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

Objective: Increasing ownership of health service providers by large for-profit corporations, along with high ownership concentration that reduces competition, may negatively affect healthcare access, quality, and costs. Our objective was to determine the ownership of Australian diagnostic imaging clinics by ownership category and identify areas of high ownership concentration.

Methods: A list of clinics providing ultrasound, X-ray, and at least one advanced imaging modality (computed tomography and/or magnetic resonance imaging (MRI)) were obtained from Services Australia on 31 March 2024. Information about ownership of diagnostic imaging clinics was extracted from the Australian Business Register, the Orbis database, and if necessary, a search of the clinic website. The number and proportion of diagnostic imaging clinics by ownership category were calculated. Areas of high ownership concentration were defined as one company owning ≥30% of non-government owned clinics within a jurisdiction.

Results: A total of 1235 diagnostic imaging clinics were identified, with ownership data obtained for 1226 (99.3%). Most clinics are owned by for-profit corporations (public limited n = 412; 33.6%, institutional investor-backed n = 277; 22.6%). Areas of high ownership concentration were identified in South Australia, Tasmania, Northern Territory, and Australian Capital Territory. Four companies (two public limited and two investor-backed) own ≥50% of clinics that provide Medicare-rebatable MRI services.

Conclusions: The Australian diagnostic imaging sector is dominated by large for-profit corporations, with high ownership concentration apparent in four jurisdictions. For-profit corporations, healthcare system managers, and funders may have conflicting goals. It is incumbent upon Australian federal, state, and territory governments to ensure that public funds are used to provide affordable, high-value care.

There is increasing recognition of the benefits of robust data infrastructures, capacity building for a data informed society, and strategic policy and financial support to enable data integration (also known as data linkage). However, despite widespread availability of data, and recognition of the value of data linkage and investment in this area, data linkage continues to be complex, timely, and costly, and these elements are often underestimated by researchers. In this article, we introduce data linkage basics for Australian researchers and discuss important considerations for those embarking on healthcare research that utilises data linkage.

Objective: Palliative and end-of-life care should be considered core business for aged care and healthcare teams in these settings. With a growing ageing population, the primary care workforce faces growing demand to deliver palliative care. This study aimed to explore the experiences of allied health clinicians and tertiary educators working in, and teaching, palliative care with an ageing focus in Australia.

Methods: We undertook a qualitative study using semi-structured interviews with clinicians experienced in aged and palliative care and tertiary educators delivering aged and palliative care curriculum content from four allied health disciplines (dietetics, occupational therapy, physiotherapy, speech pathology). Guided by critical realism ontology and a constructivist epistemology, reflexive thematic analysis was used for data analysis.

Results: Eleven participants were interviewed. Thematic analysis yielded two key themes and five subthemes. The two key themes were: (i) Barriers to best practice (n = 4 subthemes) and (ii) Enablers of palliative care best practice (n = 2 subthemes). Key barriers were that curriculum content is lacking and the medical model limits the volume and quality of care delivered. Enablers to quality care were self-directed learning and clinical experience.

Conclusion: Palliative and end-of-life care in aged care should foster reablement to support continuing agency and dignity through person-centred care. Allied health professionals are well-positioned to support this approach. However, facilitating allied health best practice will require addressing the reported barriers, including clinician preparedness and funding sufficient to meet demand and need.

Objectives: To investigate the prevalence of 10 long-term health conditions in the Australian-born and Eastern Mediterranean region (EMRO)-born populations of Australia.

Method: Using the 2021 Australia census we calculated age-specific and sex-specific prevalence, age-standardised prevalence (ASP), and age-standardised prevalence ratio (ASPR) of 10 conditions. For EMRO-born people who had a health condition, we reported English proficiency, education, income and years lived in Australia.

Results: Australian-born and EMRO-born individuals had a similar ASP of heart disease (3.2% in men, 1.8% in women) and stroke (0.7% in men and 0.5% in women). There were small differences between the two groups in terms of the ASP of arthritis (ASPR: 0.9) and kidney disease (ASPR: 1.1) in women and dementia (ASPR: 1.1) in men. For EMRO-born compared with Australian-born individuals, the ASPs of asthma (ASPR women and men: 0.4), cancer (ASPR women: 0.6, men: 0.5), lung conditions (ASPR women: 0.4, men: 0.5), and mental health conditions (ASPR women and men: 0.4) were lower, and the ASP of diabetes (ASPR women: 1.8, men: 1.7) was higher. For men, the ASP of arthritis (ASPR: 0.6) was lower, and the ASP of kidney disease (ASPR: 1.4) was higher in EMRO-born individuals. For women, the ASP of dementia (ASPR: 1.4) was higher in EMRO-born individuals. EMRO-born individuals who arrived in Australia ≥10 years ago, at the time of the census, compared with those who arrived <10 years ago had a higher ASP of arthritis, asthma, cancer and lung and mental health conditions; a lower ASP of heart disease, stroke, kidney disease and dementia; and the same ASP of diabetes. Depending on the long-term conditions, 24.1-53.5% of EMRO-born individuals had low English proficiency, 9.4-23.8% did not go to school, and 51.7-89% had a weekly income (in Australian dollars)

Conclusion: To promote health equity, prevention and management strategies for long-term health conditions based on the health needs of migrants are needed.

