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

Objective: Directly influenced by hospital-related factors, potentially avoidable unplanned readmissions (PAURs) offer a more actionable indicator of care quality and safety than unplanned readmissions. Direct costs of PAURs are scarcely reported. This study estimates the direct costs of PAURs within 30 days of discharge and identifies factors associated with higher unplanned readmission costs.

Methods: We retrospectively analysed hospitalisation data for all adult general medicine patients discharged alive from a South Australian hospital between 1 July and 30 September 2022 and readmitted to any state public hospital within 30 days. A panel of senior clinicians evaluated PAURs using pre-defined criteria. Costs were estimated using the National Hospital Cost Data Collection and inflated to 2024 Australian dollars. Predictors of cost were identified using a generalised linear model.

Results: Of 375 readmitted patients, 78 readmissions were classified as PAURs. The total unadjusted unplanned readmission cost was $4,720,869, with PAURs accounting for $897,932 (19%). Mean costs were $11,512 (s.d. = $14,329) for PAURs and A$12,872 (s.d. = $19,089) for non-PAURs (P = 0.45). Readmission costs were higher among patients with congestive heart failure and chronic kidney disease (both P < 0.05). Adjusted mean cost per unplanned readmission (both PAURs and non-PAURs) was $13,703 (s.e. = $1112). PAURs were associated with a $3982 cost reduction (P = 0.037). Prior emergency department visits reduced costs (P = 0.017), whereas smoking (P = 0.043) and index admission length of stay (P < 0.05) increased costs.

Conclusion: PAURs imposed substantial costs but were less expensive per admission than non-PAURs. Higher costs were observed among patients with congestive heart failure, chronic kidney disease, smoking, and longer index admissions. System-level transitional care strategies with targeted case management for high-risk, high-cost patients may enhance continuity of care, reduce readmission-related costs, and support more strategic resource allocation across the public healthcare system.

Objective: This study aimed to identify practitioner awareness of and adherence to clinical practice guidelines for Indigenous peoples with otitis media in Australia.

Methods: Database searches were conducted in Medline, Embase, APA PsychInfo, Scopus, Web of Science Core Collection, Academic Search Premier, and CINAHL. Studies were eligible for inclusion if they reported on practitioner awareness of or adherence to clinical practice guidelines for otitis media management for Indigenous peoples in Australia. Search terms included 'Indigenous peoples', 'otitis media', and 'guidelines'.

Results: Four peer-reviewed studies published between 2007 and 2020 met eligibility for inclusion. This review identified three key concepts: (1) practitioner awareness rates for the Therapeutic Guidelines were significantly higher than for the 2001 OM Guidelines, (2) practitioners self-reported higher adherence to the Therapeutic Guidelines compared with the 2001 OM Guidelines, and (3) antibiotic prescriptions for Indigenous children varied, possibly due to use of different guidelines and adherence criteria, as well as variations in geographical areas and settings.

Conclusions: Practitioner adherence to clinical practice guidelines specific for Indigenous peoples with otitis media is critical to ensuring a consistent impact and, by extension, closing the gap in related life outcomes for Indigenous peoples in Australia. It is important to evaluate guideline impact through establishing current practitioner adherence rates. Furthermore, increasing awareness of culturally appropriate research approaches and availability of evaluation tools, such as the Aboriginal and Torres Strait Islander Quality Appraisal Tool, should improve the conduct of future Indigenous research.

Objective: International medical graduates (IMGs) are vital for addressing Australia's healthcare shortages but face significant barriers. This review aims to update evidence on their challenges, assess progress since the 2012 Lost in the Labyrinth report, and propose new actions.

Methods: This systematic scoping review focuses on literature from 2001 to 2025 in the databases of PubMed, Embase, Scopus, Web of Science, and Cochrane, including articles that reported quantitative or qualitative research or data analyses, opinion papers, and editorials. The study adapts the Health Systems Strengthening Framework to synthesise findings, with an emphasis on the Lost in the Labyrinth's recommendations.

Results: Fifty-four studies revealed persistent challenges, including supervision gaps, governance issues, financial burdens, visa inequities, and accreditation barriers. Emerging issues involved regulatory inefficiencies, insufficient support, and inequitable job access. Continuing strategies focus on supervision and workplace-based assessments (WBAs), and new recommendations propose shadowing programs, policy buffers, leadership reforms, mental health support, and equitable benefits. Despite progress, challenges persist in service delivery and equity. Six new recommendations emphasise government leadership, scalable assessments, and targeted support for an inclusive healthcare system.

Conclusions: Significant challenges remain in IMGs' registration and integration, particularly in service delivery and workforce equity. Six new recommendations complement the Lost in the Labyrinth recommendations, underscoring the need for consistent government leadership, scalable WBA, and targeted support for an inclusive, sustainable healthcare system.

