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Objective: The aim of this study was to quantify the direct and indirect costs of asthma and allergic rhinitis (AR) for 2018 in Tasmania. Methods: We used publicly available data, and Tasmanian-specific values where available, to estimate direct and indirect costs of both diseases. Direct costs included outcomes such as emergency department (ED) presentations, hospitalisations, general practice visits and medication use. Indirect costs included premature mortality and lost productivity. Results: Direct health impacts for both conditions combined included 1454 ED presentations, 682 hospitalisations, 72 446 general practice visits and 7122 specialist visits. Indirect health impacts included 13 deaths and between 483 000 and 2.8 million days of lost productivity. Total costs ranged between A$126.5 million and A$436.7 million for asthma and between A$65.3 million and A$259.7 million for AR. Per-person annual costs ranged between A$1918 and A$6617 for asthma and between A$597 and A$2374 for AR. Conclusions: The main financial burden due to asthma and AR was related to productivity losses from presenteeism and absenteeism. The magnitude of the economic impacts of AR and asthma warrants further analysis to produce a national-level assessment. Such analyses could identify cost-effective interventions that produce highest benefits for the management of these conditions in our community. What is known about the topic?: Allergic respiratory diseases, and particularly asthma and AR, pose a significant health burden, with effects including asthma-related hospital admissions, significant pharmaceutical expenditure and lost workforce and school education productivity. Australia, and particularly Tasmania, has a high prevalence of these conditions, but no recent studies have appraised or estimated their health impacts and costs. What does this paper add?: This paper proposes a unique and transparent costing model that allows the costs of these conditions to be estimated while accounting for restrictions in data availability. The model is used to provide the first comprehensive costings of asthma and AR in Tasmania, Australia. We identified that the estimated health costs are dominated by productivity losses from presenteeism and absenteeism, and that total per person costs are higher for a person with asthma compared to one with AR. What are the implications for practitioners?: This analysis has the potential to guide cost-effective interventions by identifying where the highest benefits may be obtained when managing these conditions in our community. [ABSTRACT FROM AUTHOR]

Objective: We set out to estimate healthcare costs of diabetes complications in the year of first occurrence and the second year, and to quantify the incremental costs of diabetes versus non-diabetes related to each complication. Methods: In this cohort study, people with diabetes (n = 45 378) and their age/sex propensity score matched controls (n = 90 756) were identified from a linked dataset in Tasmania, Australia between 2004 and 2017. Direct costs (including hospital, emergency room visits and pathology costs) were calculated from the healthcare system perspective and expressed in 2020 Australian dollars. The average-per-patient costs and the incremental costs in people with diabetes were calculated for each complication. Results: First-year costs when the complications occurred were: dialysis $78 152 (95% CI 71 095, 85 858), lower extremity amputations $63 575 (58 290, 68 688), kidney transplant $48 487 (33 862, 68 283), non-fatal myocardial infarction $30 827 (29 558, 32 197), foot ulcer/gangrene $29 803 (27 183, 32 675), ischaemic heart disease $29 160 (26 962, 31 457), non-fatal stroke $27 782 (26 285, 29 354), heart failure $27 379 (25 968, 28 966), kidney failure $24 904 (19 799, 32 557), angina pectoris $18 430 (17 147, 19 791), neuropathy $15 637 (14 265, 17 108), nephropathy $15 133 (12 285, 18 595), retinopathy $14 775 (11 798, 19 199), transient ischaemic attack $13 905 (12 529, 15 536), vitreous hemorrhage $13 405 (10 241, 17 321), and blindness/low vision $12 941 (8164, 19 080). The second-year costs ranged from 16% (ischaemic heart disease) to 74% (dialysis) of first-year costs. Complication costs were 109–275% higher than in people without diabetes. Conclusions: Diabetes complications are costly, and the costs are higher in people with diabetes than without diabetes. Our results can be used to populate diabetes simulation models and will support policy analyses to reduce the burden of diabetes. 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. [ABSTRACT FROM AUTHOR]

