Journal articles on the topic 'Physician and patient Australia'
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Kurti, Linda, Susan Rudland, Rebecca Wilkinson, Dawn DeWitt, and Catherine Zhang. "Physician's assistants: a workforce solution for Australia?" Australian Journal of Primary Health 17, no. 1 (2011): 23. http://dx.doi.org/10.1071/py10055.
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Significant medical workforce shortages, particularly in rural and remote locations, have prompted a range of responses in Australia at both state and Commonwealth levels. One such response was a pilot project to test the suitability of the Physician Assistant (PA) role in the Australian context. Five US-trained and accredited PAs were employed by Queensland Health and deployed in urban, rural and remote settings across Queensland. A concurrent mixed-method evaluation was conducted by Urbis, an independent research firm. The evaluation found that the PAs provided quality, safe clinical care under the supervision of local medical officers. The majority of nurses and doctors who worked with the PAs believed that the PAs made a positive contribution to the health care team by increasing capacity to meet patient needs; reducing on-call requirements for doctors; liaising with other clinical team members; streamlining procedures for efficient patient throughput; and providing continuity during periods of doctor changeover. The Pilot demonstrated that a delegated PA role can provide safe, quality health care by augmenting an established healthcare team. The PA role has the potential to benefit the community by increasing the capacity of the health care system, and to improve recruitment and retention by providing an additional professional pathway. The small size of the Pilot limits the ability to generalise regarding the future efficacy of the PA role in Australia. Further research is required to test training and deployment of PAs in a wider range of Australian clinical settings, including general practice and rural health clinics.
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Black, Christopher M., Michael Woodward, Baishali M. Ambegaonkar, Alana Philips, James Pike, Eddie Jones, Joseph Husbands, and Rezaul K. Khandker. "Quantifying the diagnostic pathway for patients with cognitive impairment: real-world data from Australia." International Psychogeriatrics 32, no. 5 (November 25, 2019): 601–10. http://dx.doi.org/10.1017/s1041610219001856.
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ABSTRACTObjectives:Rapid diagnosis of dementia is essential to ensure optimum patient care. This study used real-world data to quantify the dementia diagnostic pathway in Australia.Design:A real-world, cross-sectional survey of physicians and patients.Setting:Clinical practice.Participants:Primary care or specialist physicians managing patients with cognitive impairment (CI).Measurements:Descriptive analyses focused on key events in the diagnostic pathway. Regression modeling compared the duration between first consultation and formal diagnosis with various factors.Results:Data for 600 patients were provided by 60 physicians. Mean time from initial symptoms to first consultation was 6.1 ± 4.4 months; 20% of patients had moderate or severe CI at first consultation. Mean time from first consultation to formal diagnosis was 4.0 ± 7.4 months (1.2 ± 3.6 months if not referred to a secondary physician, and 5.3 ± 8.3 months if referred). Time from first consultation to diagnosis was significantly associated with CI severity at first consultation; time was shorter with more severe CI. There was no association of disease severity and referral to a secondary physician; 69.5% of patients were referred, the majority (57.1%) to a geriatrician. The highest proportion of patients were diagnosed by geriatricians (47.4%). Some form of test or scale was used to aid diagnosis in 98.8% of patients.Conclusions:A substantial number of Australians experience cognitive decline and behavioral changes some time before consulting a physician or being diagnosed with dementia. Increasing public awareness of the importance of early diagnosis is essential to improve the proportion of patients receiving comprehensive support prior to disease progression.
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Gamage, Prasanna J., Saran Seker, Jessica Orchard, David Humphries, Kylie Fitzgerald, and Jane Fitzpatrick. "Insights into the complexity of presentation and management of patients: the Sport and Exercise Physician’s perspective." BMJ Open Sport & Exercise Medicine 7, no. 4 (November 2021): e001228. http://dx.doi.org/10.1136/bmjsem-2021-001228.
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ObjectivesSport and Exercise Physicians represent a relatively new specialty focusing on exercise in complex diseases including musculoskeletal diseases. Our objective was to describe the characteristics, type and complexity of patient presentations, their management strategies and referral information in Australian practice.MethodsA cross-sectional study including a cohort of 11 senior Sport and Exercise Physicians in Australia studied all new patient consultations within an 8-week period. Data were analysed relating to presentation, referral source, follow-up referrals, and patient management strategies.ResultsData from 419 patients were recorded. The majority, 97% (n=406), had musculoskeletal conditions, 53% (n=222) had one or more associated comorbidities and 47% (n=195) had ongoing symptoms for >12 months. Most patients, 82% (n=355), were referred by general practitioners. Prior consultations included physiotherapy 72% (n=301) and orthopaedic 20% (n=85). A multidisciplinary network of referrals from Sport and Exercise Physicians was observed, including 210 referrals to 9 allied health specialities and 61 referrals to 17 medical specialities. Over 74% (n=311) of patients received exercise-based intervention as part of the treatment plan, including 57% (n=240) physician managed exercise interventions.ConclusionOur work shines a light on the nature and complexity of the role of Sport and Exercise Physicians in an Australian practice context. Findings will assist in implementing measures to promote patient care at the community level in managing musculoskeletal conditions. Sport and exercise medicine stakeholders and government policy makers can use this information in developing appropriate programmes to support patients and create integrated sport and exercise medicine services for the community.
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McDonald Heiner, Maurice. "Key barriers to optimal management of adult asthma in Australia: physician and patient perspectives." Current Medical Research and Opinion 23, no. 8 (June 26, 2007): 1799–807. http://dx.doi.org/10.1185/030079907x210714.
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Annear, Michael, Peter Lucas, Tim Wilkinson, and Yasuo Shimizu. "Prescribing physical activity as a preventive measure for middle-aged Australians with dementia risk factors." Australian Journal of Primary Health 25, no. 2 (2019): 108. http://dx.doi.org/10.1071/py18171.
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Dementia is increasing in Australia in line with population ageing and is expected to peak by mid-century. The development of common forms of dementia, including Alzheimer’s disease, is associated with lifestyle-related risk factors that are prevalent among middle-aged Australians, including obesity, hypertension, high cholesterol, diabetes and depression. These risk factors can be significantly ameliorated through regular participation in moderate aerobic physical activity (PA). Current national and international guidelines recommend at least 150 min of aerobic PA per week for achieving health protective effects. Lifestyle intervention is a critical area for action as there are currently no medical or pharmaceutical interventions that can halt the progression of common dementias. Physician–patient discussions concerning risk reduction via habitual aerobic PA offers a complementary intervention as part of broader dementia management. Evidence suggests that to achieve the highest rates of adherence to PA, physician advice in primary care should be supported by wider policies, institutions and community services that offer a meaningful referral pathway and patient follow up after initial assessment. International Green Prescription programs provide examples of physician-led interventions in primary care that could inform further action in Australia.
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Floss, Mayara, Kyle Hoedebecke, and Josep Vidal-Alaball. "Where is the patient’s chair? Differences in general practitioner consultation room layouts - an exploratory questionnaire." F1000Research 8 (August 15, 2019): 1439. http://dx.doi.org/10.12688/f1000research.19565.1.
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Background: Health clinic design varies from country to country. The layout of a general practitioner’s (GP’s) consulting room may influence the physician’s or patient’s experience. The aim of this study is to explore and investigate the layout of GP’s consulting rooms around the world and to describe any significant differences. Methods: Between 3rd July and 2nd August 2018, an internet-based questionnaire on Google Docs was distributed by email, social media and WhatsApp platforms to several worldwide rural medicine groups. Analysis of an internet-based questionnaire to explore possible layouts of consultation rooms within practices was performed. The questionnaire was designed with three distinct sections: first, a GP demographic profile including gender, year of graduation from medical school, country of graduation, and type of practice (private or public); second, questions relating to the office layout; third, a section for questionnaire feedback. Results: 502 responses to the questionnaire were received; 65.3% women and 34.7% men. The most common layout in Europe and America was where the physician and the patient were separated by a desk. The layout where the physician and the patient had a 90º angle facing each other was the most commonly used layout in Asia-Australia and Africa. For GPs who graduated before 1990 and between 1990-2010, the layout where the table was between the patient and physician was preferred. However, physicians graduating after 2010 preferred a layout with the physician and the patient with a 90º angle facing each other. Conclusion: The position of the GP’s desk differs between and within countries as well as the gender of the physician and year of graduation. Next steps should focus on gathering an even greater breadth of GP input, as well as comparing and contrasting those to the preferences of our patients and communities.
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Dahm, Maria. "Coming to Terms with Medical Terms – Exploring Insights from Native and Non-native English Speakers in Patient-physician Communication." HERMES - Journal of Language and Communication in Business 25, no. 49 (November 1, 2017): 79. http://dx.doi.org/10.7146/hjlcb.v25i49.97739.
