO) sessions and a 40% increase in Registrar positions. At the same time there were very large increases in Recovery Room nurses (125%) and Anaesthetic Assistants (100%). From this survey and other recent government workforce reports it is possible to derive certain workforce postulates—a specialist anaesthetist will on average anaesthetize approximately 1000 patients per annum, one in every nine people in the population will have an anaesthetic each year, and the working lifespan of a specialist anaesthetist is 30 years with 5% working half-time or less. All of this suggests that the correct Anaesthetists to Population Ratio (APR) should be reset to 1:8,500 for both Australia and New Zealand. The number of trainees required to supply a steady state replacement for this specialist workforce is also derived and the current number of training positions is shown to be in excess of these requirements. When the current shortfall in specialist anaesthetists is corrected there will need to be a gradual reduction (by approximately 40%) in the number of training positions to prevent an oversupply of anaesthetists. The factors which may potentially alter this forecast are addressed and include: change in the general population; ageing of the population; change in the average number of anaesthetics administered per anaesthetist per year; alteration in anaesthetists’ working lifespan; change in the age distribution of anaesthetists; increased economic usage of operating theatres and changes in the number of College approved training positions.
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Kitsos, Alex, Gregory M. Peterson, Matthew D. Jose, Masuma Akter Khanam, Ronald L. Castelino, and Jan C. Radford. "Variation in Documenting Diagnosable Chronic Kidney Disease in General Medical Practice: Implications for Quality Improvement and Research." Journal of Primary Care & Community Health 10 (January 2019): 215013271983329. http://dx.doi.org/10.1177/2150132719833298.
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Background: National health surveys indicate that chronic kidney disease (CKD) is an increasingly prevalent condition in Australia, placing a significant burden on the health budget and on the affected individuals themselves. Yet, there are relatively limited data on the prevalence of CKD within Australian general practice patients. In part, this could be due to variation in the terminology used by general practitioners (GPs) to identify and document a diagnosis of CKD. This project sought to investigate the variation in terms used when recording a diagnosis of CKD in general practice. Methods: A search of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices) was conducted to determine the terms used. Manual searches were conducted on coded and on “free-text” or narrative information in the medical history, reason for encounter, and reason for prescription data fields. Results: From this data set, 61 102 patients were potentially diagnosable with CKD on the basis of pathology results, but only 14 172 (23.2%) of these had a term representing CKD in their electronic record. Younger patients with pathology evidence of CKD were more likely to have documented CKD compared with older patients. There were a total of 2090 unique recorded documentation terms used by the GPs for CKD. The most commonly used terms tended to be those included as “pick-list” options within the various general practice software packages’ standard “classifications,” accounting for 84% of use. Conclusions: A diagnosis of CKD was often not documented and, when recorded, it was in a variety of ways. While recording CKD with various terms and in free-text fields may allow GPs to flexibly document disease qualifiers and enter patient specific information, it might inadvertently decrease the quality of data collected from general practice records for clinical audit or research purposes.
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Redley, Bernice, Lauren McTier, Mari Botti, Alison Hutchinson, Harvey Newnham, Donald Campbell, and Tracey Bucknall. "Patient participation in inpatient ward rounds on acute inpatient medical wards: a descriptive study." BMJ Quality & Safety 28, no. 1 (February 23, 2018): 15–23. http://dx.doi.org/10.1136/bmjqs-2017-007292.
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BackgroundMeaningful partnering with patients is advocated to enhance care delivery. Little is known about how this is operationalised at the point of care during hospital ward rounds, where decision-making concerning patient care frequently occurs.ObjectiveDescribe participation of patients, with differing preferences for participation, during ward rounds in acute medical inpatient services.MethodsNaturalistic, multimethod design. Data were collected using surveys and observations of ward rounds at two hospitals in Melbourne, Australia. Using convenience sampling, a stratified sample of acute general medical patients were recruited. Prior to observation and interview, patient responses to the Control Preference Scale were used to stratify them into three groups representing diverse participation preferences: active control where the patient makes decisions; shared control where the patient prefers to make decisions jointly with clinicians; and passive control where the patient prefers clinicians make decisions.ResultsOf the 52 patients observed over 133 ward rounds, 30.8% (n=16) reported an active control preference for participation in decision-making during ward rounds, 25% (n=13) expressed shared control preference and 44.2% (n=23) expressed low control preference. Patients’ participation was observed in 75% (n=85) of ward rounds, but few rounds (18%, n=20) involved patient contribution to decisions about their care. Clinicians prompted patient participation in 54% of rounds; and in 15% patients initiated their own participation. Thematic analysis of qualitative observation and patient interview data revealed two themes, supporting patient capability and clinician-led opportunity, that contributed to patient participation or non-participation in ward rounds.ConclusionsParticipation in ward rounds was similar for patients irrespective of control preference. This study demonstrates the need to better understand clinician roles in supporting strategies that promote patient participation in day-to-day hospital care.
