ORCID Profile
0000-0001-5703-6475
Current Organisations
Deakin University
,
Curtin University
,
University of Birmingham
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Epidemiology | Population Trends and Policies | Public Health and Health Services | Health and Community Services
Social Structure and Health | Aboriginal and Torres Strait Islander Development and Welfare | Families and Family Services |
Publisher: Public Library of Science (PLoS)
Date: 31-03-2022
DOI: 10.1371/JOURNAL.PONE.0265394
Abstract: The translation gap between knowledge production and implementation into clinical practice and policy is an ongoing challenge facing researchers, funders, clinicians and policy makers globally. Research generated close to practice and in collaboration with end users is an approach that is recognised as an effective strategy to facilitate an improvement in the relevance and use of health research as well as building research capacity amongst end users. The Research Translation Projects (RTP) program funded by the Western Australian (WA) Department of Health facilitates clinical and academic collaboration through competitive funding of short-term research projects. Its aim is to improve healthcare practice while also finding efficiencies that can be delivered to the WA health system. A mixed methods approach was adopted to evaluate the research impact of the RTP program, at completion of the two-year funding period, across a range of impact domains through the adaptation and application of the Canadian Academy of Health Sciences’ (CAHS) framework for research impact. In addition, further analysis was undertaken to address specific objectives of the RTP program more closely, in particular research capacity building and collaboration and health system Inefficiencies targeted by the program. Social network analysis was applied to assess the extent and growth of collaboration across WA health organisations over time. Results indicated that the ‘bottom up’ approach to research translation has triggered modest, yet positive outcomes across impact domains including advancing knowledge, collaboration and capacity building as well as contributing to changes in policy and practice. Additionally, the projects identified opportunities by which inefficiencies in the health system can be addressed. Further work is required to better understand the pathways by which short-term outcomes can be translated into more long-term impacts and the mechanisms that trigger this process.
Publisher: Cambridge University Press (CUP)
Date: 29-12-2018
DOI: 10.1017/S1744133117000330
Abstract: Public involvement in disinvestment decision making in health care is widely advocated, and in some cases legally mandated. However, attempts to involve the public in other areas of health policy have been accused of tokenism and manipulation. This paper presents research into the views of local health care leaders in the English National Health Service (NHS) with regards to the involvement of citizens and local communities in disinvestment decision making. The research includes a Q study and follow-up interviews with a s le of health care clinicians and managers in senior roles in the English NHS. It finds that whilst initial responses suggest high levels of support for public involvement, further probing of attitudes and experiences shows higher levels of ambivalence and risk aversion and a far more cautious overall stance. This study has implications for the future of disinvestment activities and public involvement in health care systems faced with increased resource constraint. Recommendations are made for future research and practice.
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2020-045172
Abstract: Sustainability at a system level relates to the capacity of the system to be able to service the ongoing health needs of the population. It is a multifaceted concept encompassing both the affordability and efficiency of a system and the system’s ability to adapt and change. To address issues that currently threaten health system sustainability, healthcare leaders, policy makers, clinicians and researchers are searching for solutions to ensure the delivery of safe, value-based care into the future. The timely translation of research evidence into sustainable interventions that can be adopted into the health system is one way of bolstering the sustainability of the system as a whole. We present a protocol for the realist evaluation of a research translation funding programme to understand how the research translation process contributes to health system sustainability and value-based healthcare. Underpinned by the realist evaluation framework, we will: (1) Develop the Initial Program Theory (IPT) of the research translation process (2) Test the program theory through case study analysis and (3) Refine and consolidate the theory through stakeholder consultation. The evaluation uses a case ex le of a research translation programme, chosen for its representation of a microcosm of the broader health system and the heterogeneity of service improvement activities taking place within it. Across the three phases, analysis of data from documents about the research translation program and interviews and focus groups with stakeholders and program users will draw on the context (C), mechanism (M), outcome (O) formula that is core to realist evaluation. In addition, system dynamic methods will capture the feedback loops and complex relationships among the IPT and context-mechanism-outcome configurations. This approach to evaluation of a research translation funding programme may be adapted to similar programmes operating in other settings. Curtin University Human Research Ethics Committee, Western Australia, approved this study (approval number: HRE2020-0464). Results will be published in scientific journals, and communicated to respondents and relevant partners.
Publisher: Informa UK Limited
Date: 03-2011
Publisher: SAGE Publications
Date: 04-2004
DOI: 10.1258/135581904322987535
Abstract: Objectives: To provide an overview of alternative approaches to modelling in economic evaluation, and to highlight situations where each of the alternative modelling techniques should be employed. Methods: A review of the available approaches to modelling in the economic evaluation of health care interventions with a leading discussion of ex les of published studies leading to guidance in the selection of an appropriate approach in different circumstances. Results: The main approaches to modelling used in economic evaluations in health care are decision trees, Markov models and in idual s ling models. These methods assume independence of in iduals within the model. Where interaction between in iduals is important, other methods such as discrete-event simulation or system dynamics are preferable. Conclusions: The paper highlights the crucial question to be answered when selecting the approach to modelling: can the in iduals being simulated in the model be regarded as independent? This issue is very commonly not recognised by analysts but is fundamental to the appropriate application of modelling in economic evaluation.
Publisher: Informa UK Limited
Date: 09-03-2021
DOI: 10.1080/08870446.2021.1890730
Abstract: This process evaluation aimed to evaluate the feasibility and acceptability of Aussie-FIT, a group-based weight loss intervention for men with overweight and obesity in Australia. Process data and data collected from: (1) six-participant focus groups ( We explored the feasibility and acceptability of program setting and context, recruitment strategies, factors impacting implementation and mechanisms of impact. Recruitment via Australian Football League (AFL) clubs was highly effective 426 men expressed interest within 3 days of advertising, 130 men took part. Program attendance was not consistently recorded by coaches. Coach interviews indicated a 'core group of men' participated in each session (typically 10-12 of 15 men). Program delivery proved feasible in the AFL context. Program acceptability and satisfaction were high. Internalisation of autonomous motives was identified as driving behaviour change. Behaviour change to support maintained weight loss was facilitated through habit formation, goal setting and effective management of multiple goals. Aussie-FIT sets a blueprint for future weight loss interventions that utilise behaviour change strategies and principles of self-determined motivation to support men to lose weight. Australian New Zealand Clinical Trials Registry: ACTRN12617000515392. © 2021 Informa UK Limited, trading as Taylor & Francis Group.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2020
Publisher: Emerald
Date: 09-08-2011
Publisher: Hindawi Limited
Date: 02-09-2022
DOI: 10.1111/HSC.13151
Abstract: The need to reorient the health system to ensure greater involvement of consumers in healthcare has, in recent years, been highlighted as a priority in both literature and policy. This change requires renegotiating power relations among health organisations, health professionals and health consumers. This study presents findings from a trial of a program designed to foster collaborative relationships between clinicians and consumers of health services in the Australian setting. The King's Fund Collaborative Pairs program is a leadership development program that brings together a consumer, patient or community leader to work together in pairs with a service provider clinician or manager to develop new ways of working together. The trial involved 88 participants paired together undertaking one of seven programs conducted from October 2018 to August 2019. Participants were guided through a series of activities in five face-to-face sessions run by facilitators trained by the King's Fund. A qualitative evaluation was undertaken via semi-structured interviews (n = 40) with organisations involved, facilitators and participants. A brief review of program documentation was also included. Thematic analysis was undertaken to evaluate program acceptability, implementation and to identify program impacts. The evaluation, although limited in scope, found the program changed the way some participants understood the nature of consumer and provider relationships and how collaborative working relationships could be developed. The impact of the program on organisations sponsoring participants was less evident as numbers of participants from each organisation were limited and the time required for cultural change to develop is typically longer than the evaluation period allowed for. We highlight key recommendations addressing program recruitment, facilitation and format to inform future iterations of the program.
Publisher: Emerald
Date: 28-10-2013
DOI: 10.1108/JHOM-11-2012-0225
Abstract: – The aims of this paper are to explore the experiences of budget holders within the English National Health Service (NHS), in their attempts to implement programmes of disinvestment, and to consider factors which influence the success (or otherwise) of this activity. – Between 24 January and 15 March 2011 semi-structured, telephone interviews were conducted with representatives of 12 Primary Care Trusts in England. Interviews focussed on: understanding of the term “disinvestment” current activities, and perceived determinants of successful disinvestment decision making and implementation. Data were organised into themes according to standard qualitative data coding practices. – Findings indicate that experiences of disinvestment are varied and that organisations are currently adopting a range of approaches. There are a number of apparently influential determinants of disinvestment which relate to both health system features and organisational characteristics. According to the experiences of the interviewees, many of the easier disinvestment options have now been taken and more ambitious plans, which require wider engagement and more thorough project management, will be required in the future. – Findings from the research suggest that issues around understanding and usage of disinvestment terminology should be addressed and that a more in-depth and ethnographic research agenda will be of most value in moving forward both the theory and practice of disinvestment. – This research suggests that, in the English NHS at least, there is a disjuncture between common usage of the term “disinvestment” and the way that it has previously been understood by the wider research community. In addition to this, the research also highlights a broader range of potential determinants of disinvestment than are considered in the extant literature.
Publisher: Cold Spring Harbor Laboratory
Date: 21-11-2021
DOI: 10.1101/2021.11.20.21266372
Abstract: Preclinical, clinical and epidemiological studies support the hypothesis that aberrant systemic metabolism of amyloid-beta (Aβ) in the peripheral circulation is causally related to the development of Alzheimer’s disease (AD). Specifically, recent studies suggest that increased plasma concentrations of lipoprotein-Aβ compromises the brain microvasculature, resulting in extravasation and retention of the lipoprotein-Aβ moiety. The latter results in an inflammatory response and neurodegeneration ensues. Probucol, a historic cholesterol-lowering drug, has been shown in murine models to suppress lipoprotein-Aβ secretion, concomitant with maintaining blood-brain-barrier function and suppressing neurovascular inflammation. Probucol has also been shown to protect cognitive function in dietary-induced amyloidogenic mice. This protocol details the Probucol in Alzheimer’s Study (PIA-study), a double-blind, randomised, placebo-controlled drug intervention trial investigating if Probucol attenuates cognitive decline in patients with mild-to-moderate AD. The primary objective of the 104-week study is to assess whether Probucol supports cognitive function and delays brain atrophy in AD patients. A secondary objective is to determine whether Probucol treatment will reduce cerebral amyloid burden. The study is a phase II single-site, randomised, placebo-controlled, double-blind clinical trial assessing the efficacy of Probucol in AD. A total of 300 participants with mild-to-moderate AD will be recruited and randomised 1:1 (active: placebo). Cognitive function, regional volumetric changes in brain and cerebral amyloid load will be evaluated via the cognitive subscale test, AD assessment scales (ADAS-Cog), magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, respectively, after a 104-week intervention. The study has been approved by the Bellberry Limited Human Research Ethics Committee (Approval number: HREC2019-11-1063 Version 4, 6 th October 2021). The investigator group will disseminate study findings through peer-reviewed publications, key conferences and local stakeholder events. This trial has been registered with the Australian New Zealand Clinical Trial Registry (ACTRN12621000726853). This is the first-in-human (FIH) randomised double-blind placebo-controlled study to assess the efficacy of Probucol in delaying cognitive decline in in iduals with mild cognitive impairment (MCI) and mild-to-moderate dementia due to Alzheimer’s disease (AD). The 24-month intervention study will be the first to investigate whether treatment with Probucol will stabilise structural/functional changes in brain and if cerebral amyloid load will decrease in in iduals with AD, following treatment with Probucol. Probucol is clinically used to treat cardiovascular disease with well-characterised efficacy and safety profiles, thus reducing risk of the study, and if applicable, accelerate clinical translation of the study findings.
Publisher: Springer Science and Business Media LLC
Date: 17-04-2020
DOI: 10.1186/S13643-020-01349-Y
Abstract: Emergency telehealth has been used to improve accessibility of rural and remote patients to specialist care. Evidence to date has demonstrated effectiveness and cost-effectiveness of telehealth in rural and remote emergency departments within a variety of contexts. However, systematic reviews to date have not focused on the rural and remote emergency departments. The purpose of this study is to review the outcome measures used in evaluations of emergency telehealth in rural and remote settings and assess evidence relating to their effectiveness and cost-effectiveness. Randomised controlled trials, non-randomised controlled trials, and full and partial economic evaluations (e.g. cost-effectiveness, cost-benefit, and cost-utility analyses) of telehealth in rural and remote emergency departments will be included. Comprehensive literature searches will be conducted in multiple electronic databases (from 1990 onwards): MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, EconLit, CRD databases (e.g. NHS Economic Evaluation database), and Tufts Cost-Effectiveness Registry. Two authors will independently screen all citations, full-text articles, and abstract data. The methodological quality (or risk of bias) of in idual studies will be appraised using an appropriate tool. A systematic narrative synthesis will be provided with information presented in the text and tables to summarise and explain the characteristics and findings of the studies. If feasible, we will conduct random effects meta-analysis. This review will identify gaps in the current body of evidence relating to the effectiveness and cost-effectiveness of rural and remote emergency telehealth services. By confining to articles written in the English language, this analysis may be subjected to publication bias and results need to be interpreted accordingly. We believe the results of this review could be valuable for the design of future economic evaluations of emergency telehealth services implemented in the rural and remote context. PROSPERO CRD42019145903
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJOPEN-2020-043836
Abstract: The Western Australia (WA) Acute TeleStroke Programme commenced incrementally across regional WA during 2016–2017. Since the introduction of the TeleStroke Programme, there has been monitoring of service outputs, including regional patient access to tertiary stroke specialist advice and reperfusion treatment however, the impact of consultation with a stroke specialist via telehealth (videoconferencing or telephone) on the effectiveness and cost-effectiveness of stroke care and the drivers of cost-effectiveness has not been systematically evaluated. The aim of the case study was to examine the impact of consultation with a stroke specialist via telehealth on the effectiveness and cost-effectiveness of stroke and transient ischaemic attack care using a mixed methods approach. A categorical decision tree model will be constructed in collaboration with clinicians and programme managers. A before and after comparison using state-wide administrative datasets will be used to run the base model. If s le size and statistical power permits, the cases and comparators will be matched by stroke type and presence of CT scan at the initial site of presentation, age category and presenting hospital. The drivers of cost-effectiveness will be explored through stakeholder interviews. Data from the qualitative analysis will be cross-referenced with trends emerging from the quantitative dataset and used to guide the factors to be involved in subgroup and sensitivity analysis. Ethics approval for this case study has been granted from the Western Australian Country Health Service Human Research and Ethics Committee (RGS3076). Reciprocal approval has been granted from Curtin University Human Research Ethics Office (HRE2019-0740). Findings will be disseminated publicly through conference presentation and peer-review publications. Interim findings will be released as internal reports to inform the service development.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJGH-2021-005112
Abstract: Rotation work, characterised by travelling long distances to work in isolated areas where workers typically rotate consecutive days working and living on-site with periods at home, is increasingly used in the resources and construction sectors globally. Such employment practices may have an impact on workers’ health and well-being. This systematic review explores the impact rotation work has on mental and physical outcomes in rotation workers in the resources and construction sectors. The PubMed, Medline, EMBASE, CINAHL, PsycINFO, and Scopus databases were systematically searched on 1 May 2020 to identify quantitative, qualitative and mixed-method studies addressing the health of rotation workers published in peer-reviewed journals. Findings from the studies were summarised narratively. Of 6268 studies retrieved, 90 studies were included in the review. Studies suggested higher prevalence of psychological distress in onshore rotation workers and higher overweight/obesity rates among rotation workers as compared with the general population. We found more sleep problems and higher levels of smoking during work periods compared with off-site days and higher alcohol intake during off-site days compared with on-site days. Workers generally perceived their physical health status as good. High-perceived job demands (such as workload, repetitive work) were associated with mental distress and exhaustion, sleep problems and perceived poor physical health status, while high-perceived job resources (such as job clarity/control, support) were associated with low mental distress and exhaustion, less smoking and alcohol intake, and better sleep. Rotation work is associated with several poorer health behaviours and outcomes, such as sleep problems, smoking, alcohol consumption and overweight/obesity. Interventions needed to improve rotation workers’ health should include maximising available job resources and reducing job demands. Further longitudinal studies are needed to explore the long-term health effects of rotation work and the short-term contextual effects of the different aspects of rotation work.
