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

Objective: Queensland implemented a centralised voluntary assisted dying (VAD) pharmacy model to promote safety, consistency and equitable access to VAD substances. In a geographically dispersed state, such as Queensland, a potential concern is whether centralisation affects time-to-delivery (TTD) for patients in regional and rural areas. This audit examined whether differences exist in TTD between South East Queensland (SEQ; metropolitan) and non-SEQ (non-metropolitan) patients, and explored reasons for prescription and visit cancellations to determine whether geographic factors, particularly remoteness, influenced service reliability.

Methods: All VAD substance deliveries between 1 January 2023 and 31 January 2024 were analysed. TTD was defined as the difference between the patient's preferred and actual supply dates. Comparisons were made across region (SEQ vs non-SEQ), hospital and health service districts, and Modified Monash Model categories. Reasons for prescription and visit cancellations were also explored, as these cases were not captured in the TTD dataset if a delivery did not proceed, and may reveal potential geographic barriers for timely access.

Results: Of 911 patients, 723 (83%) received the VAD substance on their preferred date. No statistically significant differences in TTD were observed across region, hospital and health service districts or Modified Monash Model classifications, demonstrating consistent and reliable statewide delivery - an indicator of safety and standardised practice. Cancellations (prescriptions n = 58, visits n = 56) were geographically uniform and most commonly due to patient death.

Conclusions: Queensland's centralised VAD pharmacy enables equity of access and safe delivery of VAD substances regardless of geography, supporting standardised practice and mitigating operational risks through centralised oversight.

Objective: This scoping review aimed to describe current multi-component services and programs with the primary purpose of preventing suicide and self-harming behaviours among adolescents and young adults aged 12-25 years in Australia and summarise evaluations of these initiatives.

Method: A systematic search of Embase, PsycINFO, PubMed, Scopus, and grey literature was conducted to identify relevant publications from 2014 to 2024. Data on identified services and programs were then analysed using a narrative synthesis approach. A quality assessment of evidence was also employed.

Results: The review included six journal articles and six grey literature reports, detailing five different multi-component services and programs. Findings indicated relatively few existing multi-component strategies, with most targeting suicide or suicide and self-harm prevention. No identified multi-component programs focused solely on preventing self-harm. Three programs were delivered in community-based settings, one was web-based, and one was school-based. Common program components included psychoeducational materials/interventions, peer-to-peer support, and professional support/counselling. There was significant variation in how initiatives were evaluated.

Conclusions: The review suggests that there are few multi-component strategies for preventing suicide and self-harm among young Australians. Most of those identified were only introduced within the past 6 years, leaving little opportunity for comprehensive, long-term evaluations. Although available evidence indicates promising results, the scarcity of completed evaluations limits understanding of their overall effectiveness. The absence of multi-component programs specifically addressing self-harm highlights a key gap, emphasising the need for targeted, evidence-based prevention strategies that distinguish between self-harm with suicidal intent and non-suicidal self-harm.

Objective: High levels of patients failing to attend specialist clinic appointments contribute to extended waiting times and the inherent clinical risk related to deferred care. We undertook three separate sub-studies to better understand failure to attend (FTA) drivers.

Methods: An initial quantitative study was performed to identify variables linked to a high FTA rate. A second qualitative study recruited 60 patients to identify barriers and facilitators to clinic attendance. Based on these findings, the following four interventions were evaluated to reduce FTA: (i) increased frequency of SMS messaging, (ii) real-time booking of review appointments, (iii) incorporation of behavioural nudges in SMS messages, and (iv) targeted communications to 'high-risk' FTA patients.

Results: New patients and patients who had previously missed a clinic were at greatest risk of failing to attend. The qualitative analysis identified factors that contributed to high FTA rates. These were incorporated into four FTA interventions that successfully reduced FTA rates, albeit by differing rates (net reduction in FTA ranging from 10.8 to 54.9%).

Conclusion: We described an integrated approach to reduce FTA rates in specialist clinics, thereby improving clinic capacity and reducing the risk of adverse clinical outcomes related to deferred access to care.

Objective: Adaptive leadership has gained attention in health care as a useful framework for navigating increasing complexity and unpredictability. This rapid review examined the application of adaptive leadership in healthcare settings and the associated outcomes.

Methods: The systematic search was conducted in Medline Complete, PubMed, Embase, CINAHL and PsycInfo databases. Articles were included if they were peer-reviewed empirical studies on adaptive leadership in primary and acute healthcare settings that assessed an organisational or individual outcome, and were published between 2010 and 2025.

Results: Fifteen peer-reviewed studies were eligible for inclusion. Several main study designs were present, with one-third being case studies, case reports or case series. Three studies used a cross-sectional quantitative survey and another was quasi-experimental. Adaptive leadership was primarily used as a framework to analyse qualitative data. Two studies applied it as a problem-solving approach and three studies measured it quantitatively. While acknowledging the limitations of drawing causal inferences from case studies and qualitative research, study authors generally interpreted their results as supporting positive effects of adaptive leadership, including its role in: (a) supporting change initiatives and innovation in care planning; (b) improving safety citizenship behaviours, increasing employee engagement and facilitating the identification of process improvements; and (c) enhancing trust, helping patients co-create solutions and learn new skills.

Conclusions: The scarcity of research and diversity of outcomes limits the overall conclusions that can be made regarding the efficacy of adaptive leadership in health care. Further research is required with more rigorous study designs examining direct applications of adaptive leadership.