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Using medical terminology involves a large risk of miscommunication in English-medium consultations as patients often do not know or misunderstand the terms commonly used by physicians, or even misuse terms in their interactions with medical professionals (Hadlow/Pitts 1991; Street 2003). Patients and physicians also frequently associate different meanings with the same medical terms, which further threatens patient-physician communication (Hadlow/Pitts 1991). To date most investigations on the impact of medical terminology have focused on native English speaking (NES) individuals in monolingual encounters, while insights from non-native English speaking (NNES) physicians and patients have been largely neglected. Through semi-structured interviews, this qualitative explorative study investigates the experiences of patients and physicians from diverse linguistic backgrounds in medical encounters within Australia. A particular focus is given to the way NES and NNES participants perceive and judge the impact of the meaning of medical terms on patient-physician communication. Findings suggest that both the use and meaning of medical terminology are perceived and judged very differently by individuals who come from different language backgrounds and who hold varying degrees of medical knowledge. Findings indicate that common blanket recommendations urging medical professionals to avoid or explain jargon may be futile since physicians and patient also diverge in their understanding of what constitutes jargon or medical terminology.
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Sathananthan, Dharshan, Edward Young, Garry Nind, Biju George, Angelie Ashby, Sharon Drummond, Kasia Redel, Neville Green, and Rajvinder Singh. "Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy." Endoscopy International Open 05, no. 02 (February 2017): E110—E115. http://dx.doi.org/10.1055/s-0042-121667.
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Abstract Background and study aims Physician-directed nurse-administered balanced propofol sedation (PhD NAPS) in patients undergoing endoscopy and/or colonoscopy is being increasingly utilized worldwide. However, this method of sedation is not universally employed in Australian hospitals due to concerns surrounding its safety. The aim of this study was to assess the safety of PhD NAPS in low-risk patients undergoing endoscopy and/or colonoscopy. Patients and methods This study was conducted at a single tertiary teaching hospital in Adelaide, Australia. It was a prospective study involving 1000 patients with an ASA score of 1 – 3 presenting with any indication for endoscopy, colonoscopy or both. A total of 981 patients (451 male) with a mean age of 53 years (range: 16 – 87) were recruited from January 2010 to October 2012. 440 endoscopies, 420 colonoscopies, and 121 combined procedures were performed. The intra-procedural adverse events (AEs) were recorded. Results There were no major intra-procedural adverse events. Minor AEs occurred in 6.42 % of patients, and resolved spontaneously or with intravenous fluid boluses in all cases. Conclusion PhD NAPS is safe when the proceduralist and nursing staff are adequately trained and strict patient selection criteria are used.
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Malcolmson, Don. "The Patient's Right to Know." Journal of Medical Regulation 101, no. 3 (September 1, 2015): 32–36. http://dx.doi.org/10.30770/2572-1852-101.3.32.
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Patient's expectations have changed from being an acceptor of doctors' orders to being an active partner in a therapeutic relationship. In Australia, General Practitioners (GPs) are the “gatekeepers” for specialists' referrals. The Australian Health Practitioner Regulation Agency (AHPRA) maintains an online searchable register of doctors. Details displayed include registration conditions, undertakings and reprimands. Doctors who practice privately in Australia are regarded as carrying on a business covered by consumer protection legislation. Australian Consumer Law (ACL) prohibits false or misleading representations in connection with the supply of goods or services. Under the ACL, a GP's conduct is misleading if representations about the specialist are inaccurate, or the overall impression conveyed is likely to mislead the patient. Many patients lack the time, energy or desire to seek out registration details of specialists, and rely on GP advice. A key issue for GPs is knowledge of any specialists' registration conditions: Is there a duty on a referring practitioner to check and advise the patient of any conditions? Is there a duty on the regulating body to advise practitioners of specialists whose registration is restricted? Even though disclosure may cause distress to the practitioner, this does not mean that disclosure would be unfair. Rather, the relevant question is whether there is a legitimate public safety interest in disclosure. A balance should be struck between the rights of the individual practitioners and the public expectation of safety, competency and currency. This paper suggests that consumer laws could be used strike this balance, requiring referring physicians to inform patients about the regulatory status of the physician to whom they are being referred.
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Walker, Katherine, Matthew Johnson, William Dunlop, Margaret Staples, Hamish Rodda, Ian Turner, and Michael Ben-Meir. "Feasibility evaluation of a pilot scribe-training program in an Australian emergency department." Australian Health Review 42, no. 2 (2018): 210. http://dx.doi.org/10.1071/ah16188.
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Objective Medical scribes have an emerging and expanding role in health, particularly in Emergency Medicine in the US. Scribes assist physicians with documentation and clerical tasks at the bedside while the physician consults with his or her patient. Scribes increase medical productivity. The aim of the present study was to examine the feasibility of a pilot hospital-administered scribe-training program in Australia and to evaluate the ability of an American training course (Medical Scribe Training Systems) to prepare trainee scribes for clinical training in an emergency department in Australia. Methods The present study was a pilot, prospective, observational cohort study from September 2015 to February 2016 at Cabrini Emergency Department, Melbourne. Scribe trainees were enrolled in the pre-work course and then trained clinically. Feasibility of training scribes and limited efficacy testing of the course was undertaken. Results The course was acceptable to users and demand for training exists. There were many implementation tasks and issues experienced and resources were required to prepare the site for scribe implementation. Ten trainees were enrolled for preclinical training. Six candidates undertook clinical training, five achieved competency (required seven to 16 clinical shifts after the preclinical course). The training course was helpful and provided a good introduction to the scribe role. The course required adaptation to a non-US setting and the specific hospital setting. In addition, it needed more detail in some common emergency department topics. Conclusion Training scribes at a hospital in Australia is feasible. The US training course used can assist with preclinical training. Course modification is required. What is known about the topic? Scribes increase emergency physician productivity in Australia. There is no previous work on how to train scribes in Australia. What does this paper add? We show that implementing a scribe-training program is feasible and that a training package can be purchased from the US to train scribes in Australia and that it is useful. We also show the adaptation that the course may require to meet Australian emergency department needs. What are the implications for practitioners? Scribes could become an additional member of the emergency department team in Australia and can be trained locally.
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Meskó, Bertalan, Nóra Radó, and Zsuzsa Győrffy. "Opinion leader empowered patients about the era of digital health: a qualitative study." BMJ Open 9, no. 3 (March 2019): e025267. http://dx.doi.org/10.1136/bmjopen-2018-025267.
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ObjectivesWe aimed to explore the opinion leader empowered patients’ relationship with their medical professionals, their experiences and beliefs about technologies, and how they see the future. We also attempted to determine whether technologies, the access to it or patient empowerment are the main driving forces behind these changes.DesignA qualitative interview study analysed with interpretative phenomenological analysis.SettingAll interviews were conducted and recorded individually with the same trained interviewer via a Skype call.ParticipantsThe study is based on qualitative, semistructured interviews with 11 opinion leader empowered patients from six countries including UK, USA, Australia, Sweden, South Africa and Ireland.ResultsWe identified four superordinate themes emerging from e-patients’ experiences: (1) impact of technology, (2) the meaning of empowerment, (3) the changing physician–patient relationship and (4) expectations for the future. The relationship e-patients have with their physicians is based on efficient communication, proactivity, the desire for asking questions and the use of technologies. The interviews have shown that the rapid development of technology has fundamentally changed the lives of these e-patients, and technology eventually is transforming the physician–patient relationship into a partnership. Regarding the future of the physician–patient partnership, e-patients emphasised that change will rather be cultural than technological.ConclusionsThe interviews have shown that cooperation between technology and healthcare is not enough on its own: the most decisive factor is the return of the human touch and reciprocal communication. All of these suggest that technology is an important ally in the ‘renaissance of medicine’ that starts to treat patients as it should have always had.
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Philip, Jennifer, Rachel Wiseman, Peter Eastman, Chi Li, and Natasha Smallwood. "Mapping non-malignant respiratory palliative care services in Australia and New Zealand." Australian Health Review 44, no. 5 (2020): 778. http://dx.doi.org/10.1071/ah19206.
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ObjectiveDespite needs, people with advanced non-malignant respiratory disease are infrequently referred to palliative care services. Integrated models of palliative care and respiratory service delivery have been advocated to address this inequity of access. This study mapped current ambulatory palliative care service provision for patients with advanced non-malignant respiratory disease in Australia and New Zealand. MethodsAn online survey was distributed to the palliative care physician membership of the Australian and New Zealand Society of Palliative Medicine. Information was sought regarding access to specific breathlessness and integrated respiratory and palliative care services, and their operation. Data were described using descriptive statistics. ResultsIn all, 133 respondents (93 from Australia, 40 from New Zealand; representing 55 Australian and 26 New Zealand discrete sites) with complete data were available for analysis. More than half the respondents reported seeing patients with advanced non-malignant respiratory disease frequently (56/97; 58%), and 18 of 81 services (22%) reported having breathlessness or integrated respiratory and palliative care services caring for this patient group. Such services were mostly staffed by respiratory and palliative care doctors and nurses and based in the clinic environment, with limited support available outside this setting. Of the 63 respondents without existing breathlessness or integrated services, 49 (78%) expressed interest in their establishment, with limited resources cited as the most common barrier. ConclusionsThere is limited availability of integrated respiratory and palliative care or specialised breathlessness services in Australia and New Zealand despite widespread support by palliative care physicians. This study provides a snapshot to inform strategic service development. What is known about the topic?People with advanced respiratory disease have very significant morbidity with complex needs equivalent to, and in many cases more intense than, people with end-stage lung cancer; they also have significant mortality. Yet, these people frequently do not access palliative care services. The establishment of integrated respiratory and palliative care services has been advocated as an effective means to overcome the barriers to palliative care access. Such services have demonstrated improved patient and family-reported outcomes, as well as service-level improvements. What does this paper add?This paper maps the availability of integrated respiratory palliative care services in Australia and New Zealand. We reveal that although most palliative care physicians report seeing patients with advanced respiratory disease in practice, just one-fifth of services report having an integrated service approach. There was high interest and enthusiasm for such services (78%), but resources limited their establishment. What are the implications for practitioners?Palliative care services recognise the needs of patients with advanced respiratory disease and the benefits of integrated respiratory and palliative care services to address these needs, but scarcity of resources limits the ability to respond accordingly. This study provides a snapshot of current service level to inform strategic development.
