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

ObjectiveParkinson's disease (PD) is one of the most prevalent neurodegenerative disorders, globally affecting approximately 120 per 100,000 people by age 70. Deep brain stimulation (DBS) is a US Federal Drug Administration (FDA)-approved and highly effective treatment for late-stage PD. However, country-specific reimbursement regulations and health policies may affect access to PD-DBS. We aimed to evaluate the uptake rate and 'treatment gap' for DBS across high-income countries.MethodsWe reviewed previous literature to investigate the cost and utilisation of PD-DBS in high-income countries across Asia, Europe, Oceania, and North America (Australia, Canada, France, Germany, Hong Kong, Japan, Korea, the Netherlands, New Zealand, Norway, Spain, Switzerland, UK, and USA). Using previous estimates of DBS candidate eligibility rates, we calculated theoretical DBS uptake rates and treatment gaps nationally.ResultsPD-DBS utilisation was highest in Australia and the USA and lowest in Korea and New Zealand. The total cost of PD-DBS in the first 12months was highest in the USA and France and lowest in the UK and Germany. The utilisation rate (i.e. uptake rate) of PD-DBS (% DBS surgeries per PD case) was highest in Australia and the USA, and lowest in New Zealand and the UK, where the treatment gap reflected these trends.ConclusionsOur results highlight differences in access to DBS for PD patients among high-income countries, which we discuss in the context of health systems. Better access to effective PD treatments such as DBS is critical given the increasing prevalence of PD in an ageing world and the associated, avoidable morbidity.

In this case study we describe how Sydney Local Health District (SLHD) Disability Inclusion and Advice Service (DIAS) provided support to disability group homes during the COVID-19 Delta and Omicron waves. The study provides insights into group home providers' experience of supports implemented by SLHD and other stakeholders. A mixed method approach was undertaken that included analysing data from a database and electronic medical records and a survey of disability group home managers. DIAS developed a range of processes to support prevention, outbreak preparedness and response. This included developing a Disability Shared Living COVID-19 Pathway, engaging with group home providers through a fortnightly Community of Practice, assisting with improving vaccination status and procuring personal protective equipment. During an outbreak DIAS provided a 24h, 7days per week on call support, coordinated outbreak management team meetings and collaborated with several internal and external stakeholders. SLHD infection prevention and control nurses were recruited to undertake a process of reviewing outbreak management plans and providing support during an outbreak. Most disability providers (86%) reported that they felt very prepared to manage outbreaks at the time of the survey (August 2022) compared with the pre-Delta wave, for which 36% reported feeling 'not prepared'. The proportion who rated the support from the stakeholders as very supportive/supportive was as follows: SLHD (100%), NSW Health (64%), National Disability Insurance Agency (50%) and National Disability Insurance Scheme Quality & Safeguards Commission (37%). Our case study provides insights into the support that LHDs can provide to disability homes in response to future outbreaks.

ObjectiveAllied health workforce planning is difficult and needs to be informed by data. Clinical care ratios (CCR) are commonly used to differentiate between clinical and non-clinical demands. This study aimed to identify trends within and across allied health disciplines and determine if the CCR differed by allied health discipline within one New Zealand district.MethodsMeans of CCR data across six allied health roles over 1year were compared using a one-way ANOVA. Post hoc analysis was conducted to determine role differences.ResultsThere were statistically significant differences between the CCR of the six allied health disciplines. Both occupational therapy and physiotherapy had bimodal distributions of CCR. Allied health assistants had the lowest mean and median CCR.ConclusionsNon-clinical activity represents a significant proportion of allied health activity within the New Zealand hospital system. Insights into the CCR of allied health disciplines may support more effective workforce planning and enable service leaders to match the right task to the right profession.