Objective: This study aimed to identify how telehealth supports access to Voluntary Assisted Dying (VAD) globally and explore potential risks and benefits of telehealth for VAD consultations.

Methods: A systematic review of peer-reviewed articles on telehealth and VAD examining global use of telehealth to support access to VAD, global restrictions to telehealth-enabled VAD, and practical and clinical implications of using telehealth in supporting VAD was performed. PubMed, Embase (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and Scopus were searched and supplemented by handsearching relevant articles. Study quality was assessed using the SQUIRE (The Standard for Quality Improvement Reporting Excellence) guidelines.

Results: Two hundred and thirty articles were identified and then screened by two reviewers. Data were extracted from 26 included articles. Guided by Braun and Clarke's thematic analysis methodology, manual open coding was undertaken, and peer debriefing meetings resulted in the final key themes. Overall, findings indicate that telehealth can facilitate VAD services, enhance patient and provider experiences, and mitigate access inequities. The analysis highlighted that telehealth could further improve VAD access, especially in rural and remote areas. Until then, there are ongoing legal ambiguities for providers in Australia.

Conclusions: Telehealth can improve access to VAD, particularly in remote areas, reducing travel burdens for terminally ill patients. Global evidence from VAD and other sensitive medical fields supports the conclusion that telehealth's benefits outweigh its risks. Legislative clarity in Australia is necessary to resolve conflicts between federal and state laws and to provide clarity for healthcare providers and improve access for eligible patients. Future research should include more robust measures of the efficacy of telehealth.

Objective: Identify factors influencing retention and attrition of physiotherapists in Australia.

Methods: Cross-sectional survey and analysis of 10 years of Australian Health Practitioner Regulation Agency (Ahpra) registration data, involving current or previously registered physiotherapists.

Results: Among participants, 6,045 (80.2%) intended to stay in the profession, 711 (9.3%) were unsure, and 779 (10.3%) intended to leave. Of those intending to leave 87% wanted to leave within one-year. Reasons for leaving included retirement, unsatisfactory remuneration, lack of career advancement, professional dissatisfaction, and mental burnout. Respondents more likely to leave or be unsure included: older physiotherapists (over 50: OR = 1.6, 95% CI = 1.2-2.0), those with fewer than 15 years of experience (OR ~ 2.0, 95% CI ~ 1.1-2.8), males (OR = 1.2, 95% CI = 1.0-1.4), practitioners with further qualifications (OR = 1.2, 95% CI = 1.1-1.4), those without Australian Physiotherapy Association (APA) membership (OR = 1.7, 95% CI = 1.5-2.0), those with non-practising (OR = 12.2, 95% CI = 9.2-16.1), and unregistered practitioners (OR = 39.5, 95% CI = 28.7-54.4). From 2014 to 2023, physiotherapists per 100,000 population rose by 41.6% and the replacement rate (~2.5) remained stable overall, with higher replacement rates among males.

Conclusion: Most physiotherapists intended to stay with registration data indicating strong workforce growth and stable replacement rates over the past decade. However, nearly one in five physiotherapists plan to leave or remain uncertain - most citing retirement, remuneration, career progression, dissatisfaction, or burnout as reasons. Strategies targeting these factors may improve retention.

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 pirivately 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 catastrophizing). Willingness to undergo spinal surgery within five 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 toward guideline-based, high-value non-surgical care.

This policy reflection asks why there is so much attention paid to persons receiving aged and home care at the expense of those in the unpaid economy? Why do some calls for a new initiative for older Australians fall on deaf ears. It answers these questions by presenting an example of failed efforts by a range of key lobby groups for a Senior Dental Benefits Scheme and discusses the differences between a preventive social model of health versus a reactive medical model of health for older Australians.

Objective: The aim of this study was to estimate avoidance of hospital bed-days and the resulting cost savings from a wholistic quality improvement program that was implemented to systematically reduce hospital-acquired complications (HACs) in an Australian local health service between 2018 and 2023.

Methods: This was an uncontrolled retrospective observational analysis of prospectively collected data. An association between HAC and length of stay (LOS) was explored through a zero truncated negative binomial regression model for two LOS cohorts, using 21 days as the threshold for long-stay share of bed-days. Bed-day cost avoidance was estimated by applying the adjusted marginal effect of HAC on LOS, multiplied by the estimated number of HAC episodes averted, average weighted average units per bed-day, and the national efficiency price in respective years.

Results: HACs were found to increase hospital bed-days by an average of 5.5 days (95% CI: 5.19-5.86) for episodes with LOS of 1-21 days, and by 7.1 days (95% CI: 6.78-7.48) for episodes with LOS exceeding 21 days. The program resulted in an estimated avoidance of HACs in 2991 episodes of care over a 5-year period, averaging 598 episodes per year. This equated to avoidance of a total of 16,751 hospital bed-days, or 3350 annually. Annual cost voidance from bed-days ranged from A$6.4 to A$11.5 million between 2019 and 2023. The budget for program management was A$514,500 per year, resulting in average net benefits of A$7.1 to A$8.2 million, a 14-16-fold return on investment for the health service.

Conclusion: Findings suggest that financially viable opportunities are available for hospitals to achieve sustained reduction in HACs, which have the potential for wider adoption to tackle the challenges associated with adverse events in hospitals.