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Shepherd, Heather L., Martin H. N. Tattersall, and Phyllis N. Butow. "Physician-Identified Factors Affecting Patient Participation in Reaching Treatment Decisions." Journal of Clinical Oncology 26, no. 10 (April 1, 2008): 1724–31. http://dx.doi.org/10.1200/jco.2007.13.5566.
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Purpose Cancer physicians report high comfort with shared decision making but a lower frequency of using this approach in practice. Information regarding physicians’ perceptions of what helps and what hinders patient involvement in decision making may facilitate understanding of this discrepancy. Methods We surveyed 604 Australian cancer physicians treating breast, colorectal, gynecologic, hematologic, or urologic cancer to investigate barriers and facilitators to reaching treatment decisions with their patients and their support of strategies to encourage patient involvement and reflection on treatment options. Factor analysis and regression analyses were used to investigate relationships between variables and identify predictors of greater reporting of barriers to sharing treatment decisions with patients. Results Insufficient information at the first consultation (28.9%) and insufficient time (28.4%) were the most frequently reported barriers to reaching treatment decisions with patients. Multivariate analysis revealed that less experienced physicians more commonly reported system barriers (P = .00). Patients trusting their physician and being accompanied at the consultation were most helpful to reaching a treatment decision. Providing written information about treatment options, making a further appointment to reach a decision, encouraging the patient to speak with their family physician and treatment team, and the presence of a third person during the consultation were felt to encourage involvement and reflection on treatment decisions. Conclusion Cancer physicians experience difficulties when reaching treatment decisions with their patients. Interventions and strategies that physicians support are required to enhance patient involvement in reaching a treatment decision.
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Gee, Christine, Anne Tonkin, Sharon Gaby, Veronika Urh, Sarah Anderson, Matthew Hardy, and Martin Fletcher. "Responding to Sexual Boundary Notifications: The Evolving Regulatory Approach in Australia." Journal of Medical Regulation 107, no. 2 (July 1, 2021): 25–31. http://dx.doi.org/10.30770/2572-1852-107.2.25.
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ABSTRACT A sexual boundary violation by a health practitioner has an immense impact on a patient, and the trust and confidence in the health care system and the health care regulator are negatively affected. The Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia (MBA) in 2017 commissioned an independent review in response to a specific high-profile case of multiple physician-patient* sexual boundary violations. In response to recommendations for process improvement, Ahpra and the MBA worked to transform the regulatory management of sexual boundary notifications.The purpose of this paper is to explore the structural and cultural changes that have been made to manage sexual boundary violation notifications and lessons learned through the process. Three factors — specialized decision-making, training for investigators and policy and cultural changes — were identified as key elements of the change process. Since the changes in 2017, the rate of immediate regulatory action taken in response to sexual boundary notifications has increased substantially, with a higher proportion of decisions resulting in suspension of a physician’s registration. Further work on the experience of those who are part of the notification process and supporting people to share their stories and experiences through the notification and tribunal process is ongoing.
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Lorains, J. "Bedside ultrasound in the Acute Medical setting – Practiced by the Acute Physician or Ultrasonographer?" Acute Medicine Journal 7, no. 2 (April 1, 2008): 91. http://dx.doi.org/10.52964/amja.0205.
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Ultrasound is widely used by physicians in the emergency medical setting in the USA, Australia and Europe. The objective in bringing ultrasound to the bedside is to bring immediacy to diagnostic decisions and improve safety for interventional procedures. Additionally within the NHS there are increasing pressures to limit bed usage and manage more conditions in an ambulatory setting. Shortening the time to scan and decisions based on the results would be of benefit to the individual patient and the organisation.
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Shah, Smita, Brett G. Toelle, Susan M. Sawyer, Jessica K. Roydhouse, Peter Edwards, Tim Usherwood, and Christine R. Jenkins. "Feasibility study of a communication and education asthma intervention for general practitioners in Australia." Australian Journal of Primary Health 16, no. 1 (2010): 75. http://dx.doi.org/10.1071/py09056.
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The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor–patient communication. The impact of the modified PACE Australia program on the processes and outcomes of GP care of children with asthma is now being measured in a randomised controlled trial.
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Gibson, David A. J., Rachael E. Moorin, David B. Preen, Jon D. Emery, and C. D'Arcy J. Holman. "Effects of the Medicare enhanced primary care program on primary care physician contact in the population of older Western Australians with chronic diseases." Australian Health Review 35, no. 3 (2011): 334. http://dx.doi.org/10.1071/ah09852.
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Objective. Assess uptake of Medicare’s enhanced primary care (EPC) services in Western Australia (WA) in 2001 to 2006, evaluating effect of EPC services on the regularity of contact with general practitioners (GPs) in patients aged 65+ years. Method. Whole-population cohort study using linked routinely collected health service data from State and Federal health databases. Analyses include age-standardised rate of EPC services, odds of EPC utilisation relative to other GP services using logistic regression, and total GP service regularity pre- and post-implementation of the EPC program. Results. EPC services provided to WA seniors increased 345% 2001 to 2006, comprising an increasing proportion of the total GP services (1.1 to 3.6%). Uptake of EPC services accelerated abruptly after 2004 due to greater use of ‘care plans’. EPC services were associated with a history of chronic disease, especially type 2 diabetes (OR = 1.74, 95% CI 1.66–1.82). Regularity of total GP services was improved with any EPC service exposure, with greater improvement occurring in the presence of annual EPC service exposure. Conclusions. EPC item uptake responded favourably to item changes from Medicare Australia. Prior exposure to EPC items increased the regularity of GP services, an outcome inversely associated with chronic disease progression. What is known about the topic? The Australian Federal government has invested substantial funds (over $200 million in 2007–08 alone) in the enhanced primary care (EPC) program with the intention of improving patient outcomes, specifically aged patients and those suffering from chronic disease. The EPC program uses high value Medicare items to incentivise GPs to engage in long-term planned care. However, limited research has examined the effect of this program on patient service utilisation and outcomes. What does this paper add? This paper provides a whole-population perspective on the EPC utilisation trends from 2001 to 2006 for Western Australian residents over 65 years of age. The paper then examines the likelihood of using the EPC program on the basis of calendar year, sex, age and chronic disease history. A comparison of the regularity of GP service utilisation for those exposed to the EPC program is also made. What are the implications for practitioners? The adjustments made to the EPC program in 2004, after feedback from GPs, appears to have substantially increased the utilisation of the program. Additionally, patients suffering from several different chronic diseases are more likely to be exposed to the EPC program. Exposure to the EPC program also appears to provide an improvement in regularity of service utilisation which has been associated with improved outcomes in the literature.
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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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Lim, Andy, Namankit Gupta, Alvin Lim, Wei Hong, and Katie Walker. "Description of the effect of patient flow, junior doctor supervision and pandemic preparation on the ability of emergency physicians to provide direct patient care." Australian Health Review 44, no. 5 (2020): 741. http://dx.doi.org/10.1071/ah20180.
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ObjectiveA pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. MethodsA retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. ResultsA total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56–4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P<0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1–3.4, P<0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4–15.6, P<0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. ConclusionsEmergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic?An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician’s ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add?This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician’s ability to complete primary consults. What are the implications for practitioners?When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.
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Hernan, Andrea L., Sally J. Giles, Andrew Carson-Stevens, Mark Morgan, Penny Lewis, James Hind, and Vincent Versace. "Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England." BMJ Open 11, no. 4 (April 2021): e042551. http://dx.doi.org/10.1136/bmjopen-2020-042551.
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BackgroundPatient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement.ObjectiveThe aim of this study was to characterise the nature of patient-reported safety incidents in primary care.DesignSecondary analysis of two cross sectional studies.ParticipantsAdult patients from Australian and English primary care settings.MeasuresPatients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented.ResultsA total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent.ConclusionsThe nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.
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Axisa, Carmen, Louise Nash, Patrick Kelly, and Simon Willcock. "Psychiatric morbidity, burnout and distress in Australian physician trainees." Australian Health Review 44, no. 1 (2020): 31. http://dx.doi.org/10.1071/ah18076.