Publisher: SAGE Publications
Date: 05-04-2018
Abstract: People with a cleft of the lip and/or palate (CL/P) differ from their peers due to their facial appearance, hearing and speech difficulties, and the significant time spent attending appointments and recovering from surgical interventions. These differences may impact life outcomes including occupation, income, education, relationships, psychosocial health issues, and lifestyle choices. A self-administered questionnaire was posted to 338 former and current patients of the Cleft Lip and Palate Unit of Princess Margaret Hospital (PMH), Perth, Western Australia. Completed questionnaires were returned by 158 former and current patients. In comparison to the Australian Bureau of Statistics, study participants attained equivalent highest education levels, full-time annual income levels, occupational categories, employment rates, and home ownership levels. They did not marry later and demonstrated positive health–related lifestyle behaviors. However independent living was significantly delayed, and the number of romantic relationships, marriages, and children was lower, with separation/ orce rates also being lower. A key finding was that 78% of participants self-reported that they experienced at least 1 psychosocial health issue and more than half experienced anxiety and/or depression. When comparing the sociological outcomes for the study participants, the psychosocial outcomes were the areas of most concern. Further investigation is required to determine the causes for the high self-reported rates of anxiety and/or depression found in this study.
Publisher: Emerald
Date: 21-11-2016
DOI: 10.1108/JHOM-10-2016-0189
Abstract: Worldwide, there is significant growth in the cost of (and demand for) healthcare, which often clashes with a requirement to contain expenditure. This duality leads to an increasing need for a systematic approach to disinvestment in health technologies. The purpose of this paper is to consider the challenges and opportunities for disinvestment policy decisions in Australia. It discusses the implementation of the Choosing Wisely c aign and the need for rigorous evaluation of such c aigns in the Australian healthcare system. The authors highlight characteristics of disinvestment: what it is and what it is not and discuss international ex les of identifying low value care, including the recent Choosing Wisely initiative. The authors discuss the barriers to implementing initiatives such as Choosing Wisely and the complexities in evaluating their effectiveness. While the primary purpose of the Choosing Wisely c aign is improved decision making through clinical engagement, it is expected that implementation could lead to resource savings alongside improvements in patient safety and service quality. While there is research looking to understand the barriers and facilitators to the implementation of initiatives such as Choosing Wisely, little is known about broader patient impacts, and more attention on the quantification of their effect on both patient outcomes and resource use is needed. This work highlights the limited knowledge around implementation of disinvestment strategies and the paucity of research around the impact of strategies such as Choosing Wisely in the Australian public hospital system. This is important as future research in this area will give greater certainty about the benefits and consequences of Choosing Wisely leading to improved opportunities for resource savings and patient safety and quality.
Publisher: Wiley
Date: 25-08-2021
DOI: 10.1002/HPM.3061
Publisher: Wiley
Date: 23-08-2022
Abstract: To mitigate flooding associated with the gas diffusion layer (GDL) during electroreduction of CO 2 , we report a hydrophobicity‐graded hydrophobic GDL (HGGDL). Coating uniformly dispersed polytetrafluoroethylene (PTFE) binders on the carbon fiber skeleton of a hydrophilic GDL uniformizes the hydrophobicity of the GDL and also alleviates the gas blockage of pore channels. Further adherence of the PTFE macroporous layer (PMPL) to one side of the hydrophobic carbon fiber skeleton was aided by sintering. The introduced PMPL shows an appropriate pore size and enhanced hydrophobicity. As a result, the HGGDL offers spatial control of the hydrophobicity and hence water and gas transport over the GDL. Using a nickel‐single‐atom catalyst, the resulting HGGDL electrode provided a CO faradaic efficiency of over 83 % at a constant current density of 75 mA cm −2 for 103 h operation in a membrane electrode assembly, which is more than 16 times that achieved with a commercial GDL.
Publisher: CSIRO Publishing
Date: 22-07-2020
DOI: 10.1071/AH19214
Abstract: Objectives HealthPathways, pioneered in Canterbury, New Zealand, in 2008, is a web-based tool designed to promote health care integration and patient management in primary care and to reduce fragmentation in the delivery of health services. This cross-sectional study evaluated the utilisation and perceptions of this tool among health professionals in Australia and New Zealand. Methods A cross-sectional survey was administered online through Research Electronic Data Capture (REDCap) to general practitioners (GPs), practice nurses and managers, nurse practitioners, specialist and community nurses, hospital clinicians, nurses, managers, and allied health professionals between April and September 2018. The frequency of HealthPathways use in the previous month was modelled as an ordered response using an ordered logistic regression model after adjusting for the possible effects of sex, age, years in clinical practice, location and time spent in practice. Results Health professionals perceived HealthPathways to be useful in primary care management and referral, as well as in the prereferral treatment of patients. GPs in New Zealand, New South Wales and Victoria were 73%, 47% and 27% more likely to have used HealthPathways ≥10 times in the previous month respectively. Conclusion The results suggest that HealthPathways is having a positive effect on healthcare systems in New Zealand and Australia. However, differences in uptake suggests the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. What is known about the topic? Early evaluations suggest that HealthPathways is a useful tool for health professionals, although uptake and utilisation may be limited. However, there is no comparative evidence regarding uptake and implementation of the tool. What does the paper add? This study is among the first to provide a comparative narrative of the literature assessing the implementation and uptake of HealthPathways across Australia and New Zealand. It is also among the first to compare the perceptions of allied health professionals in the use of HealthPathways across Australia and New Zealand. What are the implications for practitioners? The results of this study suggest the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Emerald
Date: 21-02-2011
Publisher: Springer Science and Business Media LLC
Date: 11-07-2017
Publisher: MDPI AG
Date: 15-08-2022
Abstract: Sufficient knowledge on the work productivity impact of the health of fly-in fly-out (FIFO) workers in the mining sector in Australia is lacking. This study examined the impact of health and lifestyle behaviours on the work productivity of FIFO workers in the mining industry in Australia. FIFO workers completed an online questionnaire on health and work productivity loss measures. Linear regressions were used to model annual work productivity losses through absenteeism, presenteeism and total productivity loss. Workers with a high risk for health conditions were, on average, associated with 3.87% more productivity loss (absenteeism: 1.27% and presenteeism: 2.88%) than those with low risk. Workers who had multiple health risks classified as medium (3–4 health conditions) and high (5 or more health conditions) reported 1.75% and 7.46% more total productivity loss, respectively, than those with fewer multiple health risks (0–2 health conditions). Health conditions were estimated to account for an annual additional productivity cost due to absenteeism of AUD 8.82 million, presenteeism of AUD 14.08 million and a total productivity loss of AUD 20.96 million per 1000 workers. FIFO workers with high health risks experience more absenteeism, presenteeism and overall productivity loss. These measures provide strong economic justifications that could support the need for targeted workplace health interventions.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.ENVRES.2022.114349
Abstract: In areas with moderate to severe air pollution, pollutant concentrations are associated with dementia risk. It is unclear whether the same relationship is present in regions with lower ambient air pollution. To determine whether exposure to air pollution is associated with risk of incident dementia in general, and Alzheimer's disease and vascular dementia in particular, in older men living in a relatively low ambient air pollution region. The cohort comprised 11,243 men residing in Perth, Australia. Participants were aged ≥65 years and free of a dementia diagnosis at time of recruitment in 1996-1999. Incident dementia was identified from recruitment to 2018 via ICD diagnosis codes and subsequent study waves. Concentrations for three air pollutants, nitrogen dioxide (NO Of 3053 (27.2%) incident cases of dementia, 1670 (54.7%) and 355 (11.6%) had documented Alzheimer's disease and vascular dementia. The average concentration of NO Exposure to air pollution is not associated with increased risk of incident dementia in older men living in a region with relatively low ambient air pollution.
Publisher: JMIR Publications Inc.
Date: 26-11-2021
DOI: 10.2196/30632
Abstract: Emergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. The aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted. The search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. A total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and—depending on the context—improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. Emergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. PROSPERO CRD42019145903 dmkr8ry
Publisher: MDPI AG
Date: 22-11-2021
Abstract: Coronavirus disease 2019 (COVID-19) has devastated the world, and its mental health impact has been recognized in the general population. However, little is known about the mental health impact of COVID-19 on fly-in fly-out (FIFO) workers, who are flown to temporarily stay and work in remote areas, during this pandemic. This study examined the mental well-being of FIFO workers in the mining industry during COVID-19 restrictions in Western Australia. An online survey was conducted between May to November 2020 among (N = 842) FIFO workers who underwent COVID-19 screening at a large mining company in Western Australia. The mental well-being score among workers was higher than population norms. One-way ANOVA with Bonferroni post-hoc tests showed significant differences in mental well-being by age, being placed under travel quarantine, undertaking self-isolation, impact of social distance guidelines, and experience of COVID-19 related symptoms. Multiple linear regression analysis showed workers who were younger, placed under travel quarantine and experienced two or more COVID-19 related symptoms were more likely to have worse mental well-being. Acknowledging the negative emotions and distress experiences among the vulnerable groups could help in providing suitable support to help lessen these negative experiences in FIFO workers.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2020
DOI: 10.1186/S12877-020-01912-1
Abstract: Globally, about 50 million people were living with dementia in 2015, with this number projected to triple by 2050. With no cure or effective treatment currently insight, it is vital that factors are identified which will help prevent or delay both age-related and pathological cognitive decline and dementia. Observational data have suggested that hearing loss is a potentially modifiable risk factor for dementia, but no conclusive evidence from randomised controlled trials is currently available. The HearCog trial is a 24-month, randomised, controlled clinical trial aimed at determining whether a hearing loss intervention can delay or arrest the cognitive decline. We will randomise 180 older adults with hearing loss and mild cognitive impairment to a hearing aid or control group to determine if the fitting of hearing aids decreases the 12-month rate of cognitive decline compared with the control group. In addition, we will also determine if the expected clinical gains achieved after 12 months can be sustained over an additional 12 months and if losses experienced through the non-correction of hearing loss can be reversed with the fitting of hearing aids after 12 months. The trial will also explore the cost-effectiveness of the intervention compared to the control arm and the impact of hearing aids on anxiety, depression, physical health and quality of life. The results of this trial will clarify whether the systematic correction of hearing loss benefits cognition in older adults at risk of cognitive decline. We anticipate that our findings will have implications for clinical practice and health policy development. Australian and New Zealand Clinical Trials Registry ( ANZCTR: 12618001278224 ), registered on 30.07.2018.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/AH14155
Abstract: Inefficiencies in the co-ordination and integration of primary and secondary care services in Australia, have led to increases in waiting times, unnecessary presentations to emergency departments and issues around poor discharge of patients. HealthPathways is a program developed in Canterbury, New Zealand, that builds relationships between General Practitioners and Specialists and uses information technology so that efficiency is maximised and the right patient is given the right care at the right time. Healthpathways is being implemented by a number of Medicare Locals across Australia however, little is known about the impact HealthPathways may have in Australia. This article provides a short description of HealthPathways and considers what it may offer in the Australian context and some of the barriers and facilitators to implementation. What is known about the topic? Early evidence on HealthPathways suggests that the program does seem to be strengthening relationships between GPs and secondary care specialists. In New Zealand advances in efficiency and system integration have been noted. However, there is limited evidence on the effectiveness of HealthPathways in Australia. What does this paper add? It is one of the first published papers to provide a perspective around HealthPathways and draws existing evidence and research to explore some of the barriers and facilitators to the development and implementation of HealthPathways in Australia. What are the implications for practitioners’? Early evidence suggests HealthPathways could help GPs and other practitioners’ in the delivery of health services, it could also help to strengthen practitioner relationships.
Publisher: Journal of Infection in Developing Countries
Date: 31-01-2020
DOI: 10.3855/JIDC.11817
Abstract: Introduction: Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. Little is known about antibiotic prescribing practices at public health facilities in low- and middle-income countries. We examined patterns of antibiotic prescribing in public health facilities in Nepal and explored factors influencing these practices. Methodology: A cross-sectional study of antibiotic prescribing in public health facilities was conducted in the Rupandehi district of Nepal. Six public health facilities were selected based on WHO guidelines, and data were extracted from administrative records for 6,860 patient encounters. Patterns of antibiotic prescribing were investigated using descriptive statistics. Chi-squared tests and logistic regressions were applied to explore factors associated with antibiotic prescribing. Results: Of patients attending public health facilities, the proportion prescribed at least one antibiotic (44.7%) was approximately twice the WHO recommended value (20.0 to 26.8%). The antibiotic prescribing rate for hospital inpatients (64.6%) was higher than for other facilities, with the prescribing rate also high in primary health care centres (50.4%) and health posts (52.2%). The most frequently (29.9%) prescribed antibiotic classes were third-generation cephalosporins. Females (p = 0.005) and younger (p 0.001) patients were more likely to be prescribed antibiotics. High prescribing rates of antibiotics for selected diseases appeared contrary to international recommendations. Conclusion: Antibiotic prescribing in public health facilities was high compared with WHO guidelines, suggesting the need for strategies to reduce misuse of antibiotics. This study provides useful information to assist in formulating policies and guidelines to promote more appropriate use of antibiotics in Nepal.
