Australian health review : a publication of the Australian Hospital Association最新文献

ObjectivesThis study aimed to evaluate the outcomes of Australia's first public hospital all-age Sport and Exercise Medicine Outpatient Clinic (SEMOC).MethodsA retrospective cross-sectional study of patients referred to and reviewed in the SEMOC, during a study period from March to October 2023, was performed. Outcomes were the number of appointments, number of patients reviewed, proportion reviewed within Queensland Health recommended timeframes, patient satisfaction, proportion of Aboriginal and Torres Strait Islander patients, and the rurality of the patients based on the Modified Monash Model of remoteness.ResultsThere were 29 clinics, 472 allocated appointments, and 270 new patients referred to the SEMOC (1.7 appointments per patient). Almost a quarter (23.7%) of patients identified as Aboriginal and Torres Strait Islander peoples and a third (31.9%) were from rural or remote regions. Most (88.7%) patients referred during the study period were seen within the Queensland Health recommended timeframes, and almost all patients referred on for orthopaedic review were booked for surgery (93.6%). Over 90% of patients were satisfied with the quality of treatment they received and rated the overall service as good to excellent.ConclusionA SEMOC public hospital model has been shown to be feasible for providing care to patients with musculoskeletal conditions, reaching patients who face barriers to health care, reducing wait times, and improving referral for surgery. The model may assist in meeting Australia's growing demand for orthopaedic and musculoskeletal medicine and expand within Australia's public hospital system to become a nationally accepted practice.

ObjectiveThis study aimed to examine group-based trajectories of hospital service use by people with chronic kidney disease (CKD) in the last 12months of life.MethodsA retrospective cohort study was conducted using hospital admission and mortality data in New South Wales, Australia. Individuals aged ≥18years who were hospitalised during 2014-2021 and who died during 2015-2021 were included. A group-based trajectory analysis was conducted including all-cause admissions and unplanned-only admissions. Multinomial logistic regression examined predictors of trajectory group membership.ResultsThere were 10,653 adults who had at least one CKD hospital admission 12months prior to death. Four group-based trajectories of hospital service use were identified for all-cause admissions (i.e. Very-Low, Low, Moderate, High) and three group-based trajectories for unplanned-only admissions (i.e. Low, Moderate, High). The study identified associations between frequent hospitalisations and key patient characteristics and health conditions. Individuals in the High hospitalisation group were more likely to have cancer (OR 4.55; 95% CI: 2.54-8.16). Additionally, the High unplanned hospitalisation group showed increased likelihoods of being adults aged 18-64years (OR 1.94; 95% CI: 1.32-2.84) and having diagnosis of congestive heart failure (OR 1.80; 95% CI: 1.26-2.55), cancer (OR 2.25; 95% CI: 1.49-3.40), mental disorders (OR 1.88; 95% CI: 1.35-2.62) or smoking (OR 2.01; 95% CI: 1.49-2.70) compared with the Low hospitalisation group.ConclusionsGroup-based trajectory analysis revealed specific patterns in hospital service usage. Understanding these patterns helps in devising targeted strategies to decrease unplanned hospitalisations among these high-risk patients.

ObjectiveRecording consultations can benefit patients and healthcare providers, but advantageous recording practices are dogged by legal concerns. In Australia, relevant laws are poorly understood. We postulate that local policies are more important than law in guiding consultation recording. This study aimed to describe the availability and content of consultation recording policy in Australian hospitals.MethodsWe conducted a scoping review utilising JBI methods and our previously published protocol. We collected policies from Australian hospitals (April-October 2023) about the audio/video recording of patients, providers or others within the hospital. We reported findings descriptively and analysed policies' alignment with the law.ResultsOf the 43 hospitals examined, 17/43 (40%) had relevant policies, 17/43 (40%) had a partial policy and 9/43 (21%) had no policy. Policies were usually difficult to find and were stricter than relevant law.ConclusionsWhen patients want to record their appointments, it can be hard to identify relevant hospital policy. Policies generally weigh against consultation recording and are more restrictive than Australian law allows. These results indicate that healthcare services should develop clear, readily available policies on recording, balancing patients' and providers' interests.