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Objective The aim of this study was to evaluate the prevalence of psychiatric morbidity, alcohol use, burnout and compassion satisfaction among physician trainees in New South Wales, Australia, and examine links between personal, demographic and lifestyle factors. Methods A total of 67 physician trainees were recruited to the study. Fifty-nine completed the online survey (88% response rate). Outcome measures included the Depression Anxiety Stress Scale, Professional Quality of Life Scale and Alcohol Use Disorders Identification Test. Results Approximately half the respondents met screening criteria for depression (53%), stress (51%) and anxiety (46%). Secondary traumatic stress was exceptionally high across the cohort, with higher scores in females (P=0.001). The main reasons for not seeking help for depression or anxiety were lack of time (81%), fear of lack of confidentiality or privacy (41%), embarrassment (39%) and effect on registration (27%). Eighty-eight per cent of respondents agreed that doctors feel they need to portray a healthy image, but only 54% engaged in regular exercise and 24% slept ≤6h each day. Conclusion The results demonstrate high levels of non-psychotic psychiatric morbidity among physician trainees and a need to improve their well-being. Workplace systems need to promote healthy work environments and support physician trainees through good mentorship and supervision. What is known about the topic? Doctors’ health and patient care can be affected when doctors experience burnout and psychiatric morbidity. What does this paper add? This paper adds to the evidence of psychiatric morbidity, burnout, secondary trauma and increased demographic data on a cohort of junior doctors undertaking speciality training. In addition, it provides reasons for not seeking help and positive and negative coping methods used by these junior doctors. What are the implications for practitioners? The level of distress is high and requires system changes to support both individual health measures and structural change to work and study programs.
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Raeburn, Toby, Carol Liston, Jarrad Hickmott, and Michelle Cleary. "Colonial surgeon Patrick Hill (1794–1852): unacknowledged pioneer of Australian mental healthcare." History of Psychiatry 30, no. 1 (November 12, 2018): 90–103. http://dx.doi.org/10.1177/0957154x18809925.
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Despite making a substantial contribution to the development of mental health services in colonial Australia, until now the story of Dr Patrick Hill’s (1794–1852) life has been overlooked by historians. This paper reviews primary sources including clinical notes, patient lists, letters, government documents and newspaper articles which reveal that Dr Hill was a dedicated physician who played a vital role in the development of Australian mental healthcare. He was held in such esteem that by the time of his sudden death in 1852 he had been elevated to the most senior medical office in New South Wales. Dr Hill’s career serves to exemplify how the local practice of individual colonial doctors helped build the reputation of medicine in the modern era.
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Freed, Gary L., and Amy R. Allen. "Outpatient consultant physician service usage in Australia by specialty and state and territory." Australian Health Review 43, no. 2 (2019): 200. http://dx.doi.org/10.1071/ah17125.
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Objectives To determine national service usage for initial and subsequent outpatient consultations with a consultant physician and any variation in service-use patterns between states and territories relative to population. Methods An analysis was conducted of consultant physician Medicare claims data from the year 2014 for an initial (item 110) and subsequent consultation (item 116) and, for patients with multiple morbidities, initial management planning (item 132) and review (133). The analysis included 12 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, general medicine, geriatric medicine, haematology, immunology and allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology). Main outcome measures were per-capita service use by medical speciality and by state and territory and ratio of subsequent consultations to initial consultations by medical speciality and by state and territory. Results There was marked variation in per-capita consultant physician service use across the states and territories, tending higher than average in New South Wales and Victoria, and lower than average in the Northern Territory. There was variation between and within specialties across states and territories in the ratio of subsequent consultations to initial consultations. Conclusion Significant per-capita variation in consultant physician utilisation is occurring across Australia. Future studies should explore the variation in greater detail to discern whether workforce issues, access or economic barriers to care, or the possibility of over- or under-servicing in certain geographic areas is leading to this variation. What is known about the topic? There are nearly 11million initial and subsequent consultant physician consultations billed to Medicare per year, incurring nearly A$850million in Medicare benefits. Little attention has been paid to per-capita variation in rates of consultant physician service use across states and territories. What does this paper add? There is marked variation in per-capita consultant physician service use across different states and territories both within and between specialties. What are the implications for practitioners? Variation in service use may be due to limitations in the healthcare workforce, access or economic barriers, or systematic over- or under-servicing. The clinical appropriateness of repeated follow-up consultations is unclear.
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Zuo, Yeqin, Bernie Mullen, Rachel Hayhurst, Karen Kaye, Renee Granger, and Jonathan Dartnell. "OP08 Using Real World Data To Support National Postmarketing Surveillance." International Journal of Technology Assessment in Health Care 34, S1 (2018): 3. http://dx.doi.org/10.1017/s0266462318000739.
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Introduction:While medicines and medical tests are developed in a controlled clinical trial environment, postmarketing surveillance in the real world can be challenging. MedicineInsight—a database of longitudinal patient-level clinical information from primary care practices in Australia—is a novel program that collects primary care data to improve postmarketing surveillance at a national level.Methods:MedicineInsight collects de-identified clinical information from primary care practice information systems using data extraction tools. MedicineInsight currently includes 3.6 million regular patients of 3,300 family physicians (general practitioners) from 650 primary care practices across Australia. MedicineInsight data include longitudinal clinical information on diagnosis and medicines (dose, strength, route of administration, medication switches over time, adverse events, and allergies), and pathology testing data. A series of observational studies was developed for postmarketing surveillance of management of a range of health priorities including type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary disease (COPD), depression, and antibiotics use.Results:Forty-four percent of patients with T2DM in the MedicineInsight database did not have a recorded hemoglobin A1c result and thirty-one percent did not have a recorded blood pressure reading in the previous 6 months. While guidelines recommend a stepwise approach to the initiation of COPD therapy, forty-nine percent of patients with COPD (with or without asthma) were prescribed dual therapy at initiation and a small number (4.5 percent) were prescribed triple therapy. Between 2011 and 2015, the annual rate of antidepressant prescribing per 1,000 family physician encounters increased by eight percent. High volumes of antibiotics were prescribed for respiratory tract infections in Australian primary care, notwithstanding guideline recommendations that antibiotics are not recommended in most cases.Conclusions:Large scale, real-world clinical data from primary care practices can play an important role in postmarketing surveillance at a national level.
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Tinley, Paul. "Occupational Stress Among Australian Podiatric Physicians in General and Geriatric Practice." Journal of the American Podiatric Medical Association 105, no. 2 (March 1, 2015): 130–34. http://dx.doi.org/10.7547/0003-0538-105.2.130.
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Background High levels of occupational stress have been reported in podiatric physicians practicing in Australia. One possible stressor is the predominance of the treatment of aged patients with chronic disease in podiatric medical practice. Methods Forty podiatric physicians attending a regional podiatric medical conference were invited to participate in the research using a convenience sampling method. Podiatric physicians were asked to complete a survey examining occupational stress in general and specifically in relation to practice with older adults (defined as those older than 65 years). Results The survey of sources of occupational stress among podiatrists identified patient demands and expectations as the most significant stressor in general and geriatric practice for the podiatric physician. The perceived limited clinical gains and chronic nature of the conditions in older patients was also ranked highly as a stressor. Conclusions Working with the elderly is a substantial part of podiatric medical practice and, as such, needs to be seen with a more positive attitude by many practitioners. The development of geriatric practice as a speciality within the profession may help raise the value of working with the elderly. This has implications for preparing podiatric physicians for practice with the geriatric population along with the need for strategies to avoid or minimize these work stressors.
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Evans, Andrew, Victor SC Fung, John O’Sullivan, Rick Stell, Richard White, David Williams, and Koray Onuk. "026 Characteristics of advanced parkinson’s disease patients seen in movement disorder clinics – australian results from the cross-sectional observe study." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 6 (May 24, 2018): A11.1—A11. http://dx.doi.org/10.1136/jnnp-2018-anzan.25.
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IntroductionTo evaluate the proportion of Parkinson’s disease (PD) patients identified as having advanced Parkinson’s disease (APD) according to physician’s judgement: Australian results.MethodsThis cross-sectional, non-interventional observational study was performed in movement disorder clinics from 18 countries. Results from the Australian cohort are presented here. Participants included consecutive adults with PD attending a routine clinical visit, or inpatients at participating clinical sites, and who could speak English. The primary outcome was the proportion of patients diagnosed with APD via physician judgement. Secondary objectives included to evaluate clinical characteristics of APD versus non-APD; to assess the percentage of APD considered for device-aided therapies (DAT); to explore referral practices for APD; and to compare the percentage of APD identified in routine clinical practice by physician’s judgment to APD identified based on APD criteria derived using the Delphi method.Results100 patients were recruited in Australia: 61.0% (95%CI 51.4%–70.6%) diagnosed with APD by physician judgement. Patients were 66.6±8.5 years, 65% were male, were living at home (97%), and diagnosed for median 10.7 years (0–30.5 years). Motor fluctuations were present in 68%. For those with APD, referral was predominantly to enable access to DAT (49%), while for non-APD, referral was largely for diagnostic purposes (41%). Referral to a movement disorder clinic occurred 4.8 years (median) following diagnosis for APD, or 3.6 years for non-APD. While 62% were eligible for DAT, only two-thirds of these received them. The most commonly used DAT was deep brain stimulation (64.3%). There was fair agreement between physician’s judgement and the APD criteria by Delphi method (Cohen’s kappa) 0.325 (95%CI 0.150–0.500).ConclusionThe definition of APD requires refinement in order to facilitate greater agreement among movement disorder specialists. A third of PD patients eligible for DAT remain untreated. Current Australian practice is weighted towards deep brain stimulation.