Extended scope of practice (ESoP) and advanced scope of practice (ASoP) physiotherapy roles have been in place in the UK for over 20 years. However, interest in these types of services appears to be only just evolving within Australia. Although ESoP and/or ASoP cardiorespiratory roles in intensive care units (ICU) may be perceived to be more achievable in large metropolitan teaching hospitals, at least 67% of Australian ICUs provide physiotherapy services. Very little has been published on the practicalities (e.g. training pathways, evidence for use and guidelines) of developing advanced or extended scope cardiorespiratory physiotherapy services within Australian ICUs. This report describes the development and implementation of a physiotherapy-led bronchoscopy service from a regional hospital perspective. What is known about the topic?: Although ESoP and ASoP physiotherapy roles are well established in the UK, such services appear to be only just evolving in Australia. Clarity on the definitions of extended and advanced physiotherapy roles have been articulated by the Australian Physiotherapy Association. However, there is a paucity of evidence published on the practicalities of establishing advanced or extended scope cardiorespiratory physiotherapy services within Australian ICUs. What does this paper add?: One of the main emerging areas of ESoP and/or ASoP in the cardiorespiratory field is the use of bronchoscopy by physiotherapists. This paper describes the framework, implementation, limitations and barriers of developing a physiotherapy-led bronchoscopy service from a regional hospital perspective. What are the implications for practitioners?: This paper allows the potential for our credentialing and practice framework model to be transferred in other public hospitals commencing or considering implementing physiotherapy-led bronchoscopy services within their ICU. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Objective: In light of concerns surrounding neoliberal government approaches to addressing Aboriginal disadvantage, this project examined how Elders consider the Closing the Gap programs for improving community health outcomes. Methods: A participatory action research project was undertaken in collaboration with eight Elders from a remote Aboriginal community in Australia's island state of Tasmania. The findings emerged from thematic analysis of individual interviews and yarning circles. Results: The Closing the Gap programs were seen by Elders as having instrumental value for addressing Aboriginal community disadvantage. However, the programs also represented a source of ongoing dependency that threatened to undermine the community's autonomy, self-determination and cultural foundations. The findings emerged to represent Elders attempting to reconcile this tension by embedding the programs with cultural values or promoting culture separately from the programs. Ultimately, the Elders saw culture as the core business of community well-being and effective program delivery. Conclusion: The findings are reflective of tensions that arise when neoliberal policies are imposed on Aboriginal ways of knowing, being and doing. The Elders premised cultural well-being as the key determinant of Aboriginal community health. What is known about the topic?: Closing the Gap represents successive neoliberal policy responses of Australian governments to address ongoing Aboriginal disadvantage. What does this paper add?: Closing the Gap programs were recognised by Aboriginal Elders for providing the community with improved services, but also a threat to the community's cultural foundations and self-determination. The findings illustrate ongoing tensions between neoliberal principles and Aboriginal cultural values. What are the implications for practitioners?: More effective Closing the Gap approaches require greater collaboration between policy stakeholders and community Elders. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to understand the factors motivating health and human services professionals in the workplace, thus adding to the body of knowledge associated with employee motivation. Methods: Brainstorming research was performed on frontline and emerging managers in Tasmanian public sector organisations. Coding categories were inductively developed from the data, then deductively analysed using Herzberg's two-factor model. Results: Communication was the most significant factor affecting staff motivation. When described as 'good', it was open, honest, appropriate and timely. Emotional factors, including a sense of being respected and valued, were also highly regarded. Material resources, such as budgets, staffing and physical amenities, were the third most cited factor affecting workforce motivation. Conclusions: Contrary to most previous research, the present study found that some factors – like communication or resources – could be a source of satisfaction and dissatisfaction, depending on whether they supported the individual and the team. The research method chosen in the present study differed from most using the two-factor model in that it did not use closed survey questions. The breadth of these results reflects the ability to provide a more nuanced response. What is known about the topic?: Professionals working in health and human services have a high degree of authority and autonomy. Increasing staff motivation has the potential to positively influence organisational and individual outcomes. What does this paper add?: This paper provides greater insight into factors increasing staff motivation. It also suggests methodological improvements for studies using the two-factor model. What are the implications for practitioners?: The insights into staff motivation may be used by employers to improve outcomes and increase workforce satisfaction. [ABSTRACT FROM AUTHOR]

Objective. This paper examines the quality and safety of the physical environment in Australian residential aged care facilities (RACFs). Design. Cross-sectional study. One assessor completed environmental audits to identify areas of the physical environment that needed to be addressed to improve the wellbeing and safety of residents. Setting. Nine RACFs participating in a broader falls prevention project were audited. RACFs were located in Queensland, Tasmania or Victoria and were chosen by convenience to represent high level, low level, dementia and psychogeriatric care, regional and metropolitan facilities, small and large facilities and a culturally specific facility. Main outcome measure. An environmental audit tool was adapted from a tool designed to foster older person friendly hospital environments. The tool consisted of 147 items. Results. Across all sites 450 items (34%) required action. This ranged from 21 to 44% across sites. The audit domains most commonly requiring action included signage, visual perception and lighting, and outdoor areas. Conclusions. Although not representative of all residential facilities in Australia, this audit process has identified common environmental problems across a diverse mix of residential care facilities. Results highlight the need for further investigation into the quality of physical environments, and interventions to improve physical environments in Australian RACFs. INSET: What is known about the topic?. [ABSTRACT FROM AUTHOR]

