Australian Health Review

What is known about the topic? Deep brain stimulation (DBS) is a US Federal Drug Administration (FDA)-approved and highly effective treatment for late-stage PD; however, inequities in access to DBS for PD exist across high-income countries, likely stemming from differences in DBS cost and utilisation. What does this paper add? Our study is the first to use cost and utilisation data to calculate a PD-DBS treatment gap informing accessibility barriers. What are the implications for practitioners? The results of this study can be utilised to guide future national policy decisions and advocacy efforts by patient organisations and specialist societies.

What is known about the topic? Multiparametric magnetic resonance imaging (mpMRI) is increasingly used in the diagnosis of prostate cancer. In 2018, it was included in the Medicare Benefits Schedule with the expectation that the number of prostate biopsies performed would decrease. What does this paper add? By 2022, biopsies increased nearly 12% with over a 50% increase in the 80–89 age group – those least likely to benefit from curative treatment. What are the implications for practitioners? The criteria for funding mpMRI and the performance of prostate biopsies should be altered to enable better use of resources.

What is known about the topic? Peripheral intravenous catheters (PIVCs) are required in most hospital admissions, but multiple insertion attempts, device failure and post-insertion complications are common, resulting in poor patient outcomes and wasted healthcare resources. What does this paper add? This case study explored how clinical and executive hospital staff in three Australian hospitals view PIVC insertion from a cost and resourcing perspective, in order to better understand attitudes around PIVC use and practice. What are the implications for practitioners? Hospital staff reported that PIVC insertions are considered as part of routine care and therefore the varying and unpredictable costs of successful cannulation are largely ‘hidden’. Improved escalation procedures and investment in advanced insertion skills (including ultrasound-guided cannulation) may help reduce inefficiencies and waste.

What is known about the topic? It has been challenging for oil and gas companies to deliver and evaluate value-based healthcare services to improve workers’ wellbeing, supplementing essential emergency services and occupational health. What does this paper add? The Remote Health Value Framework (RHVF), developed and tested in this work, offers a blueprint for designing and evaluating models of care considering the companies’ and workers’ priorities. What are the implications for practitioners? The RHVF’s application has the potential to improve industry standards, enabling a data-driven approach to healthcare investments that closely align with both corporate objectives and employee wellbeing.

What is known about the topic? Surveillance of antimicrobial use is a useful tool to identify overuse or inappropriate use and enable targeted interventions to optimise antimicrobial prescribing and reduce the risk of antimicrobial resistance. What does this paper add? The methodology currently used to monitor antimicrobial use in Australian hospitals could be utilised to conduct facility-level surveillance in Australian prisons and would provide a mechanism to benchmark use between facilities and identify unexpected or inappropriate use. What are the implications for practitioners? Surveillance of antimicrobial use in prisons would support prison healthcare workers to monitor use over time, identify any increasing or unexpected trends in use, and target educational interventions to ensure compliance with antimicrobial prescribing guidelines.

What is known about the topic? High turnover rates among hospital chief executive officers (CEOs) negatively impact organisational stability and healthcare quality, causing disruptions in strategic decision-making, decreased employee morale, and potential declines in patient care standards. What does this paper add? This study identifies stress, lack of board support, and resource constraints as key factors driving CEO turnover in Australian hospitals. It also offers effective retention strategies, including fostering mutual respect between CEOs and boards, fulfilling training needs, and ensuring clear role definitions. What are the implications for practitioners? Implementing supportive organisational cultures, clear role definitions, and robust succession planning can enhance CEO retention. These measures will improve stability, strategic planning, and healthcare management, ultimately benefiting staff and patient care.

What is known about this topic? Clinical care ratios are useful in benchmarking allied health workplace activities. More experienced allied health professionals undertake more non-clinical activity. What does this research add? Non-clinical tasks represent a significant proportion of allied health workplace activities within Health New Zealand. What are the implications for practitioners? Clinical care ratios may be useful for managers and funders to understand allied health work demands and support more effective workforce planning. Measurement of non-clinical activities can ensure allied health professionals have time allocated for non-patient work.

