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Objective: To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods: Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results: Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion: This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic?: Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add?: This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth's purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners?: The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers. [ABSTRACT FROM AUTHOR]

Objective: Allied health structures and leadership positions vary throughout Australia and New Zealand in their design and implementation. It is not clear which organisational factors support allied health leaders and professionals to enhance clinical outcomes. The aim of this project was to identify key organisational contexts and corresponding mechanisms that influenced effective outcomes for allied health professionals. Methods: A qualitative realist evaluation was chosen to describe key aspects of allied health organisational structures, identify positive outcomes and describe how context and processes are operationalised to influence outcomes for the allied health workforce and the populations they serve. Results: A purposive sample of nine allied health leaders, five executives and 49 allied health professionals were interviewed individually and in focus groups, representing nine Queensland Health services. Marked differences exist in the title and focus of senior allied health leaders' roles. The use of a qualitative realist evaluation methodology enabled identification of the mechanisms that work to achieve effective and efficient outcomes, within specific contexts. Conclusions: The initial middle range theory of allied health organisational structures in Queensland was supported and extended to better understand which contexts were important and which key mechanisms were activated to achieve effective outcomes. Executive allied health leadership roles enable allied health leaders to use their influence in organisational planning and decision-making to ensure allied health professionals deliver successful patient care services. Professional governance systems embed the management and support of the clinical workforce most efficiently within professional disciplines. With consistent data management systems, allied health professional staff can be integrated within clinical teams that provide high-quality care. Interprofessional learning opportunities can enhance collaborative teamwork and, when allied health professionals are supported to understand and use research, they can deliver positive patient and business outcomes for the health service. What is known about the topic?: A collective allied health organisational structure encourages engagement of allied health professionals within healthcare organisations. Organisational structures commonly include management and leadership strategies and service delivery models. Allied health leaders in Queensland work across a range of senior management levels to ensure adequate resources for sufficient suitably skilled professional staff to meet patient needs. What does this paper add?: Literature to date has described how allied health professionals operate within organisational structures. This paper examines key aspects of allied health management, governance and leadership, together with mechanisms that support allied health professionals to deliver effective clinical and business outcomes for their local community. What are the implications for practitioners?: Health service executives and allied health leaders should consider supporting executive allied health leadership roles to influence strategic planning and decision-making, as well as to deliver outcomes that are important to the health service. When allied health leaders implement integrated professional and operational governance systems, executives described allied health professionals as influential in supporting team-based models of care that add value to the business and improve outcomes for patients. When allied health leaders use consistent data management, executives reinforced the benefit of aligning activity data with financial costs to monitor, recognise and reimburse appropriate clinical interventions for patients. When allied health leaders support allied health workforce capability through educational and research opportunities, clinicians can use research to inform their clinical practice. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assist hospitals contemplating digital transformation by assessing the reported qualitative effects of rapidly implementing an integrated eHealth system in a large Australian hospital and determining whether existing literature offers a reliable framework to assess the effects of digitisation. Methods: A qualitative, single-site case study was performed using semistructured interviews supplemented by focus groups, observations and documentation. In all, 92 individuals across medical, nursing, allied health, administrative and executive roles provided insights into the eHealth system, which consisted of an electronic medical record, computerised decision support, computerised physician order entry, ePrescribing systems and wireless device integration. These results were compared against a known framework of the effects of hospital digitisation. Results: Diverse, mostly positive, effects were reported, largely consistent with existing literature. Several new effects not reported in literature were reported, namely: (1) improvements in accountability for care, individual career development and time management; (2) mixed findings for the availability of real-time data; and (3) positive findings for the secondary use of data. Conclusions: The overall positive perceptions of the effects of digitisation should give confidence to health services contemplating rapid digital transformation. Although existing literature provides a reliable framework for impact assessment, new effects are still emerging, and research and practice need to shift towards understanding how clinicians and hospitals can maximise the benefits of digital transformation. What is known about the topic?: Hospitals outside the US are increasingly becoming engaged in eHealth transformations. Yet, the reported effects of these technologies are diverse and mixed with qualitative effects rarely reported. What does this paper add?: This study provides a qualitative assessment of the effects of an eHealth transformation at a large Australian tertiary hospital. The results provide renewed confidence in the literature because the findings are largely consistent with expectations from prior systematic reviews of impacts. The qualitative approach followed also resulted in the identification of new effects, which included improvements in accountability, time management and individual development, as well as mixed results for real-time data. In addition, substantial improvements in patient outcomes and clinician productivity were reported from the secondary use of data within the eHealth systems. What are the implications for practitioners?: The overall positive findings in this large case study should give confidence to other health services contemplating rapid digital transformation. To achieve substantial benefits, hospitals need to understand how they can best leverage the data within these systems to improve the quality and efficiency of patient care. As such, both research and practice need to shift towards understanding how these systems can be used more effectively. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore the features of sustainable antimicrobial stewardship (AMS) programs in Australian rural hospitals and develop recommendations on incorporating these features into rural hospitals' AMS programs. Methods: Lead AMS clinicians with knowledge of at least one AMS program sustained for >2 years in a health service in rural Australia were recruited to the study. A series of interviews was conducted and the transcripts analysed thematically using a framework method. Results: Fifteen participants from various professional disciplines were interviewed. Key features that positively affected the sustainability of AMS programs in rural hospitals included a hospital executive who provided strong governance and accountability, dedicated resources, passionate local champions, area-wide arrangements and adaptability to engage in new partnerships. Challenges to building AMS programs with these features were identified, particularly in engaging hospital executive to allocate AMS resources, managing the burn out of passionate champions and formalising network arrangements. Conclusions: Strategies to increase the sustainability of AMS programs in rural hospitals include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop formal network arrangements and a framework for integrated AMS programs across primary, aged and acute care. What is known about the topic?: AMS programs facilitate the responsible use of antimicrobials. Implementation challenges have been identified for rural hospitals, but the sustainability of AMS programs has not been explored. What does this paper add?: Factors that positively affected the sustainability of AMS programs in rural hospitals were a hospital executive that provided strong governance and accountability, dedicated resources, network or area-wide arrangements and adaptability. Challenges to building AMS programs with these features were identified. What are the implications for practitioners?: Recommended actions to boost the sustainability of AMS programs in rural hospitals are required. These include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop network arrangements and support to create integrated AMS programs across acute, aged and primary care. [ABSTRACT FROM AUTHOR]

