ORCID Profile
0000-0003-1090-4401
Current Organisation
Deakin University
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Publisher: Public Library of Science (PLoS)
Date: 15-06-2023
DOI: 10.1371/JOURNAL.PONE.0286533
Abstract: The study aims to assess the cost-effectiveness of a personalised telehealth intervention to manage chronic disease in the long run. The Personalised Health Care (PHC) pilot study was a randomised trial with an economic evaluation alongside over 12 months. From a health service perspective, the primary analysis compared the costs and effectiveness of PHC telehealth monitoring with usual care. An incremental cost-effectiveness ratio was calculated based on costs and health-related quality of life. The PHC intervention was implemented in the Barwon Health region, Geelong, Australia, for patients with a diagnosis of COPD and/or diabetes who had a high likelihood of hospital readmission over 12 months. When compared to usual care at 12 months, the PHC intervention cost AUD$714 extra per patient (95%CI -4879 6308) with a significant improvement of 0.09 in health-related quality of life (95%CI: 0.05 0.14). The probability of PHC being cost-effective by 12 months was close to 65%, at willingness to pay a threshold of AUD$50,000 per quality-adjusted life year. Benefits of PHC to patients and the health system at 12 months translated to a gain in quality-adjusted life years with a non-significant cost difference between the intervention and control groups. Given the relatively high set-up costs of the PHC intervention, the program may need to be offered to a larger population to achieve cost-effectiveness. Long-term follow-up is required to assess the real health and economic benefits over time.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2022
DOI: 10.1186/S13047-022-00589-6
Abstract: Lower extremity utations (LEAs) as a result of type 2 diabetes mellitus (T2DM) cause considerable morbidity, mortality, and burden on the healthcare system. LEAs are thought to be preventable, yet the rate of LEAs, particularly in Australia, has risen despite the availability of preventative healthcare services. Understanding patient’s perspectives of risk factors for LEAs may provide valuable insight into why many LEAs occur each year. The aim of this study was to explore patient’s perspectives of risk factors for LEAs as a result of T2DM. A qualitative descriptive methodology involving non-probability purposive s ling was used to recruit inpatients at a tertiary metropolitan hospital in South Australia. Semi-structured interviews were conducted, and data were transcribed verbatim. Data from the interviews were analysed using thematic analysis and the constant comparison approach. A total of 15 participants shared their perspectives of risk factors for lower extremity utations. Most (86%) of participants were male and Caucasian, with a median age of 66.4 years ranging from 44-80 years. The median duration of diabetes was 25.2 years, ranging from 12-40 years. More than half of the participants had undergone a previous utation with 86% being unemployed or retired and 73% living in metropolitan Adelaide. Two main themes emerged: competing priorities and awareness. Finance and family care were identified as subthemes within competing priorities. While subthemes in the context of awareness related to lack of awareness of risk, experiences with health care professionals and perspectives of disease severity. The findings from this research indicate that addressing risk factors for LEAs for patients with T2DM require a holistic and nuanced approach which considers in idual patient’s circumstances, and its influence on how risks are viewed and managed.
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-052156
Abstract: To investigate the additional programme cost and cost-effectiveness of ‘right@home’ Nurse Home Visiting (NHV) programme in relation to improving maternal and child outcomes at child age 3 years compared with usual care. A cost–utility analysis from a government-as-payer perspective alongside a randomised trial of NHV over 3-year period. Costs and quality-adjusted life-years (QALYs) were discounted at 5%. Analysis used an intention-to-treat approach with multiple imputation. The right@home was implemented from 2013 in Victoria and Tasmania states of Australia, as a primary care service for pregnant women, delivered until child age 2 years. 722 pregnant Australian women experiencing adversity received NHV (n=363) or usual care (clinic visits) (n=359). First, a cost–consequences analysis to compare the additional costs of NHV over usual care, accounting for any reduced costs of service use, and impacts on all maternal and child outcomes assessed at 3 years. Second, cost–utility analysis from a government-as-payer perspective compared additional costs to maternal QALYs to express cost-effectiveness in terms of additional cost per additional QALY gained. When compared with usual care at child age 3 years, the right@home intervention cost $A7685 extra per woman (95% CI $A7006 to $A8364) and generated 0.01 more QALYs (95% CI −0.01 to 0.02). The probability of right@home being cost-effective by child age 3 years is less than 20%, at a willingness-to-pay threshold of $A50 000 per QALY. Benefits of NHV to parenting at 2 years and maternal health and well-being at 3 years translate into marginal maternal QALY gains. Like previous cost-effectiveness results for NHV programmes, right@home is not cost-effective at 3 years. Given the relatively high up-front costs of NHV, long-term follow-up is needed to assess the accrual of health and economic benefits over time. ISRCTN89962120 .
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/5932675
Abstract: Background . Parkinson disease (PD) is a costly chronic condition in terms of managing both motor and nonmotor symptoms. The burden of disease is high for in iduals, caregivers, and the health system. The aim of this study is to estimate the annual cost of PD from the household, health system, and societal perspectives. Methods . A prospective cohort study of newly referred people with PD to a specialist PD clinic in Melbourne, Australia. Participants completed baseline and monthly health resource use questionnaires and Medicare data were collected over 12 months. Results . 87 patients completed the 12-month follow-up assessments. The mean annual cost per person to the health care system was $32,556 AUD. The burden to society was an additional $45,000 per annum per person with PD. The largest component of health system costs were for hospitalisation (69% of total costs). The costs for people with moderate to severe disease were almost 4 times those with mild PD ($63,569 versus $17,537 p 0.001 ). Conclusion . PD is associated with significant costs to in iduals and to society. Costs escalated with disease severity suggesting that the burden to society is likely to grow with the increasing disease prevalence that is associated with population ageing.
Publisher: Wiley
Date: 27-06-2023
DOI: 10.1111/JOCN.16810
Abstract: To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration. This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses' vital sign measurement and escalation of care for deteriorating patients. The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24‐h periods within the same week were audited at three time points: pre‐intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post‐intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi‐square test. A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre‐Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre‐Medical Emergency Team ( n = 2403) or Medical Emergency Team triggers ( n = 273). One or more nursing interventions were documented in 29.5% of audits with pre‐Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers. When rapid response system triggers were documented, there were gaps in escalation of care per policy however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under‐recognised element of the organisational response to deteriorating patients. Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date. This study addresses the gap in the literature regarding nurses' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards. The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. No Patient or Public Contribution.
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-047970
Abstract: Community-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation. An assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews. Ethical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars. ACTRN12619000936123.
No related grants have been discovered for Shalika Bohingamu Mudiyanselage.