What is known about the topic? Changes in the medical workforce over time are likely to impact health service delivery. What does this paper add? This paper examined changes in the gender, age, origin of qualification, and the region of work of Australia’s medical workforce from 2013 to 2022. What are the implications for practitioners? An increase in gender parity and a decrease in the mean hours worked suggests improvements in workforce participation and sustainability, but lack of growth in medical workforce was noted in remote and very remote regions of Australia.

What is known about the topic? People with a disability (PWD) are at higher risk of morbidity and mortality following COVID-19 infection but little is known about how PWD were supported during the COVID-19 pandemic. What does this paper add? Describes one local health district (LHD's) approach to prevent, manage and minimise COVID-19 outbreaks in disability group homes along with insights from the disability group home managers on their experience of support provided by the LHD and other stakeholders. What are the implications for practitioners? Awareness of effective strategies supporting PWD that could be replicated in health organisations.

What is known about the topic? Previous research varied in methodology, using self-reports and healthcare data to understand COVID-19 social distancing public health measures’ effects on mental health. What does this paper add? This study introduces robust, objective data via a natural experiment design, examining the impact of successive lockdowns on mental health service usage and medication expenditures in specific Australian regions. What are the implications for practitioners? Findings highlight the need for flexible mental health services that can swiftly respond to increased demands during prolonged restrictions, without necessarily increasing medication use, guiding future policy and resource allocation.

What is known about the topic? Inpatient visitors are an essential part of patient support worldwide. Little is known about the nature of visiting flows. What does this paper add? This is the first observational study exploring visitor patterns, time, destination, and parking costs in an acute hospital setting. What are the Implications for practitioners? The study raises questions about hospital planning and the possibility for future research defining the needs of visitors, whether those expectations were met, and how the concept of visiting could be realigned in order to meet those demands.

What is known about the topic? Occupational violence is a global issue in health care, requiring effective interventions. What does this paper add? This paper presents a pilot study of an innovative Ambassador program trialled in three acute inpatient surgical wards at an Australian hospital, yielding promising outcomes. What are the implications for practitioners? Clinicians, managers and researchers may consider this new model to mitigate occupational violence.

What is known about the topic? While some transfers from nursing homes to EDs are necessary, many are avoidable and place older people at an undue risk of harm, burden healthcare services, and incur significant costs. What does this paper add? A multifaceted approach is required to reduce advisable ED transfers, including improved staffing, consumer engagement, interfaces with clinical expertise, and technology integration. What are the implications for practitioners? Practitioners should advocate for better staffing levels, conduct advance care planning in collaboration with residents’ families, and utilise technologies such as telehealth to enhance in-reach expertise and reduce unnecessary transfers.

What is known about the topic? The COVID-19 pandemic had a significant effect on the wellbeing of healthcare workers worldwide, and targeted supportive interventions could benefit healthcare workers. What does the paper add? This study contributes to the existing literature by examining the contribution that staff wellness rounding can make as an intervention for supporting the wellbeing of healthcare workers during crisis-type events. What are the implications for practitioners? The model was delivered by multidisciplinary healthcare leaders who were not specifically trained in psychology or counselling. It facilitated interactions and fostered collegiality between healthcare workers and executive leaders and used available resources effectively to support staff wellness.

What is known about the topic? The environmental footprint of health care itself is important. Carbon footprinting of surgical operations are becoming more common, although detailed analyses are rare. What does this paper add? The carbon footprint of a total knee replacement was 132 kg CO₂e, i.e. the equivalent of driving >900 km in a typical 2022 Australian car. Orthopaedic surgery itself contributed to 80% of the emissions, with anaesthesia and operating room energy use contributing 10% each to the total carbon footprint. What are the implications for practitioners? By replacing single-use with reusable equipment, and by using 100% renewable energy for decontamination, the greenhouse gas emissions for a total knee replacement can become negligible.

What is known about the topic? Workforce costs are known to be a significant contributor to the cost of health services and complex health technologies. What does this paper add? This paper systematically quantifies the variation in workforce costs across five Australian states, demonstrating that these differences are substantial enough to influence cost-effectiveness outcomes for genomic testing services. By identifying key areas of cost variation – such as base salaries, superannuation contributions, and allowances – this paper highlights how jurisdictional variations can contribute to differential health service costs, potentially impacting the affordability and sustainability of health programs and technologies, across states. What are the implications for practitioners? We provide reproducible estimates of workforce costs for use by health economists and policymakers conducting economic evaluations. The framework presented in this paper can also be adapted by other professionals in health economics and health workforce planning to assess jurisdictional variations and their implications for resource allocation and service delivery.