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Laba, J. M., S. Senan, D. Schellenberg, S. Harrow, L. Mulroy, S. Senthi, A. Swaminath, et al. "Identifying barriers to accrual in radiation oncology randomized trials." Current Oncology 24, no. 6 (December 20, 2017): 524. http://dx.doi.org/10.3747/co.24.3662.
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Background Data about factors driving accrual to radiation oncology trials are limited. In oncology, 30%–40% of trials are considered unsuccessful, many because of poor accrual. The goal of the present study was to inform the design of future trials by evaluating the effects of institutional, clinician, and patient factors on accrual rates to a randomized radiation oncology trial.Methods Investigators participating in sabr-comet (NCT01446744), a randomized phase ii trial open in Canada, Europe, and Australia that is evaluating the role of stereotactic ablative radiotherapy (sabr) in oligometastatic disease, were invited to complete a survey about factors affecting accrual. Institutional ethics approval was obtained. The primary endpoint was the annual accrual rate per institution. Univariable and multivariable linear regression analyses were used to identify factors predictive of annual accrual rates.Results On univariable linear regression analysis, off-trial availability of sabr (p = 0.014) and equipoise of the referring physician (p = 0.014) were found to be predictive of annual accrual rates. The annual accrual rates were lower when centres offered sabr for oligometastases off-trial (median: 3.7 patients vs. 8.4 patients enrolled) and when referring physicians felt that, compared with having equipoise, sabr was beneficial (median: 4.8 patients vs. 8.4 patients enrolled). Multivariable analysis identified perceived level of equipoise of the referring physician to be predictive of the annual accrual rate (p = 0.023).Conclusions The level of equipoise of referring physicians might play a key role in accrual to radiation oncology randomized controlled trials. Efforts to communicate with and educate referring physicians might therefore be beneficial for improving trial accrual rates.
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Ingman, Wendy V., Bernadette Richards, Jacqueline M. Street, Drew Carter, Mary Rickard, Jennifer Stone, and Pallave Dasari. "Breast Density Notification: An Australian Perspective." Journal of Clinical Medicine 9, no. 3 (March 3, 2020): 681. http://dx.doi.org/10.3390/jcm9030681.
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Breast density, also known as mammographic density, refers to white and bright regions on a mammogram. Breast density can only be assessed by mammogram and is not related to how breasts look or feel. Therefore, women will only know their breast density if they are notified by the radiologist when they have a mammogram. Breast density affects a woman’s breast cancer risk and the sensitivity of a screening mammogram to detect cancer. Currently, the position of BreastScreen Australia and the Royal Australian and New Zealand College of Radiologists is to not notify women if they have dense breasts. However, patient advocacy organisations are lobbying for policy change. Whether or not to notify women of their breast density is a complex issue and can be framed within the context of both public health ethics and clinical ethics. Central ethical themes associated with breast density notification are equitable care, patient autonomy in decision-making, trust in health professionals, duty of care by the physician, and uncertainties around evidence relating to measurement and clinical management pathways for women with dense breasts. Legal guidance on this issue must be gained from broad legal principles found in the law of negligence and the test of materiality. We conclude a rigid legal framework for breast density notification in Australia would not be appropriate. Instead, a policy framework should be developed through engagement with all stakeholders to understand and take account of multiple perspectives and the values at stake.
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de Gruchy, Adam, Catherine Granger, and Alexandra Gorelik. "Physical Therapists as Primary Practitioners in the Emergency Department: Six-Month Prospective Practice Analysis." Physical Therapy 95, no. 9 (September 1, 2015): 1207–16. http://dx.doi.org/10.2522/ptj.20130552.
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Background Increasing pressure on the emergency department (ED) throughout the world has meant the introduction of innovative ways of working. One such innovation is the advanced practice physical therapist (APP) acting as a primary contact practitioner. There has been little research into the role beyond identifying patient satisfaction with management, cost-effectiveness, and time efficiency. In order to give further support and assist in development of an APP service in the ED, an increased exploration of patient caseload demographics, resource utilization, and management outcomes is needed. Objectives The purpose of this study was to provide quantitative data regarding patient demographics, time efficiency, resource utilization, and management outcomes to examine the APP role in the ED. Design This was a prospective observational study of practice. Setting The study was conducted in a single ED in Melbourne, Australia. Method Data collection was conducted over a 6-month period. Patient demographics and diagnoses, assessment times, hospital resource utilization, and discharge destinations were recorded. Results One thousand seventeen patients (45% female; median age=34 years, interquartile range=25–52) were managed by the APPs; 89% had conditions triaged as not serious or life threatening, and 97% had musculoskeletal pathologies, with the most common diagnosis being fracture or dislocation. Four-hour length-of-stay targets were met in 95% of the patients. Forty-six percent of the patients seen were managed independently, without any support from medical colleagues. The most frequent discharge destination was a referral back to the primary care physician or to hospital outpatient clinics. When comparing similar diagnostic groups, the APPs were significantly more time-efficient than ED physicians in their patient management. Conclusions This study described in detail the caseload managed by the APP in the ED and identified the role as a valuable asset to an ED, managing a great deal of their caseload independently, safely, and time efficiently.
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Szer, Jeffrey, Cecily J. Forsyth, and Anja Giese. "Real-World Use of Therapeutic Anticoagulation in Patients with Paroxysmal Nocturnal Hemoglobinuria. Results of a Survey of Physicians in Australia." Blood 126, no. 23 (December 3, 2015): 4537. http://dx.doi.org/10.1182/blood.v126.23.4537.4537.
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Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is a rare and life-threatening hematopoietic stem cell disorder characterized by uncontrolled complement-mediated hemolysis. Patients with PNH are at increased risk of thromboembolism and premature death. This risk is predominantly due to the effects of chronic hemolysis and platelet activation. Eculizumab, a monoclonal antibody that inhibits terminal complement activation, has been shown to reduce hemolysis and dramatically reduce the rate of thromboembolism. A previous publication (Kelly et al, 2011) suggested that cessation of therapeutic anticoagulation (TAC) in PNH patients on eculizumab with no prior history of thrombosis is safe. There are very few reports on the outcomes of cessation of TAC in PNH patients on eculizumab who have a prior history of thrombosis or on the use of non-vitamin K antagonist oral anticoagulant (NOAC) agents in PNH patients with a history of thrombosis. In Australia, patients with PNH are predominantly managed by individual hematologists rather than at a single centre and hence anticoagulation practices following the introduction of eculizumab therapy are variable. We surveyed Australian hematologists managing eculizumab-treated patients with PNH to obtain the details of anticoagulation management and incidence of thrombotic events in their patients. We received responses from 30 hematologists caring for a total of 58 patients with PNH on eculizumab (1-17 patients per hematologist) and the table summarises the results. TAC as primary prophylaxis had been ceased in 10 patients with no recurrent thrombotic events. One (1) patient remains on primary prophylaxis due to persistently high D-dimer and factor VIII levels. TAC for secondary prophylaxis had been ceased in 2 patients due to bleeding (1 patient with subdural hematoma, 1 patient with gastrointestinal bleeding) and neither of these patients had a further thrombotic event. One patient, with a prior history of thrombosis, requested cessation of TAC and subsequently developed a provoked thrombosis. Three patients not receiving TAC when eculizumab was commenced developed thrombosis; two (2) patients had provoked deep venous thromboses and one patient developed a splanchnic vein thrombosis following a cholecystectomy in association with severe sepsis. One patient had a portal vein thrombosis immediately prior to commencing eculizumab therapy but has never received TAC due to severe coexistent thrombocytopenia from myelodysplasia. This patient has not had a recurrent thrombosis. Three (3) patients with thrombotic events prior to eculizumab therapy (1 patient with pulmonary emboli, 1 patient with cerebral venous sinus thrombosis and 1 patient with inferior vena cava thrombosis) had anticoagulant therapy changed from warfarin to rivaroxaban. At a follow-up of at least twelve months for all 3 patients there have been no recurrent thrombotic events and no bleeding complications. In conclusion, these Australian data are consistent with those reported by Kelly suggesting that cessation of primary prophylaxis in PNH patients on eculizumab is safe. Cessation of TAC in PNH patients on eculizumab with a prior thrombosis can be considered if there are clear contraindications to anticoagulation. Thromboprophylaxis in situations of increased risk of venous thromboembolism remains essential for all PNH patients not on TAC, even when they are on eculizumab therapy. The three patients on rivaroxaban as secondary prophylaxis are, to our knowledge, the first reported patients with PNH treated on a NOAC. Table. Number of patients New thrombotic events Eculizumab treated 58 Ceased TAC: Total1. As 1o prophylaxis2. As 2o prophylaxis(i) Due to bleeding(ii) At patient request 1410431 -None-None1 (provoked) TE in patients not on TAC at commencement of eculizumab 3 3 (provoked) NOAC as 2o prophylaxis 3 None Disclosures Szer: Alexion: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Alexion: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Alexion Australia: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Shire: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Shire: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Forsyth:Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Giese:Alexion: Employment.
