Public Health Research & Practice最新文献

Aim: The decline in the real value of rebates from Australia's national public health insurance scheme, Medicare, over the past decade has contributed to increased out-of-pocket costs for eyecare services, which threatens affordability. This study measured eyecare affordability and cost barriers among patients seen in collaborative care.

Methods: We conducted a cross-sectional survey of 252 patients who had attended a collaborative eyecare clinic in the previous year. A modified affordability subscale was used to measure eyecare and general healthcare affordability. Two population scores were calculated: the average percentage of patients experiencing cost barriers (mean of the five item percentages for general healthcare, and optometric and specialist eyecare), and the proportion indicating one or more cost barriers. Factors associated with eyecare and general healthcare affordability were identified using linear regression.

Results: The response rate was 46.8% (n = 118/252). The mean percentage of patients not obtaining services because of cost ranged from 23.4% (standard deviation [SD] 8.8) for general healthcare to 25.5% (SD 6.3) for specialist eyecare. Direct or indirect cost barriers to one or more services were experienced by 45.2% (n = 52/115) of respondents for optometric eyecare and 40.4% (n = 44/109) for specialist eyecare. Services not covered by private health insurance or Medicare (for example, out-of-pocket dental and optical) were ranked the most difficult to afford. Poorer self-rated health (p = 0.004, β = 0.293) and the lack of private hospital health insurance (p = 0.014, β= 0.249) were associated with reduced optometric eyecare affordability. This was also true for specialist eyecare affordability (self-rated health p = 0.002, β = 0.306; private hospital health insurance p = 0.004, β = 0.286). A lack of private hospital health insurance (p = 0.001, β = 0.312), younger age (p < 0.001, β = -0.418) and holding a concession card (p = 0.011, β = 0.272) were all associated with reduced affordability of general healthcare.

Conclusion: A high proportion of patients seen in collaborative care experience cost barriers to accessing eyecare, particularly for services not covered by private health insurance or Medicare. These findings indicate that affordability concerns exist despite significant reductions in the direct cost of services within a collaborative care setting. They also provide insights on the subpopulations most vulnerable to rising eyecare costs.

Objectives: Australian lockdowns in response to the initial coronavirus disease 2019 (COVID-19) outbreak in 2020 were associated with small and transient changes in the use of systemic cancer therapy. We aimed to investigate the impacts of the longer and more restrictive lockdowns in the Australian states of New South Wales (NSW) and Victoria during both the Delta subvariant lockdowns in mid-2021 and the Omicron subvariant outbreak in late 2021/early 2022.

Study type: Population-based, controlled interrupted time series analysis.

Methods: We conducted a national observational study using de-identified records of government-subsidised cancer medicines dispensed to a random 10% sample of Australians between July 2018 and July 2022. We used controlled interrupted time series analysis to investigate changes in the dispensing, initiation and discontinuation of all cancer medicines dispensed to residents of NSW and Victoria, using the rest of Australia as a control series. We used quasi-Poisson regression to model weekly counts and estimate incidence rate ratios (IRRs) for the effect of (each) the Delta phase lockdown and the Omicron outbreak on our systemic cancer therapy outcomes.

Results: Between July 2018 and July 2022, cancer medicines were dispensed 592 141 times to 33 198 people in NSW and Victoria. Overall, there were no changes to the rates of dispensing, initiation or discontinuation of antineoplastics during the Delta phase lockdowns. In both states during the Omicron outbreak, there were significant decreases in the dispensing of antineoplastics (NSW IRR 0.89; 95% confidence interval [CI] 0.84, 0.93. Victoria IRR 0.92; 95% CI 0.88, 0.96) and in the initiation of endocrine therapy (NSW IRR 0.85; 95% CI 0.74, 0.99. Victoria IRR 0.78; 95% CI 0.65, 0.94), and no changes in the discontinuation of any systemic cancer therapy.

Conclusions: The 2021 lockdowns and 2021/2022 Omicron outbreaks in NSW and Victoria had significant impacts on the dispensing, initiation and discontinuation of systemic cancer therapies, however, the overall effects were minimal. The impacts of lockdowns were less significant than the Omicron outbreaks, suggesting COVID-19 infection, health system capacity, and patient and community concerns were important factors for treatment changes.

