Australian Health Review最新文献

Diagnostic error affects up to 10% of clinical encounters and is a major contributing factor to 1 in 100 hospital deaths. Most errors involve cognitive failures from clinicians but organisational shortcomings also act as predisposing factors. There has been considerable focus on profiling causes for incorrect reasoning intrinsic to individual clinicians and identifying strategies that may help to prevent such errors. Much less focus has been given to what healthcare organisations can do to improve diagnostic safety. A framework modelled on the US Safer Diagnosis approach and adapted for the Australian context is proposed, which includes practical strategies actionable within individual clinical departments. Organisations adopting this framework could become centres of diagnostic excellence. This framework could act as a starting point for formulating standards of diagnostic performance that may be considered as part of accreditation programs for hospitals and other healthcare organisations.

Objective A significant proportion of Australians defer or do not fill prescriptions they require due to cost. This article explores whether, and under what circumstances, physicians have a duty to assist these patients by disclosing how they can access more affordable medicines via personal importation. Methods This study involved a critical examination of Australian statutory and case law pertaining to physicians' duty to disclose material information to identify key principles applicable to the context of cost-motivated personal importation. Results There are several legal principles that suggest that physicians have a duty to advise patients of options for accessing more affordable medicines, including via personal importation. These include a duty to warn of inherent and non-inherent risks, a duty to disclose treatments that offer clear advantages, and a duty to facilitate access to the means for achieving patients' health goals. However, it is unclear whether, and on what grounds, responsibility for harm arising from a patient's inability to afford prescribed medicines should be attributed to the prescribing physician. Arguments supporting attribution of such a responsibility are proposed to motivate further legal, policy and ethical debate. Conclusions Physicians have a duty to take reasonable steps to mitigate foreseeable harm to their patients, however the law is silent on whether this duty extends to taking steps to help patients access medicines that they can afford. This investigation provides a framework to guide the development of sound policy and law on informed financial consent and economically motivated prescribing.

Objective To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009-10 and 2021-22. Method We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Schedule (MBS) program. All dollar figures are expressed in constant 2021 Australian dollars. Results Radiotherapy and nuclear therapeutic medicine MBS claims increased by 78% whereas MBS funding increased by 137% between 2009-10 and 2021-22. The main driver of Medicare funding growth has been the Extended Medicare Safety Net, which has increased by 404%. Over the 13 year observation period, the percentage of bulk-billed claims peaked in 2017-18 at 76.1% but fell to 69.8% in 2021-22. For non-bulk billed services, average OOP costs per claim increased from $20.40 in 2009-10 to $69.78 in 2021-22. Conclusion Despite increased Medicare funding, patients face increasing financial barriers to access radiation oncology services. Policies with regard to funding radiotherapy services should be reviewed to ensure that services are easily accessible and affordable for all those needing treatment and at a reasonable cost to Government.

Objectives There is limited evidence regarding the effectiveness of transition care programs (TCP) in improving health-related outcomes and discharge destination for older adults. This study aimed to (i) identify changes in health-related outcomes in older adults undergoing a facility-based TCP between admission and discharge; and (ii) compare health-related outcomes between participants discharged home and those discharged to permanent residential care. Method A prospective, observational study was conducted with older adults aged ≥60 years who participated in a facility-based TCP that provided short-term rehabilitation including mobility training, group exercise and cognitive activities. Physical, cognitive and social outcomes were measured at admission and discharge. Data were analysed using linear mixed modelling. Results Of the 41 participants (mean age 80.1 (±8.9) years), 26 (63.4%) were discharged home compared with 14 (34.2%) to residential care. Participants showed statistically significantly improvement in performance of activities of daily living (ADL), mobility and health-related quality of life, with a statistically and clinically significant decline in performance of instrumental ADL. Participants discharged home had statistically and clinically significant greater improvement in mobility compared with those discharged to residential care (de Morton mobility index: home, 13.6 (95% CI: 9.8, 17.4) vs residential, 6.9 (95% CI: 1.7, 12.0), P interaction  = 0.04) and statistically and clinically significant less decline in instrumental ADL (Lawton's scale: home, -0.8 (95% CI: -1.3, -0.2) vs residential, -2.1 (95% CI: -2.9, -1.4), P interaction  = 0.002). Conclusion Older adults participating in a facility-based TCP had improvements in physical, cognitive and social functional abilities. However, those who returned home still had residual mobility deficits and decreased performance of instrumental ADL when compared with normative community level recommendations, which could impact on longer term community living. Further research investigating which program service components could be modified to further improve rehabilitation outcomes could benefit older adults in returning and remaining at home.

Objective Nursing workplace injuries related to staff-assisted patient/resident movement occur frequently, however, little is known about the programs that aim to prevent these injuries. The objectives of this study were to: (i) describe how Australian hospitals and residential aged care services provide manual handling training to staff and the impact of the coronavirus disease 2019 (COVID-19) pandemic on training; (ii) report issues relating to manual handling; (iii) explore the inclusion of dynamic risk assessment; and (iv) describe the barriers and potential improvements. Method Using a cross-sectional design, an online 20-min survey was distributed by email, social media, and snowballing to Australian hospitals and residential aged care services. Results Respondents were from 75 services across Australia, with a combined 73 000 staff who assist patients/residents to mobilise. Most services provide staff manual handling training on commencement (85%; n  = 63/74), then annually (88% n  = 65/74). Since the COVID-19 pandemic, training was less frequent, shorter in duration, and with greater online content. Respondents reported issues with staff injuries (63% n  = 41), patient/resident falls (52% n  = 34), and patient/resident inactivity (69% n  = 45). Dynamic risk assessment was missing in part or in whole from most programs (92% n  = 67/73), despite a belief that this may reduce staff injuries (93% n  = 68/73), patient/resident falls (81% n  = 59/73) and inactivity (92% n  = 67/73). Barriers included insufficient staff and time, and improvements included giving residents a say in how they move and greater access to allied health. Conclusion Most Australian health and aged care services provide clinical staff with regular manual handling training for staff-assisted patient/resident movement, however, issues with staff injuries, as well as patient/resident falls and inactivity, remain. While there was a belief that dynamic in-the-moment risk assessment during staff-assisted patient/resident movement may improve staff and resident/patient safety, it was missing from most manual handling programs.