Publisher: Swansea University
Date: 27-01-2020
Abstract: General practice is often a patient’s first point of contact with the health system and the gateway to specialist services. In Australia different aspects of the health system are managed by the Commonwealth Government and in idual state/territory governments. Although there is a long history of research using administrative data in Australia, this split in the management and funding of services has hindered whole-system research. Additionally, the administrative data typically available for research are often collected for reimbursement purposes and lack clinical information. General practices collect a range of patient information including diagnoses, medications prescribed, results of pathology tests ordered and so on. Practices are increasingly using clinical information systems and data extraction tools to make use of this information. This paper describes approaches used on several research projects to access clinical, as opposed to administrative, general practice data which to date has seen little use as a resource for research. This information was accessed in three ways. The first was by working directly with practices to access clinical and management data to support research. The second involved accessing general practice data through collaboration with Primary Health Networks, recently established in Australia to increase the efficiency and effectiveness of health services for patients. The third was via NPS MedicineWise’s MedicineInsight program, which collects data from consenting practices across Australia and makes these data available to researchers. We describe each approach including data access requirements and the advantages and challenges of each method. All approaches provide the opportunity to better understand data previously unavailable for research in Australia. The challenge of linking general practice data to other sources, currently being explored for general practice data, is discussed. Finally, we describe some general practice data collections used for research internationally and how these compare to collections available in Australia. Keywords: General practice administrative data big data, health information systems, medical records systems
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.IJMEDINF.2022.104803
Abstract: Australia has seen a rapid uptake of virtual care since the start of the COVID-19 pandemic. We aimed to describe the willingness of consumers to use digital technology for health and to share their health information and explore differences by educational attainment and area of remoteness. We conducted an online survey on consumer preferences for virtual modes of healthcare delivery between June and September 2021. Participants were recruited through the study's partner organisations and an online market research company. Australian residents aged ≥18 years who provided study consent and completed the survey were included in the analysis. We reported the weighted percentages of participants who selected negative response to the questions to understand the size of the population that were unlikely to adopt virtual care. Age-adjusted Poisson regression models were used to estimate the prevalence ratios for selecting negative response associated with education and remoteness. Of the 1778 participants included, 29% were not aware of digital technologies for monitoring/supporting health, 22% did not have access to technologies to support their health, and 19% were not willing to use technologies for health. Over a fifth of participants (range: 21-34%) were not at all willing to use seven of the 15 proposed alternative methods of care. Between 21% and 36% of participants were not at all willing to share de-identified health information tracked in apps/devices with various not-for-profit organisations compared to 47% with private/for-profit health businesses. Higher proportions of participants selected negative response to the questions in the lower educational attainment groups than those with bachelor's degree or above. No difference was observed between area of remoteness. Improving the digital health literacy of people, especially those with lower educational attainment, will be required for virtual care to become an equitable part of normal healthcare delivery in Australia.
Publisher: Wiley
Date: 03-11-2011
DOI: 10.1002/HEC.1677
Abstract: Economic analysis is increasingly being employed in formal resource allocation decision-making processes in health care. As a consequence, the methods employed by economic analysts are increasingly subject to close scrutiny. One such area of methodology concerns the instruments used to elicit preferences for various health states for use in the construction of quality-adjusted life years. There are a number of techniques which may be used to elicit preferences and different techniques produce different results. The objective of this study was to explore the test-retest reliability of two techniques: Time Trade Off (TTO) and Person Trade Off (PTO) valuations were collected by a general population postal survey. A total of 798 respondents returned questionnaires. The intra class correlation coefficients ranged from 0.40 to 0.88 for TTO and, -0.17 to 0.82 for PTO, with the majority of coefficients being >0.50. The reliability coefficients varied between techniques and health states, with the TTO technique tending to produce higher coefficients. While the reliability results for TTO were generally positive, the reliability results for PTO are less clear.
Publisher: Wiley
Date: 09-2002
DOI: 10.1080/0959523021000002688
Abstract: In this paper it is argued that the sheer extent of the co-occurrence of mental health and drug dependency disorders means inevitably that alcohol and other drug (AOD) staff encounter such problems. However, it is contended that the AOD work-force has a number of characteristics that often act as impediments to people with co-occurring disorders receiving, in that sector, appropriate, integrated, 'one-stop-shop' care. Nevertheless, because of the configuration of mental health services in Australia, as essentially acute services for people with severe mental illnesses, there has been, and will continue to be, an overspill of people with mental health disorders and drug problems disorders into the AOD sector. It is there absolutely necessary that initiatives are put into place that support and enable the AOD sector to respond more effectively to people with co-occurring disorders.
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJOPEN-2022-063656
Abstract: General practitioners (GPs) routinely provide care for patients with heart failure (HF) however, adherence to management guidelines, including titrating medication to optimal dose, can be challenging in this setting. This study will evaluate the effectiveness of a multifaceted intervention to support adherence to HF management guidelines in primary care. We will undertake a multicentre, parallel-group, randomised controlled trial of 200 participants with HF with reduced ejection fraction. Participants will be recruited during a hospital admission due to HF. Following hospital discharge, the intervention group will have follow-up with their GP scheduled at 1 week, 4 weeks and 3 months with the provision of a medication titration plan approved by a specialist HF cardiologist. The control group will receive usual care. The primary endpoint, assessed at 6 months, will be the difference between groups in the proportion of participants being prescribed five guideline-recommended treatments (1) ACE inhibitor/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor at least 50% of target dose, (2) beta-blocker at least 50% of target dose, (3) mineralocorticoid receptor antagonist at any dose, (4) anticoagulation for patients diagnosed with atrial fibrillation, (5) referral to cardiac rehabilitation. Secondary outcomes will include functional capacity (6-minute walk test) quality of life (Kansas City Cardiomyopathy Questionnaire) depressive symptoms (Patient Health Questionnaire-2) self-care behaviour (Self-Care of Heart Failure Index). Resource utilisation will also be assessed. Ethical approval was granted by the South Metropolitan Health Service Ethics Committee (RGS3531), with reciprocal approval at Curtin University (HRE2020-0322). Results will be disseminated via peer-reviewed publications and conferences. ACTRN12620001069943.
Publisher: Elsevier BV
Date: 02-2022
Abstract: This study explored the healthcare needs and barriers to health services in older homeless women in the Perth metropolitan area, Western Australia. Twenty-two older women experiencing homelessness completed a questionnaire and semi-structured interview. Data were analysed using descriptive statistics and thematic analysis. The study highlighted that these women had complex and inter-related issues that affected their health. The nine major themes that emerged from the interview data consisted of: safe accommodation financial insecurity experience of trauma and abuse stigma, embarrassment and fear of being judged the health impact of not fulfilling their role as family nurturer mental health complex interaction of physical and mental health issues healthcare costs and the need for ongoing psychosocial and healthcare support once housed. Provision of safe and secure accommodation is pivotal to women's health, as is the need for greater understanding of the impact of poverty, women's traditional roles, social disconnection and domestic violence, and ongoing access to healthcare and support services. Implications for public health: A structural and systemic approach based on a social determinants of health framework is required to address the health needs of the increasing numbers of older women becoming homeless in this country.
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-058826
Abstract: Preclinical, clinical and epidemiological studies support the hypothesis that aberrant systemic metabolism of amyloid beta (Aβ) in the peripheral circulation is causally related to the development of Alzheimer’s disease (AD). Specifically, recent studies suggest that increased plasma concentrations of lipoprotein-Aβ compromise the brain microvasculature, resulting in extravasation and retention of the lipoprotein-Aβ moiety. The latter results in an inflammatory response and neurodegeneration ensues. Probucol, a historic cholesterol-lowering drug, has been shown in murine models to suppress lipoprotein-Aβ secretion, concomitant with maintaining blood–brain-barrier function, suppressing neurovascular inflammation and supporting cognitive function. This protocol details the probucol in Alzheimer’s study, a drug intervention trial investigating if probucol has potential to attenuate cognitive decline, delay brain atrophy and reduce cerebral amyloid burden in patients with mild-to-moderate AD. The study is a phase II, randomised, placebo-controlled, double-blind single-site clinical trial held in Perth, Australia. The target s le is 314 participants with mild-to-moderate AD. Participants will be recruited and randomised (1:1) to a 104-week intervention consisting of placebo induction for 2 weeks followed by 102 weeks of probucol (Lorelco) or placebo. The primary outcome is changed in cognitive performance determined via the Alzheimer’s Disease Assessment Scales-Cognitive Subscale test between baseline and 104 weeks. Secondary outcomes measures will be the change in brain structure and function, cerebral amyloid load, quality of life, and the safety and tolerability of Lorelco, after a 104week intervention. The study has been approved by the Bellberry Limited Human Research Ethics Committee (approval number: HREC2019-11-1063 Version 4, 6 October 2021). Informed consent will be obtained from participants prior to any study procedures being performed. The investigator group will disseminate study findings through peer-reviewed publications, key conferences and local stakeholder events. Australian New Zealand Clinical Trials Registry (ACTRN12621000726853).
Publisher: JMIR Publications Inc.
Date: 08-02-2023
DOI: 10.2196/46370
Publisher: Informa UK Limited
Date: 09-2011
Publisher: Springer Science and Business Media LLC
Date: 02-05-2019
Publisher: Oxford University Press (OUP)
Date: 29-08-2020
Abstract: To investigate factors that enable or challenge the initiation and actioning of health and wellbeing policy in Australian local governments using political science frameworks. An online survey was distributed to staff and elected members of Australian local governments. The survey sought responses to a range of variables as informed by political science frameworks. Data were analysed using descriptive statistics and results were compared between local governments of different geographical sizes and locations using Kruskal–Wallis non-parametric testing. There were 1825 survey responses, including 243 CEOs, representing 45% of Australian local governments. Enablers for local government policy initiation and action included the high priority given to health and wellbeing (44%), local leadership (56%) and an organizational (70%) and personal obligation (68%) to the community to act. Less true is a favourable legislative environment (33%), leadership from higher levels of government (29%) and sufficient financial capacity (22%). Cities are better positioned to initiate and action health policy, regardless of the broader legislative environment. Health and wellbeing is a high priority for Australian local governments, despite lack of funding and limited lobbying and support from other sectors and higher levels of government. The insights from political science frameworks assist to understand the policy process, including the interrelatedness of enablers and challenges to initiating and actioning health and wellbeing policy. Further understanding the policy drivers would support practitioners and researchers advocating to influence local health and wellbeing policy.
Publisher: Elsevier BV
Date: 03-2023
Publisher: BMJ
Date: 06-2017
Publisher: Emerald
Date: 13-05-2014
Publisher: Springer Science and Business Media LLC
Date: 08-2015
Publisher: Public Library of Science (PLoS)
Date: 06-08-2020
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/BMJOPEN-2018-022663
Abstract: Overweight and obesity are highly prevalent among Australian men. Professional sports settings can act as a powerful ‘hook’ to engage men in weight loss programmes the Football Fans in Training programme delivered in professional UK soccer clubs was successful and cost-effective in helping men lose weight. The Australian Football League (AFL) is a potentially attractive setting to engage men in a weight loss programme. We aim to develop, pilot and evaluate the feasibility of a weight loss intervention for overweight/obese middle-aged men, delivered in AFL settings, to promote weight loss and healthier lifestyles and determine its suitability for a future randomised control trial. 120 overweight/obese male fans will complete baseline physical and psychological health measures and objective measures of physical activity (PA), weight, waist size and blood pressure prior to randomisation into the intervention or waitlist comparison group. The intervention group will receive 12 weekly 90 min workshops incorporating PA, nutrition education, behaviour change techniques and principles of effective motivation. Four community coaches will be trained to deliver Aussie-FIT at two AFL clubs in Western Australia. Measurements will be repeated in both groups at 3 months (post-intervention) and 6 months (follow-up). Outcomes will include programme uptake, attendance, changes in lifestyle and weight variables to inform power calculations for a future definitive trial, fidelity of programme delivery, acceptability, satisfaction with the programme and perceptions of effectiveness. We will also determine trial feasibility and potential to gather cost-effectiveness data. Ethics approval was granted by Curtin University’s Human Research Ethics Committee (HREC2017-0458). Results will be disseminated via peer-reviewed publications, conference presentations and reports. A multicomponent dissemination strategy will include targeted translation and stakeholder engagement events to establish strategies for sustainability and policy change. ACTRN12617000515392 Pre-results.
Publisher: Hindawi Limited
Date: 05-2013
DOI: 10.1111/HSC.12046
Abstract: Public sector organisations are facing one of the most difficult financial periods in history and local decision-makers are tasked with making tough rationing decisions. Withdrawing or limiting services is an emotive and complex task and something the National Health Service has always found difficult. Over time, local authorities have gained significant experience in the closure of care homes - an equally complex and controversial issue. Drawing on local knowledge and best practice ex les, this article highlights lessons and themes identified by those decommissioning care home services. We believe that such lessons are relevant to those making disinvestment decisions across public sector services, including health-care. The study employed semi-structured interviews with 12 Directors of Adult Social Services who had been highlighted nationally as having extensive experience of home closures. Interviews were conducted over a 2-week period in March 2011. Results from the study found that having local policy guidance that is perceived as fair and reasonable was advocated by those involved in home closures. Many local policies had evolved over time and had often been developed following experiences of home closures (both good and bad). Decisions to close care home services require a combination of strong leadership, clear strategic goals, a fair decision-making process, strong evidence of the need for change and good communication, alongside wider stakeholder engagement and support. The current financial challenge means that public sector organisations need to make tough choices on investment and disinvestment decisions. Any such decisions need to be influenced by what we know constitutes best practice. Sharing lessons and experiences within and between sectors could well inform and develop decision-making practices.
