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Changing Decision-making Behaviour In General Practice By Providing Access To Online Evidence.
Funder
National Health and Medical Research Council
Funding Amount
$206,375.00
Summary
The case for a shift to evidence-based practice, and the substantial economic and health outcome benefits of that shift, have been repeatedly made. Despite the vision, significant barriers to evidence-based practice remain, and the demonstration of a positive role for on-line systems would result in a significant change in strategies for clinician behaviour change. This study will make a specific and significant contribution to our understanding of the efficacy and effectiveness of online eviden ....The case for a shift to evidence-based practice, and the substantial economic and health outcome benefits of that shift, have been repeatedly made. Despite the vision, significant barriers to evidence-based practice remain, and the demonstration of a positive role for on-line systems would result in a significant change in strategies for clinician behaviour change. This study will make a specific and significant contribution to our understanding of the efficacy and effectiveness of online evidence retrieval systems as a component in any evidence-based strategy, through a rigorous and controlled approach to the study of clinical behaviour change. It will also provide a powerful test of the value of search filters as a specific technology in support of evidence retrieval. The focus on prescribing patterns in NHMRC priority areas as an outcome measure will also provide a significant data set reflecting current practice in primary care.Read moreRead less
The Safety And Effectiveness Of Hospital E-prescribing Systems: A Controlled Time Series Study
Funder
National Health and Medical Research Council
Funding Amount
$740,460.00
Summary
Prescribing errors represent a significant public health issue internationally. In the US over 770,000 people are harmed or die each year in hospitals as a result of adverse drug events. In Australia 2% of hospital patients experience harm or death due to medication errors. The risk of these errors is rising each year with the increased intensity of medical care, use of complex and potent drug regimens and the increasing age and severity of hospital patients. Electronic prescribing systems are b ....Prescribing errors represent a significant public health issue internationally. In the US over 770,000 people are harmed or die each year in hospitals as a result of adverse drug events. In Australia 2% of hospital patients experience harm or death due to medication errors. The risk of these errors is rising each year with the increased intensity of medical care, use of complex and potent drug regimens and the increasing age and severity of hospital patients. Electronic prescribing systems are believed to significantly reduce the number of errors which occur and reduce harm to patients as a result. No studies have demonstrated that these systems result in reducing prescribing errors that cause harm to patients. Alarmingly, anecdotal evidence from overseas suggests that use of electronic prescribing systems introduces new types of errors. This is consistent with a growing body of scientific research which suggests that individuals' decision-making may be significantly influenced by information generated by a computer, resulting in new types of errors. The aim of this project is to undertake a controlled time series study to assess the safety and effectiveness of two electronic prescribing systems to reduce prescribing errors in Australian hospitals. The study will compare error rates before and after the introduction of the systems. In addition, the study will be the first to focus on measuring new types of errors that may result from system use and to investigate how computer use influences clinicians' decision-making. This study will provide critical information about the effectiveness and safety of these systems which are being introduced into Australian hospitals. Unlike other medical interventions, which require stringent safety testing before use with patients, there are no minimum safety requirements for electronic prescribing systems. The data from this study is urgent in developing recommendations to ensure the safety of electronic prescribing systems for Australia.Read moreRead less
The Impact Of Electronic Medication Administration Records (e-MAR) On Medication Administration Safety And Nurses' Work
Funder
National Health and Medical Research Council
Funding Amount
$735,675.00
Summary
The demands on health systems, both nationally and internationally, are growing, exacerbated by an ageing population and health workforce shortages. The incorporation of information technology into new health care delivery models promises both improvements in the safety and efficiency of care delivery. Medication errors are one of the most significant safety issues for health care systems. Medication management occupies a significant amount of nurses' time, and is also fraught with error potenti ....The demands on health systems, both nationally and internationally, are growing, exacerbated by an ageing population and health workforce shortages. The incorporation of information technology into new health care delivery models promises both improvements in the safety and efficiency of care delivery. Medication errors are one of the most significant safety issues for health care systems. Medication management occupies a significant amount of nurses' time, and is also fraught with error potential. One-third of all medication errors that cause patient harm arise from medication administration errors (MAEs). Electronic medication administration records (e-MARs) provide the potential to make the administration of medications safer for patients by reducing error rates, and also by allowing nurses to more efficiently manage medication tasks. However there is very limited research from Australia or overseas which has examined whether they computerised system work and in fact reduce error rates or save nurses time. In this project we will conduct prospective, controlled observational studies to determine the effectiveness of an electronic medication administration record (e-MAR) to reduce MAEs and the amount of time nurses spend in the medication administration process. The project will apply innovative data collection tools using PDA software purpose-built for these studies which have undergone extensive pilot testing in clinical settings. The results will have important implications for hospitals across Australia and internationally as they consider the implementation of e-MARs. This research will provide the first comprehensive data of medication administration errors in Australia against which future preventative error strategies can be evaluated. The results will provide the evidence needed to develop recommendations about how to reduce MAEs and improve the design of e-MARs.Read moreRead less