Objectives and importance of study: For public policy to respond effectively to social, economic, and health challenges, there is an urgent need for research-policy collaboration to advance evidence-informed policy. Many organisations seek to promote these engagement activities, but little is known about how this is experienced by researchers and policy actors. This study aimed to understand how policy actors and researchers in Australia experience collaboration and the impediments and enablers they encounter. Study type and methods: An online survey was developed, and using convenience sampling, self-identified Australian policy actors and researchers were invited to participate. Results: In total, 170 responses were analysed, comprising 58% policy actors and 42% researchers. Respondents reported the primary purpose for collaboration was evidence-informed policy making. Policy actors reported that the most common barrier to collaboration with academics was 'budget constraints' while academics reported 'budget, 'political risk' and 'structural barriers'. Reported enablers were 'leadership' and 'connections'. Conclusions: Our findings build upon existing evidence that highlights the importance of collaboration for facilitating evidence-informed policy. Structural deficits in both policy agencies and research funding systems and environments continue to present challenges to policy-research partnerships. Future initiatives could use these findings to implement preferred collaboration methods, alongside rigorous evaluation, to explore 'what works' in promoting engagement for evidence-informed policy.

Objectives: During winter 2022, as part of a multifaceted approach to optimise oral antiviral uptake in the Barwon South West region in Victoria, Australia, the Barwon South West Public Health Unit (BSWPHU) implemented an innovative, targeted SMS messaging program that encouraged people with coronavirus disease 2019 (COVID-19) to be assessed for antiviral treatment. In this study, we investigated patterns of antiviral uptake, identified barriers and facilitators to accessing antivirals, and examined the potential impact of targeted SMS messaging on oral antiviral uptake.

Methods: We conducted a cross-sectional study of notified COVID-19 cases aged 50 years and older, and Aboriginal and Torres Strait Islander people aged 30-49 years, in the BSWPHU catchment area over a 6-week period commencing 21 July 2022. We analysed survey data using descriptive statistics and generalised linear models.

Results: Of the 3829 survey respondents, 36.7% (95% confidence interval (CI) 35.2, 38.2) reported being prescribed oral antivirals, with 75.4% (95% CI 72.8, 77.9) of these aged ≥70. Antiviral prescriptions increased significantly over the 6-week survey period. Most prescriptions (87.5%; 95% CI 85.7, 89.2) were provided by the respondents' usual general practitioners (GPs). Barriers to receiving antivirals included respondents being unable to get a medical appointment in time (3.7%; 95% CI 3.1, 4.2), testing too late in their illness (2.3%; 95% CI 1.8, 2.8) and being unable to access medications in time after receiving a prescription (0.2%; 95% CI 0.1, 0.6). Facilitators to receiving antivirals included respondents first hearing about antivirals from a trusted source such as a family member, friend or usual doctor. Nearly one in eight people who were prescribed antivirals reported first hearing about them from the SMS message sent by BSWPHU.

Conclusions: Oral antiviral treatment uptake in south-west Victoria in July-August 2022 was high among survey respondents and increased over time. GPs were the key prescribers in the community. Targeted SMS messaging to COVID-19 cases is a simple, low-cost intervention that potentially increases antiviral uptake.

Objective: To document the outcomes of a dedicated Science Communication Community of Practice (CoP) for increasing prevention-focused knowledge translation (KT) and evidence uptake. Type of program: Shared priorities and a united vision to communicate the value of prevention research led to the formation of a dedicated Science Communication CoP within an Australian public health prevention-focused research collaboration. Members of the CoP included science communication experts and early- and mid-career researchers (EMCRs) with KT-focused roles.

Methods: The CoP met monthly, with semi-structured meetings led by an experienced science communication professional. A priority of the CoP was to develop resources that could help members and external parties to communicate their findings, especially EMCRs and those working on low-resourced projects. Insights from CoP members were synthesised to document if, and how, the CoP increased communication and KT capacity.

Results: CoP members found that participatory dialogue - dialogue that involves sharing perspectives and listening to others in order to develop a shared understanding - helped promote a greater understanding of science communication techniques and led to KT being embedded within projects. The CoP itself resulted in shared narratives and communication outputs that could not have been produced by individual members, primarily due to a lack of dedicated resourcing. Members found that engaging in the CoP increased their use of a range of science communication skills, tactics, and methods (e.g., targeted messaging for policy and practice, use of media and social media, and event management to engage audiences and build trust).

Lessons learnt: The CoP helped build a greater working knowledge of science communication among its members, leading to increased KT activities. Within an environment of low resourcing for science communication, bringing researchers together with science communication experts can help promote the communication of synthesised evidence and unified messaging on 'what works for prevention'.

