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

Objective This appraisal aims to map Australian digital healthcare strategies at the territory, state, and national levels, utilising a value-based healthcare (VBHC) framework to identify key processes in building value into digital health initiatives. Methods The researchers conducted an Advanced Google search to identify strategic frameworks relevant to delivering digital healthcare solutions. They screened documents based on set inclusion and exclusion criteria. Using Braun and Clarke's approach to thematic analysis, the researchers mapped the contents of the strategic digital health documents against a published VBHC framework to identify 10 common key processes for embedding VBHC into digital health initiatives. Results The strategic documents collectively align with VBHC. In mapping these documents, this review identified 10 key processes organisations delivering digitally based healthcare services can use to integrate VBHC into digital healthcare services. Additionally, the review highlighted two gaps in the strategic documents that could enhance their alignment with VBHC principles. First, to address the health inequities that certain groups face, it is essential to explore how priority populations connect with virtual care services. Second, a national approach must be undertaken to develop patient-centred outcomes and experience measures to demonstrate how digital health innovations improve service effectiveness and accessibility. Conclusions In mapping the digital strategies against a published VBHC framework, we have identified 10 key processes for embedding VBHC into new digital health innovations. Strategic documents must advocate for building digital health innovations that consider priority populations and foster patient-centred measures that enhance effectiveness and accessibility.

Medical radiation science practitioners employed as radiation therapists, radiographers and nuclear medicine technologists are leaving the profession in droves. Many of these practitioners are experiencing mental health and wellbeing issues resulting from their work. Indications are that the sector is made up of an increasingly fragile workforce and the retention of these practitioners is at a critical juncture. The mental health and wellbeing of practitioners in this context is not well supported by senior management, line managers or human resource management (HRM). The retention of these practitioners is paramount, to maintain the diagnosis and treatment capabilities of an ever-increasing patient demand. As a way forward, HRM needs to recalibrate and develop a co-designed multi-level approach with all stakeholders to better support the mental health and wellbeing of these practitioners.

Objective Building capacity to embed research into care is central to improving healthcare delivery. Psychologists are well equipped and uniquely positioned to conduct clinical research given the significant research component of clinical training. Despite this, relatively little is known about how psychologists working in Australian public health rate their own skills and capacity for research at a team and organisational level. Methods Ninety-two psychologists working at Monash Health, Victoria, Australia completed the validated Research Capacity and Culture tool and answered questions relating to perceived barriers and motivators to research engagement in their clinical roles. Results While psychologists rated their own individual capacity to engage in research as high, they perceived the research skills and success of their clinical teams and the organisation as low to moderate. Inductive content analyses revealed constraints of clinical role, lack of system/infrastructure, and lack of organisational/team visibility as barriers to research engagement, whereas drive for clinical excellence, internal motivation and a positive team culture were highlighted as motivators. Conclusions We discuss the potential untapped resource of psychologists in Australian public health who are interested and skilled to engage in research but perceive challenges of a lack of research capacity and culture within their team and organisation.

Objective Voluntary assisted dying is a contested practice that some end-of-life care providers choose not to offer to patients. In some jurisdictions, this has restricted access. Queensland addressed this with a law designed to ensure that access to voluntary assisted dying was not hindered. The aim of this research was to explore how privately funded health services that provide end-of-life care, prepared for, and identified challenges related to, enabling access to voluntary assisted dying in Queensland. Methods An interpretivist exploratory study was undertaken. Health service representatives responsible for developing and implementing organisational voluntary assisted dying policy were invited to participate in semi-structured interviews. Data were analysed thematically. Results Fifteen participants participated in an interview. Analysis of the data generated four themes: navigating a spectrum of values and beliefs; knowing and understanding voluntary assisted dying; moderating voluntary assisted dying conversations; and finding space for voluntary assisted dying in end-of-life care. The preparedness of privately funded health services for voluntary assisted dying varied, yet all providers were committed to providing compassionate end-of-life care while meeting their new legal obligations. The need to support staff with a range of values and beliefs about voluntary assisted dying was highlighted. Conclusions Using law to balance the rights of individuals to access voluntary assisted dying and those of non-participating organisations obliges all health services to consider patient access, the views of staff, and broader organisational values concerning voluntary assisted dying. Future research will explore whether access to voluntary assisted dying is affected.

Objectives An Aboriginal and Torres Strait Islander Outpatient Clinic (the Clinic) was established in 2021 at a large metropolitan health service in Melbourne, Australia. The Clinic is a tailored, inclusive, culturally safe and consumer-focused hospital outpatient service model of care. This study is an evaluation of the Clinic. Methods The study used a mixed-methods approach using prospective and retrospective recruitment. Eleven patients attending the Clinic in 2024 or in the 12months prior were interviewed to investigate their experience with the Clinic. In addition, 15 patients completed a cross-sectional patient satisfaction survey. Results Four key themes emerged: (1) healthcare provider relationship, (2) positive impact on health, (3) logistic factors and (4) cultural safety. Sub-themes were identified for the key themes. Survey responses were very positive (>80% provided a strongly agree response) for survey items related to interpersonal skills and cultural safety. Positive, but slightly lower ratings (<70% provided a strongly agree response) were received for statements relating to shared decision making, education and access. Recommendations were made regarding navigating the health service, including allocation of a point of contact for assistance with appointments, an additional and final appointment after their plan of care is established, and basing the Clinic in the community. Conclusions An Aboriginal and Torres Strait Islander Outpatient Clinic previously designed with information provided by Aboriginal patients and healthcare providers was evaluated from the patient's perspective. The findings contribute to a better understanding of enablers to accessing health care for Aboriginal and Torres Strait Islander peoples.

