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The Development And Evaluation Of Management Strategies Designed To Address Poly-morbidity In Older People: Implications
Funder
National Health and Medical Research Council
Funding Amount
$2,150,705.00
Summary
Medicines are used to prevent or manage the symptoms of chronic disease, and thus their appropriate use impacts significantly on the quality of life of the elderly. Poly-morbidity, multiple chronic health problems affecting the one individual, is a common and increasing issue in our ageing population. In Australia, 60% of 65 year olds have 2 or more chronic conditions, while 80% of 85 year olds have 4 or more chronic conditions. As a result, medicine use is almost universal in the older populati ....Medicines are used to prevent or manage the symptoms of chronic disease, and thus their appropriate use impacts significantly on the quality of life of the elderly. Poly-morbidity, multiple chronic health problems affecting the one individual, is a common and increasing issue in our ageing population. In Australia, 60% of 65 year olds have 2 or more chronic conditions, while 80% of 85 year olds have 4 or more chronic conditions. As a result, medicine use is almost universal in the older population and it is common for older patients to take multiple medications concurrently. There are no studies which report on current patterns of care and their outcomes in these patients. The use of individual disease-specific management guidelines may be problematic for those with poly-morbidity. Disease specific treatment guidelines often fail to take into account complexities that arise when patients suffer from more than one chronic disease particularly when it is common for one treatment to be both beneficial and harmful in the same person. In addition, the evidence for medicine-based treatment often comes from studies on younger people. Consequently, older patients with lower tolerance are at a greater risk of adverse drug reactions and are admitted to hospital as a result of such reactions at a disproportionately high rate. The aim of this study is to establish a methodology, by examination of two health databases, for developing guidelines to achieve the best possible outcomes for older Australians with common combinations of chronic conditions. This research will provide a better understanding of the consequences of current patterns of care for older people with multiple chronic conditions, and enable the development of improved approaches to care. We will demonstrate the methodology using selected commonly occurring combinations of chronic conditions in older Australians. More realistic guidelines generated by undertaking this analysis in these major population databases will reduce the extent to which the elderly are placed at risk of adverse drug reactions, and better enable health care practitioners, in consultation with their elderly patients, to ensure the best possible health and quality of life outcomes for many older Australian patients who suffer from two or more chronic conditions.Read moreRead less
SEARCH - Study Of Environment On Aboriginal Resilience And Child Health
Funder
National Health and Medical Research Council
Funding Amount
$2,114,618.00
Summary
The SEARCH program of research investigates the relationship between environmental determinants of health in a cohort study with five year follow up involving 800 urban NSW Aboriginal families with approximately 2000 children aged 0-17. A subset of 480 families will be recruited to participate in a randomised controlled trial of the impact of a health broker on (i) improving treatment of otitis media, and (ii) a feasibility study of an intervention to improve housing in 50 households. These two ....The SEARCH program of research investigates the relationship between environmental determinants of health in a cohort study with five year follow up involving 800 urban NSW Aboriginal families with approximately 2000 children aged 0-17. A subset of 480 families will be recruited to participate in a randomised controlled trial of the impact of a health broker on (i) improving treatment of otitis media, and (ii) a feasibility study of an intervention to improve housing in 50 households. These two studies will form the basis of an urban Aboriginal cohort study spanning 20 years with funding from alternate sources.Read moreRead less
Which Heart Failure Intervention Is Most Cost-effective And Consumer Friendly In Reducing Hospital Care: The Which
Funder
National Health and Medical Research Council
Funding Amount
$921,640.00
Summary
Chronic heart failure (CHF) is a costly, debilitating and deadly condition that has reached near epidemic proportions in Australia. In the absence of a permanent cure for CHF, the number of people affected by CHF has risen beyond 350,000 and is expected to increase by 20-30% in the next 20 years. We recently reviewed the benefits of applying nurse-led, CHF management programs (CHF-MPs) to typically old and fragile patients, in whom recurrent hospital admissions and a premature death are common. ....Chronic heart failure (CHF) is a costly, debilitating and deadly condition that has reached near epidemic proportions in Australia. In the absence of a permanent cure for CHF, the number of people affected by CHF has risen beyond 350,000 and is expected to increase by 20-30% in the next 20 years. We recently reviewed the benefits of applying nurse-led, CHF management programs (CHF-MPs) to typically old and fragile patients, in whom recurrent hospital admissions and a premature death are common. We confirmed the results of pioneering Australian research that CHF-MPs dramatically improve health outcomes in CHF. CHF-MPs now form part of