ObjectivesThe prevalence of chronic diseases among immigrants varies across different ethnic groups attributed to the disparities in their risk factors. This study aimed to explore the prevalence and correlates of chronic diseases among the rapidly growing South Asian population in Australia.MethodsAn online survey was administered (2020-2021) among South Asian immigrants in Australia. Diagnosed chronic diseases, smoking habits, physical activity, alcohol consumption, body mass index, and fruit and vegetable intake were assessed. A multivariable logistic regression model was used to examine factors associated with chronic disease.ResultsOverall, 50% of the study participants had one chronic disease and 39% had more than one chronic disease (n=282). Back pain (30%), depression (22%), diabetes (21%), hypertension (19%), and heart disease (12%) were the most reported diseases. Approximately 78% of participants were insufficiently active and 38% regularly consumed alcohol. Approximately three-quarters consumed fruits and vegetables less than once per day. Multivariable analyses showed that those who were aged more than 50years (OR=4.38, 95% CI 1.66-11.56), consumed alcohol more than once/month (OR=3.25, 95% CI 1.17-8.96), and ate less than one serving of vegetables/day (OR=2.94, 95% CI 1.19-7.26) had higher odds of having two or more chronic diseases.ConclusionsFifty percent of study participants presented with preventable diseases, signifying a substantial health burden. Public health interventions should primarily focus on reducing alcohol intake and increasing fruit and vegetable consumption, particularly among individuals of advanced age, to reduce the overall burden on the healthcare system.

ObjectiveTo evaluate how surgeons in Australia and Aotearoa New Zealand perceive the effectiveness of the Operating with Respect (OWR) face-to-face training program in reducing workplace bullying.MethodsA cross-sectional survey examined the perceived effectiveness of the Royal College of Surgeons' (RACS) face-to-face OWR training and complementary interventions in reducing workplace bullying in surgical settings. The sample included supervisory surgeons, RACS committee members, and targeted educators. The survey instrument had 35 questions, including five related to the research question. In December 2020, the survey was distributed by RACS to all surgeons who undertook OWR training between April 2017 and December 2019. Likert scales and coded free text responses were used to explore the effectiveness of face-to-face OWR training and other interventions included in the 2015 RACS Action Plan.ResultsOf the 756 surveys sent, 252 were received. The face-to-face OWR training program was rated as moderately effective. RACS's overarching approach to anti-bullying was almost equally important, highlighting the need to consider a broader ecosystem of reform.ConclusionsThis study finds the RACS full-day anti-bullying training moderately effective in reducing bullying in surgical workplaces. However, enhancing its impact requires a sustained, multi-faceted strategy, including broader policy reforms, accountability measures, and cultural changes, to foster a long-term respectful environment in surgical settings.

ObjectiveConsumer involvement is when patients (their families, friends, and caregivers) work with researchers on research projects. While health services are expected to support consumer-researcher collaborations, conducive environments still need to be developed, with limited research into how Australian health services support this practice. This study explores current consumer involvement in research activity and staff perceptions at an Australian tertiary hospital and health service.MethodsResearch-active employees at a health service were invited to participate in an online cross-sectional survey. It assessed experience with and confidence in involving consumers in research, the perceived value of consumer involvement, and considerations related to challenges, facilitators, and solutions to enhance consumer involvement in health service research.ResultsAmong 83 respondents, including medical, nursing, and allied health professionals, 54 completed the survey. Approximately half had experience with involving consumers in research. Over 80% recognised that involving consumers enhanced research relevance. Identified barriers included challenges in finding (46.6%) and compensating (59.3%) consumers, as well as deficiencies in researcher skills, knowledge (32.2%), and time constraints (39%). Facilitators comprised access to experienced researchers and educational opportunities. Moreover, 87% advocated for increased support to involve consumers within health services, with the appointment of a designated consumer involvement officer deemed the most beneficial solution by 92.5% of respondents.ConclusionsWhile individual barriers inhibit consumer involvement in research, more prominent institutional factors such as financial and technical support may determine successful and meaningful collaborations. As health services evolve towards co-design models in research, the outcomes of this study will guide initiatives aimed at enhancing consumer involvement in the research process within Australian health services.

ObjectivePatient engagement, as measured by the Patient Activation Measure (PAM®), has been used to assess patients' ability to manage their own care. This study aimed to determine whether the PAM® could predict healthcare use in older adults aged >70years, living independently in the community with mild frailty, within 30days after emergency department (ED) discharge.MethodsA prospective single-centre observational cohort study was completed including older adults who presented to an ED. The 13-item PAM® and selected International Consortium for Health Outcomes Measures were completed prior to ED discharge.ResultsTwo hundred patients were recruited with a mean age of 84.8years (s.d. 6.9). The mean PAM® score was 58.6 (s.d. 13.3), with 12.5% at Level 1 (n=25), 40% at Level 2 (n=80), 34.5% at Level 3 (n=69) and 13.0% at Level 4 (n=26). The PAM® level was significantly associated with ED presentations in the past 6months (P=0.030). The PAM® level did not predict healthcare use within 30days of discharge consisting of time until ED representation (P=0.557), number of ED representations (P=0.560), number of hospital admissions (P=0.499), length of stay in hospital (P=0.254) and number of post-discharge contacts (P=0.667).ConclusionsOverall, the PAM® did not predict prospective short-term healthcare use. However, the PAM® was significantly associated with 6-month previous ED use. With more than 50% of patients at Level 1 or 2, indicating lower capacity for self-management, tailored interventions are required to assist mildly frail patients to manage discharge care plans and engage in preventative strategies.