Publisher: Wiley
Date: 31-10-2021
DOI: 10.1002/GPS.5449
Abstract: This study aimed to test if a behavioural activation (BA) programme was more effective than usual care at reducing the risk of conversion to major depression over 52 weeks among adults aged 65 years or older living in rural Western Australia. Secondary aims were to test if participants assigned to the BA intervention experienced greater decline in the severity of depressive and anxiety symptoms than older adults treated with usual care over 26 and 52 weeks, as well as greater improvement in physical and mental health‐related quality of life. Randomised controlled clinical trial that started recruitment in February 2016 in rural Western Australia. We used the electoral roll to invite adults aged 65 years or over living in suitable regions of Western Australia to take part in the study. We recruited those who consented and screened positive to at least one of the two Whooley questions: feeling down/depressed/hopeless or little interest or pleasure over the past month. Participants were randomly assigned to usual care or usual care plus a phone‐delivered BA program (1:1). The intervention consisted of a self‐managed BA program supported by three 45‐min phone sessions delivered by a BA therapist over a period of 8 weeks. We used the DSM‐5 criteria to establish the presence of a major depressive episode, and Patient Health Questionnaire, Generalised Anxiety Disorder Scale and SF‐36 to assess symptoms of depression, anxiety and quality of life. Of the 309 older adults randomised, 307 started the trial: 153 usual care and 154 BA (computer‐generated random permuted even blocks ranging in size from 8 to 20). Six participants developed a major depressive episode during follow‐up, four of them in the usual care group (odds ratio of depression associated with the intervention = 0.49, 95% CI = 0.04, 3.49—blind assessment). Seventy‐three (23.8%) participants were lost over 52 weeks—there were no differences between usual care and intervention group. Intention‐to‐treat analyses using mixed regression models found modest non‐significant effects of the BA intervention, while complete‐case analyses showed that participants treated with BA compared with usual care experienced significant improvements in depression and anxiety symptoms over 52 weeks, as well as improved mental health quality of life. Few participants developed a major depressive episode during follow‐up. The BA intervention was associated with improved symptoms of depression and anxiety, although the clinical significance of these benefits remains unclear.
Publisher: Springer Science and Business Media LLC
Date: 21-04-2021
DOI: 10.1186/S12961-021-00710-4
Abstract: Health and medical research funding agencies are increasingly interested in measuring the impact of funded research. We present a research impact case study for the first four years of an Australian National Health and Medical Research Council funded Centre of Research Excellence in Cardiovascular Outcomes Improvement (2016–2020). The primary aim of this paper was to explore the application of a research impact matrix to assess the impact of cardiovascular outcomes improvement research. We applied a research impact matrix developed from a systematic review of existing methodological frameworks used to measure research impact. This impact matrix was used as a bespoke tool to identify and understand various research impacts over different time frames. Data sources included a review of existing internal documentation from the research centre and publicly available information sources, informal iterative discussions with 10 centre investigators, and confirmation of information from centre grant and scholarship recipients. By July 2019, the impact on the short-term research domain category included over 41 direct publications, which were cited over 87 times (median journal impact factor of 2.84). There were over 61 conference presentations, seven PhD candidacies, five new academic collaborations, and six new database linkages conducted. The impact on the mid-term research domain category involved contributions towards the development of a national cardiac registry, cardiovascular guidelines, application for a Medicare Benefits Schedule reimbursement item number, introduction of patient-reported outcome measures into several databases, and the establishment of nine new industry collaborations. Evidence of long-term impacts were described as the development and use of contemporary management for aortic stenosis, a cardiovascular risk prediction model and prevention targets in several data registries, and the establishment of cost-effectiveness for stenting compared to surgery. We considered the research impact matrix a feasible tool to identify evidence of academic and policy impact in the short- to midterm however, we experienced challenges in capturing long-term impacts. Cost containment and broader economic impacts represented another difficult area of impact to measure.
Publisher: Oxford University Press (OUP)
Date: 08-2023
Abstract: Dental caries, a non-communicable disease, is one of the most prevalent diseases globally and share common modifiable risk factors with obesity such as excess sugar intake. However, prioritization by governments to improve population oral health has been limited and is typically excluded from the discourse of public health policy development. Therefore, interventions that target dental caries can have other co-benefits including obesity prevention. In Victoria, Australia, local government authorities have a regulatory requirement to develop their Municipal Health and Wellbeing Plans. The aim of this paper is to identify whether prioritization for oral health by local government authorities in Victoria has changed through the subsequent renewal of the Victorian Public Health and Wellbeing Plans 2011–2015 and 2019–2023. Three desktop audits for all publicly available Municipal Health and Wellbeing Plans by local government authorities in Victoria were conducted between 2014 and 2022. Key terms related to oral health was searched within these policy documents and categorized into six indicators: (i) included oral health as a priority, (ii) linked healthy eating and oral health, (iii) supported the Achievement Program, (iv) included the Smiles 4 Miles program, (v) advocated for fluoridated drinking water, and (vi) included other strategies related to oral health. Overall, there was statistically significant reduction in five of the six indicators, with the exception for prioritization of other strategies related to oral health such as targeting excess sugar intake and smoking. A multi-sectoral approach, that includes oral health would be advantageous to address the growing burden of non-communicable diseases.
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-040183
Abstract: Digital behavioural weight loss interventions have the potential to improve public health however, these interventions are often not adequately tailored to the needs of the participants. This is the protocol for a trial that aims to determine the effectiveness and cost-effectiveness of the Choosing Health programme as a means to promote weight loss and weight loss maintenance among overweight/obese adults. The proposed study is a two-group randomised controlled trial with a nested interrupted time series (ITS) within-person design. Participants (n=285) will be randomly assigned to either the Choosing Health digital intervention or a control group. For intervention participants, ecological momentary assessment will be used to identify behavioural determinants for each in idual in order to tailor evidence-based behaviour change techniques and intervention content. Control group participants will receive non-tailored weight loss advice via e-book and generic emails. The primary outcome is the mean difference in weight loss between groups at 6 months controlled for baseline. Secondary outcomes include blood pressure and percentage of body fat self-reported measures of physical activity, sitting time, quality of life, cost and theory-derived correlates of weight loss. Secondary outcomes will be measured at baseline, 3, 6 and 12 months. The primary outcome for ITS will be daily weight loss plan adherence. Data will be analysed using regression and time series analyses. Ethics approval was granted by Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland, approval number 03/P/12/2019. The project results will be disseminated through structured strategy implemented in collaboration with the Ministry of Health. This trial was registered with www.clinicaltrials.gov registration number NCT04291482 .
Publisher: Elsevier BV
Date: 04-2020
Publisher: AMPCo
Date: 02-2017
DOI: 10.5694/MJA16.00398
Publisher: JMIR Publications Inc.
Date: 12-12-2020
Abstract: espite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant’s father, has been identified as a crucial element for successful breastfeeding. he objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. he study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator Milk Man, a breastfeeding smartphone app designed specifically for fathers and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. his study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically erse populations that are likely to benefit most from additional partner supports. ustralian New Zealand Clinical Trials Registry ACTRN12614000605695 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695 R2-10.1186/s12884-015-0601-5
Publisher: Emerald
Date: 29-11-2013
DOI: 10.1108/JICA-09-2013-0037
Abstract: – The purpose of this paper is to contribute an Australian perspective to the debate on health system integration by identifying some key Australian challenges to integration, policy responses to enhance integration and potential insights from these for international policy makers, researchers and practitioners. – Drawing on the systems theory concept of entropy, the authors contend that there exist factors that contribute to system fragmentation. Whilst policy responses to these challenges are contextual, there are generalisable features worth exploring internationally. – The authors suggest that recognition of inherent system-based barriers is an important initial stage in moving towards integration. Whilst process and people factors are important contributors to integration, the political will to move in this direction is a necessary dynamic to energise the system through appropriate funding, incentives and governance structures. – The paper provides a fresh Australian perspective to the international discourse on barriers and opportunities to enhance health system integration.
Publisher: Emerald
Date: 20-03-2009
DOI: 10.1108/14777260910942597
Abstract: The purpose of this paper is to evaluate the claims made for the clinical microsystems approach of healthcare improvement within an English NHS context. The research adopted a Realistic Evaluation approach to examine a series of pilot clinical microsystems sites to determine what worked for whom, when and within what circumstances. Interviews and group discussions were used to collect qualitative data, whist quantitative outcome data was also collected within each of the sites. Data was triangulated to produce case studies for each of the sites. The research concurred with many of the claims for clinical microsystems, particularly that democratic, consensual approaches to change and improvement can be better received than externally derived initiatives with imposed targets. The clinical microsystem approach emphasises identifying and nurturing strengths – of both teams and in iduals – and this reinforced these positive aspects. The case study sites demonstrated higher staff morale, empowerment, commitment and clarity of purpose. To a lesser extent the research also indicated an enhanced predisposition towards improvement and innovation and a seemingly embedded sense of improvement as an ongoing (if essentially episodic) process. The evaluation was limited in terms of the numbers of case study sites that it was able to incorporate. This s le represented sites of different sizes, coverage of primary, secondary and tertiary care and those reporting more and less positive experiences of the clinical microsystems approach – but any findings may be limited in their generaliseability and further studies may be needed to test out the relevance of these findings in wider settings. Future microsystem programmes will need to address components of patient involvement and process/outcome monitoring if the broader legitimacy of the approach is to be cemented and enhanced. In particular, the importance of strong data collection in achieving “high performing” status is emphasised. There is currently no other empirical studies within the academic literature which investigate the value of the clinical microsystems approach to an English NHS context.
Publisher: JMIR Publications Inc.
Date: 13-12-2022
Abstract: he COVID-19 pandemic triggered a rapid scale-up of telehealth services in Australia as a means to provide continued care through periods of physical restrictions. The factors that influence engagement in telehealth remain unclear. he purpose of this study is to understand the experience of Australian people who engaged in a telehealth consultation during the pandemic period (2020-2021) and the demographic factors that influence engagement. web-based survey was distributed to Australians aged over 18 years that included 4 questions on frequency and type of clinical consultation, including with a general practitioner (GP), specialist, allied health, or nurse 1 question on the experience of telehealth and 2 questions on the quality of and satisfaction with telehealth. Statistical analysis included proportion of responses (of positive responses where a Likert scale was used) and regression analyses to determine the effect of demographic variables. f the 1820 participants who completed the survey, 88.3% (1607/1820) had engaged in a health care consultation of some type in the previous 12 months, and 69.3% (1114/1607) of those had used telehealth. The most common type of consultation was with a GP (959/1114, 86.1%). Older people were more likely to have had a health care consultation but less likely to have had a telehealth consultation. There was no difference in use of telehealth between metropolitan and nonmetropolitan regions however, people with a bachelor’s degree or above were more likely to have used telehealth and to report a positive experience. A total of 87% (977/1114) of participants agreed or strongly agreed that they had received the information they required from their consultation, 71% (797/1114) agreed or strongly agreed that the outcome of their consultation was the same as it would have been face-to-face, 84% (931/1114) agreed or strongly agreed that the doctor or health care provider made them feel comfortable, 83% (924/1114) agreed or strongly agreed that the doctor or health care provider was equally as knowledgeable as providers they have seen in person 57% (629/1114) of respondents reported that they would not have been able to access their health consultation if it were not for telehealth 69% (765/1114) of respondents reported that they were satisfied with their telehealth consultation, and 60% (671/1114) reported that they would choose to continue to use telehealth in the future. here was a relatively high level of engagement with telehealth over the 12 months leading up to the study period, and the majority of participants reported a positive experience and satisfaction with their telehealth consultation. While there was no indication that remoteness influenced telehealth usage, there remains work to be done to improve access to older people and those with less than a bachelor’s degree.
Publisher: Springer Science and Business Media LLC
Date: 22-07-2022
DOI: 10.1186/S40798-022-00483-2
Abstract: The COVID-19 pandemic has led to a shift in healthcare towards telehealth delivery, which presents challenges for exercise physiology services. We aimed to examine the impact of the COVID-19 pandemic on the reach, efficacy, adoption and implementation of telehealth delivery for exercise physiology services by comparing Australian practises before (prior to 25 January 2020) and during the COVID-19 pandemic (after 25 January 2020). This retrospective audit included 80 accredited exercise physiology clinicians. We examined relevant dimensions of the RE-AIM framework (reach, effectiveness, adoption and implementation) from the clinician perspective. During the COVID-19 pandemic, 91% ( n = 73/80) of surveyed clinicians offered telehealth delivery service, compared to 25% ( n = 20/80) prior. Mean (SD) telehealth delivery per week doubled from 5 (7) to 10 (8) hours. In-person delivery decreased from 23 (11) to 15 (11) hours per week. Typical reasons for not offering telehealth delivery were client physical/cognitive incapacity ( n = 33/80, 41%) and safety ( n = 24/80, 30%). Clinician-reported reasons for typical clients not adopting telehealth delivery were personal preference ( n = 57/71, 80%), physical capacity ( n = 35/71, 49%) and access to reliable delivery platforms ( n = 27/71, 38%). Zoom ( n = 54/71, 76%) and telephone ( n = 53/71, 75%) were the most commonly used platforms. Of the reasons contributing to incomplete treatment, lack of confidence in delivery mode was sevenfold higher for telehealth compared to in-person delivery. No serious treatment-related adverse events were reported. During the COVID-19 pandemic, telehealth delivery of exercise physiology services increased and in-person delivery decreased, which suggests the profession was adaptable and agile. However, further research determining comparative efficacy and cost-effectiveness is warranted.
Publisher: SAGE Publications
Date: 12-04-2019
Abstract: Management of a cleft of the lip and/or palate (CL/P) involves a multidisciplinary team approach lasting from birth to potentially postskeletal maturity. This condition is complex, with both medical and psychosocial implications that may place in iduals with a cleft at higher risk of developing psychosocial problems. A self-administered questionnaire was completed by a s le from the Western Australian cleft population comprising 3 age groups: child (n = 100), adolescent (n = 101), and adult (n = 158). Public speaking, being photographed, special relationships, and participation in school were identified as the areas most impacted by having a cleft. Hearing and speech were reported to have a higher importance than facial and dental appearance. Participants rated support given to them by their parents as the most important, with high ratings for treatment providers. For teasing, the impact of cleft was significantly higher among participants with cleft lip and palate for both the adolescent and adult age groups. There was little significant difference by gender across the variables, which suggests that males are just as likely to require support as females. The impact of a cleft across multiple psychosocial domains needs to be recognized and addressed as part of craniofacial team care across age groups.