ObjectivePatients who do not wait (DNW) to be seen are a problem for emergency department (ED) care. The aim of this study was to identify the rate and reasons of DNW patients during 1month of the COVID-19 pandemic.MethodsAn observational cohort study of DNW patients presenting to Austin Hospital ED was carried out in August 2021. Patients were identified using hospital coding data and surveyed by telephone. DNW patients' reasons were explored, and their demographics and clinical outcomes compared with those who received care.ResultsOf 7641 patients presenting to ED in the study period, 6% (n=452) were DNW patients. Compared with those who received care, DNW patients were younger (P<0.001), had lower triage categories (P=0.001) and were more likely to have self-presented (P=0.006). A total of 47% of DNW patients (n=213) participated in the survey. Reasons for leaving included waiting time (61%, n=129), symptom improvement (13%, n=28), reassurance from staff (7%, n=15) and ED crowding (6%, n=12). A total of 75% of DNW patients (n=159) sought alternative medical care; 14% (n=29) reported hospitalisation within 7days. 64% (n=137) did not feel that the experience affected their likelihood of seeking future ED care; 32% (n=69) felt less likely to seek future ED care.ConclusionsDuring the month studied, the DNW rate was 6%. Reassuringly, most patients sought alternative medical care, although one-third were dissuaded from returning to the ED. Future research should focus on high-risk group delineation and qualitative description of the experiences and reasons of DNW patients.

The Australian Podiatry Board's proposal to change the title 'podiatric surgeon' to 'surgical podiatrist' lacks evidence and is contrary to broader healthcare reform agendas. The current title 'podiatric surgeon' reflects scope of practice. Instead of a title change, regulators should focus on removing barriers to effective collaborative care.

BackgroundMany residents of shared supported disability homes (sometimes referred to as group homes) require assistance from staff to manage their medicines. Disability support workers in Australia often call a 24-h emergency poisons information service for advice following a medication incident.ObjectiveTo describe the number, type and timing of medication incident calls to the Victorian Poisons Information Centre from supported disability homes in Victoria, Australia.MethodsThis was a retrospective audit of poisons centre calls from supported disability homes over a 3-month period (October to December 2021). Incidents not related to therapeutic medication use, including deliberate self-poisoning, were excluded. Calls were categorised by incident-type, time-of-call and risk of an adverse event (low/moderate/high) based on the type of medicine involved.ResultsA total of 391 medication incident calls were included (mean 4.3 per day). The most common incidents were missed doses (n=145/391, 37%) and accidental overdoses (e.g. double-dose) (n=80/391, 20%). Most calls to the poisons centre (n=284/391, 73%) were received outside business hours (before 9am or after 5pm). For incidents where the medicine(s) were known (n=326), a moderate-risk medicine (most commonly an anticonvulsant or antipsychotic) or high-risk medicine (most commonly an anticoagulant or opioid) was involved in two-thirds of cases (n=217, 66.6%).ConclusionsCalls to an emergency poisons information service about medication incidents were common, and were mostly outside business hours. Nearly half of the calls were about incidents unrelated to poisoning or toxicology, including missed doses. The study highlights a gap in medication management support for residents and disability support workers, especially after-hours, that needs to be addressed.

ObjectiveResearch capacity in health care involves the ability to conduct, access, evaluate, and apply research evidence and results in elevated quality of care. Despite its significance, mental health organisations face challenges in assessing and enhancing their research capacity. This study aimed to evaluate the research capacity and culture within a large metropolitan health service's Mental Health and Wellbeing Program (MHWP).MethodsA cross-sectional, observational study using the Research Capacity and Culture (RCC) tool was conducted among approximately 1081 MHWP employees. An online survey recorded staff views on research readiness, interest, motivators, and barriers.ResultsOf 220 survey entries, 100 were completed. The majority were female (n=68), under 40years old (n=51), and employed full-time (n=54). The highest RCC domain score was for organisational culture. Half of the respondents thought research was not part of their role, yet 70% wanted more involvement. Motivators included skill development, while barriers included a lack of time and funds.ConclusionsThe findings emphasise the need for targeted strategies to enhance research culture at the individual level. However, opportunities also exist at the team and organisational levels. The study provided insights that can guide future interventions and capacity-building initiatives.