Using Conversational Computer Technology To Improve Diabetes Management: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$708,606.00
Summary
The diabetes epidemic is a growing challenge for the Australian health care system with over 1 million Australians living with diabetes. The impact on individuals' lives and the whole of Australian society is very substantial indeed. There is very good evidence that this impact would be reduced by developing new approaches to manage the disease and facilitate improved self-management. Recent developments in information and communications technologies offer some promising new ways and tools for a ....The diabetes epidemic is a growing challenge for the Australian health care system with over 1 million Australians living with diabetes. The impact on individuals' lives and the whole of Australian society is very substantial indeed. There is very good evidence that this impact would be reduced by developing new approaches to manage the disease and facilitate improved self-management. Recent developments in information and communications technologies offer some promising new ways and tools for achieving this. This research will evaluate a computer-controlled, interactive telephone system for improving the management and self-management of Type 2 diabetes in addition to routine care. Patients with Type 2 diabetes will be recruited from Brisbane and each patient will be randomly assigned to receive either this new program or just their usual care from their doctor or Diabetes Clinic. The first group will call the system weekly for six months using a regular phone or a mobile phone if they wish. During the call, they will answer questions by speaking into the phone, listen to feedback and strategies for improving management of their diabetes and then discuss their next targets and behavioural actions. They will receive systematic and tailored advice on blood glucose testing, nutrition and physical activity, as well as medication taking and foot care. The system individualises conversations according to the user s answers and responses over all the interactive sessions. The trial will formally evaluate the clinical impact on blood glucose control and the adoption and maintenance of the targeted health habits, as well as the intervention s cost-effectiveness and users satisfaction with the system. This project s significance lies in the excellent potential of using this new technology to provide a 'low cost' but effective program to help people better manage Type 2 diabetes.Read moreRead less
Novel Statistical Methods For Genetic Epidemiology
Funder
National Health and Medical Research Council
Funding Amount
$481,505.00
Summary
We are in the midst of a genomics revolution that is transforming epidemiology, medicine and drug discovery. However, the scarcity of sophisticated statistical techniques to deal with the complicated problems inherent in genetic investigations of complex diseases is currently the critical factor limiting the success of human gene discovery programs. Statistical genetic methodology is currently one of the fastest developing areas of epidemiology. In information-intensive' areas such as genetic ep ....We are in the midst of a genomics revolution that is transforming epidemiology, medicine and drug discovery. However, the scarcity of sophisticated statistical techniques to deal with the complicated problems inherent in genetic investigations of complex diseases is currently the critical factor limiting the success of human gene discovery programs. Statistical genetic methodology is currently one of the fastest developing areas of epidemiology. In information-intensive' areas such as genetic epidemiology, genomics, and proteomics, there is a high demand for data analysis and statistical skills. WA has some world class expertise in statistical science, both in academia and in industry. However, this expertise has not yet been applied in a system way to genetic data analysis. We propose to undertake advanced methodological research in statistical genetics and bioinformatics, to produce easy-to-use and accessible software tools and resources that allow methodological advances to be accessed by the Australian research community, and to apply our new methods and tools both to specific disease research and to the developing human genome epidemiology (HuGE) enterprise in WA. These new initiatives in methodological research will draw together a number of currently separate research strands and will provide new tools and resources that will allow applied Australian programs to improve the efficiency of their research into the causes of important. Methodological development in both bioinformatics and statistical genetics are recognized international areas of need.Read moreRead less
Evaluating The Safety Of Computer Decision Support Systems In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$300,389.00
Summary
Use of clinical software has many benefits. However it is also likely that clinical software will introduce new computer-generated errors that may harm patients. This project will evaluate the safety of software for prescribing in general practice. We will firstly examine mechanisms for errors generated by clinical software on its own, and then in the hands of typical users. The outcomes will have broad potential to guide the regulation, use and design of clinical software in general practice.