the recommended gold-standard management of CHF. However, we also have evidence that only a small proportion of patients are exposed to a CHF-MP in Australia. Residual issues such as consumer preference and the cost of applying these programs are hindering their wide-spread application. The WHICH? Study addresses this _road block� to implementing a potentially valuable health care service by tackling a number of critical issues: which form of CHF-MP (home or specialist clinic-based follow-up), will produce the best health outcomes, save the most money and meet the needs of consumers at the same time? To answer this question, we will undertake a randomised, head-to-head study of a home versus clinic-based CHF-MP, in 1000 recently hospitalised CHF patients recruited from SA, VIC, NSW and QLD. Patterns and of health care and consumer preferences and quality of life will then be compared for these two different forms of CHF-MP from a combined health economic, health policy and consumer perspective to determine the best form of CHF-MP to be applied. A _consensus� vision for applying an Australia-wide service will then be developed. The potential impact of the results of the study will then be modelled on the status of Australian CHF-MPs in the year 2010 and a blue-print for action devised.Read moreRead less
Determining Critical Points In The Potential Palliative Care Pathway In The Last Year Of Life
Funder
National Health and Medical Research Council
Funding Amount
$356,461.00
Summary
People with serious illnesses who are approaching the end of their lives undergo a journey where, along the way, they experience several critical points. Although we know these critical points are crucial to how they might access the best kind of care, we are unsure exactly when these points may occur and how they may vary for different kinds of people. We need to know when is the best time to start withdrawing invasive and purely curative treatments, when are discussions about approaching death ....People with serious illnesses who are approaching the end of their lives undergo a journey where, along the way, they experience several critical points. Although we know these critical points are crucial to how they might access the best kind of care, we are unsure exactly when these points may occur and how they may vary for different kinds of people. We need to know when is the best time to start withdrawing invasive and purely curative treatments, when are discussions about approaching death best introduced and how we can care for people from a diverse range of backgrounds and beliefs within our current health care system. We also need to identify and promote the best possible ways of supporting patients at the end of life and their families as they negotiate the often complex path towards a good death. With this kind of information, health care practitioners, particularly those involved in palliative care, can design better services that put in place pathways where assessment of patient and family needs, referral to the most appropriate services and coordination of all the aspects of care are easy to understand and access for all people. This kind of care can be expensive so we need to use the money allocated to palliative care wisely. This can be achieved with thoughtful research that identifies those most in need, at the time of most need and investigates the best approaches to alleviating pain in suffering in the weeks and months before death. A fair and equitable health care system is not just about keeping people healthy, but also about dealing humanely with the inevitability of deathRead moreRead less
Modelling The Economics Of The Australian Health Care System For Policy Analysis
Funder
National Health and Medical Research Council
Funding Amount
$3,500,000.00
Summary
The program will build a suite of economic models capable of providing timely relevant analysis of almost any major health policy option or issue, providing expertise in government and academia to use the kind of sophisticated quantitative tools of analysis common in sectors of the economy of an equivalent size to health. Through a PhD and postdoctoral program, it will increase capacity in quantitative health economics in Australia to answer key questions in health services, health promotion and ....The program will build a suite of economic models capable of providing timely relevant analysis of almost any major health policy option or issue, providing expertise in government and academia to use the kind of sophisticated quantitative tools of analysis common in sectors of the economy of an equivalent size to health. Through a PhD and postdoctoral program, it will increase capacity in quantitative health economics in Australia to answer key questions in health services, health promotion and illness prevention, developed with partners in government, clinicians and industry.Read moreRead less
Development And Implementation Of An Educational Program To Guide Palliative Care For People With Motor Neurone Disease
Funder
National Health and Medical Research Council
Funding Amount
$258,525.00
Summary
The project aims to improve the quality of care for people with MND and their family carers through the development, testing and implementation of an educational program for health professionals and other service providers focused on the palliative care needs of this population. The project is taking place in three sites: Western Australia, Victoria and South Australia, in collaboration with the MND associations in the three states. The effectiveness of the flexible model of care provided to peo ....The project aims to improve the quality of care for people with MND and their family carers through the development, testing and implementation of an educational program for health professionals and other service providers focused on the palliative care needs of this population. The project is taking place in three sites: Western Australia, Victoria and South Australia, in collaboration with the MND associations in the three states. The effectiveness of the flexible model of care provided to people with MND and their carers as a result of the implementation of the MND Education Program will be assessed and a national implementation plan will be developed.Read moreRead less
