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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
Table of Contents
Australian Health Review

Australian Health Review

Volume 46 Number 6 2022

AH21316Patterns of specialist out-of-pocket costs for Australian Medicare services: implications for price transparency

Kelsey Chalmers 0000-0001-7291-8898, Adam G. Elshaug, Sallie-Anne Pearson and Bruce E. Landon
pp. 645-651

What is known about the topic? Australia has high out-of-pocket (OOP) medical costs. Statistics on price transparency websites could mask specialist variability. What does this paper add? Most specialists have a discrete tiered ‘fee list’ they charge, which can vary across locations. Specialists with high OOP costs may still bulk-bill many patients. What are the implications for practitioners? Publishing a specialist’s fee list would be most transparent, allowing users to see a range of potential OOP costs. Additionally, individual specialists would avoid being labelled the highest charging provider, which might hide their lowest fees to prospective patients.

AH22126The link between out-of-pocket costs and inequality in specialist care in Australia

Mohammad Habibullah Pulok 0000-0002-9168-5732, Kees van Gool and Jane Hall
pp. 652-659

What is known about the topic? Higher out-of-pocket (OOP) costs act as a potential barrier to accessing specialist services, particularly among low-income patients. What does this paper add? This study finds that inequality in Medicare-funded specialist care in Australia is greater for the visits incurring OOP costs, whereas there is almost no inequality in services without OOP costs. What are the implications for practitioners? OOP costs in the use of specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists’ services.

AH22154Paying the price – out-of-pocket payments for mental health care in Australia

Sebastian Rosenberg, Shin Ho Park and Ian Hickie
pp. 660-666

What is known about the topic? A$35 m is spent on Medicare mental health services every week but there has been little research on the out-of-pocket payments charged to Australians. What does this paper add? Looking at Medicare data from 2013 to 2021, this paper answers three main questions: how much are out-of-pocket payments for mental health in Australia; what trends can be seen; and what variations exist? What are the implications for practitioners? Medicare’s Better Access Program is under current review and this research can help practitioners, funders and policy-makers understand the significant investment made in mental health services.

AH22180Costs of major complications in people with and without diabetes in Tasmania, Australia

Ngan T. T. Dinh 0000-0003-2339-2628, Barbara de Graaff, Julie A. Campbell, Matthew D. Jose, Burgess John, Timothy Saunder, Alex Kitsos, Nadine Wiggins and Andrew J. Palmer
pp. 667-678

What is known about the topic? Most of the costs related to diabetes are due to management of complications. What does this paper add? Diabetes complication treatment required substantial healthcare resources, even after the first year of occurrence. Costs of treating complications are higher for people with diabetes versus those without. What are the implications for practitioners? Complications identified as key drivers should be preferentially targeted to reduce diabetes burden. Our results can be used as input for economic models to simulate the costs associated with the progression of diabetes and to assess the cost-effectiveness of interventions that reduce complications.

AH22045Clinical concern and the deteriorating patient: a review of rapid response 2018–20

Dana S. Forcey, Jessamy C. Dyer and Ingrid K. Hopper
pp. 679-685

What is known about the topic? Rapid response reviews, including those initiated for clinician gestalt for clinical concern, are important tools to identify deteriorating patients in the inpatient setting. What does this paper add? Rapid response reviews for clinical concern are of particular relevance in vulnerable populations and may be important in identifying deteriorating patients and reassessing care trajectory. What are the implications for practitioners? Clinical concern may be just as clinically relevant as rapid response reviews prompted by standard criteria, especially in vulnerable populations. This might prompt investigation of better identifiers and tools for escalation of concerns for vulnerable patients, which may improve outcomes in this patient group.


What is known about the topic? Multidisciplinary pain management programs (PMPs) are the best treatment for chronic pain, but not everyone benefits from such programs to the same extent. What does this paper add? Ethnicity, employment status, and pain condition are associated with PMP outcomes, but mainly in the long term. What are the implications for practitioners? Program content, delivery, and follow up should be adapted to facilitate equity in long-term outcomes.


What is known about the topic? It can be difficult to address the myriad standards and guidelines that regulate, monitor, and improve the safety and quality of palliative care. What does this paper add? This case study demonstrates how seven practice standards and guidelines relevant to palliative care were synthesised to develop an online resource that aids accreditation efforts. What are the implications for practitioners? This case study demonstrates a way to develop a single resource for service managers and clinicians across public and private sectors that supports accreditation efforts and alleviates information overload and compliance fatigue.

AH22161The profile, clinical characteristics, and outcomes of alcohol- and non-alcohol-related patient presentations to Queensland emergency departments: a multi-site observational study

Julia Crilly 0000-0002-1455-8983, Katie East, Josea Brown, Ping Zhang, Josh Byrnes, Jeremy Furyk, Jill Duncan, Leonie Jones, Nathan J. Brown, David Green, Sean Rothwell and David Rosengren
pp. 701-709

What is known about the topic? The harmful use of alcohol is a major health issue globally contributing to morbidity and mortality. What does this paper add? The demographic profile, clinical characteristics, and outcomes of people presenting to emergency departments with alcohol-related harm differ to people arriving for other reasons. What are the implications for practitioners? Indicating alcohol as a cause of an ED presentation, as standard practice, may foster quality assurance/improvement activities.

