Australian Health Review
Volume 47 Number 4 2023
AH23048Supply and demand – a health economic perspective on the Australian hospital and elective surgery crisis
What is known about this topic? There were pre-existing healthcare workforce and infrastructure shortages before the pandemic. What does this paper add? The COVID-19 pandemic has contributed to longstanding structural shortfalls in the supply of healthcare services. The challenges occur in the context of increased demand following the suspension of a range of healthcare services during the pandemic. What are the implications for practitioners? Rebalancing of supply and demand in healthcare requires national action on workforce recruitment and retention.
AH23048 Abstract | AH23048 Full Text | AH23048PDF (650 KB) Open Access Article
What is known about the topic? Most allied health services in Australia are delivered by small, private practices in the primary care setting with limited government funding. What does this paper add? The findings indicate that allied health has a peripheral status in Australia’s primary care landscape. What are the implications for practitioners? Greater priority to the funding and integration of allied health is needed in primary care policy.
AH22268 Abstract | AH22268 Full Text | AH22268PDF (681 KB) Open Access Article
What is known about the topic? Out-of-pocket payments can have significant impacts on healthcare choices; whether or not to delay or seek care. What does this paper add? This article provides an overview of out-of-pocket payments and their impacts on decision-making with a focus on Medicare-subsidised mental health services. Current government measures to contain out-of-pocket payments are overviewed and their limitations highlighted. What are the implications for practitioners? Current Medicare Benefits Schedule and Pharmaceutical Benefits Scheme (PBS) safety nets are not consumer centric, the PBS Safety Net particularly so. Changes should be made to these schemes to further address the burden of out-of-pocket payments.
AH23063Obstacles in establishing a national disease registry in Australia: lessons from the development of the CHAANZ Congenital Heart Disease Registry
What is known about the topic? Research ethics and governance are essential elements in research, but these systems are imperfect, with many groups reporting the need for reform of the systems governing research. What does this paper add? We report on our own experiences in establishing a National Disease registry, and the numerous inconsistencies encountered, prior to being able to conduct any research. What are the implications for practitioners? We propose several strategies which could be implemented to facilitate a more streamlined, centralised approach to research ethics and governance.
AH23063 Abstract | AH23063 Full Text | AH23063PDF (1.4 MB) Open Access Article
What is known about the topic? Staff and consumer capabilities are essential for effective collaboration on quality improvement (QI) committees, however, research is lacking. What does this paper add? This learning and development needs analysis provides direction for effective design of education and support programs. What are the implications for practitioners? Staff and consumers should continuously develop QI partnership capabilities together, and through multiple learning approaches. Increased exposure to innovative co-design strategies is needed to enhance capabilities and influence on organisational systems and policies. Sharing power and leadership was also a high learning need with self-reflection being vital.
AH23009Public health service board members’ understanding of care quality in residential aged care services
What is known about the topic? Recent high-profile reports into serious failings in Australian public sector residential aged care services (PSRACS) raise concerns about the capability of health service boards to ensure residents receive quality care. What does this paper add? Findings provide a description of the focused and limited information that board members in six public health services receive about PSRACS. What are the implications for practitioners? To assist boards to monitor the care quality in PSRACS, we recommend boards visit PSRACS to see first-hand the care environment and to listen to the views of staff, residents and families.
AH23072General practitioners’ perspectives on discharge summaries from a health network of three hospitals in South Australia
What is known about the topic? Discharge summaries are an important handover document when transitioning care from hospital to general practice. Delays, omissions and inaccuracies in discharge summaries can contribute to adverse patient outcomes. What does this paper add? This paper provides contemporary perspectives of general practitioners about discharge summaries and scope for improvements. What are the implications for practitioners? General practitioners value receiving discharge summaries that are timely, follow a format, provide clear details for ongoing care, and are an appropriate length.
AH23037Evaluating the impact of junior doctors in quality improvement – a 10-year review
What is known about the topic? The importance of engaging junior doctors in quality improvement initiatives is well recognised. What does this paper add? Introduces and evaluates the Improvement House Medical Officer position at a large tertiary hospital. What are the implications for practitioners? Other health services may be inspired to implement quality improvement programs for the benefit of their health service, patients and junior doctors.
What is known about the topic? Some people with mental health problems are brought in by police to an emergency department (ED). People brought in by police are recognised as having poorer health profiles compared to other arrival modes. What does this paper add? Several patient and clinical factors influence ED length of stay and hospital admission for people with a mental health problem brought in by police, indicating a need for targeted health care that addresses these factors. What are the implications for practitioners? This study justifies the need to develop specialised pre-hospital models of care and embed early assessment processes in an ED for people with mental health problems brought in by police.