Objective: Australia has a critical shortage of general practitioners (GPs). A third of the profession are expected to leave within the next 5 years, and recruitment initiatives have been insufficient to address the gap. Female GPs practice differently to their male colleagues and seem to be reducing their clinical work at higher rates. The aim of this study was to explore the reasons why they are leaving, so that Australian communities are better able to attract and retain their expertise and capacity.

Methods: The study used a narrative methodology with an online survey method. We recruited female GPs who were retiring or reducing their clinical workload by at least 50% and used descriptive, comparative and open-ended questions. The survey explored the way physical, emotional, social, financial and occupational wellbeing influenced their decisions to: become GPs, remain in general practice, choose to leave and consider returning.

Results: There was rapid uptake with 770 eligible participants completing the survey within a month. The cohort was broadly representative of the female GP population, in age, experience and geographical distribution. Female GPs expressed a deep commitment to their patients and communities, but described financial, social and occupational barriers to care that were physically, mentally and morally harmful. GPs felt 'targeted' by politicians and policy makers who treated them with 'malignant disregard'.

Conclusions: Female GPs describe unsustainable working conditions that prevent them from working in a profession they love. Rebuilding trust will be a core task if this critical workforce is to be retained.

Objective: To establish a dataset of the speech pathology workforce in the Australian Capital Territory, addressing gaps in workforce data caused by the absence of National Registration and Accreditation Scheme regulation.

Methods: A 21-question online survey was adapted and distributed by subject matter and health workforce experts, based on existing workforce survey data for National Registration and Accreditation Scheme regulated allied health professionals, and previous allied health and speech pathology workforce surveys in other Australian health jurisdictions. Descriptive statistics and regression analysis were performed to examine the relationship between demographic and employment characteristics.

Results: The survey revealed an emerging speech pathology workforce requiring structured supervision and support, that is inequitably distributed across the Australia Capital Territory. The collected demographic and basic employment characteristics of speech pathologists in the Australian Capital Territory were largely consistent with 2021 Census data and Speech Pathology Australia estimates. The survey provided greater granularity of speech pathology workforce data that aligns more closely with datasets used for other AH professions under the National Registration and Accreditation Scheme.

Conclusions: This research has established a purpose-built dataset of the speech pathology workforce in the Australian Capital Territory. The granularity of this data can better inform workforce planning for speech pathology and other allied health professions not covered by the National Registration and Accreditation Scheme. A public online register based on this framework for speech pathologists and allied health professions would enhance the understanding of critical workforce dynamics over time and allow more robust planning of the allied health workforce.

Objectives: The Guided Self-Determination (GSD) method is an evidence-based life-skill intervention program that involves self-directed and shared decision-making between people with an ongoing health issue and GSD-trained healthcare practitioners. Type 2 diabetes (T2D) is a significant contributor to disease burden for Aboriginal and Torres Strait Islander peoples. This paper describes the process of developing a co-designed, culturally tailored GSD program to improve diabetes self-management and wellbeing for Aboriginal and Torres Strait Islander peoples.

Methods: Two co-design workshops were held with Aboriginal peoples with lived experience of T2D, in conjunction with healthcare practitioners.

Results: The participants' feedback highlighted the need for plain language and pictorials; using respectful Indigenous language terms; the importance of emphasising successful diabetes management; the inclusion of mind mapping; and the use of strengths-based yarning as the foundation of the program.

Conclusions: The importance of tailoring communication methods to fit the cultural and linguistic context for Aboriginal people was integral to participants. Using less medical and technical language and including diagrams, drawings or symbols ensured that the information was accessible. By aligning language and communication styles with that of Aboriginal people, healthcare practitioners can help ensure that their messages are valued and understood. In the next phase of the project, the effectiveness of the co-designed GSD program will be evaluated using diabetes self-management and quality of life measures. In addition, the feasibility and acceptability of the GSD program will be explored.

Objective: This study aimed to examine peripheral intravenous catheter (PIVC) policies across Queensland public health services, their underpinning evidence, and alignment with the 2021 Australian PIVC Clinical Care Standard.

Methods: A document review and analysis of public state and health service PIVC policies, procedures, and guidelines across Queensland was performed. Data were extracted using standardised forms, collated, reviewed, and compared for each health service and the state overall. Document characteristics and underpinning evidence (e.g. references, supporting resources, alignment with the 10 PIVC Standard Quality Statements) were analysed descriptively. Binary adherence (yes adherent, no not adherent, other) was assessed for the 10 PIVC Standard Quality Statements.