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Horrocks, Peter, Vivienne Tippett, and Peter Aitken. "An Evaluation of the Self-Reported Knowledge Base of Disaster Management Core Competencies of Australian Paramedics." Prehospital and Disaster Medicine 34, s1 (May 2019): s129—s130. http://dx.doi.org/10.1017/s1049023x19002814.
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Introduction:Evidence-based training and curriculum are seen as vital in order to be successful in preparing paramedics for an effective disaster response. The creation of broadly recognized standard core competencies to support the development of disaster response education and training courses for general health care providers and specific health care professionals will help to ensure that medical personnel are truly prepared to care for victims of mass casualty events.Aim:To identify current Australian operational paramedic’s specific disaster management education and knowledge as it relates to disaster management core competencies identified throughout the literature and the frequency of measures/techniques which these paramedics use to maintain competency and currency.Methods:Paramedics from all states of Australia were invited to complete an anonymous online survey. Two professional bodies distributed the survey via social media and a major ambulance service was surveyed via email.Results:The study population includes 130 respondents who self-identified as a currently practicing Australian paramedic. Paramedics from all states except South Australia responded, with the majority coming from Queensland Ambulance Service (N= 81%). In terms of experience, 81.54% of respondents report being qualified for greater than 5 years. Initial analysis shows that despite the extensive experience of the practitioners surveyed when asked to rate from high to low their level of knowledge of specific disaster management core competencies a number of gaps exist.Discussion:Core competencies are a defined level of expertise that is essential or fundamental to a particular job, and serve to form the foundation of education, training, and practice for operational service delivery. While more research is needed, these results may help inform industry, government, and education providers to better understand and to more efficiently provide education and ongoing training to paramedics who are responsible for the management of disaster within the Australian community.
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Wajon, P. R., R. G. Walsh, and N. L. P. Symons. "A Survey of Cardiopulmonary Bypass Perfusion Practices in Australia in 1992." Anaesthesia and Intensive Care 21, no. 6 (December 1993): 814–21. http://dx.doi.org/10.1177/0310057x9302100612.
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Twenty-four cardiopulmonary bypass (CPB) perfusion units around Australia were surveyed to determine the characteristics of CPB perfusion as practised in Australia in 1992. Twenty completed survey forms were received. Findings were compared with those of a similar study performed by one of the authors for the year 1986. The field of CPB perfusion continues to expand both in terms of numbers of cases and increasing technological complexity. The major technological changes evident are the now clear dominance of membrane over bubble oxygenators and the proliferation of inline SvO2 monitoring devices. The greatest change in practice has been to the virtually universal use of cardioplegia. There remains considerable variation in the composition of the cardioplegia solutions used in the responding units. A range of minimum perfusion pressures for CPB is noted, whereas most units employ similar minimum perfusion flows. Methods of central nervous system and renal protection are mainly hypothermia and diuretics, respectively, with a scattering of other techniques. Staffing of CPB perfusion units is essentially unchanged since 1986 and at least five units had no medical perfusionist appointed in 1992.
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Gardner, Glenn, Anne Gardner, Sandy Middleton, Julie Considine, Gerard Fitzgerald, Luke Christofis, Anna Doubrovsky, Margaret Adams, and Jane O'Connell. "Mapping workforce configuration and operational models in Australian emergency departments: a national survey." Australian Health Review 42, no. 3 (2018): 340. http://dx.doi.org/10.1071/ah16231.
