Australian Health Review

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 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? 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 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? 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? 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? 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? 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? 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? 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 already known about the topic? Chronic kidney disease leads to frequent hospitalisations, but it is not well-known whether patients follow different trajectories of hospital service use at the end-of-life. What this paper adds? Increasing age, comorbidities, and being a smoker were all associated with a higher hospitalisation. Adults residing in a rural location and with cancer, diabetes, congestive heart failure, and mental disorder diagnoses were more likely to have an unplanned admission. What are the implications for practitioners? Strategies to reduce unplanned hospitalisations could involve services such as home-based hospital care, patient-focused renal support, telehealth monitoring or outpatient care.

What is known about the topic? Patients commonly leave the emergency department without being seen. What does this paper add? Wait time was the primary reason that patients left without medical review. Outcomes were similar for those who left compared with those who were seen. Most sought alternative medical review and did not feel the experience influenced future emergency attendance. What are the implications for practitioners? The motivation of patients to return to emergency or seek alternative care may reduce potential risks associated with leaving. Strategies improving wait time duration or tolerability remain a priority.

What is known about the topic? When patients or providers want to record consultations, they may not know whether they are allowed to. Because relevant law is complex and not well known, hospital policies are likely to guide behaviour. What does this paper add? We asked Australia’s 43 largest hospitals for their policies, finding that most had no, or only a scant, policy. Policies usually unduly restricted recording. What are the implications for practitioners? Healthcare providers should have clear, accessible policies that allow consultation recording where appropriate, in support of high-quality provider–patient communication and information provision.

What is known about the topic? Podiatric foot and ankle surgery has a greater than 40-year history in Australia. A proposal to change the title of podiatric surgeon by the podiatry board is under consultation. What does this paper add? This paper provides an argument why such as change is contrary to current healthcare policy agendas and supports professional silos in health care. What are the implications for practitioners? This paper provides context for all healthcare practitioners as to the need for regulation in title and scope to be consistent with the concepts of regulatory right touch.

What is known about the topic? There are few studies describing the types or outcomes of medication incidents that occur in supported disability homes. What does this paper add? This study describes medication incidents that resulted in calls to an emergency poisons information service. The most common incidents were missed doses and accidental overdoses; the majority of calls were outside business hours. What are the implications for practitioners? Strategies to prevent common medication incidents at supported disability homes are needed, along with better access to pharmacist advice outside business hours to reduce the burden on emergency services.

What is known about the topic? Allied health workforce planning is complex and fragmented across multiple professions and jurisdictions, lacking the population ratio metrics analogous to clinical care ratios commonly used in medical and nursing workforce planning. What does this paper add? This paper aims to present a model for developing population-based indicators and indices of need suitable for comparative benchmarking. What are the implications for practitioners? Indices of need can provide comparative benchmarks to guide allied health workforce planning.

What is known about the topic? Improving research culture and capacity in health care results in elevated quality of care. Research culture and capacity are not uniform among healthcare professions, and some are ‘research emergent’. What does this paper add? Our study unveils challenges and strengths among 100 responding mental health workers of an approximately 1100 strong workforce that emphasises organisational culture’s importance. It also underscores staff’s desire for research involvement, facing barriers such as time and resource scarcity. What are the implications for practitioners? These findings establish a starting point for tracking progress and inform strategies for enhancing mental healthcare service quality through tailored interventions that increase research capacity.

What is known about the topic? The context of demographic reporting and diversity within paediatric clinical trials with Australian sites, a multi-cultural nation with highly increasing numbers of migrants, remains unclear. What does this paper add? Of 262 studies included, 154 (58.8%) clinical trials did not report any of the variables of interest. Indigenous status was most reported (n = 40, 15.3%), followed by ethnicity and cultural background (n = 30, 11.5%). What are the implications for practitioners? Current levels of reporting are low, reducing the generalisability of results from these clinical trials and raising questions surrounding equity in paediatric clinical trials.

What is known about this topic? Health and education profession students experience a range of stressors on personal wellbeing when undertaking professional placements including financial stress. What does this paper add? Financial stress and food insecurity during unpaid placements impact emotional wellbeing, resulting in burnout and stress. What are the implications for practitioners? The costs associated with professional placements have the potential to worsen inequity, delay professional course progression, and influence transition to the health and teaching workforce. Further advocacy and embedding of financial wellbeing strategies and novel placement models in curriculum are required.

What is known about this topic? Despite worsening workforce shortages, literature pertaining to allied health professionals on recruitment and retention in hospitals is limited and mainly focused on remote and rural areas. What does this paper add? This review highlights themes important to the recruitment and retention of staff, namely job advancement, company policies, and quality of leadership. What are the implications for practice? This provides actionable insights for managers and policymakers to assist with the retention of allied health professionals.

What is known about the topic? Frailty is associated with significant mortality and morbidity in hospitalised patients. The roles of the physiotherapist and occupational therapist need further study. What does this paper add? This study provides evidence that early intervention by physiotherapists and occupational therapists in frail patients is associated with better outcomes, specifically reduced pressure injury and reduced hospital length of stay. What are the implications for practitioners? Early intervention by physiotherapists and occupational therapists can be beneficial in the management of frailty. More research is required to further define the specific interventions that are effective.

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? 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? 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? 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? 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? 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? 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? 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? 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.