Objective. To assess the timeliness of analgesia provided to patients presenting with musculoskeletal conditions, by advanced practice physiotherapists, medical officers and nurse practitioners in two Tasmanian emergency departments. Methods. A retrospective case-controlled comparative observational study collected patient data over a 6 month period. Index cases were consecutive cases treated by an advanced practice physiotherapist, with a medical and nurse practitioner cohort case-matched based on clinical and demographic factors. Time to analgesia from initial triage and time to analgesia from patient allocation to health professional groups were analysed using Mann–Whitney U-test. Further assessment comparing betweengroup differences in access to analgesia within 30 and 60 min of emergency department triage was included. Results. Two hundred and twenty-four patients who received analgesia while in the primary care of advanced practice physiotherapists were matched against 308 others. Median time to analgesia for the advanced practice physiotherapy group was 40.5 min compared with 59 min in the comparison group (P = 0.001). Allocation to analgesia time for the advanced practice physiotherapy group was 27 min, compared with 30 min in the comparison group (P = 0.465). Access to analgesia within 30 min of presentation to the emergency department is low (36.1% vs 30.8%, P = 0.175). Conclusion. For musculoskeletal presentations in two Tasmanian emergency departments, patients received more timely analgesia when in the care of an advanced practice physiotherapist compared with medical or nurse practitioner care. Further improvements in analgesia access are possible, with time from allocation to analgesia a potential target for intervention. [ABSTRACT FROM AUTHOR]

Objective. To estimate the risk of an emergency department (ED)/inpatient visit due to complications in people with diabetes and compare them to their non-diabetes counterparts. Methods. This matched retrospective cohort study used a linked dataset in Tasmania, Australia for the 2004–17 period. People with diabetes (n = 45 378) were matched on age, sex and geographical regions with people without diabetes (n = 90 756) based on propensity score matching. The risk of an ED/inpatient visit related to each complication was estimated using negative binomial regression. Results. In people with diabetes, the combined ED and admission rates per 10 000 person-years were considerable, especially for macrovascular complications (ranging from 31.8 (lower extremity amputation) to 205.2 (heart failure)). The adjusted incidence rate ratios of ED/inpatient visits were: retinopathy 59.1 (confidence interval 25.8, 135.7), lower extremity amputation 11.1 (8.8, 14.1), foot ulcer/gangrene 9.5 (8.1, 11.2), nephropathy 7.4 (5.4, 10.1), dialysis 6.5 (3.8, 10.9), transplant 6.3 (2.2, 17.8), vitreous haemorrhage 6.0 (3.7, 9.8), fatal myocardial infarction 3.4 (2.3, 5.1), kidney failure 3.3 (2.3, 4.5), heart failure 2.9 (2.7, 3.1), angina pectoris 2.1 (2.0, 2.3), ischaemic heart disease 2.1 (1.9, 2.3), neuropathy 1.9 (1.7, 2.0), non-fatal myocardial infarction 1.7 (1.6, 1.8), blindness/low vision 1.4 (0.8, 2.5), non-fatal stroke 1.4 (1.3, 1.6), fatal stroke 1.3 (0.9, 2.1) and transient ischaemic attack 1.1 (1.0, 1.2). Conclusions. Our results demonstrated the high demand on hospital services due to diabetes complications (especially macrovascular complications) and highlighted the importance of preventing and properly managing microvascular complications. These findings will support future resource allocation to reduce the increasing burden of diabetes in Australia [ABSTRACT FROM AUTHOR]