Publisher: Public Library of Science (PLoS)
Date: 31-08-2022
DOI: 10.1371/JOURNAL.PONE.0273935
Abstract: In Australia, telehealth is not new, with several telehealth specialist services being available for those living in rural and remote communities. However, prior to the COVID-19 pandemic, telehealth was not routinely available for primary care or urban specialist appointments. There has been an increased focus in the use of telehealth within primary care, and particularly general practice, but overall, there has been limited research to date to guide telehealth best-practice based on consumer experiences and preferences within these settings. We aimed to capture the consumer experience of telehealth during the COVID-19 pandemic, through a novel Kitchen Table Discussion (KTD) method. This increases access to a broader community consumer cohort, with consumer hosts leading discussions in a safe environment. The KTDs were conducted in May 2021, with 10 community members each hosting a group of up to 10 participants. A total of 90 participants took part from across Australia, with the majority living in major cities, although a significant proportion lived in inner and outer regional areas of Australia, or had experience living in rural, regional or remote areas. Seventy percent of participants reported using telehealth in the past. Data were analysed sequentially using thematic analysis and identified key themes: modality, convenience, access, wait time, existing relationship, communication, connectivity, cost, and privacy. Overall, the future of telehealth looks hopeful from the perspective of the consumer, but significant improvements are required to improve consumer engagement and experience. It is evident that ‘one size does not fit all’, with results suggesting consumers value the availability of telehealth and having choice and flexibility to use telehealth when appropriate, but do not want to see telehealth replacing face-to-face delivery. Participants tended to agree that telehealth was not a preferred method when physical examination was required but would suit certain points of the patient journey.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/PY17110
Abstract: The Drug and Alcohol Withdrawal Network (DAWN) is a home-based withdrawal service based in Perth, Western Australia. Literature on outcomes, costs and client attitudes towards this type of home-based detoxification in Australia is sparse. Therefore, this study assessed these factors for clients enrolled over a 5-year period (July 2011–June 2016). Client experience was explored through semi-structured interviews with 10 clients. Over the study period, 1800 clients (54% male, mean age 38 years) were assessed, and there were 2045 episodes of care. Although most first-episode clients (52%) listed alcohol as the primary drug of concern, the proportion listing meth hetamine increased from 4% in 2011–12 to 23% in 2015–16. In 94% (n = 639) of withdrawal detoxification episodes with completed surveys, clients used their ‘drug of primary concern’ most days or more often at baseline this had reduced to 23% (n = 149) at the conclusion of detoxification. Five-year direct costs were A$4.8 million. Clients valued the person-centred holistic approach to care, including linking with other health providers. Barriers included low awareness of the program and difficulties finding an appropriate support person. Further exploration of cost-effectiveness would substantiate the apparently lower per client cost, assuming medical suitability for both programs, for home-based relative to inpatient withdrawal.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.SOCSCIMED.2012.09.014
Abstract: In a context of ever increasing demand, the recent economic downturn has placed further pressure on decision-makers to effectively target healthcare resources. Over recent years there has been a push to develop more explicit evidence-based priority-setting processes, which aim to be transparent and inclusive in their approach and a number of analytical tools and sources of evidence have been developed and utilised at national and local levels. This paper reports findings from a qualitative research study which investigated local priority-setting activity across five English Primary Care Trusts, between March and November 2012. Findings demonstrate the dual aims of local decision-making processes: to improve the overall effectiveness of priority-setting (i.e. reaching 'correct' resource allocation decisions) and to increase the acceptability of priority-setting processes for those involved in both decision-making and implementation. Respondents considered priority-setting processes to be compartmentalised and peripheral to resource planning and allocation. Further progress was required with regard to disinvestment and service redesign with respondents noting difficulty in implementing decisions. While local priority-setters had begun to develop more explicit processes, public awareness and input remained limited. The leadership behaviours required to navigate the political complexities of working within and across organisations with differing incentives systems and cultures remained similarly underdeveloped.
Publisher: Springer Science and Business Media LLC
Date: 07-2022
DOI: 10.1186/S12875-022-01759-Y
Abstract: The potential for data collected in general practice to be linked and used to address health system challenges of maintaining quality care, accessibility and safety, including pandemic support, has led to an increased interest in public acceptability of data sharing, however practitioners have rarely been asked to share their opinions on the topic. This paper attempts to gain an understanding of general practitioner’s perceptions on sharing routinely collected data for the purposes of healthcare planning and research. It also compares findings with data sharing perceptions in an international context. A mixed methods approach combining an initial online survey followed by face-to-face interviews (before and during COVID-19), designed to identify the barriers and facilitators to sharing data, were conducted on a cross sectional convenience s le of general practitioners across Western Australia (WA). Eighty online surveys and ten face-to-face interviews with general practitioners were conducted from November 2020 – May 2021. Although respondents overwhelmingly identified the importance of population health research, their willingness to participate in data sharing programs was determined by a perception of trust associated with the organisation collecting and analysing shared data a clearly defined purpose and process of collected data including a governance structure providing confidence in the data sharing initiative simultaneously enabling a process of data sovereignty and autonomy. Results indicate strong agreement around the importance of sharing patient’s medical data for population and health research and planning. Concerns pertaining to lack of trust, governance and secondary use of data continue to be a setback to data sharing with implications for primary care business models being raised. To further increase general practitioner’s confidence in sharing their clinical data, efforts should be directed towards implementing a robust data governance structure with an emphasis on transparency and representative stakeholder inclusion as well as identifying the role of government and government funded organisations, as well as building trust with the entities collecting and analysing the data.
Publisher: Wiley
Date: 03-2008
DOI: 10.1080/09595230701829405
Abstract: Implementing consumer participation initiatives in Australian drug treatment services successfully is predicated on the support of those most centrally involved. This paper describes service providers' and consumers' (1) beliefs about and commitment to consumer participation and (2) perceived barriers to conducting or participating in consumer participation. Data were collected from 64 providers and 179 consumers of drug treatment services. The data showed that almost all consumers (89.9%, n = 161) and providers (84.4%, n = 54) believed in the principle of consumer participation (that consumers' views should be included in service planning and delivery) and a large proportion would be willing to conduct or participate in consumer participation activities in future. Providers were less supportive of activities in which consumers would be involved in decision-making that relates directly to staff (such as staff training, recruitment and performance appraisal), and expressed concerns about the practicality of operationalising such activities, the inadequacy of consumers' skills, consumers' lack of interest and the appropriateness of having consumers involved in such decision-making. A small proportion of consumers also indicated that they did not want to participate, expressing beliefs that it was not their place to be involved and that they lacked the required skills. Overall, these findings revealed that there was considerable support for the further development of consumer participation in drug treatment services, but the predominant obstacle was the view that it is not consumers' place to take part, and that they lack the interest and skills to do so.
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJOPEN-2020-046460
Abstract: Mild traumatic brain injury (mTBI) is a complex injury with heterogeneous physical, cognitive, emotional and functional outcomes. Many who sustain mTBI recover within 2 weeks of injury however, approximately 10%–20% of in iduals experience mTBI symptoms beyond this ‘typical’ recovery timeframe, known as persistent post-concussion symptoms (PPCS). Despite increasing interest in PPCS, uncertainty remains regarding its prevalence in community-based populations and the extent to which poor recovery may be identified using early predictive markers. (1) Establish a research dataset of people who have experienced mTBI and document their recovery trajectories (2) Evaluate a broad range of novel and established prognostic factors for inclusion in a predictive model for PPCS. The Concussion Recovery Study ( CREST ) is a prospective, longitudinal observational cohort study conducted in Perth, Western Australia. CREST is recruiting adults aged 18–65 from medical and community-based settings with acute diagnosis of mTBI. CREST will create a state-wide research dataset of mTBI cases, with data being collected in two phases. Phase I collates data on demographics, medical background, lifestyle habits, nature of injury and acute mTBI symptomatology. In Phase II , participants undergo neuropsychological evaluation, exercise tolerance and vestibular/ocular motor screening, MRI, quantitative electroencephalography and blood-based biomarker assessment. Follow-up is conducted via telephone interview at 1, 3, 6 and 12 months after injury. Primary outcome measures are presence of PPCS and quality of life, as measured by the Post-Concussion Symptom Scale and the Quality of Life after Brain Injury questionnaires, respectively. Multivariate modelling will examine the prognostic value of promising factors. Human Research Ethics Committees of Royal Perth Hospital (#RGS0000003024), Curtin University (HRE2019-0209), Ramsay Health Care (#2009) and St John of God Health Care (#1628) have approved this study protocol. Findings will be published in peer-reviewed journals and presented at scientific conferences. ACTRN12619001226190.
Publisher: Springer Science and Business Media LLC
Date: 21-09-2017
Publisher: Emerald
Date: 16-11-2015
DOI: 10.1108/JHOM-01-2015-0013
Abstract: – As Australia struggles to meet increased demand for healthcare and contain expenditure there has been a focus on primary care and its role in demand management and keeping people out of expensive secondary care. However, with domestic policy struggling to find a suitable approach consideration of English policy could well be fruitful in the quest to strengthen and develop primary care in Australia. The purpose of this paper is to consider policy developments in England and explores these in relation to the Australian healthcare system. – The authors highlight the key changes to policy that have occurred in the English healthcare system in recent years, and discuss whether they have proven successful. The authors discuss the barriers to implementing similar approaches in Australia, particularly the difference in system structure that would necessitate policy adaptation. – Whilst there are differences in the structure and organisation of funding and service provision between countries, there are developments in England that are worthy of consideration from an Australian perspective. These include a focus on funding and commissioning that rewards quality not just activity and volume. As Australia sees the development of new primary care organisations that are tasked with commissioning then developments and lessons around the technical and relational aspects will be important to consider. – The work highlights that Australia might consider learning from the English experience in this area and the types of incentives that may increase efficiency and quality of health service provision. This is important as it potentially gives greater certainty about those approaches most likely to yield beneficial outcomes for patients and the broader system.
Publisher: Emerald
Date: 21-07-2021
DOI: 10.1108/JHOM-02-2021-0056
Abstract: As a discipline, health organisation and management is focused on health-specific, collective behaviours and activities, whose empirical and theoretical scholarship remains under-utilised in the field of implementation science. This under-engagement between fields potentially constrains the understanding of mechanisms influencing the implementation of evidence-based innovations in health care. The aim of this viewpoint article is to examine how a selection of theories, models and frameworks (theoretical approaches) have been applied to better understand phenomena at the micro, meso and macro systems levels for the implementation of health care innovations. The purpose of which is to illustrate the potential applicability and complementarity of embedding health organisation and management scholarship within the study of implementation science. The authors begin by introducing the two fields, before exploring how exemplary theories, models and frameworks have been applied to study the implementation of innovations in the health organisation and management literature. In this viewpoint article, the authors briefly reviewed a targeted collection of articles published in the Journal of Health Organization and Management (as a proxy for the broader literature) and identified the theories, models and frameworks they applied in implementation studies. The authors then present a more detailed exploration of three interdisciplinary theories and how they were applied across three different levels of health systems: normalization process theory (NPT) at the micro in idual and interpersonal level institutional logics at the meso organisational level and complexity theory at the macro policy level. These ex les are used to illustrate practical considerations when implementing change in health care organisations that can and have been used across various levels of the health system beyond these presented ex les. Within the Journal of Health Organization and Management , the authors identified 31 implementation articles, utilising 34 theories, models or frameworks published in the last five years. As an ex le of how theories, models and frameworks can be applied at the micro in idual and interpersonal levels, behavioural theories originating from psychology and sociology (e.g. NPT) were used to guide the selection of appropriate implementation strategies or explain implementation outcomes based on identified barriers and enablers to implementing innovations of interest. Projects aiming to implement change at the meso organisational level can learn from the application of theories such as institutional logics, which help elucidate how relationships at the macro and micro-level have a powerful influence on successful or unsuccessful organisational action. At the macro policy level, complexity theory represented a promising direction for implementation science by considering health care organisations as complex adaptive systems. This paper illustrates the utility of a range of theories, models and frameworks for implementation science, from a health organisation and management standpoint. The authors’ viewpoint article suggests that increased crossovers could contribute to strengthening both disciplines and our understanding of how to support the implementation of evidence-based innovations in health care.
Publisher: BMJ
Date: 15-12-2006
Publisher: Oxford University Press (OUP)
Date: 29-04-2020
DOI: 10.1111/IJPP.12625
Abstract: Pharmacists’ roles are expanding to delivering a wider set of professional services including medication management optimisation, vaccinations and screening services. Robust research determining whether pharmacists have the capacity to offer such services in the Australian community pharmacy setting is lacking. This protocol details a mixed methods study that investigates the variation in pharmacists’ daily tasks and the workspace they work in as a measure of their workload capacity for expanding pharmacy services. An observational time and motion study will be conducted in up to twenty community pharmacies in metropolitan and rural regions of Australia. A trained observer will follow a pharmacist and record the type, location and duration of tasks undertaken over the course of their working day. Data will be collected and analysed using the electronic Work Observation Method By Activity Timing (WOMBAT) tool. Pharmacists’ work patterns will be described as time for each task, and by proportionating multitasking and interruptions. This information will be combined with workspace data collected using floor plans, photographs and a qualitative assessment of the working environment completed by the observer. Analysis will include heat-mapped floor plans visually highlighting pharmacist movements. Pharmacists may provide solutions to the strained health workforce and system. There is limited quantitative evidence on whether pharmacists have the time or work setting to support such needs. The use of time and motion methodology is novel to Australian community pharmacy research, and the findings will provide a better understanding of pharmacists’ capacity and work environment.
