Australian Health Review最新文献

Objective This case study describes the development and outcomes of a new integrated and multidisciplinary care pathway. Spearheaded by allied health, the 'COVID community navigator team', applied established principles of reverse triage to create additional surge capacity. Methods A retrospective cohort study examined workflow patterns using electronic medical records of patients who received navigator input at the Royal Melbourne Hospital between 20 September 2021 and 20 December 2021. Results There were 437 eligible patient encounters identified. On average patients stayed 4.15 h in the emergency departments (ED) (s.d. = 4.31) and 9.5 h (s.d. = 10.9) in the short stay unit. Most patients were discharged into a 'low risk pathway' with community general practitioner follow up. Of discharged patients, only 38 re-presented to the ED with symptoms related to their initial COVID-19 diagnosis (34.9% of total re-admissions). Of these re-admissions, more than half did not require admission to a ward. Conclusion The findings presented here provide support for the clinical utility of a multidisciplinary reverse triage approach in surge planning for anticipated presentation peaks.

Out-of-pocket healthcare payments are a concern for all, particularly those least able to afford them, a situation only being exacerbated by the current cost-of-living crisis. This article aims to provide an overview of out-of-pocket payments and their impacts on decision-making: whether, or not to delay care or seek care at all. The impact of average out-of-pocket payments on demand for mental healthcare services is provided as a specific example. The available data indicate a positive linear relationship between the average out-of-pocket payments for Medicare services by type of provider, and the proportion of patients who decide not to obtain care from a given type provider. This article also poses that current safety net processes are not consumer centric, the Pharmaceutical Benefits Scheme (PBS) Safety Net particularly so, and that change is required. It is recommended that a consumer-centric approach should be adopted with everyone listed on a Medicare card automatically included in the assessment of the Medicare and PBS Safety Nets and for the PBS Safety Net to be automatically assessed through Services Australia. Links to websites are provided to support individual decision-making and registering for available safety nets. Finally, supply side considerations and their implications for market equilibrium and the economy are briefly overviewed.

Objectives To assess whether compliance with the nationally endorsed Optimal Care Pathways is evident in 75% of patients treated with curative intent treatment and if this compliance was impacted by the COVID-19 pandemic (hereinafter COVID-19). Methods This retrospective study included patients undergoing curative treatment with radiotherapy in head and neck (HN), breast, lung and gastrointestinal malignancies between January 2019 and June 2021 in a single NSW outer metropolitan cancer service. For care delivered within the remit of cancer services, the primary outcome measure was the proportion of patients whose treatment complied with the Optimal Care Pathways recommended time frame. Secondary outcome measures included evaluating the effect of COVID-19 on the proportion of patients being treated within the recommended time frame. Results There were n  = 733 eligible patients across the five tumour streams with the majority being breast cancer patients comprising 65% (n  = 479) of the cohort, followed by HN cancer patients (n  = 125, 17%). None of the tumour subsites abided by the 75% compliance rate. Oesophageal cancer patients had the lowest compliance rate of 4% (P  < 0.001), with a similarly low compliance rate for rectal cancer patients at 33% (P  = 0.002). None of the hypothesis tests to assess for detriment in treatment time during COVID-19 were statistically significant (P  > 0.05). Conclusion Despite the availability of best practice guidelines, there is limited compliance throughout all cancer subtypes, which has not been negatively influenced by COVID-19. Improved awareness of the Optimal Care Pathways, and implementation of the associated infrastructure and systems, are required to support compliance.

Out-of-pocket healthcare payments are a concern for all, particularly those least able to afford them, a situation only being exacerbated by the current cost-of-living crisis. This article aims to provide an overview of out-of-pocket payments and their impacts on decision-making: whether, or not to delay care or seek care at all. The impact of average out-of-pocket payments on demand for mental healthcare services is provided as a specific example. The available data indicate a positive linear relationship between the average out-of-pocket payments for Medicare services by type of provider, and the proportion of patients who decide not to obtain care from a given type provider. This article also poses that current safety net processes are not consumer centric, the Pharmaceutical Benefits Scheme (PBS) Safety Net particularly so, and that change is required. It is recommended that a consumer-centric approach should be adopted with everyone listed on a Medicare card automatically included in the assessment of the Medicare and PBS Safety Nets and for the PBS Safety Net to be automatically assessed through Services Australia. Links to websites are provided to support individual decision-making and registering for available safety nets. Finally, supply side considerations and their implications for market equilibrium and the economy are briefly overviewed.