ObjectiveAllied health workforce planning faces challenges because of insufficient metrics that accurately reflect population need for services. This paper presents a method and proof-of-concept in the podiatry profession for developing population-based need indicators and indices suitable for allied health workforce planning and comparative benchmarking.MethodsPopulation-based indicators of podiatry need were selected and combined into an index of need by Statistical Area Level 3 (SA3) in Australia. Medicare patient age and sex distributions for relevant item numbers were used to determine the inclusion of specific population age groups and sex as indicators. Other indicators included diabetes, socioeconomic status, and Aboriginal and Torres Strait Islander status. The need index was calculated based by aggregating these indicators at the SA3 level. The resulting need index was compared with podiatry supply (per capita clinician counts) using a population-weighted correlation coefficient (pwCorr).ResultsAnalysis of Medicare usage data led to the inclusion of indicators: population aged 65 and over, and female gender. The need index had a small but significant negative correlation with supply at the SA3-level (pwCorr =-0.12, P=0.03) and positively, but not significantly, correlated at the state/territory-level (pwCorr=0.42, P=0.30).ConclusionsDeveloping profession-specific population-based need indices provides a valuable tool for allied health workforce planners to benchmark need and supply within professions. Combining single need indicators with supply metrics offers a concise framework for effective workforce planning and advocacy.

Objective'Placement poverty' refers to the financial burdens imposed upon students by the completion of mandatory professional placement. We aimed to identify the financial implications of mandatory professional placements on student wellbeing.MethodsA cross-sectional online survey (August 2023 to January 2024) completed during students' most recent professional placement in the final year of their degree. Eligible participants were health or teaching students studying at Australian and New Zealand universities in degrees requiring mandatory professional placement. Questions included total and accommodation costs, financial support, impact of finances on placement preferences, presence of food insecurity, and implications for student wellbeing.ResultsParticipants (n=530) were mostly health professional (65%) students (median, 25; interquartile range (IQR), 22-30 years, 95.3% domestic, 88.3% full time, 2.0% New Zealand). Health students had higher total costs (in Australian dollars) for the recent placement ($1500; IQR, 600-3453) compared to teaching students ($1200; IQR, 600-2757) (P=0.02), likely due to longer placement duration (6weeks for health students). A higher proportion of health students required financial support (P=0.0001). Placement preferences were always or sometimes (63.8%) determined by cost rather than learning opportunity. Food insecurity was experienced by most students (70.2%) (10.4% marginal, 32.1% moderate, 27.7% severe), with no difference by degree type. Thematic analysis identified themes of burnout, emotional distress, inability to focus on learning, postponing care of oneself, urgent need for financial support, unanticipated family and other circumstances, and worsened societal inequity.ConclusionsOur study identified widespread financial difficulty in students undertaking placement that adversely impacted personal wellbeing. Strategies are needed to support wellbeing and ameliorate the financial burden.

ObjectiveEnsuring equitable access to clinical trials for children from Indigenous and ethnically and linguistically diverse backgrounds should be central to clinical trial design. This review aims to expansively review the reporting of Indigenous status (Aboriginal and/or Torres Strait Islander origin), ethnicity, culture, location, language and country of birth in paediatric clinical trials with Australian sites.MethodsThis scoping review systematically searched PubMed, CINAHL and Embase for international clinical trials with Australian sites conducted between 2018 and 2022 involving children (aged <18years) to determine the reporting of Indigenous status, race, ethnicity, language and country of birth.ResultsOf the 262 studies included, 154 (58.8%) clinical trials did not report any of the variables of interest. When reported, terms used by authors were heterogeneous. 'Indigenous status' was most reported (n=40, 15.3%) and self-identification was the most common method to determine this (n=14, 35.9%). International clinical trials had higher rates of reporting for ethnicity, cultural background and race. Overall, more than 60 terms were used to categorise study participants in relation to 'Indigenous status', 'ethnicity and cultural background', 'race', 'race and ethnicity' or 'natural skin colour'.ConclusionsThis review demonstrated low rates of reporting of demographic variables in paediatric clinical trials. Clear reporting standards, partnering with consumers to co-design trials and self-identification during collection are required. Ensuring adequate access to clinical trials for Indigenous children and children from ethnically, linguistically and geographically diverse backgrounds is essential in building health equity and ensuring patient safety.