Objective Quality maternity service provision relies on having a robust midwifery workforce. Although previous models suggested future growth of the workforce, this is at odds with recent reports of staffing shortfalls and difficulties in recruitment. We developed an updated model to provide long-term projections of supply and demand for the Australian midwifery workforce. Methods A dynamic stock and flow model was built from baseline data from 2022, with projections through to 2030. It was assumed that 79% of the midwifery workforce would provide clinical care, working 20h per week to meet a workload of 40 pregnancies per full-time equivalent midwife per year. Results If recruitment and attrition remain stable, both headcount and full-time equivalent numbers of midwives will increase by 2030, exceeding demand. The average annual workload per full-time equivalent midwife would fall to 34 pregnancies. However, if voluntary attrition rose by 10%, there would be a rapid and devastating decrease in numbers. The average workload for a full-time equivalent midwife would rise to 66 pregnancies per year by 2030. Conclusions The Midwifery Futures model demonstrated the sensitivity of the Australian midwifery workforce to a small change in attrition. Preventing midwives' exit from the workforce by improving their experiences in the workplace and increasing access to midwifery continuity roles would build workforce resilience. Minimising attrition, enhancing midwives' engagement, and matching student intake to attrition can assist in maintaining a robust Australian midwifery workforce.

Objective Healthcare workers (HCWs) form an essential segment of the workforce. Investigating active commuting within the workforce, especially HCWs, is important. However, limited research exists in this domain. Methods This study, conducted under the auspices of the Greater Western Sydney Health Partnership, a collaboration between three western Sydney local health districts, surveyed over 5000 HCWs to explore their commuting behaviours and attitudes towards commuting. Results We found that almost three quarters (72.8%) of HCWs drove a private vehicle to work, usually parking on site. Less than 5% of respondents used carpooling or active transport methods such as walking or cycling. Distance was stated as a critical barrier to walking or cycling, although road safety and security concerns were also important. Time constraints, as well as the lack of public transport services, were considered barriers to utilising public transport. The survey results highlight the constraints preventing the widespread adoption of non-car commuting modes and should inform decision-making on incentivising healthy commuting options among HCWs. Conclusions HCWs in a metropolitan Global North context such as western Sydney predominantly drive to work, with only 16.9% using public transport or walking or cycling, with various barriers being cited as reasons. We recommend further efforts to develop effective interventions for promoting active commuting among HCWs.

Objective Mobile Health (mHealth), a subset of digital health, requires people to own smartphones, but ownership barriers overlap with social factors linked to type 2 diabetes (T2D) burden. We describe the prevalence of smartphone ownership, app use and mobile internet access and factors around uptake and utilisation among people with T2D accessing care in a community setting. Methods A cross-sectional survey was performed with people with diabetes attending a community-based general practitioner-led diabetes clinic located in Inala, a multiculturally diverse but socioeconomically marginalised suburban region of Brisbane, Queensland. The survey was read aloud to participants, with interpreters if required. Results There were 104 participants, the median age was 63years, 47.1% were female and 44.2% spoke language(s) other than English (LOTE) at home. Smartphone ownership was high (85.6%), and average self-rated confidence with advanced feature use was between 'somewhat confident' and 'confident'. Older adults were significantly less likely to own smartphones, less confident with advanced features and less likely to use apps regularly, but many knew someone who could support uptake. LOTE spoken at home was not associated with ownership, mobile internet access, app use or self-rated confidence with advanced feature use, suggesting smartphone technology is already part of daily life. Conclusions Smartphone ownership and utilisation does not appear to be a major barrier to mHealth uptake in our context. Older adults need tailored supports and education to encourage mHealth uptake.

Objective This study aimed to assess the value of an online palliative care resource (CareSearch) in providing evidence-based information to clinicians and consumers; and online palliative care information more broadly from the perspective of key stakeholder organisations. Methods Nine semi-structured interviews with representatives from key stakeholder organisations were undertaken. A pragmatic, qualitative analytical approach was used to identify key findings. Results Seven key findings were identified. These emphasised the criticality of CareSearch, the importance of access to high-quality online palliative care information, the need for a robust palliative care evidence base, challenges to the delivery of palliative care, the need to improve visibility, the need to improve accessibility, and the importance of co-design and lived experience. Conclusions CareSearch and online palliative care information have a critical role to play in responding to the challenges facing the sector. Maximising the value of such information will require improvements in access to evidence, visibility, usability, and the development of resources tailored to diverse users.

Objective Australian Bureau of Statistics data on socio-economic status, service accessibility/remoteness and population denominators are useful in epidemiology, though complex to understand and apply. We provide information and resources to facilitate their use. Methods We compiled data from the Socio-Economic Indexes for Areas (SEIFA), the Accessibility/Remoteness Index of Australia (ARIA) and population estimates from across multiple years, taking into account changes in availability and formats of these data over time. Syntax was written to support use of these data in studies using administrative health data, alongside a user guide with notes and instructions. Results Where research data contains an event date plus a postcode, Statistical Area Level 2 and/or Statistical Local Area, these resources can be used to attach a SEIFA score and decile, remoteness areas and age-sex-specific population denominators to each record for years 2000-2025 (population denominators to 2023). These variables can be used as cohort descriptors, as model covariates or to calculate ARIA/SEIFA stratified rates. Conclusions These resources are useful for individual research projects, while also contributing to building capacity in the use of geographical measures. We focused on the measures most commonly used in Australia, although the approach outlined can be applied to other geographical measures.