Objective This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission.

Objective The Child Dental Benefits Schedule (CDBS) was introduced in 2014, and its aim was to support access to dental care for eligible children in Australia. Dental caries, and pulp and periapical diseases were the major dental reasons for children's hospitalisations. This study investigated if the availability of the CDBS had any effects on hospitalisation rates in Australian children. Methods This study was a retrospective analysis of Medicare data from the Australian Government and the hospitalisation data from The Australian Institute of Health and Welfare (AIHW) from 2008 (6 years before the commencement of the CDBS) to 2020 (6 years after the commencement of the CDBS). Results Although the hospitalisation rate trend was reducing before the CDBS started (2008-14), this reduction was not statistically significant. The reduction of hospitalisation rates was higher after the commencement of the CDBS (2014-20) and was statistically significant, but the regression model analysis showed a positive correlation between the CDBS and hospitalisation rate. The analysis without 'abnormal' year data (2019-20, COVID-19 pandemic year) supported no statistically significant decrease in hospitalisation rate after the commencement of the CDBS in 2014 until 2019. Conclusion Although the CDBS is improving access to dental care for eligible children, any possible effects the CDBS might have on hospitalisations are not yet evident.

Optimising junior doctor rosters is a common subject of debate both in Australia and overseas. While total work hours are recognised to increase the risk of fatigue-related complications for both junior doctors and their patients, patterns of work are less commonly described. Multiple low quality evidence recommendations exist to guide rostering practices to reduce predominantly the risk of fatigue-associated error and burnout, but also to avoid disruptions to continuity of care and provide adequate training opportunities. Given available evidence is poor, further centre and specialty-specific studies are required to delineate optimal rostering patterns for Australian junior doctors.

Objective To investigate the reasons patients with non-traumatic musculoskeletal pain (NTMSP) present to an emergency department (ED), their experience of care and perceptions about managing their condition in the future. Methods A qualitative study using semi-structured interviews with patients with NTMSP presenting to a suburban ED. A purposive sampling strategy included participants with different pain characteristics, demographics and psychological factors. Results Eleven patients with NTMSP who presented to an ED were interviewed, reaching saturation of major themes. Seven reasons for ED presentation were identified: (1) desire for pain relief, (2) inability to access other healthcare, (3) expecting comprehensive care at the ED, (4) fear of serious pathology/outcome, (5) influence of a third party, (6) desire/expecting radiological imaging for diagnosis and (7) desire for 'ED specific' interventions. Participants were influenced by a unique combination of these reasons. Some expectations were underpinned by misconceptions about health services and care. While most participants were satisfied with their ED care, they would prefer to self-manage and seek care elsewhere in the future. Conclusions The reasons for ED presentation in patients with NTMSP are varied and often influenced by misconceptions about ED care. Most participants reported that, in future, they were satisfied to access care elsewhere. Clinicians should assess patient expectations so misconceptions about ED care can be addressed.

Objective We aim to examine the activities undertaken by medical and surgical ward nurses at a major health service in Victoria, Australia, to inform nursing and midwifery strategic workforce planning. Methods This descriptive, exploratory study was conducted on 17 wards from three acute care hospitals in one of Victoria's largest health services. The Work Observation Method by Activity Timing tool was used to enable participants to document the time spent in each of 10 nursing activity domains. Results Data from 70 respondents across all shifts showed nurses spent one-third of their time in direct care. Registered nurses spent a lower proportion of time than enrolled nurses in direct care and medications overall. Compared with enrolled nurses, registered nurses spent less time in direct care on morning shifts and documentation on afternoon shifts, and more time on ward-related activities on afternoon shifts. Conclusions Medical and surgical enrolled nurses and registered nurses spent comparable proportions of time engaged in specific activities. Further research is required to understand the influences on the time devoted to direct care and how time spent in direct care intersects with other activities, and the relationship with patient outcomes and quality of care indicators.