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Hall, Alix, Sang Minh Nguyen, Lisa Mackenzie, Rob Sanson-Fisher, Ian Olver, Tran Van Thuan, and Tran Thanh Huong. "What Caused My Cancer? Cancer Patients’ Perceptions on What May Have Contributed to the Development of Their Cancer: A Cross-Sectional, Cross-Country Comparison Study." Cancer Control 26, no. 1 (January 1, 2019): 107327481986378. http://dx.doi.org/10.1177/1073274819863786.
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Accurate public perceptions on the risk factors associated with cancer are important in promoting primary, secondary, and tertiary prevention. Limited studies have explored this topic among patients with cancer in non-western, low-to-middle-income countries. A cross-sectional survey to compare Australian and Vietnamese cancer patients’ perceptions of what caused their cancer was undertaken. Adult, patients with cancer from both countries, receiving radiotherapy treatment completed a standardized survey, which included a 25-item module assessing their beliefs on the causes of their cancer. Items ranged from known evidence-based causes (eg, smoking, sun exposure) to non-evidence-based beliefs (eg, stress or anxiety, physical injury, or trauma). Country-specific logistic regression analyses were conducted to identify differences in the determinants of patients’ top perceived causes. A total of 585 patient surveys were completed (75% response rate; 285 from Australia, and 300 from Vietnam). Most patients were male (58%) and aged 60 years and older (55%). The most frequently reported risk factor overall and for the Australian sample was “getting older” (overall = 42%, Australia = 49%, and Vietnam = 35%). While the most frequently reported risk factor for the Vietnamese sample was “poor diet” (overall = 39%, Australia = 11%, and Vietnam = 64%). There were differences in the characteristics associated with the top causes of cancer identified by Australian and Vietnamese patients. Patients’ beliefs about what may have caused their cancer are complex and likely to be impacted by multiple factors, including the country from which they reside. Developing public awareness campaigns that are accurate and tailored to address the specific beliefs and possible misconceptions held by the target community are needed.
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Barrett, E., U. Wijenayake, U. Shah, D. Morris, R. Preece, and E. Jesulola. "Investigating the appropriateness of physician-ordered diagnostic computed tomography for patient management in a rural hospital in New South Wales, Australia." Clinical Radiology 74, no. 12 (December 2019): 977.e17–977.e23. http://dx.doi.org/10.1016/j.crad.2019.08.022.
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Abdelmessih, Erini, Maree-Donna Simpson, Jennifer Cox, and Yann Guisard. "Exploring the Health Care Challenges and Health Care Needs of Arabic-Speaking Immigrants with Cardiovascular Disease in Australia." Pharmacy 7, no. 4 (November 11, 2019): 151. http://dx.doi.org/10.3390/pharmacy7040151.
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The Arabic-speaking immigrant group, which makes up the fourth largest language group in Australia, has a high prevalence of cardiovascular disease. The objective of this study was to explore the health care challenges and needs of Arabic-speaking immigrants with cardiovascular disease (CVD), using a comparative approach with English-speaking patients with CVD as the comparable group. Methods: Participants were recruited from community settings in Melbourne, Australia. Face-to-face semi-structured individual interviews were conducted at the recruitment sites. All interviews were audio-taped, transcribed, and coded thematically. Results: 29 participants with CVD were recruited; 15 Arabic-speaking and 14 English-speaking. Arabic-speaking immigrants, and to a lesser extent English-speaking patients with CVD may have specific health care challenges and needs. Arabic-speaking immigrants’ health care needs include: effective health care provider (HCP)-patient communication, accessible care, participation in decision-making, and empowerment. English-speaking participants viewed these needs as important for CVD management. However, only a few English-speaking participants cited these needs as unmet health care needs. Conclusion: This study suggests that Arabic-speaking immigrants with CVD may have unique needs including the need for privacy, effective HCP-patient communication that takes into account patients’ limited English proficiency, and pharmacist-physician collaboration. Therefore, there may be a need to identify a health care model that can address these patients’ health care challenges and needs. This, in turn, may improve their disease management and health outcomes.
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Ridge, Andrew, Gregory M. Peterson, Bastian M. Seidel, Vinah Anderson, and Rosie Nash. "Healthcare Providers’ Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study." International Journal of Environmental Research and Public Health 18, no. 23 (December 3, 2021): 12767. http://dx.doi.org/10.3390/ijerph182312767.
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Potentially preventable hospitalisations (PPHs) are common in rural communities in Australia and around the world. Healthcare providers have a perspective on PPHs that may not be accessible by analysing routine patient data. This study explores the factors that healthcare providers believe cause PPHs and seeks to identify strategies for preventing them. Physicians, nurses, paramedics, and health administrators with experience in managing rural patients with PPHs were recruited from southern Tasmania, Australia. Semi-structured telephone interviews were conducted, and reflexive thematic analysis was used to analyse the data. Participants linked health literacy, limited access to primary care, and perceptions of primary care services with PPH risk. The belief that patients did not have a good understanding of where, when, and how to manage their health was perceived to be linked to patient-specific health literacy challenges. Access to primary healthcare was impacted by appointment availability, transport, and financial constraints. In contrast, it was felt that the prompt, comprehensive, and free healthcare delivered in hospitals appealed to patients and influenced their decision to bypass rural primary healthcare services. Strategies to reduce PPHs in rural Australian communities may include promoting health literacy, optimising the delivery of existing services, and improving social support structures.
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Shanmugam, Ramalingam. "Patients’ over-visit phobia versus physician’s over-prescription phobia." International Journal of Research in Medical Sciences 6, no. 9 (August 25, 2018): 2929. http://dx.doi.org/10.18203/2320-6012.ijrms20183629.
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Background: Hospital administrators conduct survey of patients to solicit their satisfactions and/or concerns for accreditation or renewal of license. For the first time in the literature, this article defines and illustrates the existence of patient’s over-visit phobia and the physician’s over-prescription phobia. These phobias pave way to formulate policy to increase hospital’s efficiency.Methods: The number, of times a patient visits the physician (with a visitation rate) and the number, of prescriptions written by a physician (with a prescription rate) are assumed to follow Poisson type probability patterns. This article, in a novel manner, untangles intricacies and inter-relations of these two phobias.Results: An analysis of the Australian Health Survey data, using our model and methodology, estimates visit and prescription rate to be and respectively. The chance for patient’s visit phobia and physician’s prescription phobia is respectively 0.33 (with a reluctance level 2.16 to make additional visits) and 0.46 (with an avoidance level 3.17 to prescribe more medicines).Conclusions: A few comments and suggestions are stated to save service time/cost for the sake of more hospital’s efficiency. With a methodology in this article, level of over-visits by the patients and the level of over-prescriptions by the physicians are estimable to reduce the waste of hospital’s resources.
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Einsiedel, Lloyd J., Eileen van Iersel, Robert Macnamara, Tim Spelman, Malcolm Heffernan, Linda Bray, Hamilton Morris, Brenda Porter, and Anthony Davis. "Self-discharge by adult Aboriginal patients at Alice Springs Hospital, Central Australia: insights from a prospective cohort study." Australian Health Review 37, no. 2 (2013): 239. http://dx.doi.org/10.1071/ah11087.
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Objective. To determine rates and risk factors for self-discharge by Aboriginal medical inpatients at Alice Springs Hospital. Methods. Prospective cohort study. Interviews were conducted in primary language by Aboriginal Liaison Officers, from July 2006 to August 2007. Topics included understanding of diagnosis, satisfaction with services and perceptions of staff and environment. Risk factors for self-discharge were then determined prospectively. Results. During the study period 202 (14.7%) of 1380 patients admitted to general medical units at Alice Springs Hospital, were interviewed. Self-discharge rates for all admissions were significantly lower during the study period than they had been previously (pre-study, mean 22.9 ± standard error 0.3%; study, 17.0 ± 0.2%) (P < 0.001). Most interviewees (73.4%) did not know their reason for admission (73.4%) or estimated length of stay (82.3%). Forty interviewees (19.8%) self-discharged. Mean monthly self-discharge rates differed between the three medical units (Unit A, 13.9 ± 0.3%; Unit B, 17.3 ± 1.37%; Unit C, 20.0 ± 0.4%) (P = 0.005). Multivariable predictors of self-discharge included male sex (hazard ratio (HR) 2.4; 95% confidence interval (CI) 1.1, 5.2), a past history of self-discharge (HR 3.2; 95%CI 1.5, 6), planned transfer to a tertiary referral centre (HR 3.8; 95%CI 1.3–7.4) and a desire to drink alcohol (HR 4.5; 95%CI 1.8–10.2). Conclusions. Physician, institutional and patient factors all contribute to self-discharge. Improving cultural safety may be the key to lowering self-discharge rates. What is known about the topic? Rates of self-discharge by Aboriginal adults in Central Australia are the highest reported worldwide. Previous studies have been retrospective and focussed on patient demographics without addressing the environmental and cultural contexts in which self-discharge occurs. What does this paper add? In this acute care setting, we found a pervasive failure to communicate effectively with Aboriginal patients. Consequently, most patients were unaware of their diagnosis or length of stay. Self-discharge was a common practice; nearly half of all previously admitted patients had self-discharged in the past. We demonstrate that physician, hospital and patient factors all contribute to this practice. Prospectively determined risk factors included the treating medical team, the need for transfer outside Central Australia, and patient factors such as male gender and alcohol dependence. Self-discharge rates fell significantly with Aboriginal Liaison involvement. What are the implications for practitioners? Cross-cultural communication skills must be markedly improved among medical staff caring for this marginalised population. Critical to reducing rates of self-discharge are improvements in institutional cultural safety by involving Aboriginal Liaison Officers and family members. However, persistently high self-discharge rates suggest a need to redirect medical services to a more culturally appropriate community-based model of care.