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Objective Hospital emergency departments (ED) in Australia and internationally have been experiencing increased demand, resulting in reduced hospital quality, impaired access and adverse health outcomes. Effective evaluation of new ED service models and their effect on outcomes is reliant on baseline measures of the staffing configuration and organisational characteristics of the EDs being studied. The aim of the present study was to comprehensively measure these variables in Australian EDs. Methods Australian hospital EDs with 24-h medical and nursing cover were identified and invited to participate in the study. Telephone interviews were conducted with nursing or medical department managers to collect data related to hospital characteristics, ED workforce and training and ED service and operational models. Results Surveys were completed in 87% of the population sample (n = 135). Metropolitan EDs were significantly more likely to retain higher full-time equivalents (FTEs) in several medical (staff specialist, registrar, resident and intern) and nursing (nurse practitioner (NP), nurse educator, nurse unit manager and registered nurse) positions. NPs were employed by 52% of Australian EDs overall, but this ranged from 40% to 75% depending on jurisdiction. The most commonly used operational models were FastTrack teams (72% of EDs), short-stay/observational unit (59%) and patient liaison models for aged care (84%) and mental health (61%). EDs that employed NPs were significantly more likely to use FastTrack (P = 0.002). Allied health services most frequently available within these EDs were radiology (60%), social work (69%), physiotherapy (70%) and pharmacy (65%). Conclusions The present study has established a baseline measure of the staffing configuration and organisational characteristics of Australian EDs. What is known about the topic? EDs are overcrowded due, in part, to the combined effect of increased service demand and access block. Innovative service and workforce models have been implemented by health departments aiming to improve service and performance. National uptake of these service and workforce innovations is unknown. What does this paper add? The present study is the most comprehensive to date profiling Australian EDs covering hospital characteristics, workforce configuration, operational models and NP service patterns and practice. What are the implications for practitioners? Information from the present study will assist health service planners to evaluate workforce and service reform models, and to monitor trends in emergency service development.
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Ahern, Elizabeth Stephanie, Harry Michael Gasper, Bryan Chan, Natasha Anne Roberts, Brett Gordon Maxwell Hughes, David Wyld, Glen Kennedy, Melissa A. Eastgate, and Zarnie Lwin. "Psychosocial impacts of COVID-19 on oncology workforces: Metro versus regional Australia." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 111. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.111.
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111 Background: The COVID-19 pandemic poses psychosocial challenges to the oncology workforce. We postulate that these impacts may affect the entire patient-facing workforce. Whether distress is different in varying settings (metro vs regional hospitals) is unknown. Methods: Cancer Care staff were approached via all-staff email for a weekly online survey administered at two hospital sites, Royal Brisbane and Women’s Hospital (RBWH) (metro) and Sunshine Coast Hospital and Health System (SCHHS) (regional). Surveys included Likert-scale items exploring perceptions of departmental preparation, COVID-19 related query burden and staff well-being, and distress thermometer derived from NCCN. Mean and 95% confidence interval were calculated, with non-parametric t-tests adjusted for multiple comparisons (Holm-Sidak); significance was deemed p < 0.05. Results: 117 participants at RBWH and 59 at SCHHS consented. The survey opened April 3, 2020. Data is presented for the initial 6 weeks (COVID-19 preparation phase). Highest survey response was noted in week 1 (87%) and lowest at week 6 (36%). 65% unique responses were from RBWH. 60% participants worked in an outpatient setting, while 37% had inpatient care role. The remainder worked in either community-based or mixed settings. Significant heterogeneity was detected between sites (RBWH vs SCHHS) for some occupational roles: RBWH had more representation of administrative (19% vs 8%, p < 0.001) and ancillary staff (2% vs 0%, p = 0.005) but SCHHS had more allied health (28% vs 17%, p = 0.005). Nursing and medical staff proportions at SCHHS and RBWH were similar (50% vs 45%, and 14% vs 18% respectively). Higher levels of distress were noted early; mean (95% CI) distress thermometer result (0-10) during week 1 was 4.7 (4.3-5.2) at RBWH and 4.9 (4.2-5.5) at SCHHS. Mean distress scores significantly reduced over time: correlative scores during week 6 were 3.2 (2.3-4.1) at RBWH and 2.5 (1.6-3.4) at SCHHS. Distress levels comparing RBWH with SCHHS were similar (p = 0.22-0.76). No significant difference was noted in staff perception of self-support comparing RBWH with SCHHS, and over 80% responders felt well-supported at work most, or all of the time. Concurrently, participants perceived that the Cancer Care department of their site was either “well” or “very well” prepared for COVID-19 over 85% of the time, with no difference between sites. Conclusions: High perceptions of support and preparedness were evident, with no regional difference. Distress scores reduced over time during the COVID-19 preparation phase, in the context of low COVID-19 rates.