Publisher: Cold Spring Harbor Laboratory
Date: 14-12-2020
DOI: 10.1101/2020.12.12.20248054
Abstract: The Western Australia Acute TeleStroke Programme commenced incrementally across regional Western Australia (WA) during 2016-2017. Since the introduction of the TeleStroke Programme, there has been monitoring of service outputs including regional patient access to tertiary stroke specialist advice and reperfusion treatment, however, the impact of consultation with a stroke specialist via telehealth (videoconferencing or telephone) on the effectiveness and cost-effectiveness of stroke care, and the drivers of cost-effectiveness has not been systematically evaluated. The aim of the case study is to examine the impact of consultation with a stroke specialist via telehealth on the effectiveness and cost-effectiveness of stroke and TIA care using a mixed methods approach. A categorical decision tree model will be constructed in collaboration with clinicians and programme managers. A before and after comparison using State-wide administrative datasets will be used to run the base model. If s le size and statistical power permits, the cases and comparators will be matched by stroke type and presence of CT scan at the initial site of presentation, age category and presenting hospital. The drivers of cost-effectiveness will be explored through stakeholder interviews. Data from the qualitative analysis will be cross-referenced with trends emerging from the quantitative dataset and used to guide the factors to be involved in sub-group and sensitivity analysis. Ethics approval for this case study has been granted from the WACHS Human Research and Ethics Committee (RGS3076). Reciprocal approval has been granted from Curtin University Human Research Ethics Office (HRE2019-0740). Findings will be disseminated publicly through conference presentation and peer-review publications. Interim findings will be released as internal reports to inform the service development. Comparison of the impact of stroke specialist consultation via telehealth in regional Australia in supporting the management of different stroke subtypes The decision tree model will be constructed in collaboration with clinicians and programme administrators directly involved in the delivery of the TeleStroke Programme Use of local administrative data as model inputs enables the base model to reflect the reality of the regional WA Health service delivery Collaboration with WA Health stakeholders involved in TeleStroke Programme design and implementation to optimise utility of the case study to inform service development and expansion Conversion of the functional outcome modified Rankin Scale score (mRS) to quality adjusted life years (QALY) relies on national or international averages
Publisher: Informa UK Limited
Date: 20-07-2022
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.JDIACOMP.2017.03.015
Abstract: This study aimed to develop a risk stratification strategy for evaluating the relationship between complications of diabetes and the risk of diabetic-related hospitalization to accurately classify diabetes severity. The study used administrative health records for 40,624 in iduals with diabetes aged ≥18years in Western Australian. The adapted Diabetes Complication Severity Index (DCSI), socio-demographic and clinical characteristics were used in random effects negative binomial and threshold effect models to determine the optimal stratification strategy for diabetes severity based on the homogeneity of the risk of hospitalization in response to variation of the DCSI. The optimal stratification of people with diabetes was specified by four sub-populations. The first sub-population was no complications with an inverse association with the risk of hospitalizations (coefficient-0.247, SE 0.03). Further three sub-populations with DCSI at one (coefficient 0.289, SE 0.01), two (coefficient 0.339, SE 0.01) and three or more (coefficient 0.381, SE 0.01) were used to accurately describe the impact of DCSI on the risk of hospitalization. A stratification into four subpopulations based on the homogeneous impact of diabetes DCSI on the risk of hospitalization may be more suitable for evaluating health care interventions and planning health care provision.
Publisher: Informa UK Limited
Date: 20-03-2023
Publisher: SAGE Publications
Date: 2012
DOI: 10.1258/JHSRP.2011.011104
Abstract: The world class commissioning (WCC) programme was introduced in the English NHS in 2007 to develop primary care trust (PCT) commissioning of health services. There has been limited evaluation of health commissioning initiatives over the years and in particular little is known about how commissioners interpret and implement initiatives and guidance intended to strengthen commissioning. This research explores the development and implementation of WCC and draws implications for future commissioning arrangements. This research draws on interviews with key informants (n = 6) and a literature review to analyse the aims of, and stimulus for, WCC. In-depth interviews (n = 38) were conducted in three PCTs in the north of England in 2009 to analyse the interpretation and implementation of WCC. The aims and rationale of WCC, in particular, the specification of commissioning skills and the aspirations to improve health outcomes, were largely welcomed and supported by interviewees. However, the implementation of WCC posed a number of challenges, including: availability of resources and knowledge lack of a supportive organizational culture and networks and the dominance of central government control. The findings have implications for emerging clinical commissioning groups (CCGs) in the English NHS. Specifically, the research highlights the need for a system-wide approach to improving commissioning, including appropriately aligned policy and objectives underpinned by a co-ordinated and supportive organizational culture.
Publisher: BMJ
Date: 23-07-2019
DOI: 10.1136/HEARTJNL-2019-315134
Abstract: To determine whether sex differences exist in the management of patients with a history of coronary heart disease (CHD) in primary care. General practice records of patients aged ≥18 years with a history of CHD in a large general practice dataset in Australia, MedicineInsight, were analysed. Sex-specific, age-standardised proportions of patients prescribed with recommended medications assessed for cardiovascular risk factors and achieved treatment targets according to the General Practice Management Plan were reported. Records of 130 926 patients (47% women) from 438 sites were available from 2014 to 2018. Women were less likely to be prescribed with recommended medications (prescribed ≥3 medications: women 44%, men 61% p .001). Younger patients, especially women aged years, were substantially underprescribed (aged years prescribed ≥3 medications: women 2%, men 8% p .001). Lower proportions of women were assessed for cardiovascular risk factors (blood test for lipids: women 70%–76%, men 77%–81% p .001). Body size was not commonly assessed (body mass index: women 59%, men 62% p .001 waist: women 23%, men 25% p .001). Higher proportions of women than men achieved targets for most risk factors (achieved ≥4 targets in patients assessed for all risk factors: women 82%, men 76%). Gaps in preventative management including prescription of indicated medications and risk factor monitoring have been reported from the late 1990s and this large-scale general practice data analysis indicate they still persist. Moreover, the gap is larger in women compared to men. We need new ways to address these gaps and the sex inequity.
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.JVAL.2012.04.006
Abstract: To explore the extent of and barriers to the use of economic evaluation in compiling the Jordan Rational Drug List in the health care system of Jordan. The research reported in this article involved a case study of the Jordan Rational Drug List. Data collection methods included semi-structured interviews with decision makers and analysis of secondary documentary sources. The case study was supplemented by additional interviews with a small number of Jordanian academics involved in the production of economic evaluation. The research found that there was no formal requirement for cost-effectiveness information submitted as part of the decision-making process for the inclusion of new technologies on the Jordan Rational Drug List. Both decision makers and academics suggested that economic evidence was not influential in formulary decisions. This is unusual for national formulary bodies. The study identified a number of barriers that prevent substantive and routine use of economic evaluation. While some of these echo findings of previous studies, others-notably the extent to which the sectional interests of clinical groups and commercial (pharmaceutical) industry exert undue influence over decision making-more obviously result from the specific Jordanian context. Economic evaluation was not found to be influential in the Jordan Rational Drug List. Recommendations for improvement include enhancing capacity in relation to generating, accessing, and/or applying health economic analysis to priority setting decisions. There is a further need to incentivize the use of economic evaluation, and this requires that organizational and structural impediments be removed.
Publisher: Informa UK Limited
Date: 07-09-2023
Publisher: Public Library of Science (PLoS)
Date: 21-02-2020
Publisher: Elsevier BV
Date: 05-2020
Publisher: Hindawi Limited
Date: 10-2002
DOI: 10.1046/J.1365-2710.2002.00426.X
Abstract: To assess the clinical effectiveness of tegaserod for the treatment of irritable bowel syndrome (IBS). Systematic review. Six placebo-controlled, randomized controlled trials (RCTs) retrieved from electronic searches (Medline, Embase, FDA website) and hand-searching. Any outcome was accepted. In a small pharmacodynamic study, tegaserod 4 mg/day accelerated orocecal transit compared with placebo, but did not affect gastric emptying rate and colonic transit. Five placebo-controlled studies evaluated Subject's Global Assessment of gastrointestinal (GI) symptoms in predominantly female patients who fulfilled Rome criteria for constipation-predominant IBS. Responder rates were higher with tegaserod 1-24 mg/day than with placebo, although it was not possible in this review to evaluate the consistency of this effect, to fully quantify the effect size, or identify patients who may gain most benefit from this treatment. Currently published data on tegaserod for IBS are limited (two of six RCTs published in full, four as abstracts). Tegaserod may be an appropriate treatment for occasional use for relief of GI symptoms associated with constipation-predominant IBS. Further research, comparing tegaserod with alternative treatments for GI symptoms of IBS, should help define the place of this drug in therapy.
Publisher: Oxford University Press (OUP)
Date: 26-01-2019
Abstract: Studies examine longitudinal continuity of GP contact though few consider ‘regularity of GP contact’, i.e., the dispersion of contacts over time. Increased regularity may indicate planned ongoing care. Current measures of regularity may be correlated with the number of contacts and may not isolate the phenomenon of interest. To compare two published and one newly developed regularity index in terms of their ability to measure regularity of GP contacts independently of the number of contacts and the impact on their association with hospitalization. A cohort at risk of diabetes-related hospitalization in Western Australia from 1990 to 2004 was identified using linked administrative data. For each regularity index, relationships with number of GP contacts were assessed. Hospitalization was then regressed on each index with and without number of contacts as a covariate. Among 153,414 patients the new regularity index showed a reduced association with number of contacts compared with existing indices. Associations with hospitalization differed between measures for previously published indices, there were no significant associations between regularity and hospitalization, whereas on the new index, most regular GP contact was associated with reduced hospitalization (IRR = 0.90, 95% CI = 0.88–0.93). When number of contacts was added as a covariate, point estimates for this index showed little change, whereas for existing measures this addition changed point estimates. A new measure of regularity of GP contact was less correlated with the number of contacts than previously published measures and better suited to estimating unconfounded relationships of regularity with hospitalization.
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-032422
Abstract: Private pharmacies are widely established in most low/middle-income countries (LMICs) including Nepal, and are often considered as a patient’s first point of contact for seeking healthcare. The aim of this study was to investigate the pattern of antibiotic dispensing in private pharmacies through exit interviews with patients to review their medication information. Cross-sectional study. Data collection was carried out in 60 days at 33 randomly selected private pharmacies in the Rupandehi district of Nepal. Patients attending private pharmacies (n=1537). The pattern of antibiotic prescribing and dispensing was investigated using WHO’s core prescribing indicator, ‘ the percentage of patients prescribed an antibiotic’ . Frequency distributions were presented based on patients’ characteristics, sources of antibiotic, registration status of pharmacies and education of the pharmacist or drug retailer, and disease or condition. χ 2 tests and regression analysis were applied to explore factors associated with the pattern of antibiotic dispensing. Of patients attending private pharmacies, the proportion receiving at least one antibiotic (38.4%) was above the WHO recommended value (20.0%–26.8%). The most commonly dispensed antibiotics were cefixime (16.9%) and the third-generation cephalosporins (38.0%) class. High dispensing rates of antibiotics for selected conditions (eg, respiratory infections, diarrhoeal cases) appeared contrary to international recommendations. The percentage of antibiotic dispensed was highest for patients who obtained their medicines from unlicensed pharmacies (59.1%). Young people were more likely to receive antibiotics than other age groups. The antibiotic dispensing pattern from private pharmacies in Nepal was high compared with WHO guidelines, suggesting initiatives to reduce inappropriate use of antibiotics should be implemented. The findings of this study may be generalisable to other LMICs in order to assist in developing policies and guidelines to promote more appropriate dispensing and prescribing practices of antibiotics and limit the spread of antibiotic resistance.
Publisher: BMJ
Date: 27-03-2015
Publisher: Springer Science and Business Media LLC
Date: 08-01-2023
DOI: 10.1186/S40798-022-00539-3
Abstract: The COVID-19 pandemic markedly changed how healthcare services are delivered and telehealth delivery has increased worldwide. Whether changes in healthcare delivery borne from the COVID-19 pandemic impact effectiveness is unknown. Therefore, we examined the effectiveness of exercise physiology services provided during the COVID-19 pandemic. This prospective cohort study included 138 clients who received exercise physiology services during the initial COVID-19 pandemic. Outcome measures of interest were EQ-5D-5L, EQ-VAS, patient-specific functional scale, numeric pain rating scale and goal attainment scaling. Most (59%, n = 82) clients received in-person delivery only, whereas 8% ( n = 11) received telehealth delivery only and 33% ( n = 45) received a combination of delivery modes. Mean (SD) treatment duration was 11 (7) weeks and included 12 (6) sessions lasting 48 (9) minutes. The majority (73%, n = 101) of clients completed 80% of exercise sessions. Exercise physiology improved mobility by 14% ( β = 0.23, P = 0.003), capacity to complete usual activities by 18% ( β = 0.29, P 0.001), capacity to complete important activities that the client was unable to do or having difficulty performing by 54% ( β = 2.46, P 0.001), current pain intensity by 16% ( β = − 0.55, P = 0.038) and goal attainment scaling t-scores by 50% ( β = 18.37, P 0.001). Effectiveness did not differ between delivery modes (all: P 0.087). Exercise physiology services provided during the COVID-19 pandemic improved a range of client-reported outcomes regardless of delivery mode. Further exploration of cost-effectiveness is warranted.
Publisher: Elsevier BV
Date: 06-2014
Publisher: BMJ
Date: 02-05-2007
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.SOCSCIMED.2019.112776
Abstract: There is extensive evidence on the relationship between receiving a cancer diagnosis and labour market outcomes. However, there is limited evidence on the relationship between a cancer diagnosis and non-labour market outcomes such as household work, passive leisure and physical leisure. Furthermore, most current research focuses on time allocation at a given time point, ignoring both the life course perspective and long term effects. Using data from the Australian Longitudinal Study on Women's Health (ALSWH), we observe time allocation for 91 women diagnosed with breast cancer and 486 women diagnosed with skin cancer, and 2711 women living without cancer. Our analysis is unique in combining sequence analysis and multivariate multinomial logit modelling. Using sequence analysis, we first analyse life-courses post a cancer diagnosis for paid work, household work, passive leisure and physical leisure from 2004 to 2016. Using multivariate multinomial logit modelling, we test whether a cancer diagnosis influences such life-courses. We consider the robustness of results to cancer severity and change in time allocation before and after a cancer diagnosis. We identify three clusters for paid work and two clusters for household work, passive leisure and physical leisure. Neither a breast cancer nor skin cancer diagnosis has a significant effect on the pathways of time allocation. Such results are robust to severity of diagnosis with 'cured' and 'non-cured' breast cancer, and skin cancer treated with and without 'chemotherapy or radiotherapy'. Women post a breast cancer diagnosis are less likely to maintain their pre-cancer's time use on paid work, household work and passive leisure however, such effects are not significant. Being diagnosed with breast cancer or skin cancer has no significant long-term effect on the pathways of time allocation. Future work should explore the relationship between time allocation and wellbeing and the preference for time allocation.