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Zisman-Ilani, Yaara, Rana Obeidat, Lauren Fang, Sarah Hsieh, and Zackary Berger. "Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions." JMIR Formative Research 4, no. 8 (August 3, 2020): e18223. http://dx.doi.org/10.2196/18223.
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Background Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. Objective This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. Methods A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. Results A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. Conclusions The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.
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Peisah, C., and K. Wilhelm. "Physician don't heal thyself: a descriptive study of impaired older doctors." International Psychogeriatrics 19, no. 5 (May 16, 2007): 974–84. http://dx.doi.org/10.1017/s1041610207005431.
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Background: The growing and welcome interest in the issues leading to distress and impairment in younger doctors has not been mirrored by a focus on the similar issues in older doctors which is surprising given the aging medical workforce.Objectives: To improve understanding of impairment in older doctors and to facilitate the planning of primary prevention strategies.Method: Consecutive case records of notifications to the Impaired Registrants Program of the New South Wales Medical Board, Australia, of doctors over 60 years from January 2000 to January 2006 (N = 41) were examined. Details of demographics, type of practice, nature of referral, medical morbidity, cognitive examination, psychiatric diagnosis and outcome of assessment were recorded.Results: Impaired older doctors suffered cognitive impairment (54%), substance abuse (29%) and depression (22%) and 17% had two comorbid psychiatric conditions. Twelve percent had frank dementia. Two work patterns – the “workhorse” and the “dabbler” – were observed, as was a culture of postponed retirement due to a sense of obligation and working “until you drop.” Impaired older doctors were found to have higher chronic illness burden compared with community norms. Almost half were the subject of patient complaints or of poor performance within ten years of presentation.Conclusion: To our knowledge there has been no other comprehensive examination of patterns of impairment in older doctors. Older doctors are prone to suffer “the four Ds”: dementia, drugs, drink and depression. We need to encourage mature doctors to adapt to age-related changes and illness and validate their right to timely and appropriate retirement.
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Hallinan, Christine Mary, and Yvonne Ann Bonomo. "The Rise and Rise of Medicinal Cannabis, What Now? Medicinal Cannabis Prescribing in Australia 2017–2022." International Journal of Environmental Research and Public Health 19, no. 16 (August 10, 2022): 9853. http://dx.doi.org/10.3390/ijerph19169853.
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Medicinal cannabis was legalised in Australia in November 2016. By August 2022, there were 5284 specialist physician and general practitioner (GP) prescribers who submitted Special Access Scheme (SAS) applications to the Therapeutic Goods Administration (TGA) for the provision of medicinal cannabis prescriptions their patients. In this article we examine the impact of the delivery of publicly available clinical guidance documents, provision of education to prescribers, establishment of the TGA online portal, and launching of cannabis clinics on the number of applications approved by the TGA over time. We considered these findings in the context of the need to align the interventions facilitating the prescribing of medicinal cannabis with the establishment of processes to enable the systematic monitoring of patient outcomes. The cumulative number of medicinal cannabis Special Access Scheme-B (SAS-B) prescription approvals from January 2017 to June 2022 was 258,926. SAS-B approvals increased at an average rate of 208.55% p < 0.000, (95% CI 187.25–229.85) per month. Conclusion: There has been a rapid growth in prescribing since the legalisation of medicinal cannabis in Australia and this expansion has not been accompanied by parallel processes for the monitoring of medicinal cannabis. The capture of more highly granulated data, as found in the electronic medical record (EMR), patient smartphone applications, and social media provide an opportunity to monitor medicinal cannabis effectiveness and safety across multiple prescribing indications.
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Loh, Pk (Poh-Kooi). "Telemedicine and Alzheimer's Disease from Studio-Based Videoconferencing to Mobile Handheld Cell Phones." Journal of brain disease 1 (January 2009): JCNSD.S2296. http://dx.doi.org/10.4137/jcnsd.s2296.
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The use of Telemedicine in the assessment of cognitive impairment and Alzheimer's Disease is evolving with advances in Information and Communication Technology. This article outlines the course of evolution in Western Australia, a large state with a sparse population outside of the capital city. The starting point of the evolution, video-conferencing in Telehealth studios, is reviewed as well as the next stage, use of desktop technology, which enables the physician to consult from the office or clinic. A pilot study currently being undertaken to assess the validity of the latest stage in evolution of Telehealth—the use of handheld mobile cell phone video calling that allows the physician and patient to interact at locations convenient to both parties. The pitfalls and implications of the use of this stage, should it prove to be a valid approach, are discussed.
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Clayton, Josephine M., Phyllis N. Butow, Martin H. N. Tattersall, Rhonda J. Devine, Judy M. Simpson, Ghauri Aggarwal, Katherine J. Clark, et al. "Randomized Controlled Trial of a Prompt List to Help Advanced Cancer Patients and Their Caregivers to Ask Questions About Prognosis and End-of-Life Care." Journal of Clinical Oncology 25, no. 6 (February 9, 2007): 715–23. http://dx.doi.org/10.1200/jco.2006.06.7827.
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Purpose To determine whether provision of a question prompt list (QPL) influences advanced cancer patients’/caregivers’ questions and discussion of topics relevant to end-of-life care during consultations with a palliative care (PC) physician. Patients and Methods This randomized controlled trial included patients randomly assigned to standard consultation or provision of QPL before consultation, with endorsement of the QPL by the physician during the consultation. Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC services were invited to participate. Consultations were audiotaped, transcribed, and analyzed by blinded coders; patients completed questionnaires before, within 24 hours, and 3 weeks after the consultation. Results A total of 174 patients participated (92 QPL, 82 control). Compared with controls, QPL patients and caregivers asked twice as many questions (for patients, ratio, 2.3; 95% CI, 1.7 to 3.2; P < .0001), and patients discussed 23% more issues covered by the QPL (95% CI, 11% to 37%; P < .0001). QPL patients asked more prognostic questions (ratio, 2.3; 95% CI, 1.3 to 4.0; P = .004) and discussed more prognostic (ratio, 1.43; 95% CI, 1.1 to 1.8, P = .003) and end-of-life issues (30% v 10%; P = .001). Fewer QPL patients had unmet information needs about the future (χ21 = 4.14; P = .04), which was the area of greatest unmet information need. QPL consultations (average, 38 minutes) were longer (P = .002) than controls (average, 31 minutes). No differences between groups were observed in anxiety or patient/physician satisfaction. Conclusion Providing a QPL and physician endorsement of its use assists terminally ill cancer patients and their caregivers to ask questions and promotes discussion about prognosis and end-of-life issues, without creating patient anxiety or impairing satisfaction.
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Islam, Md Irteja, Claire O’Neill, Hibah Kolur, Sharif Bagnulo, Richard Colbran, and Alexandra Martiniuk. "Patient-Reported Experiences and Satisfaction with Rural Outreach Clinics in New South Wales, Australia: A Cross-Sectional Study." Healthcare 10, no. 8 (July 26, 2022): 1391. http://dx.doi.org/10.3390/healthcare10081391.
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Introduction: Many studies have been conducted on how physicians view outreach health services, yet few have explored how rural patients view these services. This study aimed to examine the patient experience and satisfaction with outreach health services in rural NSW, Australia and the factors associated with satisfaction. Methods: A cross-sectional study was conducted among patients who visited outreach health services between December 2020 and February 2021 across rural and remote New South Wales, Australia. Data on patient satisfaction were collected using a validated questionnaire. Both bivariate (chi-squared test) and multivariate analyses (logistic regression) were performed to identify the factors associated with the outcome variable (patient satisfaction). Results: A total of 207 participants were included in the study. The mean age of respondents was 58.6 years, and 50.2% were men. Ninety-three percent of all participants were satisfied with the outreach health services. Respectful behaviours of the outreach healthcare practitioners were significantly associated with the higher patient satisfaction attending outreach clinics. Conclusions: The current study demonstrated a high level of patient satisfaction regarding outreach health services in rural and remote NSW, Australia. Further, our study findings showed the importance of collecting data about patient satisfaction to strengthen outreach service quality.