Objective To explore service availability and accessibility for people with advanced chronic obstructive pulmonary disease (COPD) and their carers and strategies for improvement, including the potential role of a COPD care co-ordinator in ensuring best-practice care in the Australian context. Methods This qualitative study used focus groups and interviews with health professionals, carers and consumers to explore gaps and restrictions in services, barriers to access and the functioning of services. Data were analysed deductively. Results Key themes arising from the data included difficulties around access to care, lack of continuity of care, poor care co-ordination, the need for active disease management as well as supportive care, and poor communication. A COPD care co-ordinator was suggested as an effective strategy for ensuring best-practice care. Conclusions People with advanced COPD often have difficulty navigating the acute, primary and community care systems to deal with the multiple services that they may require. Lack of communication between health professionals and services is frequently a significant issue. A COPD care co-ordinator, encompassing advanced nursing skills, could ensure that care is centred on the needs of the person and their carer and that they receive continuing, appropriate and accessible care as they approach the end of their life. What is known about the topic? The importance of care co-ordination as a quality care indicator in chronic disease is growing, and the care co-ordinator role as a facilitator of quality care is increasingly being recognised in the UK and US. There is currently little information in the Australian context about how a COPD care co-ordinator role could be implemented, where it could be situated and the level of skill required. What does this paper add? This paper explores the specific issues in developing a COPD care co-ordinator role and provides a detailed model of care for the introduction of care co-ordinators into the Australian setting. What are the implications for practitioners? The proposed COPD care co-ordinator role has the potential to improve quality, continuing care for people with advanced COPD. It could facilitate the linkage of multidisciplinary teams across acute, primary and community care settings and promote timely and effective communication. The role would provide a clear point of contact for all practitioners and the opportunity for nurses to develop an advanced practice role in COPD care co-ordination, combining a palliative care approach with a chronic disease management framework. [ABSTRACT FROM AUTHOR]

Background. Research on frequent or avoidable hospital admission has not focussed on the perspectives of service providers or rural settings. The link between social isolation and admission is not well explored, although social isolation is known to have negative health effects. Objective. This paper reports further analysis from a study investigating service providers' perspectives on factors influencing frequent hospital admission in older patients with chronic disease, and explores the perceived role of social isolation. Methods. Semi-structured interviews with 15 purposively sampled community-based service providers in rural New South Wales, Australia were thematically analysed. Results. Social isolation was repeatedly identified as an important contributory factor in frequent and/or avoidable admission. Patients were described as socially isolated in three broad and interrelating ways: living alone, not socialising and being isolated from family. Social isolation was perceived to contribute to admission by limiting opportunities offered by social interaction, including opportunities for: improving mental health, pain tolerance and nutritional status; facilitating access to services; reinforcing healthful behaviours; and providing a monitoring role. Conclusions. Social isolation is perceived to contribute to admission in ways that may be amenable to intervention. Further research is needed to understand patients' perspectives on the role of social isolation in admission, in order to inform policy and programs aimed at reducing hospitalisation among older people with chronic disease. What is known about the topic? Social isolation has been shown to adversely affect physical health and mental health and wellbeing across a range of populations. However, less is known about the influence of social isolation on hospital admission among older people with chronic disease, and in particular in instances where admission might have been avoided. What does this paper add? This paper adds to our understanding of the ways in which social isolation might link to hospital admission among older people with chronic conditions. It does this by reporting the perspectives of community-based service providers with many years' experience of working with this patient group. What are the implications for practitioners? Practitioners need to consider the wider determinants of hospital admission among older patients with chronic disease, including social structures and support. For policy makers the implications are to review support for such patients and explore the possible impact of reducing social isolation on hospital admission. [ABSTRACT FROM AUTHOR]