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Wright, Cameron M., Richard Norman, Richard Varhol, Jacqueline Davis, Elizabeth Wilson-Taylor, Justin Dorigo, and Suzanne Robinson. "Exploring the costs and effectiveness of the Drug and Alcohol Withdrawal Network: a home-based alcohol and other drug withdrawal service." Australian Journal of Primary Health 24, no. 5 (2018): 385. http://dx.doi.org/10.1071/py17110.
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The Drug and Alcohol Withdrawal Network (DAWN) is a home-based withdrawal service based in Perth, Western Australia. Literature on outcomes, costs and client attitudes towards this type of home-based detoxification in Australia is sparse. Therefore, this study assessed these factors for clients enrolled over a 5-year period (July 2011–June 2016). Client experience was explored through semi-structured interviews with 10 clients. Over the study period, 1800 clients (54% male, mean age 38 years) were assessed, and there were 2045 episodes of care. Although most first-episode clients (52%) listed alcohol as the primary drug of concern, the proportion listing methamphetamine increased from 4% in 2011–12 to 23% in 2015–16. In 94% (n = 639) of withdrawal detoxification episodes with completed surveys, clients used their ‘drug of primary concern’ most days or more often at baseline; this had reduced to 23% (n = 149) at the conclusion of detoxification. Five-year direct costs were A$4.8 million. Clients valued the person-centred holistic approach to care, including linking with other health providers. Barriers included low awareness of the program and difficulties finding an appropriate support person. Further exploration of cost-effectiveness would substantiate the apparently lower per client cost, assuming medical suitability for both programs, for home-based relative to inpatient withdrawal.
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Renwick, Manoa. "Quality Assurance in Australian Hospitals: How Far Does it Go?" Australian Medical Record Journal 18, no. 3 (September 1988): 97–101. http://dx.doi.org/10.1177/183335838801800304.
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The Australian Institute of Health (AIH) surveyed all acute hospitals in Australia to discover the extent of quality assurance (QA) activities, the types of programs being run and the processes being used. This paper explains the Institute's research strategy and puts the survey into the context of QA in Australia today. It describes the research method, identifies sources of bias, and presents some of the results. These show that medical record administrators (MRAs) play an active role in QA by coordinating hospital programs, by implementing individual reviews of their own departments, and by servicing other departmental reviews. The results pertaining to the extent and nature of QA are discussed and it is concluded that there seems to be some review of the quality of care for the majority of hospital patients. The effectiveness of that review, and whether or not it is quality assurance, still has to be investigated. (AMRJ 1988, 18(3), 97–101).
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Yusuf, Farhat, and Stephen Leeder. "Recent estimates of the out-of-pocket expenditure on health care in Australia." Australian Health Review 44, no. 3 (2020): 340. http://dx.doi.org/10.1071/ah18191.
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Objective The aims of this study were to estimate the average annual out-of-pocket (OOP) expenditure on health care by households in Australia in 2015–16, and to compare this with the estimate for 2009–10. Methods Data from the most recent Household Expenditure Survey (HES) conducted by the Australian Bureau of Statistics were used. Various statistical methods were used to estimate the annual OOP expenditures at the household and national levels. Results The average annual OOP expenditure was A$4290 per household, representing 5.8% of the amount spent on all goods and services. Private health insurance (PHI) premiums, although not a direct expenditure on health care, were 40.6% of the total OOP expenses. Of the remaining 59.4%, nearly half was spent on doctors and other health professionals, and approximately one-third was spent on medicines. Dental treatments and specialist consultations were the most expensive, whereas visits to general practitioners incurred the least OOP expenditure. Households with PHI (58.6%) spent fourfold more on health care than those not insured. Compared with the 2009–10 survey, the biggest increases were in the cost of PHI (50.7%) and copayments to specialists (34.8%) and other health professionals (42.0%). Conclusions OOP expenditure on health care as a proportion of the total household expenditure on all goods and services has increased by more than 25% between 2009–10 and 2015–16. What is known about the topic? Australian households incur OOP expenses for health care in Australia for a wide range of goods and services, such as copayments to doctors and other health professionals beyond the Medicare rebates, the cost of medicines and other pharmaceutical goods not covered entirely by the Pharmaceutical Benefits Scheme and PHI premiums. Although other estimates of OOP expenditure are available in official reports of the Australian Institute of Health and Welfare, they are based on administrative records rather than consumer reports, and cannot be disaggregated by item or the characteristics of households. What does this paper add? This paper provides detailed information on OOP expenditure on health care as reported by a probability sample of households interviewed for the HES conducted by the ABS during 2015–16. These estimates of OOP expenditure, based on consumer reports, add a further dimension to the information available from administrative records only. What are the implications for practitioners? Practitioners should take account of the effect of increasing copayments for their services, especially on patients belonging to the lower socioeconomic categories. Increasing copayments may lead to people foregoing medical care. Health planners and politicians should note the steady upward drift in OOP expenses and factor these into their policies for future funding of health care.