Enhancing Mental Health In Aboriginal People: Reducing Violence And Developing Resilience
Funder
National Health and Medical Research Council
Funding Amount
$1,771,151.00
Summary
This project aims to determine the best ways to improve the Social Emotional Well Being (SEWB) of the Aboriginal people of Broken Hill, Menindee and Wilcannia. This project will develop a culturally appropriate and evidenced based intervention to break the cycle of ongoing grief, mental illness, alcohol and other drugs and violence. The project will proceed in a number of interrelated phases including extensive community consultations and a baseline survey. The project will then implement and ev ....This project aims to determine the best ways to improve the Social Emotional Well Being (SEWB) of the Aboriginal people of Broken Hill, Menindee and Wilcannia. This project will develop a culturally appropriate and evidenced based intervention to break the cycle of ongoing grief, mental illness, alcohol and other drugs and violence. The project will proceed in a number of interrelated phases including extensive community consultations and a baseline survey. The project will then implement and evaluate an intervention program that provides a community and individual program that adopts evidence-based approaches and modifies them to be acceptable within Aboriginal communities. These interventions aim to break the cycle of violence and mental health problems by teaching adaptive skills to reduce violent behaviours and by providing mental health interventions that reduce disorders that contribute to violence.Read moreRead less
The Pacific OPIC Study - A Four Country Study Of Obesity Prevention In Communities
Funder
National Health and Medical Research Council
Funding Amount
$1,600,580.00
Summary
Obesity is a rapidly escalating, worldwide epidemic. Many countries recognise the need to prevent obesity but there is insufficient evidence about what interventions work. The Pacific Obesity Prevention in Communities (OPIC) Project will provide data on the effectiveness of a range of interventions to prevent obesity among young people in Fiji, Tonga, New Zealand and Australia. Prevention research is particularly required in countries such as Fiji and Tonga because their prevalence of obesity is ....Obesity is a rapidly escalating, worldwide epidemic. Many countries recognise the need to prevent obesity but there is insufficient evidence about what interventions work. The Pacific Obesity Prevention in Communities (OPIC) Project will provide data on the effectiveness of a range of interventions to prevent obesity among young people in Fiji, Tonga, New Zealand and Australia. Prevention research is particularly required in countries such as Fiji and Tonga because their prevalence of obesity is extremely high. The interventions used in this project will be culturally appropriate and include at least 1000 young people in each intervention group. The outcomes of this project will be applicable to both low- and high-income countries. This project will lead to a greater understanding of the socio-cultural, policy, and economic contexts and provide crucial evidence for public health action to prevent obesity.Read moreRead less
Assessment To Service Outcomes - Care Pathways For Older Australians With Dementia, CVD And Arthritis
Funder
National Health and Medical Research Council
Funding Amount
$656,029.00
Summary
The project aims to use existing data source to answer questions similar to �What happens to people after they have been assessed and recommended for aged care? in respect of service delivery for people with one of the three chronic conditions dementia, arthritis or cardiovascular disease. The project is to provide information about issues such as �bed blockers� and determine if the outcomes are different for people who have been assessed for aged care while they are in hospital. It is to chart ....The project aims to use existing data source to answer questions similar to �What happens to people after they have been assessed and recommended for aged care? in respect of service delivery for people with one of the three chronic conditions dementia, arthritis or cardiovascular disease. The project is to provide information about issues such as �bed blockers� and determine if the outcomes are different for people who have been assessed for aged care while they are in hospital. It is to chart changes in service use over time and examine factors that affect the type of care used by older people.Read moreRead less
Genomic And Proteomic Profiling Of Dendritic Cell Heterogeneity
Funder
National Health and Medical Research Council
Funding Amount
$1,971,250.00
Summary
Dendritic cells (DC) present antigens to T cells and regulate immunity and tolerance. DC are heterogeneous, comprising seven functionally distinct subsets. We will use genomics and proteomics to identify the plasma membrane and endosomal proteins that underpin this functional heterogeneity. Such proteins are potential targets for improved protocols of vaccination and prevention of autoimmunity. This project will thus provide further opportunities for high-quality research and commercialisation.