Objective. To identify factors that influence procurement and disinvestment decisions for wound care products in the acute care setting. Methods. A qualitative descriptive study was undertaken. Eighteen face-to-face semi-structured interviews were conducted with purposively sampled senior clinical and non-clinical managers from three Australian acute care hospitals with responsibility for consumables procurement and disinvestment decisions. Data were coded and analysed thematically. Results. Three main themes (Systems and triggers, Evidence-free zone, Getting the governance right) with subthemes were identified that reflect that: (1) procurement processes were often ad hoc and workarounds common. Disinvestment was poorly understood and opportunities were missed to reduce use of low value products; (2) product selection was commonly based on clinician preference, contractual obligations and information from industry representatives; and (3) improved evidence-based governance and processes are needed to connect procurement and disinvestment decisions and to minimise the influences of clinician preference and industry representatives on product selection. Conclusions. Systematic and evidence-based approaches are needed to strengthen procurement and disinvestment decisions related to consumables such as wound care products and to minimise the purchasing of low-value products Decision-making frameworks should consider cost and clinical effectiveness and enable the identification of opportunities to disinvest from low-value products. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods. A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results. Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients' requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions. The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. [ABSTRACT FROM AUTHOR]

Objective. National medicines policies (NMP) provide a means for governments to achieve their objectives in relation to pharmaceuticals and other medicines. This research aimed to identify challenges to implementing the objectives of the Australian NMP from the perspective of key stakeholders. Methods. In 2012 and 2103, we conducted 30 semistructured interviews with stakeholders involved in the discovery, clinical testing, regulation and funding of medicines in Australia. We asked participants to describe their careers and to give their opinions on specific issues surrounding drug development, clinical research, regulation and subsidisation in Australia. Data were analysed using Morse's outline of the cognitive basis of qualitative research and Charmaz's outline of data analysis in grounded theory. The initial phase of 'open coding' revealed findings that could be mapped to three of the four objectives of the NMP. We then conducted 'focussed coding' for themes relevant to these objectives. Results. Participants identified many issues relevant to the ongoing evolution of the NMP, relating primarily to ongoing tensions between the commercial objective of ensuring a viable medicines industry, and the non-commercial objectives of ensuring that medicines are safe, effective and affordable. There were also several other challenges identified to the achievement of both the commercial and non-commercial objectives of the NMP. These included limits to government funding, globalisation, consumer advocacy, changing scientific paradigms and new information technologies. Conclusions. There are many issues that need to be addressed if policymakers are to achieve the best outcomes from the NMP. Tensions between the commercial and non-commercial objectives of the NMP suggest the need to ensure that one stakeholder group's imperatives do not stifle those of other groups. At the same time, there are several emerging issues that are likely to concern all stakeholders equally, and these are both challenges and opportunities for new kinds of collaboration. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to investigate the characteristics of the Residential Aged Care Coronial Communiqué that have promoted previously reported professional practice change, and to explore the circumstances of these changes. Methods. This was an exploratory, qualitative study for which data was collected through semi-structured interview of 15 subscribers to the Residential Aged Care Coronial Communiqué. Results. The Residential Aged Care Coronial Communiqué was reported to promote self-reported practice change though the inclusion of case studies, by being associated with the Coroner, and by providing evidence to justify change. The combination of existing concerns about risk and staff awareness, in conjunction with reading the Residential Aged Care Coronial Communiqué was also reported to promote practice change, as was having the support of senior staff and the authority to implement change. Conclusions. The combination of narrative case studies in the context of an educational publication associated with the Coroner's Office has been reported to provided evidence and incentive to promote professional practice change in an aged care setting. However the relative influence of the Residential Aged Care Coronial Communiqué, and other background circumstance and facilitating factors on practice change cannot be determined from this study. [ABSTRACT FROM AUTHOR]