Results: Documents included 17 health service procedures, one protocol, and one statewide guideline (total n = 19), released between 2015 and 2024. Most were PIVC-specific (90%), and four had exceeded their planned update timepoint. Three had no references, but had supporting resources described, whereas one document had both. One provided neither references nor supporting resources. All documents had hyperlinks to other internal and/or external resources. Of 15 released after Standard publication (post-2021), 13 (86.7%) referred to the Standard. No individual document adhered to all 10 Standard Quality Statements. None of the Quality Statements were met by all documents (adherence range 0-95%).

Conclusions: Many PIVC policies lacked a strong evidence framework and did not align with the minimum level of care expected in Australia. This likely impacts the quality of clinical care and patient outcomes. There is an urgent need for rationalisation and system-wide standardisation of policies to reduce variation and ensure clinical standards are met.

Background: Increased global attention on enhancing the support available for critical care survivors to improve their health outcomes has led to an exploration of the integration of care between intensive care and primary care. The satisfaction of the experience between critical care survivors and their general practitioner (GP) remains unknown.

Objectives: To determine how satisfied Australian critical care survivors are with their GP and general practice experience.

Methods: A prospective multi-centre observational cohort study of adult intensive care unit patients was completed across three tertiary hospitals in Victoria, Australia. Adult intensive care unit survivors who were mechanically ventilated for >24 h were eligible for inclusion. The primary outcome measure was the frequency scores of the General Practice Assessment Questionnaire domains. The General Practice Assessment Questionnaire is a 35-item survey measuring the domains of general practice reception, access, continuity of care, communication, enablement and overall satisfaction.

Results: A total of 51 participants were recruited. Of these, 98% reported having a preferred GP, 96% reported confidence and trust in their GP and 88% would recommend their clinic to new patients. High satisfaction was reported across all General Practice Assessment Questionnaire domains.

Conclusions: Survivors of critical illness report high satisfaction in their experience with their GP and general practice from participants from socioeconomically diverse areas.

Objective: Spinal surgery rates in Australia continue to rise despite limited evidence for their effectiveness in managing uncomplicated chronic back pain. This study examined patient-level factors that influence willingness to undergo surgery, to informing future work promoting non-surgical care pathways.

Methods: We conducted a cross-sectional online survey in March 2025 of 152 privately insured Australian adults with chronic low back pain. Participants reported pain characteristics, functional interference, prior imaging and pain-related beliefs (expectations of recovery, self-efficacy and catastrophising). Willingness to undergo spinal surgery within 5 years was assessed on a 5-point scale, and dichotomised into 'willing' (3-4) and 'unwilling' (0-1); respondents answering 'unsure' were excluded. Logistic regression examined predictors of willingness to consider surgery.

Results: Of 152 participants (mean age 59.3 years, 64% female), 24% expressed willingness to undergo surgery. Negative pain beliefs, higher pain intensity and younger age significantly predicted willingness, with the strongest effect seen for negative pain beliefs (OR 2.62, 95% CI 1.16-5.92, P = 0.02). Functional interference, imaging history and gender showed positive, but non-significant, associations.

Conclusion: Negative pain beliefs predict willingness to undergo spinal surgery. This finding has important policy implications, suggesting that addressing belief-driven demand may help reduce the economic burden of surgery by directing patients towards guideline-based, high-value, non-surgical care.

Objective: This study aimed to systematically map the scope, focus, and distribution of Queensland's health workforce (HWF) policies and examine their alignment with strategic HWF objectives.

Methods: A descriptive policy review was conducted using documents sourced from the Queensland Health and Health Workforce Queensland websites between January and May 2025. Documents were coded by policy type (system-level, individual-level, employment), document type, strategic domain (supply, distribution, performance), health profession, policy author, and publication year.

Results: A total of 275 policy documents were identified. Among 11 major policy groupings, most policies related to 'general HWF' and 'medical doctors and specialists' with minimal policy attention to pharmacists, physician assistants, paramedics, and aged care workers. Employment-focused policies accounted for 52% of all documents, compared with 38% focused on individual career development and only 10% on system-level strategic objectives. Most documents addressed workforce performance (65%), with fewer addressing supply (39%) or distribution (11%). Employment policy documents were largely authored by human resources and industrial relations bodies, reflecting the prominence of these actors in the HWF policy landscape.

Conclusions: Despite a high volume of HWF policy in Queensland, the policy architecture is fragmented. Profession-specific siloes, a strong emphasis on employment and industrial policy, and uneven focus across supply, distribution and performance domains suggest coordination and alignment challenges when it comes to addressing broader workforce goals. Further work is needed to understand whether and how these patterns may constrain the development of integrated, equitable workforce strategies capable of addressing persistent system-wide planning issues such as skills mix, retention and rural maldistribution.