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Lim, Irwin, Pascal Richette, Ruben Queiro-Silva, Jade Moser, Joseph C. Cappelleri, Ho Yin Ng, and David Witcombe. "Patient Perceptions of Psoriatic Arthritis Management and Communication with Physicians in Australia: Results from a Patient Survey." Rheumatology and Therapy 8, no. 2 (March 24, 2021): 761–74. http://dx.doi.org/10.1007/s40744-021-00297-w.
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Andrews, Gavin, Scott Henderson, and Wayne Hall. "Prevalence, comorbidity, disability and service utilisation." British Journal of Psychiatry 178, no. 2 (February 2001): 145–53. http://dx.doi.org/10.1192/bjp.178.2.145.
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BackgroundHealth planning should be based on data about prevalence, disability and services used.AimsTo determine the prevalence of ICD–10 disorders and associated comorbidity, disability and service utilisation.MethodWe surveyed a national probability sample of Australian households using the Composite International Diagnostic Interview and other measures.ResultsThe sample size was 10 641 adults, response rate 78%. Close to 23% reported at least one disorder in the past 12 months and 14% a current disorder. Comorbidity was associated with disability and service use. Only 35% of people with a mental disorder in the 12 months prior to the survey had consulted for a mental problem during that year, and most had seen a general practitioner. Only half of those who were disabled or had multiple comorbidity had consulted and of those who had not, more than half said they did not need treatment.ConclusionsThe high rate of not consulting among those with disability and comorbidity is an important public health problem. As Australia has a universal health insurance scheme, the barriers to effective care must be patient knowledge and physician competence.
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Wilson, H. H. K., M. Schulz, L. Mills, and N. Lintzeris. "Feasibility and outcomes of a general practice and specialist alcohol and other drug collaborative care program in Sydney, Australia." Australian Journal of Primary Health 28, no. 2 (February 2, 2022): 158–63. http://dx.doi.org/10.1071/py20197.
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Alcohol and other drug (AoD) use is an important health and community issue and may be positively affected by collaborative care programs between specialist AoD services and general practice. This paper describes the feasibility, model of care and patient outcomes of a pilot general practice and specialist AoD (GP-AoD) collaborative care program, in Sydney, Australia, based on usual care data, the minimum data set, service utilisation information and the Australian Treatment Outcome Profile (ATOP), a patient-reported outcome measure. There were 367 referrals to the collaborative care program. GPs referred 210 patients, whereas the AoD service referred 157 patients. Most GP referrals (91.9%) were for AoD problems, whereas nearly half the AoD service referrals were for other issues. The primary drugs of concern in the GP group were either opioids or non-opioids (mostly alcohol). The AoD service-referred patients were primarily using opioids. An ATOP was completed for 152 patients. At the time of referral, those in the GP-referred non-opioid group were significantly less likely to be abstinent, used their primary drug of concern more days and were more likely to be employed (all P < 0.001). A second ATOP was completed for 93 patients. These data showed a significant improvement in the number of days the primary drug of concern was used (P = 0.026) and trends towards abstinence, improved quality of life and physical and psychological well-being for patients in the program. There are few studies of GP-AoD collaborative care programs and nothing in the Australian context. This study suggests that GP-AoD collaborative care programs in Australia are feasible and improve drug use.
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Doyle, Sarah, Rebecca Pavlos, Samantha J. Carlson, Katherine Barton, Mejbah Bhuiyan, Bernadett Boeing, Meredith L. Borland, Steven Hoober, and Christopher C. Blyth. "Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians." JMIR Formative Research 6, no. 1 (January 17, 2022): e29889. http://dx.doi.org/10.2196/29889.
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Background Acute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools—a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform—into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry. Objective The objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI. Methods Semistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS). Results Most parents (9/11, 82%) indicated that they usually received verbal discharge advice, with some (5/11, 45%) recalling receiving preprinted resources from their physician. Most (8/11, 73%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88%) described their usual practice as verbal discharge instructions, with some (3/8, 38%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface. Conclusions Semistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting.
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Fok, Patrick T., David Teubner, Jeremy Purdell-Lewis, and Andrew Pearce. "Predictors of Prehospital On-Scene Time in an Australian Emergency Retrieval Service." Prehospital and Disaster Medicine 34, no. 03 (June 2019): 317–21. http://dx.doi.org/10.1017/s1049023x19004394.
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AbstractIntroduction:Prehospital physicians balance the need to stabilize patients prior to transport, minimizing the delay to transport patients to the appropriate level of care. Literature has focused on which interventions should be performed in the prehospital environment, with airway management, specifically prehospital intubation (PHI), being a commonly discussed topic. However, few studies have sought additional factors which influence scene time or quantify the impact of mission characteristics or therapeutic interventions on scene time.Hypothesis/Problem:The goal of this study was to identify specific interventions, patient demographics, or mission characteristics that increase scene time and quantify their impact on scene time.Methods:A retrospective, database model-building study was performed using the prehospital mission database of South Australian Ambulance Service (SAAS; Adelaide, South Australia) MedSTAR retrieval service from January 1, 2015 through August 31, 2016. Mission variables, including patient age, weight, gender, retrieval platform, physician type, PHI, arterial line placement, central line placement, and finger thoracostomy, were assessed for predictors of scene time.Results:A total of 506 missions were included in this study. Average prehospital scene time was 34 (SD = 21) minutes. Four mission variables significantly increased scene time: patient age, rotary wing transport, PHI, and arterial line placement increased scene time by 0.09 (SD = 0.08) minutes, 13.6 (SD = 3.2) minutes, 11.6 (SD = 3.8) minutes, and 34.4 (SD = 8.4) minutes, respectively.Conclusion:This study identifies two mission characteristics, patient age and rotary wing transport, and two interventions, PHI and arterial line placement, which significantly increase scene time. Elderly patients are medically complex and more severely injured than younger patients, thus, may require more time to stabilize on-scene. Inherent in rotary wing operations is the time to prepare for the flight, which is shorter during ground transport. The time required to safely execute a PHI is similar to that in the literature and has remained constant over the past two years; arterial line placement took longer than envisioned. The SAAS MedSTAR has changed its clinical practice guidelines for prehospital interventions based on this study’s results. Retrieval services should similarly assess the necessity and efficiency of interventions to optimize scene time, knowing that the time required to safely execute an intervention may reach a minimum duration. Defining the scene time enables mission planning, team training, and audit review with the aim of improved patient care.
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Patrona-Aurand, Rosanna, and Leanne Schubert. "Case Study of a Peripherally Inserted Central Catheter's Migration into the Pulmonary Artery." Journal of the Association for Vascular Access 17, no. 3 (September 1, 2012): 131–34. http://dx.doi.org/10.1016/j.java.2012.07.005.
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Abstract An untoward event took place in Australia in 2011 involving a patient whose entire peripherally inserted central catheter (PICC) migrated into his pulmonary artery. At this particular rural hospital, a small vascular access team was initially formed; however, the PICC insertion procedure was taken over by a physician intensivist and his medical residents, who learned the procedure from him during their 3-month rotations. The distal portion of the patient's PICC, attached initially to a distal catheter-stabilizing device, dislodged and was drawn into the vein. The patient's PICC, now in his pulmonary artery, was retrieved via interventional radiology and the patient experienced no serious side effects from this event. This case highlights the importance of using only highly trained personnel who are familiar with the medical supplies to insert PICCs.
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Ganesh, A., B. Beland, G. Jewett, DJ Campbell, M. Varma, R. Singh, A. Al-Sultan, J. Wong, and BK Menon. "P.064 Physician Approaches to Imaging and Revascularization for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 48, s3 (November 2021): S37. http://dx.doi.org/10.1017/cjn.2021.344.
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Background: Evidence informing the choice between endarterectomy and stenting for acutely symptomatic carotid stenosis (“hot carotid”) is dated, and uncertainties remain regarding the optimal imaging modality. We sought to explore the thoughts of stroke physicians regarding the perioperative management of patients with acute symptomatic carotid stenosis. Methods: We conducted semi-structured interviews regarding “hot carotid” management with purposive sampling of 20 stroke physicians from 14 centres in North America, Europe, Asia, and Australia. We identified key themes using conventional qualitative content analysis. Results: Timely imaging availability, breadth of information gained, and surgeon/interventionalist preference emerged as important themes informing the choice of imaging modality. Multidisciplinary decision making, operating room/angiography suite availability, and implications of patient age and infarct size were important themes related to the choice of revascularization. Areas of uncertainty included utility of carotid plaque imaging, timing of revascularization, and the role of intervention with borderline stenosis or intraluminal thrombus. Conclusions: Our qualitative analysis revealed themes that were important to stroke experts. Teams designing international trials will have to accommodate identified variations in practice patterns and take into consideration areas of uncertainty, such as timing of revascularization, imaging of carotid plaque and non-stenotic features of carotid disease (intraluminal thrombus, plaque morphology).
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Yiu, Angela W. P., Vincent W. Lee, Kingsley K. Ng, and Beata V. Bajorek. "Patient Feedback on a Warfarin Action Plan Used in a Local Australian Physician Practice Setting." Therapeutic Innovation & Regulatory Science 54, no. 3 (January 6, 2020): 605–12. http://dx.doi.org/10.1007/s43441-019-00093-3.
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