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McGurgan, Paul, Katrina Calvert, Elizabeth Nathan, Antonio Celenza, and Christine Jorm. "Opinions towards Medical Students’ Self-Care and Substance Use Dilemmas—A Future Concern Despite a Positive Generational Effect?" International Journal of Environmental Research and Public Health 19, no. 20 (October 14, 2022): 13289. http://dx.doi.org/10.3390/ijerph192013289.
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This study examines demographic factors which may influence opinions concerning medical students’ self-care and substance use behaviors as a means of providing insights into how future doctors view these issues compared to Australian doctors and members of the public. We conducted national, multicenter, prospective, on-line cross-sectional surveys using hypothetical scenarios to three cohorts- Australian medical students, medical doctors, and the public. Participants’ responses were compared for the different contextual variables within the scenarios and the participants’ demographic characteristics. In total 2602 medical students, 809 doctors and 503 members of the public participated. Compared with doctors and the public, medical students were least tolerant of alcohol intoxication, and most tolerant of using stimulants to assist with study, and cannabis for anxiety. Doctor respondents more often aligned with the public’s opinions on the acceptability of the medical students’ behaviors. Although opinions are not equivalent to behaviour, Australian students’ views on the acceptability for cannabis to help manage anxiety, and inappropriate use of prescription-only drugs are concerning; these future doctors will be responsible for prescribing drugs and managing patients with substance abuse problems. However, if current Australian medical student’s opinions on alcohol misuse persist, one of the commonest substance addictions amongst doctors may decrease in future.
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Doran, Evan, Jennifer Fleming, Christopher Jordens, Cameron L. Stewart, Julie Letts, and Ian H. Kerridge. "Managing ethical issues in patient care and the need for clinical ethics support." Australian Health Review 39, no. 1 (2015): 44. http://dx.doi.org/10.1071/ah14034.
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Objective To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. Methods A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. Results Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. Conclusion Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia. What is known about the topic? Clinicians working in hospitals in the US, Canada and UK have access to ethics expertise to help them manage ethical issues that arise in patient care. How Australian clinicians currently manage the ethical issues they face has not been investigated. What does this paper add? This paper describes the types of ethical issues faced by Australian clinicians, how they manage these issues and whether they think ethics support would be helpful. What are the implications for practitioners? Clinicians frequently encounter ethically and legally difficult decisions and want additional ethics support. Helping clinicians to provide ethically sound patient care should be a priority of public hospitals in NSW and elsewhere in Australia.
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Chan, David L., Lesley Moody, Eva Segelov, David C. Metz, Jonathan R. Strosberg, Nick Pavlakis, and Simron Singh. "Follow-Up for Resected Gastroenteropancreatic Neuroendocrine Tumours: A Practice Survey of the Commonwealth Neuroendocrine Tumour Collaboration (CommNETS) and the North American Neuroendocrine Tumor Society (NANETS)." Neuroendocrinology 107, no. 1 (2018): 32–41. http://dx.doi.org/10.1159/000488394.
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Objectives: There is no consensus regarding optimal follow-up in resected gastroenteropancreatic neuroendocrine tumours (NETs). We aimed to perform a practice survey to ascertain follow-up patterns by health care practitioners and highlight areas of variation that may benefit from further quantitative research. Methods: A Web-based survey targeted at NET health care providers in Australia, New Zealand, Canada, and the USA was developed by a steering committee of medical oncologists and a research methodologist. Thirty-seven questions elicited information regarding adherence to guidelines, the influence of risk factors on follow-up, and the frequency and choice of modality in follow-up. Results: There were 163 respondents: 59 from Australia, 25 from New Zealand, 46 from Canada, and 33 from the USA (50% medical oncology, 23% surgery, 13% nuclear medicine, and 15% other). Thirty-eight percent of the respondents were “very familiar” with the NCCN NET guidelines, 33% with the ENETS guidelines, and 17% with the ESMO guidelines; however, only 15, 27, and 10%, respectively, found them “very useful”; 63% reported not using guidelines at their institution. The commonest investigations used were CT scans (66%) and chromogranin A (86%). The US respondents were more likely to follow patients up past 5 years, and the Australian respondents utilized more functional and less cross-sectional imaging. When poor prognostic factors were introduced, the respondents recommended more visits and tests. Conclusions: This large international survey highlights variation in current follow-up practices not well addressed by the current guidelines. More quantitative research is required to inform the development of evidence-based guidelines tailored to the pattern of recurrence in NETs.