Human embryo research can provide important scientific insights to help humanity. But it also poses ethical questions that remain contested. Since 2002, Australian law has limited human embryo research under strict licensing conditions, but there has been no formal review in almost 15 years. The development of stem cell-based embryo models that closely resemble human embryos, and improved culturing techniques that allow human embryos to be grown to potentially beyond 14 days, have pushed the limits of current legislation. We argue that a comprehensive review is needed to address recent scientific advances and to better account for public sentiment.

Objective: Interprofessional collaborative practice (IPCP) is integral to a high-functioning healthcare system, yet little is understood about whether attitudes, knowledge and beliefs towards IPCP differ between professional groups or clinical settings.

Methods: This cross-sectional study used three surveys: the Systems Thinking Scale, Attitudes Towards Health Care Teams, and the adapted Interprofessional Collaboration Scale, to compare systems thinking and the perceptions and attitudes of healthcare professionals in a large metropolitan health service. Participants included medical, nursing, allied health and oral health professionals across hospital and community settings.

Results: A total of 293 participants (57% hospital-based, 43% community; 40% nursing, 8% medicine, 46% allied health, 6% oral health) completed the surveys. Results demonstrated differences in communication and attitudes towards IPCP across professional groups.

Conclusions: While all professional groups acknowledged the importance of IPCP, distinctions persisted across professions and settings. Understanding attitudes within various professions and contexts establishes the foundation for targeted strategies aimed at promoting interprofessional collaboration in health care.

Allied health assistants (AHAs) are a vital workforce in Australia, supporting allied health professionals (AHPs) to expand service access and progress care, ensuring workforce sustainability. Tiered models of care that include AHAs can facilitate top of scope and advanced scope work for AHPs, increasing staff satisfaction and retention. Despite the increased research interest on AHAs, barriers to maximising the potential of this workforce persist. The Victorian Department of Health recently released recommendations aimed at optimising the AHA workforce, with inadequate workforce governance recognised as a barrier. Centralising governance processes for AHAs ensures a single point of accountability and standardisation of processes, positively affecting patient safety and quality of care. To enable suitable AHA governance structures, recognition of the importance of this workforce in local and national strategies is required. However, there are few existing state-based frameworks dedicated to AHA governance, and the current draft National Allied Health Workforce Strategy does not include AHAs, which represents a missed opportunity to strengthen and grow this important element of the allied health workforce.

Objective: Voluntary assisted dying (VAD) became legal in Queensland in January 2023. This research examines the perceptions of doctors who have no in-principle objection to VAD, about the first year of VAD operation.

Methods: Semi-structured interviews were conducted with 27 doctors 1 year after VAD had been in operation.

Results: Three themes were developed: VAD is largely accepted as an end-of-life option and there is a collaborative approach with palliative care; VAD is being delivered as a public medical service, providing high-quality, timely access; and despite provision as a public medical service, there are remaining system access issues.

Conclusions: The first year of VAD in Queensland has been generally positive, however, ongoing system access issues need to be addressed to ensure long-term sustainability of the service.

Objective: Unplanned readmissions are key indicators of hospital care quality, yet research on potentially avoidable unplanned readmissions (PAURs) remains limited. This study aimed to assess the prevalence, causes, and predictors of PAURs in an Australian tertiary hospital.

Methods: This retrospective cohort study included all unplanned readmissions to a general medicine unit between 1 July and 30 September 2022, in South Australia. Patients aged ≥18 years readmitted within 30 days of discharge were included. A panel of senior clinicians assessed the preventability of each readmission using predefined criteria. Data on demographics, comorbidities, frailty, inflammatory markers, and discharge factors were collected. Predictors of PAURs were examined using multivariable logistic regression and LASSO (least absolute shrinkage and selection operator) regression for sensitivity analysis.

Results: Among 381 readmissions, 80 (21%) were classified as potentially avoidable. The mean age was 68.7 years (s.d. 18.2), and 58.3% were female. The most common cause of PAURs was relapse of the condition treated during the index admission (43%), followed by treatment-related complications (22.8%). Contributing factors included suboptimal care during the index admission (43.8%) and inadequate post-discharge follow-up (30%). Compared to non-avoidable readmissions, PAUR patients were older, more frequently readmitted within 7 days, and had higher rates of coronary artery disease and congestive heart failure (CHF). They also had higher neutrophil-to-lymphocyte ratios (NLR) on admission. Multivariable analysis identified CHF (aOR 2.46, 95% CI 1.28-4.71) and elevated NLR (aOR 1.05, 95% CI 1.02-1.08) as independent predictors.

Conclusions: Over one in five readmissions were potentially avoidable, and only a few patient characteristics can predict avoidable readmissions.