AH22084Reverse triage in COVID surge planning: a case study of an allied health supported clinical care pathway in an acute hospital setting
What is known about the topic? Reverse triage offers the potential to rapidly assess, treat and discharge patients from the emergency department. No known studies have explored this in response to the coronavirus 2019 (COVID-19) pandemic. What does this paper add? This paper supports a reverse triage approach to surge planning during the COVID-19 pandemic. We outline a multidisciplinary initiative to support discharge pathways. What are the implications for practitioners? Spearheaded by allied health, the reverse triage model described could provide a solution for surge planning during health crises.
AH22084 Abstract | AH22084 Full Text | AH22084PDF (835 KB) Open Access Article
What is known about the topic? Integrated respiratory and palliative care services for people with advanced lung disease may improve quality of life and decrease acute healthcare utilisation and cost. What does this paper add? This paper adds to our understanding of patients’, caregivers’ and general practitioners’ perspectives of this integrated care model. Participants highly valued this integrated service for providing person-centred care. Participants outlined both the effectiveness and limitations of action plan use in advanced lung disease, and of diverging preferences between patients and caregivers for discussions about future care. What are the implications for practitioners? The integration of disease-orientated care along with the provision of palliative care is highly valued from a consumer perspective.
AH23060Optimal cancer care pathways – the ideal versus reality for patient-centric cancer care during COVID-19
What is known about the topic? The Optimal Care Pathways are the only nationally endorsed guideline that provides key timeframes from diagnosis to commencement of treatment and beyond for 25 different tumour subtypes. What does the paper add? There is limited compliance throughout the entire care pathway, with limitations in data availability to benchmark the entire pathway. These compliance rates were not affected by COVID-19. What are the implications for practitioners? Adjustments should be made to incorporate the Optimal Care Pathways into cancer service performance, with robust data collection mechanisms, to ensure patients across Australia receive equitable cancer care.
AH23060 Abstract | AH23060 Full Text | AH23060PDF (714 KB) Open Access Article
AH23001Assessing the quality of care for people dying of cancer in hospital: development of the QualDeath framework
What is known about the topic? The Australian Commission on Safety and Quality in Health Care explicitly directs Australian hospitals and healthcare services to review the quality of end-of-life care provided against planned goals of care. However, there is a lack of evidence-based, systematic processes to examine the quality of dying and death of cancer patients in hospital settings. What does this paper add? QualDeath provides a framework that enables hospitals to implement a systematic approach to appraising the quality of dying and death for cancer patients. What are the implications for practitioners? QualDeath is underpinned by the principle that hospital clinicians should be evaluating the quality of care provided for every patient who dies. This provides an opportunity for reflecting on and improving the quality of care provided, as well as acknowledging examples of high-quality end-of-life care.
What is known about the topic? Falls prevention is an important part of the national health policy agenda and there is extensive literature informing hospital policy and guidelines. What does the paper add? This study provides insights into how hospital falls policies and guidelines relate to the assessment of risk, and prevention of falls in people with communication disability. What are the implications for practitioners? The results suggest that a patient's communication disability is not considered in falls risk assessment, or prevention plans. Communication disability should not be a barrier to engaging patients in this process.
What is known about the topic? To promote earlier recognition of, and response to, deteriorating ward patients, Australian rapid response systems include a pre-medical emergency team (pre-MET) tier. Escalation pathways within the pre-MET tier are poorly understood. What does this paper add? Policy-defined escalation pathways were inconsistently utilised. Clinicians identified deficiencies in communication methods (e.g. alphanumeric pagers) for escalating pre-MET deterioration. Perceptions of escalation pathways illuminated a lack of of a shared mental model about clinicians’ roles and responsibilities. What are the implications for practitioners? To optimise the management of pre-MET deterioration, ward-based communication infrastructure and interdisciplinary collaboration must be enhanced.
AH23044The contribution of rural primary health care to the coronavirus (COVID-19) vaccination program
What is known about the topic? Research on pandemic response provides important insights for future surge planning and preparedness. What does this paper add? The contribution of primary care to the COVID-19 vaccine program highlights the importance of rural general practice to the delivery of population health interventions during times of crisis. What are the implications for practitioners? Policymakers must tailor reforms towards strengthening rural primary health care in preparation for future surge response.
AH23044 Abstract | AH23044 Full Text | AH23044PDF (686 KB) Open Access Article
AH23058Assessing the research capacity and culture of allied health workforce in a national private healthcare organisation
What is known about the topic? Current knowledge on research capacity and culture in allied health professionals is primarily based on studies conducted in public hospitals. What does this paper add? This is the first study to explore the allied health research capacity and culture within a private healthcare sector, and highlights the training needs of private allied health workforce and their barriers to research provision. What are the implications for practitioners? The results suggest the development of organisational structure and more resource support at team level would have a positive flow-down effect on research culture in a private healthcare sector.