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Le, Long Khanh-Dao, Sophy Shih, Scott Richards-Jones, Mary Lou Chatterton, Lidia Engel, Christopher Stevenson, David Lawrence, Genevieve Pepin, and Cathrine Mihalopoulos. "The cost of Medicare-funded medical and pharmaceutical services for mental disorders in children and adolescents in Australia." PLOS ONE 16, no. 4 (April 9, 2021): e0249902. http://dx.doi.org/10.1371/journal.pone.0249902.
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Objective To examine the health care costs associated with mental disorders and subthreshold mental disorders within a nationally representative sample of children and adolescents in Australia. Method Data were derived from the Young Minds Matter Survey (N = 6,310). Mental disorders were classified using the Diagnostic Interview Schedule for Children Version IV. Participant data were linked to administrative data on health care costs. Adjusted generalized linear regression models and two-part models were used to estimate mean differences in costs between those with a mental disorder or subthreshold disorder and those without. Results Costs associated with health care attendances and medications were higher for children and adolescents with mental disorders and subthreshold mental disorders compared to those without a mental disorder. The additional population health care costs due to mental disorders amounted to AUD$234 million annually in children and adolescents, of which approximately 16% was attributed to out-of-pocket costs. Findings showed that those with subthreshold mental disorders or comorbid mental disorders have substantial additional costs of Medicare-funded medical and pharmaceutical services. Conclusion and implication Mental disorders in children and adolescents are associated with significant health care costs. Further research is needed to ensure that this population is receiving effective and efficient care.
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Isautier, Jennifer MJ, Tessa Copp, Julie Ayre, Erin Cvejic, Gideon Meyerowitz-Katz, Carys Batcup, Carissa Bonner, et al. "People’s Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic in Australia: Cross-Sectional Survey Study." Journal of Medical Internet Research 22, no. 12 (December 10, 2020): e24531. http://dx.doi.org/10.2196/24531.
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Background In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people’s experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits. Objective This study aimed to compare participants’ perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic. Methods A national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences. Results Of the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was “just as good as” or “better than” their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male (P=.007), having a history of both depression and anxiety (P=.016), and lower patient activation scores (ie, individuals’ willingness to take on the role of managing their health/health care) (P=.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants’ telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined. Conclusions Based on our sample’s responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic.
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Guy, Amanda J., and Peter Banks. "A survey of current rehabilitation practices for native mammals in eastern Australia." Australian Mammalogy 34, no. 1 (2012): 108. http://dx.doi.org/10.1071/am10046.
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Wildlife rehabilitation is common in Australia, with more than 30 mainly volunteer wildlife networks caring for thousands of animals annually. Here we report on a survey of 140 Australian wildlife rehabilitators that asked questions about their motivations, their methods of rehabilitation and their methods for release and post-release assessments. Most rehabilitators were motivated by animal welfare concerns and most animals coming into care were injured or orphaned wildlife. Most rehabilitators recorded each animal’s history, conducted a medical examination and briefly quarantined new arrivals; few conducted pre-release medical testing. Animal behaviour before release was a significant concern and >50% of respondents stated that animals exhibiting stereotypic behaviours were still released. However, there were no consistent criteria for the suitability of an animal for release, its release site, or which soft-release method to use. Fewer than 60% of respondents carried out post-release monitoring, which was typically <1 month, and only 40% could identify factors that contribute to release success. Predation hampers most reintroductions and is likely to reduce survival of rehabilitated wildlife, highlighting the need for strategies to reduce predation risk; 20% of respondents carried out antipredator training, though most in an unstructured way. The ability to carry out animal training, and monitor success was perceived to be limited by poor funding, poor access to monitoring equipment, little government support and time constraints. Researchers are encouraged to collaborate with wildlife volunteer networks in order to improve this potentially valuable conservation approach.