AH22212An undignified disaster reality for Australians with disability

Kelsey Chapman 0000-0001-5668-661X, Michael Norwood, Camila Shirota, Dinesh Palipana and Elizabeth Kendall
pp. 710-712

What is known about this topic? People with disability are more vulnerable to the negative impacts of disaster and are marginalised and excluded in recovery efforts. What does this paper add? The paper focuses on embedding dignity into disaster planning, response and recovery to conserve human rights of people with disability and improve outcomes. What are the implications for practitioners? Health practitioners are important front-line responders to both health and environmental disasters and should consider how dignity can improve service for people with disability and increase positive outcomes to build back better.

AH22103Implementation of an integrated respiratory palliative care service for patients with advanced lung disease

Julie McDonald 0000-0003-4115-7875, David Marco 0000-0001-8634-3036, Rebecca Howard, Euan Fox and Jennifer Weil
pp. 713-721

What is already known about the topic? International guidelines recommend palliative care for patients with advanced lung disease, although the ideal model for this care is uncertain. What does this paper add? This model of integrated respiratory and palliative care provided disease-orientated care, alongside symptom management and advance care planning, with unique physician home visit capacity, which addressed barriers to receiving specialist care. What are the implications for practitioners? This study describes a model of integrated respiratory and palliative care that can positively impact acute hospital utilisation and provide cost savings.

AH22075Preferences of parents for mental health services to suit children with chronic medical conditions

Jemimah Ride 0000-0002-1820-5499, Lachlan Cameron, Renee Jones, Kim Dalziel, Danielle Wurzel, Kung-Ting Kao, Jeremy L. Freeman and Harriet Hiscock
pp. 722-730

What is known about the topic? Children with chronic medical conditions have high rates of unmet need for mental healthcare. Qualitative research has indicated features of mental health services that may be important to consider in service design to address these unmet needs. What does this paper add? A detailed understanding of parents’ preferences for features of mental health services for children with chronic medical conditions, including their importance and prediction of uptake under different scenarios. What are the implications for practitioners? Parents preferred services with recommendation from specialists, mental health providers who understand the impact of chronic conditions, lower cost, and shorter wait time. Offering preferred mental health services is predicted to significantly reduce unmet needs and reduce inequalities in care.

AH22046An assessment of the accuracy of surgical time estimation by orthopaedic theatre staff

Stephen Butler, Tau Loseli, David Graham 0000-0003-3421-822X, Anna Watson, Mark Kao, Akshat Saxena, Brahman Sivakumar and Adrian Van der Rijt
pp. 731-735

What is known about the topic? The ability of surgeons, nurses and anaesthetists to accurately predict surgical times is often debated, with heated discussions if additional cases can fit onto a scheduled list. What does the paper add? Our paper demonstrated that despite all groups being inaccurate with timing predictions, orthopaedic surgeons were the most accurate. What are the implications for practitioners? With ever-growing pressure on health systems, it is paramount that available theatre resources are utilised with maximal efficiency.


What is known about the topic? Nurses have reported negative impacts that AI can have when they are not included in the implementation process. What does this paper add? This scoping review has identified the extent of nursing influence on the design, development and implementation of AI. What are the implications for practitioners? There are many potential avenues of nursing research to explore such as; the impact of nurse involvement in AI, what depth of nurse involvement is needed and whether clinical immersion of developers results in improved usability, and smoother implementation of AI technologies.


What is known about this topic? Hospital-acquired complications (HAC), such as urinary tract infection (UTI) result in poorer outcomes. They are difficult to track, due to inconsistencies at various levels. Sufficient clinical documentation is required for accurate coding of infection origin. What does this paper add? We evaluated the clinical documentation of patients coded as having a hospital-acquired UTI. A total of 48.89% of the cases were incorrectly coded as hospital-acquired, due to insufficient detail in clinical documentation. What are the implications for practitioners? In the current state of clinical documentation, clinical coding of HACs is inaccurate. The clinical team should be educated on the requirements for clinical documentation.


What is known about the topic? Challenges exist in the current healthcare system to provide the infrastructure and resources to build capacity and embed a culture of research. What does this paper add? This study was significant in its reach across NSW and its perspective of capturing multiple professions. What are the implications for practitioners? Factors found to be consistent across the state may be suggestive of prioritisation for further investigation and implementation at the state and/or national level.

AH22149Evolution of non-fatal burden estimates for cardiovascular disease in Australia: a comparison of national and state-wide methodology of burden of disease

Courtney Weber, Michelle Hobday, Wendy Sun, Laura Kirkland, Lee Nedkoff and Judith M. Katzenellenbogen
pp. 756-764

What is known about the topic? Accurate prevalence and subsequent burden estimates that reflect population-level disease burden are an important resource and are necessary for informing health policy decisions and resource distribution. What does this paper add? For cardiovascular disease, the comparison between direct use of linked data and other population-wide data sources highlighted the significant differences in the methods between Australia-wide and Western Australian-based studies in calculating prevalence estimates. What are the implications for practitioners? Continued, effective collaboration for improved disease models and subsequent burden estimates are necessary for appropriately informed decisions about health and resource distribution.

Committee on Publication Ethics

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