What is known about the topic? Little is known about the costs of the visiting subspecialist ophthalmology service (fly in-fly out or FIFO) for rural and remote communities. What does this paper add? Evidence suggests that the FIFO model implemented for residents in Darwin, Australia, provides excellent clinical outcomes and a minimal insignificant difference in costs. What are the implications for practitioners? The visiting subspecialist ophthalmology service (FIFO) is a useful model to provide eye services to Darwin, and further research involving other rural and remote areas should be undertaken to further build the evidence base.

What is known about the topic? A large rise in telepsychiatry consultations with increased total consultations and reduced face-to-face consultations followed the pandemic-triggered expansion of Medicare Benefits Schedule telehealth items. What does this paper add? We demonstrated that after adjusting for pre-existing trends, seasonality, and COVID-related restrictions, telehealth expansion was associated positively with all consultations and negatively with face-to-face consultations at clinically significant levels. What are the implications for practitioners? Policy changes widening telepsychiatry services have possibly led to increased uptake of psychiatric care by addressing previously unmet needs. Hybrid face-to-face/telehealth care may become the new norm.

What is known about the topic? Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) cause significant morbidity and mortality. Australian treatment costs for 2016–2031 are predicted to be AU$317 million, with 60% attributed to hospitalisations. What does this paper add? We report the first ‘real-world’ hospitalisation patterns and costs associated with ARF, RHD and complications. Admissions have increased annually over 2012–2017 with costs of AU$130.6 million. What are the implications for practitioners? Successful ARF/RHD prevention would deliver significant hospital cost savings. Investment in primary and specialist health care in regional areas may reduce frequent emergency admissions and regional transfers.

What is known about the topic? Acute care of the elderly (ACE) wards have been shown to improve outcomes for hospitalised older people through early rehabilitation and early discharge planning. What does this paper add? At least twice daily therapy on an ACE ward was feasible, facilitated discharge home and both staff and patients reported positive perceptions of the intervention. What are the implications for practitioners? Measurement of the scalability and sustainability of this model of care and further economic analysis are needed to determine whether the staffing required negates the cost of avoided subacute admission or bed days saved.

What is known about the topic? Osteoporosis is a common yet undermanaged problem. What does this paper add? This paper describes a successful approach to finding cases of osteoporosis and shows that flagging this to GPs does not lead to increased rates of management. What are the implications for practitioners? It is unclear how to engage GPs in a manner which will lead them to address population health risks.

What is known about the topic? In Australia, the true burden of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) is likely to be underestimated. What does this paper add? Capture–recapture method provided a measure of the undetected cases of ARF/RHD based on two data sources and characteristics of groups where under-notification occurred. What are the implications for practitioners? This study identifies a need to support clinicians to maintain an index of suspicion of ARF/RHD when working with groups that are not typically at high risk of ARF.

What is known about the topic? The implementation of voluntary assisted dying (VAD) legislation poses challenges for clinicians. Understanding clinician perspectives on VAD is important for future practice and policy decisions. What does this paper add? Clinicians are impacted by inadequate remuneration, barriers to training and an emotional toll. What are the implications for practitioners? Unaddressed impacts may lead to burnout and workforce sustainability challenges. Recommendations include Medicare Benefits Schedule items for remuneration, training incentives and emotional support strategies for VAD clinicians.

What is known about this topic? Much research has been generated around the benefit of teamwork in healthcare, little has been generated around how to achieve this at an organisational level. What does this paper add? This paper specifically seeks to bridge the gap in understanding how teamwork can be enabled at an organisational level, and the pathways organisations have undertaken to achieve this way of working. What are the implications for practitioners? This paper identifies the key themes across three exemplar organisations that have enabled team working at an organisational level for potential application.

What is known about the topic? People living with severe mental illness experience a 20-year reduced life expectancy due to a combination of modifiable lifestyle factors and increased rates of chronic disease. What does this paper add? This paper describes the Living Well, Living Longer integrated care program, which introduces various strategies to address this problem. What are the implications for practitioners? Living Well, Living Longer demonstrates that with strong executive support, multidisciplinary collaboration, and engagement with lived experience expertise, effective care pathways can be implemented to improve the health of people living with severe mental illness.