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/BMJOPEN-2021-055597
Abstract: To describe the pharmacists’ workflow, including tasks and time spent, to better understand their work capacity. Cross-sectional, observational, time and motion study. Community pharmacies in Western Australia and New South Wales, Australia. Currently registered and practising pharmacists were approached using snowball s ling and selected using purposive techniques to obtain balance representation of metropolitan and rural pharmacies, as well as high and low script volumes where possible. Twenty-four pharmacists across 15 pharmacies participated during the 135 sessions totalling over 274 hours of observation. Dispensing (30%), indirect patient services (17%), counselling (15%) and professional management activities (15%) were the top four duties pharmacists performed, while only 2% of time was spent on professional services such as pain clinics and influenza vaccinations. Tasks were frequently interrupted and often performed simultaneously. Breaks and consumer-contact times were limited. More time was spent on professional service activities in non-metropolitan pharmacies, in pharmacies with greater daily prescription volumes and those with one or more support pharmacists. This is the first study to quantify the pharmacists’ tasks in Australian community pharmacies. Much time is being spent on dispensing, supply and management activities with little time for providing additional professional services. An extra supporting pharmacist is likely necessary to increase professional services. These findings could support future research around barriers and enablers of conducive workflows and of extended professional services.
Publisher: Public Library of Science (PLoS)
Date: 26-07-2022
DOI: 10.1371/JOURNAL.PONE.0271619
Abstract: To provide a review of prediction models that have been used to measure clinical or pathological progression of chronic kidney disease (CKD). Scoping review. Medline, EMBASE, CINAHL and Scopus from the year 2011 to 17 th February 2022. All English written studies that are published in peer-reviewed journals in any country, that developed at least a statistical or computational model that predicted the risk of CKD progression. Eligible studies for full text review were assessed on the methods that were used to predict the progression of CKD. The type of information extracted included: the author(s), title of article, year of publication, study dates, study location, number of participants, study design, predicted outcomes, type of prediction model, prediction variables used, validation assessment, limitations and implications. From 516 studies, 33 were included for full-text review. A qualitative analysis of the articles was compared following the extracted information. The study populations across the studies were heterogenous and data acquired by the studies were sourced from different levels and locations of healthcare systems. 31 studies implemented supervised models, and 2 studies included unsupervised models. Regardless of the model used, the predicted outcome included measurement of risk of progression towards end-stage kidney disease (ESKD) of related definitions, over given time intervals. However, there is a lack of reporting consistency on details of the development of their prediction models. Researchers are working towards producing an effective model to provide key insights into the progression of CKD. This review found that cox regression modelling was predominantly used among the small number of studies in the review. This made it difficult to perform a comparison between ML algorithms, more so when different validation methods were used in different cohort types. There needs to be increased investment in a more consistent and reproducible approach for future studies looking to develop risk prediction models for CKD progression.
Publisher: Oxford University Press (OUP)
Date: 25-03-2021
Abstract: This population-based cross-stional and panel study investigated disparities in the management of coronary heart disease (CHD) by level of socioeconomic status. CHD patients (aged ≥18 years), treated in 438 general practices in Australia, with ≥3 recent encounters with their general practitioners, with last encounter being during 2016–2018, were included. Secondary prevention prescriptions and number of treatment targets achieved were each modelled using a Poisson regression adjusting for demographics, socioeconomic indicators, remoteness of patient’s residence, comorbidities, lifetime follow-up, number of patient–general practitioner encounters and cluster effect within the general practices. The latter model was constructed using the Generalised Estimating Equations approach. Sensitivity analysis was run by comorbidity. Of 137,408 patients (47% women), approximately 48% were prescribed ≥3 secondary prevention medications. However, only 44% were screened for CHD-associated risk factors. Of the latter, 45% achieved ≥5 treatment targets. Compared with patients from the highest socioeconomic status fifth, those from the lowest socioeconomic status fifth were 8% more likely to be prescribed more medications for secondary prevention (incidence rate ratio (95% confidence interval): 1.08 (1.04–1.12)) but 4% less likely to achieve treatment targets (incidence rate ratio: 0.96 (0.95–0.98)). These disparities were also observed when stratified by comorbidities. Despite being more likely to be prescribed medications for secondary prevention, those who are most socioeconomically disadvantaged are less likely to achieve treatment targets. It remains to be determined whether barriers such as low adherence to treatment, failure to fill prescriptions, low income, low level of education or other barriers may explain these findings.
Publisher: Springer Science and Business Media LLC
Date: 02-03-2021
Publisher: Wiley
Date: 15-08-2022
DOI: 10.1111/NEP.14083
Abstract: In 2020, the European Kidney Function Consortium (EKFC) published a new creatinine‐based equation to estimate glomerular filtration rate (eGFR) to overcome known limitations in existing equations. The aim of this study is to model the potential impact on service referral and health expenditure of routine reporting of eGFR using the EKFC equation as compared to the CKD‐EPI equation in a Western Australian population. eGFR was calculated for 760 614 patients with 2 368 234 creatinine results using the CKD‐EPI and EKFC formulas. Patients were grouped into a CKD cohort if they had at least two eGFR results of ml/min/1.73 m 2 from tests at least 90 days apart. The impact of each equation on the reclassification of CKD stages, CKD cohort classification, the rate of change in eGFR and direct health costs were assessed. About 90.66% of patients had a lower eGFR when calculated using the EKFC equation. About 12.6% of in iduals were classified into a different CKD stage using the EKFC equation with 97.43% of these patients classified into a higher (more advanced) stage. There was a 25.9% increase in the number of patients identified as having CKD when calculated using the EKFC equation. Direct health costs also increased with the use of EKFC reporting. Use of the EKFC equation will increase population prevalence of CKD and will result in a shift to higher stages of CKD. This has implications for monitoring and referral of patients within specialist services and has the potential to increase the need for multidisciplinary care.
Publisher: SAGE Publications
Date: 14-12-2018
Abstract: To determine if patients with cleft lip and/or palate (CL/P) from a Western Australian (WA) cohort were more dissatisfied with their body esteem than a normative non-cleft cohort, and identify demographic variables that may have significant associations with body esteem. Questionnaire study using the Body-Esteem Scale (BES) and Cleft Research Questionnaire (CRQ). Self-selected participants from a Western Australian CL/P population across 3 age groups (n=359). The BES is comprised of 3 factors: BE-Appearance, BE-Weight and BE-Attribution. Study mean BES factor scores were compared to normative non-cleft scores. Regression analysis was used to determine significant associations within each age group between BES factor scores and CRQ variables of: gender, self-reported body weight category, cleft type and importance of facial appearance rating. Study mean BE-Attribution scores were significantly lower than the normative scores and significantly lower than the mean BE-Appearance and BE-Weight factor scores within the same age groups of this study. Having a cleft type of lip and palate, being overweight, and placing a high importance on facial appearance had significant negative associations with BES scores. Maintaining a normal body weight and placing a lower level of importance on facial appearance had significant positive associations. Gender had no significant associations. In this study, the attribution aspect of body esteem had a greater negative impact on patients than their appearance and body weight. This has important implications for clinical treatment and support of patients.
Publisher: JMIR Publications Inc.
Date: 22-05-2021
Abstract: mergency telehealth has been used to improve access of patients residing in rural and remote areas to specialist care in the hope of mitigating the significant health disparities that they experience. Patient disposition decisions in rural and remote emergency departments (EDs) can be complex and largely dependent on the expertise and experience available at local (receiving-end) hospitals. Although there has been some synthesis of evidence of the effectiveness of emergency telehealth in clinical practice in rural and remote EDs for nonacute presentations, there has been limited evaluation of the influence of contextual factors such as clinical area and acuity of presentation on these findings. he aims of this systematic review are to examine the outcome measures used in studying the effectiveness of telehealth in rural and remote EDs and to analyze the clinical context in which these outcome measures were used and interpreted. he search strategy used Medical Subject Headings and equivalent lists of subject descriptors to find articles covering 4 key domains: telehealth or telemedicine, EDs, effectiveness, and rural and remote. Studies were selected using the Population, Intervention, Comparator, Outcomes of Interest, and Study Design framework. This search strategy was applied to MEDLINE (Ovid), Cochrane Library, Scopus, CINAHL, ProQuest, and EconLit, as well as the Centre for Reviews and Dissemination databases (eg, National Health Service Economic Evaluation Database) for the search period from January 1, 1990, to May 23, 2020. Qualitative synthesis was performed on the outcome measures used in the included studies, in particular the clinical contexts within which they were interpreted. total of 21 full-text articles were included for qualitative analysis. Telehealth use in rural and remote EDs demonstrated effectiveness in achieving improved or equivalent clinical effectiveness, appropriate care processes, and—depending on the context—improvement in speed of care, as well as favorable service use patterns. The definition of effectiveness varied across the clinical areas and contexts of the studies, and different measures have been used to affirm the safety and clinical effectiveness of telehealth in rural and remote EDs. The acuity of patient presentation emerged as a dominant consideration in the interpretation of interlinking time-sensitive clinical effectiveness and patient disposition measures such as transfer and discharge rates, local hospital admission, length of stay, and ED length of stay. These, together with clinical area and acuity of presentation, are the outcome determination criteria that emerged from this review. mergency telehealth studies typically use multiple outcome measures to determine the effectiveness of the services. The outcome determination criteria that emerged from this analysis are useful when defining the favorable direction for each outcome measure of interest. The findings of this review have implications for emergency telehealth service design and policies. ROSPERO CRD42019145903 dmkr8ry
Publisher: AMPCo
Date: 09-2017
DOI: 10.5694/MJA17.00165
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.JVAL.2013.03.1633
Abstract: This article explores two gaps in the health state valuation literature: the effect of processes and the stability of health state valuations, and the existence of preexisting valuations. Stability in health state valuations over time depends on whether preferences are considered to be preexisting (axiom of completeness) and therefore can be gathered reliably, or are constructed during consideration and debate. Under the former, changes in revealed preferences are evidence of poor reliability under the latter, it is a function of the deliberative process. This study explores the effect of deliberation on health state valuations elicited by using the person trade-off technique . Quantitative analysis was used to explore whether respondents changed their responses following deliberation and the impact of change on aggregate health state values. Qualitative methods were used to explore respondents' views on the elicitation process and the impact of deliberation on their responses. Following discussion and deliberation, 74% of the participants changed their person trade-off valuations and this did have an impact on the aggregate valuations. The qualitative analysis lends some support to the construction of preference assumption. The results from this exploratory study challenge the notion that in iduals have preexisting health state preferences and call for further detailed research in this area. Furthermore, it raises concerns over current practices around preference elicitation exercises, which have tended to be carried out as a solitary exercise without allowing time for respondents to reflect and deliberate on their decisions.
Publisher: Wiley
Date: 19-06-2019
DOI: 10.1111/SPOL.12412
Publisher: Wiley
Date: 03-2008
DOI: 10.1080/09595230701829397
Abstract: Consumer participation in decision-making about service planning is common in certain health services in Australia but is thought to be largely underdeveloped in drug treatment services. This paper (1) describes the current practices within Australian drug treatment services that aim to include consumers in service planning and provision and (2) determines how much consumers know about the existing opportunities for involvement. Sixty-four randomly selected service providers (representing 64 separate services) completed interviews about the current arrangements for consumer participation within their services (response rate = 82%). A total of 179 consumers completed interviews assessing their knowledge of the consumer participation activities available at the service they attended. Consumer participation activities were not uncommon in drug treatment services, although the existing activities were concerned largely with providing information to or receiving information from consumers. Activities that included consumers in higher forms of involvement, such as those in which consumers took part in decision-making, were largely uncommon. Consumers had a considerable lack of knowledge about the participation activities available to them, revealing a lack of communication between providers and consumers. While service providers were making efforts to engage consumers in service planning and provision (despite the general lack of State or Commonwealth policy directives and extra funding to do so), these appear ineffectual because of poor communication between providers and consumers. As a starting point, a critical part of any meaningful consumer participation initiative must include systems to ensure that consumers know about available opportunities.
Publisher: Georg Thieme Verlag KG
Date: 08-2022
Abstract: Background Chronic kidney disease (CKD) is a major global health problem that affects approximately one in 10 adults. Up to 90% of in iduals with CKD go undetected until its progression to advanced stages, invariably leading to death in the absence of treatment. The project aims to fill information gaps around the burden of CKD in the Western Australian (WA) population, including incidence, prevalence, rate of progression, and economic cost to the health system. Methods Given the sensitivity of the information involved, the project employed a privacy preserving record linkage methodology to link data from four major pathology providers in WA to hospital records, to establish a CKD registry with continuous medical record for in iduals with biochemical specification for CKD. This method uses encrypted personal identifying information in a probability-based linkage framework (Bloom filters) to help mitigate risk while maximizing linkage quality. Results The project developed interoperable technology to create a transparent CKD data catalogue which is linkable to other datasets. This technology has been designed to support the aspirations of the research program to provide linked de-identified pathology, morbidity, and mortality data that can be used to derive insights to enable better CKD patient outcomes. The cohort includes over 1 million in iduals with creatinine results over the period 2002 to 2021. Conclusion Using linked data from across the care continuum, researchers are able to evaluate the effectiveness of service delivery and provide evidence for policy and program development. The CKD registry will enable an innovative review of the epidemiology of CKD in WA. Linking pathology records can identify cases of CKD that are missed in the early stages due to disaggregation of results, enabling identification of at-risk populations that represent targets for early intervention and management.
Publisher: BMJ
Date: 11-2021
DOI: 10.1136/BMJOPEN-2021-051796
Abstract: Continuity and regularity of general practitioner (GP) contacts are associated with reduced hospitalisation in type 2 diabetes (T2DM). We assessed associations of these GP contact patterns with intermediate outcomes reflecting patient monitoring and health. Observational longitudinal cohort study using general practice data 2011–2017. 193 Australian general practices in Western Australia and New South Wales participating in the MedicineInsight programme run by NPS MedicineWise. 22 791 patients aged 18 and above with T2DM. Regularity was assessed based on variation in the number of days between GP visits, with more regular contacts assumed to indicate planned, proactive care. Informational continuity (claims for care planning incentives) and relational continuity (usual provider of care index) were assessed separately. Process of care indicators were glycosylated haemoglobin (HbA1c) test underuse (8 months without test), estimated glomerular filtration rate (eGFR) underuse (14 months) and HbA1c overuse (two tests within 80 days). The clinical indicator was T2DM control (HbA1c 6.5% (47.5 mmol/mol)–7.5% (58.5 mmol/mol)). The quintile with most regular contact had reduced odds of HbA1c and eGFR underuse (OR 0.74, 95% CI 0.67 to 0.81 and OR 0.78, 95% CI 0.70 to 0.86, respectively), but increased odds of HbA1c overuse (OR 1.20, 95% CI 1.05 to 1.38). Informational continuity was associated with reduced odds of HbA1c underuse (OR 0.53, 95% CI 0.49 to 0.56), reduced eGFR underuse (OR 0.62, 95% CI 0.58 to 0.67) and higher odds of HbA1c overuse (OR 1.48, 95% CI 1.34 to 1.64). Neither had significant associations with HbA1c level. Results for relational continuity differed. This study provides evidence that regularity and continuity influence processes of care in the management of patients with diabetes, though this did not result in the recording of HbA1c within target range. Research should capture these intermediate outcomes to better understand how GP contact patterns may influence health rather than solely assessing associations with hospitalisation outcomes.
