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The purpose of this case study is to explain the development of Queensland's strategic approach to health system reform, which promotes partnership across the health system to better deliver integrated and value-based health care across the continuum of care. The new health system vision was informed by undertaking literature searches on national and international health system approaches to reform and supported by extensive consultation across Queensland with more than 1100 stakeholders. Thematic analysis was undertaken to identify key themes that were translated into a high-level vision document that communicated Queensland's renewed focus on wellness and delivering more care in the community. This was circulated to stakeholders for iterative and collaborative refinement before final approvals. Collaboratively and iteratively developing the new health system vision for Queensland with key stakeholders has contributed to a shared understanding and ownership of a vision that is committed to system reform, focused on delivering high-value care that reflects what is important to consumers and health system stakeholders. What is known about the topic? Vision statements for organisations including health are common. However, there is little information available in the literature regarding approaches to developing a vision for a health system. What does this paper add? An overview of an approach to developing a new health system vision through comprehensive consultation that engages stakeholders broadly to develop an informed vision that has support from all levels of the health system. What are the implications for practitioners? The method used to develop this vision could be replicated across any large-scale organisation. Although time consuming, the outcome is a vision that is widely supported and sets the organisation up for success for implementation. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Objective: The personal importation scheme is a legislative mechanism that allows health consumers to import unapproved medicines under certain conditions. This article analyses the legal and policy basis for the scheme and considers how reforms to advertising laws for therapeutic goods may restrict communications about it. The article represents the first published analysis of the personal importation scheme's interaction with the communications of health professionals and buyer's clubs. It considers how these communications may be affected by legal amendments, particularly where unapproved medicines may be accessed through the scheme. Methods: An examination of Australian therapeutic goods law concerning the personal importation scheme was conducted, including both the historical law and recent regulatory reforms. Illustrative tables were prepared to identify scheme-related advertising that may contravene therapeutic goods law. Risk estimates were allocated to several new legal rules to indicate whether health professionals or buyer's clubs would contravene these laws when promoting the scheme to health consumers for unapproved medicines. Results: Representations made directly to the public by health practitioners or on buyer's clubs websites about accessing unapproved therapeutic goods through the personal importation scheme are likely to contravene one or more advertising laws. Conclusions: The Therapeutic Goods Administration has very strong powers to initiate compliance or enforcement action for advertising breaches in Australia for many promotional practices. Arguably, in the age of the internet and in the context of emerging expensive medicines, these powers should not be used to restrict health practitioners or buyer's clubs from sharing information about the lawful personal importation scheme to health consumers in need. Nevertheless, the study finds that health practitioners who promote or refer to the availability of unapproved medicines through the personal importation scheme outside of a consultation are likely to contravene the law and may be subject to disciplinary or enforcement action. What is known about the topic?. The personal importation scheme has not been studied extensively. This paper investigates whether recent updates to the advertising laws will affect the operation of the personal importation scheme and health practitioners' ability to refer to it in public. What does this paper add? This paper represents the first ever analysis of the way in which the personal importation scheme interacts with health practitioners' statements, buyer's clubs, and the internet. What are the implications for practitioners ? The study finds that health practitioners who promote the availability of unapproved medicines through the personal importation scheme outside professional consultations are likely to be liable to enforcement action from the Therapeutic Goods Administration. [ABSTRACT FROM AUTHOR]

Objective: Stepped care as a model of provision of mental health services has been frequently described from clinical or health administration perspectives, but less is known about the consumer perspective of stepped models of care. Method: Qualitative interviews were undertaken with 18 consumers across a range of residential mental health services in Melbourne, Australia. Interviews were designed to help understand consumers' needs and experiences in navigating different services to meet their needs at different times in their mental health journey. Results: Consumers experience fluctuations in their mental state that are best responded to by having access to a range of services, as well as to services that can respond flexibly to changing needs. Consumers do not necessarily progress through stepped care in a linear or step-up, step-down fashion. Conclusion: Stepped care services need to be flexible in accommodating people along a continuum