Australian Health Review最新文献

Objectives To examine: the impact of the coronavirus disease 2019 (COVID-19) pandemic on access to health services by middle-aged and older Australians; and the use of telehealth services during the COVID-19 pandemic and its ongoing usefulness. Methods A cross-sectional survey was conducted among participants who completed the COVID-19 supplement in the 45 and Up Study 2020 Survey. Multivariable logistic regression analysis was used to examine the association between socio-demographic characteristics and health conditions with missed/delayed access to health services, changes in health outcomes resulting from missed/delayed access, and use of telehealth services. Results Data for 45 071 participants were analysed (56% female, 72% aged ≥65 years). Almost half (42.2%) reported they had missed/delayed access to health care due to COVID-19; mainly for dental services (26.1%), visits to a general practitioner (GP) (16.3%) and specialists (12.6%). Missed/delayed visits to GPs and specialists were more likely among females, participants from non-English-speaking backgrounds, with disability/illness, living in outer regional/remote areas or with chronic health conditions. People with a disability or high/very high psychological distress were twice as likely to report worse health as a result of missed/delayed care. Half (48.0%) the study participants used telehealth during the COVID-19 pandemic and 81.9% indicated telehealth would be useful post-pandemic. Conclusions The COVID-19 pandemic impacted access to healthcare services, particularly for people with a disability, and chronic or mental health issues who also reported worse health. This may account for their higher use of telehealth services as an alternate way of accessing health care. Ongoing evaluation of telehealth services for vulnerable groups post-pandemic is required.

Objectives We set out to examine the volume, scope and quality of research related to First Nations peoples' perceptions of, and experiences with, child rearing and/or parenting programs. Methods We systematically reviewed the literature published between 2000 and 2020. Sixty-eight studies identified through electronic databases and references lists met inclusion criteria. Results The study found an 8% increase in publications in the field each year (P -value = 0.002), mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n  = 29, 41%). Scope included positive and negative experiences relating to: parenting from adult (n  = 19 studies) and teenager (n  = 4) perspectives; and pregnancy, antenatal and postnatal care from the perspective of adults (n  = 23) and teenagers (n  = 2). Descriptive studies included qualitative (n  = 40; 58%), quantitative (n  = 8, 12%) or mixed methods (n  = 7, 10%). Thirteen experimental studies reported the development, acceptability and/or effectiveness of programs (19%), of which three met the Cochrane Effective Practice and Organisation of Care design criteria. Conclusions Despite an overall increase in volume, research efforts do not demonstrate a clear scientific progression. Further methodologically rigorous studies examining child rearing and/or parenting programs developed in collaboration with First Nations populations are needed.

Objectives This study sought to describe the patterns in emergency department (ED) presentations and hospital admissions in children with Ambulatory Care Sensitive Conditions (ACSCs) before and during the coronavirus disease 2019 (COVID-19) pandemic restrictions in Victoria, Australia, to assess if changes in out-of-hospital care resulted in an increase in delayed/severe presentations. Methods This study involved secondary analysis of Victorian Emergency Minimum Dataset and Victorian Admitted Episode Dataset data. Patients (<18 years) attending EDs with a diagnosis of an ACSC were included. We compared the number and severity of ASCS presentations pre-COVID-19 (1January 2018-27 March 2020) and during COVID-19 (28 March-31 October 2020). A linear regression prediction model was built to compare the observed versus predicted presentation number in the 2020 period. Results In total, there were 108 104 paediatric ACSC ED presentations in Victoria during the study period. Females accounted for 51 462/108 104 (47.6%) of all presentations, with a median age of 3 years. A significant decrease in ED presentations was seen in 2020 (41 319 in 2018; 44 978 in 2019; and 21 807 until October 2020), predominantly due to reductions in conditions that are typically mediated by viruses in childhood (i.e. asthma, convulsions/epilepsy and ear, nose and throat conditions). The proportion of high-urgency presentations and those requiring admission was stable in 2020. Conclusions An overall reduction in the number of ED presentations and admissions with paediatric ACSCs was seen in Victoria in 2020, indicating that rates of delayed or more severe presentations did not occur as a result of changes in out-of-hospital care.