Peripheral intravenous catheters (PIVCs) are required by most hospitalised patients. Difficult intravenous access (DIVA) makes insertion challenging, with poor patient outcomes, treatment delays and resource waste from multiple insertion attempts, often by multiple clinicians. This exploratory qualitative case study aimed to investigate how clinical and executive hospital staff view PIVC insertions for patients with DIVA from a cost and efficiency perspective. Fifteen semi-structured interviews were conducted with staff from three large, urban Australian hospitals. Data was thematically analysed, with four themes generated: (1) PIVCs are not considered from a cost or resource use perspective; (2) resources required for successful PIVC insertion are variable and unpredictable; (3) limited funding and support exist for advanced skill and ultrasound-guided insertion; and (4) processes for PIVC training and competency are inefficient. Investment in advanced PIVC inserters (with ultrasound-guided cannulation skills, and ability to train and assess novice inserters), with clear escalation pathways to these clinicians may reduce inefficiencies and waste associated with difficult PIVC insertions.

ObjectiveThis study aimed to examine changes in the demographics and regions of work of Australian doctors over a period of 9years.MethodsA retrospective study of Australian Health Practitioner Regulation Agency (AHPRA) registration data was performed. Data were sourced from the Health Workforce Dataset Online Data Tool which was derived from annual registration data from AHPRA for 2013-2022. The demographic factors analysed were gender, age, and origin of qualification. Regions of work were defined using the Modified Monash (MM) model.ResultsThe number of registered doctors increased from 82,408 in 2013 to 111,908 in 2022 but mean hours worked per week decreased from 41 to 39 leading up to 2020. Trends in age and origin of qualification remained stable, but the proportion of female workers increased from 38.5% in 2013 to 44.5% in 2022. While female hours per week (~37) were consistent from 2013 to 2020, male hours per week decreased from 43 to 41. The number of registrations and total full-time equivalent (FTE) outcomes increased consistently in metropolitan (MM1) and rural (MM2-5) regions but did not increase for remote and very remote (MM6-7) regions.ConclusionThe Australian medical workforce both grew and changed between 2013 and 2022. An overall decrease in mean hours worked appears to be driven by a decline in hours worked by male workers and the increased proportion of female workers. While increased gender parity and a decrease in hours worked per week were positive outcomes, a lack of growth in the medical workforce was noted in remote and very remote regions of Australia.

ObjectiveHospital chief executive officers (CEOs) in Australia encounter various challenges such as financial constraints, changing regulations, and the necessity to uphold patient care standards. These challenges can contribute to rates of CEO turnover, which can disrupt healthcare organisations and affect the quality of services provided. This research aims to pinpoint the factors influencing hospital CEO turnover and explore effective strategies for retaining these vital leadersMethodsA survey was carried out among hospital CEOs throughout Australia. The survey, distributed through email and online platforms, gathered information on reasons behind turnover and methods for retaining CEOs. Data from 51 CEOs were analysed using statistical regression techniques and thematic analysis.ResultsThe findings from the survey indicated that 82.35% of CEOs identified stress and work-related pressure as the causes of turnover. Other significant factors included managing under-resourced organisations (68.62%), lack of support from the board (66.66%), and facing internal/external criticisms (58.82%). On average, respondents reported 5.16 reasons for leaving their positions with no significant differences found based on sociodemographic characteristics. It was pointed out that key ways to retain CEOs include building respect and trust between CEOs and board chairs, meeting the training and development needs of CEOs, and defining roles within the organisation. The importance of succession planning was also emphasised, with 94.12% of respondents acknowledging its significance for maintaining stability.ConclusionThe study underscores the multifaceted nature of CEO turnover in Australian hospitals influenced by organisational dynamics, performance factors, and personal elements. Effective retention strategies necessitate a culture within the organisation, defined roles, sufficient resources, and robust succession planning. Addressing these aspects can bolster leadership continuity and enhance the performance of healthcare organisations.