Objective This study aimed to map the geographic distribution of tertiary hospitals in Australia's most populous cities. Good access to hospital facilities improves the health and welfare of a community. The use of geographic information system (GIS) technology can assist in understanding spacial accessibility to services. Methods Using Quantum GIS, a geodatabase was constructed to incorporate hospital locations and demographic distribution data throughout Australia's 20 most populous cities. Data on the population's age groups were integrated into the geodatabase to investigate the distribution of age groups and their utilisation of access to emergency departments in tertiary public health care. Overall this study reported the geospatial distribution of 89 tertiary hospitals and the demographics of the population in areas around these hospitals. Results The majority of hospitals were located in the three most populated cities of New South Wales (NSW), Sydney, Wollongong and Newcastle, which contain a total of 32 hospitals, with 23 (72%) of the hospitals in Sydney. There were 7.8, 24.0, 53.4 and 81.0% of the population in NSW within 1.5, 3, 6 and 50 km of the hospitals, respectively. The second-highest number of hospitals was in Victoria (n  = 22), with 18 (82%) hospitals located in Melbourne. This was followed by Queensland (n  = 14), with eight (57%) hospitals located in Brisbane. Conclusions The results indicate that 82.2% of the Australian population lives within a 50 km radius of a tertiary hospital, with NSW having higher age distribution percentages than the other states. The results of this study could be used to locate and improve areas of need with a high burden of disease and low accessibility to healthcare services.

Objective To utilise a concept mapping process to identify key opportunities for electronic medical record (EMR) optimisation for allied health professionals (AHPs). Methods A total of 26 participants (allied health managers, clinicians and healthcare consumers) completed the concept mapping process, which included generating statements, and then subsequently sorting all statements into groups, and also ranking each statement for importance and changeability (0 = not important/changeable, 4 extremely important/changeable). Multivariate analysis and multidimensional scaling were then used to identify core priorities for digital optimisation. Results Participants generated 98 discrete statements that were grouped into 13 conceptual clusters. Of these, 36 statements were subsequently determined to fall within the 'green zone' on the Go-Zone plot of importance and changeability (changeability ≥2.44, importance ≥2.79), and formed the set of key optimisation priorities. Clusters with the most items in the Go-Zone plot were 'training and business rules ' and 'service statistics .' Conclusion Concept mapping facilitated identification of 36 key optimisation priorities considered both changeable and important to assist EMR optimisation for AHPs. Addressing these priorities requires action related to end-user skills and training, EMR system capacity, and streamlining of governance and collaboration for the optimisation process.

Objective Early, targeted treatment is critical to recovery and overall health following a work-related illness or injury. Limited research has explored the important dimensions of work-specific injury rehabilitation from both client and staff perspectives. Methods A total of 17 participants (13 clients with work-related injuries, 3 physiotherapists, 1 project manager) involved in a unique program providing allied health treatment in combination with return-to-work services, were interviewed. Data were analysed using reflexive thematic analysis. Results Four themes were generated: (1) a biopsychosocial approach to rehabilitation; (2) a self-paced environment where client outcomes are optimised through transparent and collaborative team processes; (3) comprehensive care aids client recovery and return to work; and (4) a desire for service expansion is hampered by systemic barriers. Conclusions Injured workers and staff provided very positive feedback about the biopsychosocial supports needed for successful return to work, particularly the use of in-house work-specific simulation tasks as gradual in-vivo exposure and collaboration with scheme stakeholders. How to best provide this holistic care within current legislative requirements remains a challenge.

Objective To assess the timeliness of analgesia provided to patients presenting with musculoskeletal conditions, by advanced practice physiotherapists, medical officers and nurse practitioners in two Tasmanian emergency departments. Methods A retrospective case-controlled comparative observational study collected patient data over a 6 month period. Index cases were consecutive cases treated by an advanced practice physiotherapist, with a medical and nurse practitioner cohort case-matched based on clinical and demographic factors. Time to analgesia from initial triage and time to analgesia from patient allocation to health professional groups were analysed using Mann-Whitney U -test. Further assessment comparing between-group differences in access to analgesia within 30 and 60 min of emergency department triage was included. Results Two hundred and twenty-four patients who received analgesia while in the primary care of advanced practice physiotherapists were matched against 308 others. Median time to analgesia for the advanced practice physiotherapy group was 40.5 min compared with 59 min in the comparison group (P  = 0.001). Allocation to analgesia time for the advanced practice physiotherapy group was 27 min, compared with 30 min in the comparison group (P  = 0.465). Access to analgesia within 30 min of presentation to the emergency department is low (36.1% vs 30.8%, P  = 0.175). Conclusion For musculoskeletal presentations in two Tasmanian emergency departments, patients received more timely analgesia when in the care of an advanced practice physiotherapist compared with medical or nurse practitioner care. Further improvements in analgesia access are possible, with time from allocation to analgesia a potential target for intervention.