The pandemic has amplified the health needs of Aboriginal and Torres Strait Islander peoples and influenced the way primary care services are delivered. The purpose of this critical perspective is to explore the research on person-centred care (PCC) that has been conducted during the pandemic, with a contextual focus on care delivered by general practitioners (GPs) to Aboriginal and Torres Strait Islander communities. The pandemic has shown that primary care needs to be flexible, adaptive and innovative to maintain PCC. During the pandemic, general practice teams maintained their focus on the delivery of PCC and adapted routine services. National health care policy and modifications to the Medicare Benefits Schedule supported the delivery of PCC. Evaluation research has shown that funding extensions made during the pandemic increased patient engagement and the delivery of routine services, which supported primary care clinic sustainability. However, the delivery of PCC by GPs in the clinical setting requires time. Adequately funded, longer primary care consultations are needed to enhance PCC and access to services for Aboriginal and Torres Strait Islander peoples.

This case study describes the development and implementation of a replicable early assessment and referral service for mothers experiencing minority group disadvantage and family violence in the perinatal period. The service aims to mitigate harms for at-risk mother-infant dyads that can lead to involvement in statutory child protection systems. In doing this, the service follows a culturally safe, restorative practice approach to supporting vulnerable families, which emphasises the relationship between worker and client to create a nurturing environment for change. The service model has been developed and refined since 2018 to now, involving stakeholders from the service team, the not-for-profit community organisation, and a university partner organisation, who provided evidence enrichment and support for clinical skill development. To date: the model has provided practitioners with structured and evidence-based ways of creating shared understandings with clients to prioritise cultural and relational needs; achieved culturally safe ways of engaging with Aboriginal and Torres Strait Islander and Culturally and Linguistically Diverse families; improved practitioners' confidence in detecting risk in parent-infant relationships; promoted effective communications with external providers; and enhanced therapeutic outcomes for vulnerable families at risk of entry into statutory child protection systems. The model may be suitable for uptake by practitioners and services seeking to improve cultural safety and therapeutic outcomes for diverse and vulnerable families. We share reflections on the scope and function of the model of care with reference to potential for broader application.

The objective of this case study is to evaluate the effectiveness of the Wide Bay region coronavirus vaccination program in preventing hospitalisation for coronavirus disease 2019 (COVID-19). Population vaccination data and the vaccination status of patients hospitalised with confirmed COVID-19 have been used to evaluate preventable hospitalisations and risk reduction during and after a 2 month period following the outbreak of COVID-19 in Wide Bay after removal of public health measures in Queensland in December 2021. Wide Bay is a rural region of Queensland including K'Gari (formerly Fraser Island) to the east, the North Burnett farming region in the west and extending from the Fraser Coast to the Discovery Coast. Two local regional hospitals received and managed hospitalised COVID-19 patients. The region had, at this time, 171 365 people 20 years and older eligible for coronavirus vaccination. The risk reduction for hospitalisation of those receiving fewer than two vaccinations, two vaccinations and three vaccinations was calculated to determine the vaccination program effectiveness. The program achieved 90% effectiveness for people with two or more vaccinations (those with two vaccinations and those receiving boosters of third or more vaccination), and 97% effectiveness for those having received three vaccinations, in preventing hospitalisation for COVID-19 during the period. This translated into a significant risk reduction for hospitalisation for those receiving two or more vaccinations, preserving capacity to enable the health service to manage all cases locally.

We provide an initial, brief description of safe relocation of our emergency surgical services from a tertiary teaching hospital to a satellite secondary hospital during the COVID-19 pandemic. The reconfiguration created increased theatre and critical care bed capacity at the tertiary site, while enabling lower acuity emergency services in a repurposed, designated COVID free hospital. The described model can be applied to situations mandating surge capacity at tertiary hospitals, in high income countries.

As all Australian states now have voluntary assisted dying legislation, and with territories likely to follow, the focus shifts to how these systems are operating in practice and can be improved. Evidence to date shows voluntary assisted dying has been implemented safely, but some access challenges remain. The legislation in each state requires the voluntary assisted dying system must be reviewed and such reviews must be evidence-based.