A Structured Systems Approach For Improving Health Promotion Practice For Chronic Diseases In Indigenous Communities
Funder
National Health and Medical Research Council
Funding Amount
$666,592.00
Summary
This project will trial a model for continuous improvement, with the aim of assisting health services and community based organisations to improve the services they deliver to promote health and prevent chronic disease in Indigenous communities.
Health Status And Development Among Aboriginal Infants In An Urban Community.
Funder
National Health and Medical Research Council
Funding Amount
$436,650.00
Summary
This research is a descriptive study of the health outcomes of Aboriginal infants, born at Campbelltown Hospital. The research will build on Centre for Health Equity's (CHETRE) work, since 1997, with the Aboriginal community, Aboriginal Medical Service (AMS) and Area Health Services (AHS) in the region to develop and advocate for services to address the needs of Aboriginal and other disadvantaged communities. CHETRE has supported the Aboriginal workers to develop additional services for Aborigin ....This research is a descriptive study of the health outcomes of Aboriginal infants, born at Campbelltown Hospital. The research will build on Centre for Health Equity's (CHETRE) work, since 1997, with the Aboriginal community, Aboriginal Medical Service (AMS) and Area Health Services (AHS) in the region to develop and advocate for services to address the needs of Aboriginal and other disadvantaged communities. CHETRE has supported the Aboriginal workers to develop additional services for Aboriginal women, such as the Aboriginal Home Visiting Team (AHV) and assisted with evaluation of these services. The AHV management comprises representatives from AMS, AHS, the Aboriginal community and CHETRE, and will provide advice and oversight for this project. The AHV developed from community concern about health status of Aboriginal infants and provides ante and postnatal care to infants and mothers. As a part of this service Aboriginal infants are systematically identified by the AHS. Further development of services is limited by lack of information on health status, use of health services, or achievement of developmental milestones by Aboriginal infants in an urban community and the assumption that outcomes are a factor of disadvantage. The researchers intend to describe in meticulous detail obstetric outcomes for 150 Aboriginal infants and their mothers born in 2004-5 and the health and development outcomes of the infants at 12 months. Baseline information on birth weight, Apgar score and obstetric history will be collected from maternal report at 2-3 week post-delivery and from routine data collections. Infants and their mothers will be followed up prospectively with further data collection points at 6 months and 12 months. Information on health status, health service use, and achievement of developmental milestones will be obtained by measurement and maternal report. An assessment by a paediatrician will be undertaken at 12 months.Read moreRead less
A Randomized Trial Of The Impact Of A Multi-intervention Anti-tobacco Strategy In 8 Indigenous Communities.
Funder
National Health and Medical Research Council
Funding Amount
$567,750.00
Summary
Tobacco smoking represents the major risk to life and health within Australian Indigenous communities. Survey data suggest that prevalence rates for the Indigenous community are more than twice those of the non-Indigenous population. These rates are reflected in the pattern of mortality and morbidity within Indigenous communities. During the period 1989-1999 the smoking-related death rate amongst Indigenous Queenslanders was almost three times greater than that of non-Indigenous Queenslanders. A ....Tobacco smoking represents the major risk to life and health within Australian Indigenous communities. Survey data suggest that prevalence rates for the Indigenous community are more than twice those of the non-Indigenous population. These rates are reflected in the pattern of mortality and morbidity within Indigenous communities. During the period 1989-1999 the smoking-related death rate amongst Indigenous Queenslanders was almost three times greater than that of non-Indigenous Queenslanders. Additionally, tobacco smoking is a major contributing factor in many conditions that constitute significant Indigenous health problems. The natural history of smoking also differs between the Indigenous and non-Indigenous populations. Indigenous smokers start younger, are more likely to develop smoking-related conditions and tend to die younger than non-Indigenous smokers. Despite the above statistics, there is little published data on the effectiveness of anti-smoking interventions within Australia's Indigenous populations. Lessons from non-Indigenous communities suggest that the most successful strategies are those that target populations at many different levels. Rather than one isolated intervention, such strategies may include policy initiatives, training and education of health staff, community education and awareness campaigns and increased access to cessation techniques. Indigenous communities generally lack the capacity to initiate these type of tobacco control strategies. This project aims to examine the impact of a multi-intervention anti-tobacco strategy within north Queensland Indigenous communities. The project has three broad aims: 1) to increase the capacity of health services to implement and deliver anti-tobacco interventions; 2) to increase community knowledge and awareness of the risks of smoking and 3) to decrease the level of tobacco consumption within communities.Read moreRead less