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Degeling, P., D. Black, G. Palmer, and J. Walters. "Attitudes and Knowledge about Case Mix Reform among Hospital Staff in Australia." Health Services Management Research 9, no. 4 (November 1996): 223–37. http://dx.doi.org/10.1177/095148489600900402.
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This paper reports some of the findings of a national survey of staff in acute care hospitals about their knowledge of case mix and their attitudes towards it. Our findings suggest that, despite the range and scope of activities that have been pursued under the Australian Casemix Development Program (ACDP), knowledge of case mix among acute care hospital staff remains patchy. The evidence also shows that significant aspects of the DRG classification system and the uses to which it can be put are not accepted by many hospital staff, particularly medical staff. The paper concludes with a discussion of what some of these findings imply for future activity on case mix reform.
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Noblet, Timothy David, John F. Marriott, Taryn Jones, Catherine Dean, and Alison B. Rushton. "Perceptions about the implementation of physiotherapist prescribing in Australia: a national survey of Australian physiotherapists." BMJ Open 9, no. 5 (May 17, 2019): e024991. http://dx.doi.org/10.1136/bmjopen-2018-024991.
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ObjectivesTo explore: (1) the views of Australian physiotherapists regarding potential implementation of non-medical prescribing in Australia, (2) how the geographical location and health sector in which a clinician works may influence their perceptions and (3) the perceptions of Australian physiotherapists about how physiotherapist prescribing might impact the care that the profession can provide.DesignA cross-sectional descriptive survey using open and closed questions.SettingParticipants completed an online questionnaire.Participants883 Australian Health Professionals Registration Authority (AHPRA)-registered physiotherapists, working across all states and territories.Outcome measuresAn online questionnaire was developed by a panel of subject experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all members of the Australian Physiotherapy Association. A reminder email was sent 4 weeks later. Quantitative data were analysed descriptively, with use of absolute risk reductions (ARRs) and 95% CIs to determine the likelihood that health sector or geographical location were associated with specific views. Thematic analysis enabled synthesis of the qualitative data.Results79.0% participants felt that physiotherapist prescribing should be introduced in Australia, with 71.2% wanting to train as prescribers. Clinical governance, risk management, regulation of clinicians and the development of an education framework were identified as priorities for implementation. Participants working in the private sector were significantly more likely to train as prescribers than those in the public sector (ARR 9.9%; 95% CI 3.5 to 16.4) or educational/research institutions (ARR 23.3%; 95% CI 12.8 to 33.8), with city dwellers significantly more likely to train compared with physiotherapists in remote regions (ARR 19.8%; 95% CI 0.8 to 39.2). Physiotherapist prescribing was predicted to improve efficiency of healthcare delivery, access to medicines and reductions in healthcare costs.ConclusionsAHPRA-registered physiotherapists perceive that the introduction of autonomous physiotherapist prescribing would be beneficial for the Australian population and should be introduced. Decision makers should consider the results of this survey in conjunction with cost–benefit and risk analysis when planning the introduction of physiotherapist prescribing.
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Angliss, V. E. "Holte Revisited — A Review of the Quality of Prosthetic Treatment." Prosthetics and Orthotics International 10, no. 1 (April 1986): 9–14. http://dx.doi.org/10.3109/03093648609103073.
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The standards recommended at the United Nations Inter regional Seminar on Standards for the Training of Prosthetists in Holte, Denmark, in 1968 were universally accepted as being ideal, practical and economical. As these standards and the services to patients are not always observed, world wide, a study was made to investigate the situation in Australia. Australia is a federation with responsibility for health and education vested in six States. The Federal Government is the principal taxing authority with the States dependent on it for financing services. The isolation of Australia led the Government during 1960 to send a rehabilitation medical officer to survey the system in Europe and North America. The best features of overseas practice became the basis for updating an Australian Service and establishing the Central Development Unit. The Artificial Limb Service is based on clinical care, formal in-service training of limb makers and fitters, patient training by therapists and the purchase of components from mass producers. The Service is answerable to lay and medical staff in the State Branches and to the Central Office of the Department, located in Canberra. The division of responsibility between the State and Federal Governments seems to lead to competition for control of services rather than to an integrated plan for Prosthetic-Orthotic training with services. Industrial conflict due to a perceived threat of the supplanting of apprentices by formally trained prosthetists-orthotists has also adversely affected development. In this paper the views of Government authorities, medical prosthetic prescribers and of personnel who conducted a pilot study in delivery of a prosthetic service are discussed.