Aim: Prescribed burning is the most common method employed to reduce fuel loads in flammable landscapes. This practice is designed to reduce the hazard associated with uncontrolled bushfires. Prescribed burns are frequently conducted close to residential areas, and the associated smoke impacts can adversely affect community health. Particulate matter is the predominant pollutant within the smoke and is strongly and consistently linked with adverse health effects. Outdoor smoke readily infiltrates buildings and reduces the quality of indoor air. Portable air cleaners containing high-efficiency particulate air (HEPA) filters are a promising indoor air quality intervention for reducing outdoor smoke exposure.

Methods: We provided 10 homes from semirural regions of Victoria, Australia, with HEPA cleaners and conducted continuous monitoring of indoor and outdoor fine particulate matter (PM2.5) for 2-4 weeks during prescribed burning periods. We calculated the potential improvements to indoor air quality when operating a HEPA cleaner during a smoke episode. Ventilation measures were conducted to identify points of smoke ingress and housing characteristics that could lead to higher infiltration rates.

Results: Depending on the house, the use of HEPA cleaners resulted in a reduction in indoor PM2.5 concentrations of 30-74%.

Conclusions: HEPA cleaners have the potential to substantially improve indoor air quality during episodic smoke episodes.

Objectives: A growing number of urban development and public health professionals are developing expertise in how urban environments influence population health to support preventive health (PH) planning, implementation and outcomes. This study aimed to address the growing interest among these experts in Sydney, Australia, to move beyond silo-based approaches to PH planning and urban development by developing a preliminary mapping of the complex adaptive system. This is a network of agents and parts that collectively relate and interact, where they seek to intervene by meshing the disparate knowledge of their multidisciplinary expertise. This mapping will help experts to better integrate PH approaches by linking primordial and primary prevention within urban environments, collectively prioritising areas for intervention within the complex adaptive system, and developing a better understanding of relations between multiple factors at play within it.

Methods: The system map was developed using a unique participatory system-mapping (PSM) process involving a modified Delphi technique consisting of three rounds between October 2019 and August 2020 and 15 urban development and public health experts engaged in PH in Sydney's urban environment.

Results: The final system map encompassed features of the local environment, determinants of health and wellbeing in urban environments, pre-clinical health and wellbeing impacts, and clinical health outcomes, providing a comprehensive map of the adverse effects of urban environments on population health. There was a high level of agreement among experts on the final system map. While experts from different disciplines generally agreed on priority areas for intervention, consensus was higher among those from similar disciplinary backgrounds.

Conclusions: The study highlights how the collective intelligence of experts from diverse disciplines can generate PSM. Furthermore, it illustrates how using systems mapping can help experts interested in complex public health problems to take a broader view of the complex adaptive system for PH planning, support collaborative prioritisation, and offer valuable insights for targeted interventions.

Objectives: Few existing economic evaluations of telephone call-back services for smoking cessation (quitlines) include productivity measures. The Economics of Cancer Collaboration Tobacco Control (ECCTC) model was developed by adopting a societal perspective, including productivity impacts.

Study type: Economic simulation modelling Methods: A multi-health state Markov cohort microsimulation model was constructed. The population was the Victorian smoking population in 2018. The effectiveness of the Victorian Quitline was informed by an evaluation and compared with no service. Risks of developing disease for smokers and former smokers were obtained from the literature. The model calculated economic measures, including average and total costs and health effects; incremental cost-effectiveness ratios; and net monetary benefit (NMB) for both the healthcare and societal perspective. An extensive uncertainty analysis was conducted.

Results: The Quitline service is cost-effective and dominant from both healthcare and societal perspectives, reducing costs with greater health benefits compared with no service. The expected incremental NMB was $2912 per person from the healthcare perspective and $7398 from the societal perspective. Total cost savings were $869 035 of healthcare costs, $1.1 million for absenteeism, $21.8 million for lost workforce participation, and $8.4 million for premature mortality, with a total reduction in societal costs of $32.2 million, over the 80 year timeframe of the model. Probabilistic sensitivity analysis suggested a high degree of certainty in these results, and overall conclusions were robust to one-way sensitivity and scenario analyses.

Conclusions: The Victorian Quitline service is cost-effective and should be retained and expanded where possible. The ECCTC model can be adapted to analyse the cost-effectiveness of other tobacco cessation interventions, populations and contexts.