Objective. To analyse Medicare expenditure by State/Territory, remoteness, and Indigenous demography to assess funding equality in meeting the health needs of remote Indigenous populations in the Northern Territory. Methods. Analytic descriptions of Medicare online reports on services and benefits by key demographic variables linked with Australian Bureau of Statistics data on remoteness and Indigenous population proportion. The Northern Territory Indigenous and non-Indigenous populations were compared with the Australian average between the 2010/2011 and 2019/2020 fiscal years in terms of standardised rates of Medicare services and benefits. These were further analysed using ordinary least squares, simultaneous equations and multilevel models. Results. In per capita terms, the Northern Territory receives around 30% less Medicare funds than the national average, even when additional Commonwealth funding for Aboriginal medical services is included. This funding shortfall amounts to approximately AU$80 million annually across both the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. The multilevel models indicate that providing healthcare for an Aboriginal and Torres Strait Islander person in a remote area involves a Medicare shortfall of AU$531-- AU$1041 less Medicare Benefits Schedule benefits per annum compared with a non-Indigenous person in an urban area. Indigenous population proportion, together with remoteness, explained 51% of the funding variation. An age--sex based capitation funding model would correct about 87% of the Northern Territory primary care funding inequality. Conclusions. The current Medicare funding scheme systematically disadvantages the Northern Territory. A needs-based funding model is required that does not penalise the Northern Territory population based on the remote primary health care service model. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this exploratory study was to investigate resource use and predictors associated with critical care unit (CCU) admission after primary bariatric surgery within the Tasmanian public healthcare system. Methods. Patients undergoing primary bariatric surgery in the Tasmanian Health Service (THS) public hospital system between 7 July 2013 and 30 June 2019 were eligible for inclusion in this study. The THS provides two levels of CCU support, an intensive care unit (ICU) and a high dependency unit (HDU). A mixed-methods approach was performed to examine the resource use and predictors associated with overall CCU admission, as well as levels of HDU and ICU admission. Results. There were 254 patients in the study. Of these, 44 (17.3%) required 54 postoperative CCU admissions, with 43% requiring HDU support and 57% requiring more resource-demanding ICU support. Overall, CCU patients were more likely to have higher preoperative body mass index and multimorbidity and to undergo sleeve gastrectomy or gastric bypass. Patients undergoing gastric banding were more likely to requireHDUrather than ICU support. Total hospital stays and median healthcare costs were higher for CCU (particularly ICU) patients than non-CCU patients. Conclusions. Bariatric surgery patients often have significant comorbidities. This study demonstrates that patients with higher levels of morbidity are more likely to require critical care postoperatively. Because this is elective surgery, being able to identify patients who are at increased risk is important to plan either the availability of critical care or even interventions to improve patients' preoperative risk. Further work is required to refine the pre-existing conditions that contribute most to the requirement for critical care management (particularly in the ICU setting) in the perioperative period. [ABSTRACT FROM AUTHOR]

Objective. To investigate factors that predict discharge destination for patients making the transition from hospital to the community. Methods. Using a prospective cohort design, 696 patients from 11 Transition Care Programs were recruited. Baseline patient and program characteristics were considered for predicting discharge destination, functional status, and patient length of stay. Results. An increased physiotherapy staffing ratio in Transition Care Program was associated with an increased likelihood that a patient was discharged home, with an improved functional or mobility status, and after a shorter length of stay. The other factor that predicted discharge to home included having an Aged Care Assessment Service classification of low level care or home with a support package. An increased physiotherapy staffing level also reduced the likelihood of discharge to low level or high level care. The other factors that predicted discharge to low level care were having higher mobility status and older age; the other factor associated with increased likelihood of predicting discharge to high level care was having an Aged Care Assessment Service classification of high level care. Conclusions. Factors on admission that predicted discharge destination were program physiotherapy staffing ratios, Aged Care Assessment Service assessment, age and mobility status. [ABSTRACT FROM AUTHOR]

Objective. To use an action learning approach to encourage a group of executive leaders, responsible for the implementation of a state health reform agenda, to consider the leadership required to drive improvement in healthcare services. Methods. Based on an assertion that knowledge is co-produced and that deliberative and structured conversation can be a mechanism to drive change, an action learning approach was used to facilitate an interagency group of executive leaders, responsible for the implementation of a state health reform agenda, who were encouraged to consider the leadership required to drive improvement in healthcare services. Results. It was difficult to assert how the group contributed specifically to the implementation of the health reform agenda but individuals gained insights and there was informal resolution of institutional tensions and differences. The method may provide new knowledge to the reform process over time. Conclusions. Getting the participants together was challenging, which may reflect the reality of time-poor executives, or a low commitment to giving time to structured and deliberative informal dialogue. Further work is required to test this thesis and the action learning approach with other parts of healthcare workforce. [ABSTRACT FROM AUTHOR]