What is known about the topic? Self-management strategies and multidisciplinary rehabilitation with self-monitoring are considered best practice for treatment of Long COVID. What does this paper add? A workplace delivered outpatient multidisciplinary service was feasible in terms of demand, acceptability and practicality and provided valued support for hospital staff experiencing Long COVID. What are the implications for practitioners? A flexible, workplace delivered multidisciplinary service was acceptable and convenient to hospital staff with Long COVID. Further research is required to confirm the effectiveness of such a service on patient outcomes.

What is known about the topic? Accessing health care in rural Australia is challenging, often leading to disparities in health outcomes, particularly for patients requiring complex and highly specialised treatment. What does this paper add? The findings of this study help to identify gaps in healthcare provision in rural Australia and assist in reducing disparity in care for regional patients with peritoneal malignancy. What are the implications for practitioners? Practitioners can be reassured that regional patients referred to specialised centres may achieve comparable outcomes to metropolitan patients, emphasising the importance of accessible specialist care for regional Australian patients.

What is known about the topic? Voluntary assisted dying (VAD) is generally operating as intended in Australia but access barriers remain. What does this paper add? Queensland implemented VAD differently with a statewide VAD support service that assists with provision of VAD and a Health Service Directive requiring all Health and Hospital Services to provide publicly-funded VAD services. This is the first research on the Queensland VAD system’s operation. What are the implications for practitioners? VAD is likely to be provided by practitioners in the public sector. Consistency in VAD provision, resourcing and VAD workforce sustainability are ongoing challenges.

What is known about the topic? Comorbid chronic conditions are common in people with cancer, but the uitlisation of Medicare chronic disease management (CDM) item numbers for them remained unexplored. What does this paper add? Approximately half of the cancer survivors had General Practitioner Management Plan and Team Care Arrangements, and just over two-fifths utilised subsidised allied health services, with notable variations by people with cancers’ characteristics. What are the implications for practitioners? The findings underscore the need for further investigation to examine the contributing factors for the variation in CDM plans and the low utilisation of allied health services, particularly those living in the outer regional or remote areas.

What is known about this topic? Barriers to accessing allied health services in primary care in Australia exist, especially among those in need. What does this paper add? We show that hotspots (areas with greater density) versus coldspots (areas with lower density) of potentially preventable hospitalisations were significantly more disadvantaged. Hotspots also had poorer access to allied health services. What are the implications for practitioners? This provides evidence to practitioners and policy makers for advocating greater access to allied health services in areas of socioeconomic disadvantage.

What is known about the topic? Shortage of hospital beds may lead to cancellation of surgeries. What does this paper add? Historical data could be used to predict hospital bed utilisation for post-surgical care. What are the implications for practitioners? A predictive tool is proposed, which may provide decision support to the planning of surgeries and bed management.

What is known about the topic? High chief executive officer (CEO) turnover in hospitals leads to instability, financial costs, and disruptions in patient care. Effective retention strategies are essential but often lack comprehensive, context-specific models. What does this paper add? This paper presents a tailored CEO retention model for Australian hospitals, integrating mutual respect, organisational culture, competitive rewards, recruitment practices, and professional development, aligned with Transformational Leadership Theory. What are the implications for practitioners? Practitioners can use this model to implement comprehensive retention strategies, enhancing organisational stability and reducing CEO turnover in hospitals.

What is known about the topic? Involving patients in communications about their health care can improve the experience and quality of care and reduce miscommunication. Digital technologies, such as mobile apps, can enable patient-centred care through improved patient–clinician communication, however, their utility for patient–bedside nurse communication has not been widely studied. What does this paper add? This prototype app shows early promise for enabling patients to articulate their care priorities to bedside nurses, and to facilitate patient-centred care. However, user perceptions regarding the influence of the app on patient involvement in bedside handover were mixed. What are the implications for practitioners? This digital app has potential to improve the safety and quality of care through improved patient–nurse communication about what matters most to patients.