Publisher: Emerald
Date: 18-03-2019
Publisher: SAGE Publications
Date: 13-04-2019
Abstract: Living with a cleft condition involves many years of multidisciplinary therapy, treatment, and surgical intervention. This complex process may have both physical and psychosocial long-term impacts. There is limited evidence of the psychosocial impact of cleft on in iduals in Australia. To obtain an understanding of the adult patient perception of having a cleft and explore the impact of the condition on their lives. Qualitative methodologies at one case study site in Western Australia. Adults with a cleft lip and/or palate (CL/P) who had received treatment at Princess Margaret Hospital, the only treatment center for cleft in Western Australia. In idual in-depth semi-structured qualitative interviews were conducted and recorded and transcribed for analysis. Fifteen adults with a CL/P. Two main themes were identified: lived experience (with 3 subthemes: normality, support networks, and impacts in later life) and advice to others. The majority of participants reported social rejection and isolation, which occurred mostly at school and in some instances at home, but did not often last into adulthood. The greatest protective factor was the support of family and friends, which if missing during their childhood, was desired and appreciated in adulthood. Adults with CL/P may require psychosocial support from their cleft team including referral to clinicians in adult services. There is also the need for earlier psychological interventions and social programs to support those with appearance-related social difficulties.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.DIABRES.2018.01.027
Abstract: We aimed to characterise use of general practitioners (GP) simultaneously across multiple attributes in people with diabetes and examine its impact on diabetes related potentially preventable hospitalisations (PPHs). Five-years of panel data from 40,625 adults with diabetes were sourced from Western Australian administrative health records. Cluster analysis (CA) was used to group in iduals with similar patterns of GP utilisation characterised by frequency and recency of services. The relationship between GP utilisation cluster and the risk of PPHs was examined using multivariable random-effects negative binomial regression. CA categorised GP utilisation into three clusters: moderate high and very high usage, having distinct patient characteristics. After adjusting for potential confounders, the rate of PPHs was significantly lower across all GP usage clusters compared with those with no GP usage IRR = 0.67 (95%CI: 0.62-0.71) among the moderate, IRR = 0.70 (95%CI 0.66-0.73) high and IRR = 0.76 (95%CI 0.72-0.80) very high GP usage clusters. Combination of temporal factors with measures of frequency of use of GP services revealed patterns of primary health care utilisation associated with different underlying patient characteristics. Incorporation of multiple attributes, that go beyond frequency-based approaches may better characterise the complex relationship between use of GP services and diabetes-related hospitalisation.
Publisher: Springer Science and Business Media LLC
Date: 04-03-2021
Publisher: Wiley
Date: 27-08-2018
DOI: 10.1111/AJAG.12578
Abstract: This process evaluation aimed to determine participants' perceptions of the strategies utilised in a six-month intervention that set out to improve physical activity and nutrition in retirement village (RV) residents. Qualitative and quantitative data were collected from intervention participants residing in 17 RVs located in Perth, Western Australia, via self-report questionnaires (n = 139) and semi-structured interviews (n = 16). Intervention resources were moderately useful and suitable. Program ambassadors were encouraging (86%), but more frequent, and more direct, contact were preferred. The main reason for withdrawing from the program was health-related conditions (aches, pains, injuries). This study provides evidence that the intervention was reasonably appropriate for older adults residing in RVs. Program ambassadors were well accepted, a successful strategy that should be considered for future interventions in RVs. Increased face-to-face engagement was preferred, but such an approach will require greater investment. The findings contribute to a small research base concerned with health behaviour interventions in RVs.
Publisher: SAGE Publications
Date: 08-2012
Abstract: Although explicit priority-setting is advocated in the health services literature and supported by the policies of many governments, relatively little is known about the extent and ways in which this is carried out at local decision-making levels. Our objective was to undertake a survey of local resource allocaters in the English National Health Services in order to map and explore current priority-setting activity. A national survey was sent to Directors of Commissioning in English Primary Care Trusts (PCTs). The survey was designed to provide a picture of the types of priority-setting activities and techniques that are in place and offer some assessment of their perceived effectiveness. There is variation in the scale, aims and methods of priority-setting functions across PCTs. A perceived strength of priority-setting processes is in relation to the use of particular tools and/or development of formal processes that are felt to increase transparency. Perceived weaknesses tended to lie in the inability to sufficiently engage with a range of stakeholders. Although a number of formal priority-setting processes have been developed, there are a series of remaining challenges such as ensuring priority-setting goes beyond the margins and is embedded in budget management, and the development of disinvestment as well as investment strategies. Furthermore, if we are genuinely interested in a more explicit approach to priority-setting, then fostering a more inclusive and transparent process will be required.
Publisher: SAGE Publications
Date: 29-07-2020
Abstract: To provide information on live-birth prevalence and hospitalizations, including anxiety and depression, for cleft lip and/or palate (CL/P) in Western Australia (WA), using live-birth data 1980 to 2015. Retrospective data linkage. Tertiary hospital. Cleft cohort consisted of people live-born with CL/P in WA between 1980 and 2015, and a gender and age-matched control group. Live-birth prevalence for CL/P by year. Hospital event counts, event ages, and length of stay (LOS) days by 18 diagnosis groups and 4 birth year categories between the cleft cohort and control group, and between cleft types. Count of events per alive persons per calendar year, and relative risk for proportions of persons in the cleft cohort and control group by diagnosis group. Live-birth prevalence for CL/P was 19.7 per 10 000 (1 in 522). The cleft cohort had significantly higher event counts, lower event ages, and higher LOS days than the control group. Cleft lip and palate had significantly higher event counts, lower event ages, and higher LOS days than cleft lip or cleft palate only. There were 2 significant differences for anxiety or depression between the cleft cohort and control group, lower event ages, and higher LOS days in 1990s birth year category. This study provides a cleft data reference for WA. Live-birth prevalence for all clefts and by cleft type offers an appropriate method for estimating service utilization and provision. Patients with cleft accessed hospital services more frequently, at an earlier age, with higher LOS days than the control group.
Publisher: Springer Science and Business Media LLC
Date: 25-07-2022
DOI: 10.1007/S00420-022-01908-X
Abstract: Fly-In Fly-Out (FIFO), which entails travelling mostly from the urban areas to stay and work in remote areas for designated periods and travel back home to spend designated days of leave, has become a common work arrangement in the mining sector globally. This study examined the mental and physical health of FIFO workers and described their health-related behaviours during on-and off-shift periods. A cross-sectional study was conducted with FIFO workers ( N = 216) in the mining industry in Australia who completed an online survey. Paired t -test and McNemer’s analysis examined the differences in health-related behaviours during workers’ on-and off-shift days. Logistic regression examined the predictors of physical health and psychological distress status of FIFO workers. Workers reported longer sleep duration (7.5 ± 1.5 h vs 6.3 ± 1.2 h, p 0.001) and better sleep quality (78.2% vs 46.3%, p 0.001) during off-shift nights than on on-shift nights. Smoking prevalence was 26.4%, and workers reported smoking a similar number of cigarettes per day during on-and off-shift days. Most workers reported drinking alcohol (86.1%) and more often at risky levels during off-shift than on-shift days (57.9% vs 34.3%, p 0.001). Fruits and vegetable consumption was low but with higher vegetable intake during off-shift days (2.8 ± 1.4 vs 2.3 ± 1.3 serves, p 0.001). Workers had good physical health status (91.2%), but 71.4% were overweight/obese and 33.4% indicated high levels of psychological distress. Working on long shifts (OR 6.63, 95% CI 1.84–23.91) and smoking (OR 7.17, 95% CI 2.67–19.26) were linked to high psychological distress. The prevalence of psychological distress and risky health behaviours was high. Interventions should aim to reduce psychological distress and support multiple behaviour changes, considering FIFO work-related characteristics including long shift hours.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2019
DOI: 10.1186/S12889-019-7924-5
Abstract: The development of antibiotic resistance is one of the biggest threats to global public health. Inappropriate use of antibiotics is recognised as a leading cause of antibiotic resistance. The aim of this study was to explore the knowledge, attitudes and practices (KAP) towards antibiotic use among adults in Nepal. A quantitative survey was conducted with 220 community members of the Rupandehi district of Nepal, with cluster s ling techniques applied to select households. Interviews were carried out face-to-face using a structured questionnaire. Responses were presented using descriptive analysis, with chi-squared tests and regression analysis applied to identify factors associated with KAP about antibiotic use and the Spearman’s rank order correlation coefficient calculated to examine the relationship between responses to the KAP questions. The s le comprised more females (54%) than males, the average age of respondents was 38.5 years and almost 60% of respondents lived in rural areas. Respondents had relatively good knowledge about aspects of antibiotic use other than identifying antibiotics. The concept of antibiotic resistance was well known but imperfectly understood. Half of respondents (50.9%) were unsure whether skipping doses would contribute to the development of antibiotic resistance, 88.2% indicated they would go to another doctor if not prescribed an antibiotic when they thought one was needed and nearly half (47.7%) believed antibiotics helped them get better more quickly if they had a fever. Most respondents reported correct practices accessing and using antibiotics, however, 84.6% at least sometimes preferred an antibiotic when they have a cough and sore throat. Logistic regression showed respondents with higher levels of education tended to have better knowledge, more appropriate attitudes and better practices about antibiotic use. Rural respondents were less likely to have better knowledge about antibiotic use, while females were more likely to report better practices. The study provides baseline evidence about the knowledge, attitudes and practices regarding antibiotic use among the population of the Rupandehl district. Its findings will be useful in designing effective and targeted interventions to decrease misconceptions about antibiotic use and to increase awareness about the risks of inappropriate use of antibiotics in the community.
Publisher: BMJ
Date: 06-2006
Publisher: SAGE Publications
Date: 10-03-2019
Abstract: Telecare – services employing technology to monitor people’s movement, medication and home environment at a distance – has emerged as a key component of global social care and health policies. The relationship between policies about telecare and the experiences and aspirations of service users has been under-interrogated. This article draws on findings from an organisational case study involving people living with complex conditions using various telecare devices and employs Hajer’s (1995) concept of argumentative discourse analysis to identify two key storylines arguing that telecare improves people’s quality of life and promotes independence. While these storylines point to seemingly logical and incontestable objectives, uncritical policy and practice fails to recognise and prioritise the aspirations of service users, leading to unintended consequences that can deepen people’s isolation and minimise organisational benefits.
Publisher: BMJ
Date: 26-07-2007
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY15037
Abstract: The concept of commissioning is starting to gain traction in the Australian health system. Primary Care Networks began operations in July 2015 with a remit around commissioning health services. Despite the centrality of this concept, we know relatively little about commissioning in Australia. Other systems have experimented with it for some time, and this paper reviews the evidence and lessons inherent within the international literature. The study defines commissioning, and explores experiences of others who have adopted commissioning approaches and the evidence concerning the outcomes of these experiments. Commissioning is a difficult topic in many senses and its application to a complex area such as health reform can make it even more challenging. Ultimately, this evidence suggests that commissioning is more than simply a technical or operational process, but one that is value-based and relational. This is not to downplay the technical aspects, which in many jurisdictions have resulted in explicit and evidenced-based approaches to planning and priority setting. However, if new commissioning organisations, such as Primary Health Networks, are to have an impact, they need to balance the operational and relational elements of commissioning.
Publisher: JMIR Publications Inc.
Date: 17-08-2023
DOI: 10.2196/45016
Abstract: The COVID-19 pandemic triggered a rapid scale-up of telehealth services in Australia as a means to provide continued care through periods of physical restrictions. The factors that influence engagement in telehealth remain unclear. The purpose of this study is to understand the experience of Australian people who engaged in a telehealth consultation during the pandemic period (2020-2021) and the demographic factors that influence engagement. A web-based survey was distributed to Australians aged over 18 years that included 4 questions on frequency and type of clinical consultation, including with a general practitioner (GP), specialist, allied health, or nurse 1 question on the experience of telehealth and 2 questions on the quality of and satisfaction with telehealth. Statistical analysis included proportion of responses (of positive responses where a Likert scale was used) and regression analyses to determine the effect of demographic variables. Of the 1820 participants who completed the survey, 88.3% (1607/1820) had engaged in a health care consultation of some type in the previous 12 months, and 69.3% (1114/1607) of those had used telehealth. The most common type of consultation was with a GP (959/1114, 86.1%). Older people were more likely to have had a health care consultation but less likely to have had a telehealth consultation. There was no difference in use of telehealth between metropolitan and nonmetropolitan regions however, people with a bachelor’s degree or above were more likely to have used telehealth and to report a positive experience. A total of 87% (977/1114) of participants agreed or strongly agreed that they had received the information they required from their consultation, 71% (797/1114) agreed or strongly agreed that the outcome of their consultation was the same as it would have been face-to-face, 84% (931/1114) agreed or strongly agreed that the doctor or health care provider made them feel comfortable, 83% (924/1114) agreed or strongly agreed that the doctor or health care provider was equally as knowledgeable as providers they have seen in person 57% (629/1114) of respondents reported that they would not have been able to access their health consultation if it were not for telehealth 69% (765/1114) of respondents reported that they were satisfied with their telehealth consultation, and 60% (671/1114) reported that they would choose to continue to use telehealth in the future. There was a relatively high level of engagement with telehealth over the 12 months leading up to the study period, and the majority of participants reported a positive experience and satisfaction with their telehealth consultation. While there was no indication that remoteness influenced telehealth usage, there remains work to be done to improve access to older people and those with less than a bachelor’s degree.
Publisher: JMIR Publications Inc.
Date: 12-04-2021
DOI: 10.2196/24579
Abstract: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant’s father, has been identified as a crucial element for successful breastfeeding. The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator Milk Man, a breastfeeding smartphone app designed specifically for fathers and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically erse populations that are likely to benefit most from additional partner supports. Australian New Zealand Clinical Trials Registry ACTRN12614000605695 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695 RR2-10.1186/s12884-015-0601-5
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 12-2020
End Date: 12-2025
Amount: $1,357,136.00
Funder: Australian Research Council
View Funded Activity