What is known about the topic? The incidence of chronic diseases among immigrants varies across different ethnic groups due to disparities in their behavioural risk factors. What does this paper add? The study explores the health of South Asian immigrants in Australia and finds that half of them have preventable chronic diseases. Having more than one chronic disease is more common in those over 50, those who do not eat enough vegetables, and those who regularly drink alcohol. What are the implications for practitioners? The study underscores the significance of healthcare providers directing their efforts towards assisting immigrants, particularly the elderly, in reducing alcohol consumption and adopting healthier dietary habits to prevent chronic diseases.

What is known about the topic? The HOSPITAL score and LACE index are used to predict readmissions, but their utility and comparative effectiveness in Australian healthcare settings are unclear. What does this paper add? This study found that both the HOSPITAL score and LACE index have modest and comparable abilities in predicting community-acquired pneumonia readmissions in Australian settings. What are the implications for practitioners? There is a need for further refinement of readmission prediction models to better suit Australian healthcare conditions.

What is known about the topic? High levels of activation measured using the Patient Activation Measure (PAM^®) have been associated with improved health behaviours, reduced emergency department (ED) representations and lower healthcare costs. What does this paper add? The PAM^® did not predict short-term healthcare use in older adults with mild frailty. However, low levels of activation were significantly associated with ED use in the previous 6 months, indicating older adults may require greater discharge supports. What are the implications for practitioners? Over 50% of patients were at low levels of activation, highlighting the importance of post-discharge care.

What is known about the topic? The impact and sustainability of integrated palliative care models for people with advanced dementia depends on how well these models can respond and adapt to the context in which they are implemented. What does this paper add? Applying KA McKercher’s (2020) principles of co-design, this case study presents a model of care developed by a diverse group of dementia and palliative care stakeholders. What are the implications for practitioners? Co-design principles can bring together a diverse range of stakeholders to develop new models of care that benefit people with dementia and their carers.

What is known about the topic? Appropriate patient selection is critical for safe and effective Hospital in the Home (HITH) services that deliver positive patient experiences. HITH research predominantly reports on hospital-specific outreach services. What does this paper add? A HITH program spanning metropolitan and adjacent regions was safe for patients but confounding likely impacts estimates of effectiveness. Patients accepted and preferred HITH and understood its impact on the health system. Perceived gaps in service quality were tolerated because of benefits of being at home including enhanced self efficacy. What are the implications for practitioners? Patients, referrers and funders can be reassured that HITH is safe, which will further enhance the program’s acceptability.

What is known about the topic? Rheumatic heart disease often presents without documented antecedent acute rheumatic fever or as advanced disease, implicating missed opportunities for early diagnosis. What does this paper add? A proportion of young persons in Australia identified with acute rheumatic fever and/or rheumatic heart disease, particularly those considered at low risk, may have had these conditions previously overlooked during emergency department or inpatient care, having received one or more prior diagnoses mimicking these conditions. What are the implications for practitioners? Clinical suspicion of acute rheumatic fever and/or rheumatic heart disease in Australian hospitals requires enhancement.

What is known about the topic? There is no current evidence pertaining to what Aboriginal and Torres Strait Islander peoples think of direct prescriptions from the pharmacist for six conditions: low-risk oral contraceptives, antibiotics for urinary tract infections, and four minor skin ailments. What does this paper add? This paper provides a protocol to ensure that Aboriginal and Torres Strait Islander peoples’ perspectives are captured and amplified for policy makers. What are the implications for practitioners? Practitioners are made aware of the perspective of the Aboriginal and Torres Strait Islander peoples regarding pharmacists prescribing certain medications.

What is known about the topic? Geriatric Evaluation and Management, Rehabilitation Hospital in the Home (GEMRHITH) is a poorly studied area of sub-acute healthcare practice. What does this paper add? The multidisciplinary GEMRHITH service supported a broader cohort of patients than traditional HITH models across medical and surgical conditions. What are the implications for practitioners? The GEMRHITH service was safe with low re-admission rates and improvements in patient functional outcome scores.

What is known about the topic? Bariatric surgery is an effective intervention to treat severe obesity. Access to this service in Queensland public hospitals was limited. Access was gained only in exceptional cases; this created unmet need and inequities. What does this paper add? This paper demonstrates that a state-wide central referral hub is an effective approach to provide equitable access to bariatric surgery according to ability to benefit regardless of location or ethnicity. What are the implications for practitioners? This provides a sustainable and equitable framework for bariatric surgery services that can be extended to other specialty services and jurisdictions.