of care and responsive to where the consumer is at on their journey, rather than predetermining the trajectory of care. What is known about the topic?: Stepped care has been identified as a critical component of comprehensive mental health care, bridging the gap between primary care and acute mental health services. The components of effective stepped care models have been broadly articulated, but the experience of moving through different components of care in response to changing needs has not previously been well described. What does the paper add?: This paper presents consumer perspectives on a model of stepped care that is designed to respond flexibly to the changing needs of consumers, rather than representing a linear model of progress through the system. What are the implications for practitioners?: Mental health services are increasingly grappling with provision of care to the 'missing middle': people with chronic mental illness yet not in an acute phase requiring in-patient hospital care. This paper presents a model of stepped care that responds to the fluctuating needs of consumers [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to conduct a learning and development needs analysis of quality improvement partnership capabilities of staff and consumers on partnership committees at an Australian metropolitan hospital and health service. Objectives were to compare consumer and staff self-rated capability importance, performance, and learning needs; to investigate if years of partnership experience influenced ratings; and to ascertain staff and consumer preferred learning strategies. Methods: An online cross-sectional survey was adapted from the Hennessy–Hicks Training Needs Analysis questionnaire. Participants self-rated the importance of, and their performance on, 10 capabilities, across four domains, of an internationally validated co-produced capability development framework. They also rated preferences regarding learning approaches and media. Results: A total of 199 members from 41 committees (174 staff; 25 consumers; response rate 35.38%) participated. There was a statistically significant learning and development need across all capabilities (P < 0.01). The highest learning need was for influencing organisational systems and policy (mean = −0.96; s.d. = 1.23), followed by equalising power and leadership (mean = −0.91; s.d. = 1.22), and then implementing partnership best practices (mean = −0.89; s.d. = 1.22). There were no statistically significant differences between consumers and staff on ratings, or correlations between years of partnership experience and ratings (P < 0.01). A combination of learning approaches was preferred, followed by learning through experience. Self-reflection was least preferred, which is concerning given it may promote equalising power and leadership. Face-to-face then videoconferencing were the preferred learning media. Conclusions: Continuous co-learning for staff and consumers about QI partnerships is essential. Committee members needed more feedback regarding their influence and to be engaged in innovative co-design practices. 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. [ABSTRACT FROM AUTHOR]

Objective: This study determined caregivers' evaluations of telehealth consultations for their child, preference over in-person consultations and potential cost savings by child condition, family socioeconomic status and location. Methods: A survey was conducted of 2436 caregivers attending a telehealth consultation with their child for a broad group of conditions between 3 June and 25 August 2020 at a tertiary paediatric hospital in Melbourne, Australia. Results: Most caregivers found telehealth consultations convenient, acceptable, safe and private, and capable of answering their questions and concerns. However, caregivers who spoke a language other than English and patients attending for behavioural and mental health, developmental or other (e.g. allied health) concerns were more likely to prefer in-person consultations over telehealth. Mean (±s.d.) reported cost savings on caregiver time were A$144.98 ± 99.04 per family per consultation, whereas mean (±s.d.) transport cost savings were A$84.90 ± 100.74 per family per consultation. Cost savings were greatest for families living in low and middle socioeconomic areas and regional or rural areas. Conclusions: Paediatric telehealth video consultations were largely viewed favourably by caregivers, except for those attending for behavioural and mental health or developmental concerns. What is known about the topic?: Adult consumers of telehealth consultations view them as useful, convenient and cost saving, but less is known about caregivers' evaluations of telehealth consultations and potential cost savings for paediatric patients, and whether these differ by family location, socioeconomic status or child condition. What does this paper add?: This is the first Australian paper to report on caregivers' evaluations across a range of paediatric conditions and locations. Most caregivers found telehealth consultations convenient, safe, acceptable, able to answer their questions and concerns about their child's health and cost saving. What are the implications for practitioners?: Caregivers of children with behavioural, mental health or developmental problems were less likely to prefer telehealth over in-person consultations, so practitioners should consider providing such consultations in person. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the experience of patients with chronic diseases regarding access to and utilisation of multidisciplinary care during COVID-19 in South Australia. Methods: Telephone interviews were conducted with 30 patients with chronic conditions attending nine general practices in metropolitan Adelaide. Supplementary data were obtained from the Medicare Benefit Schedule (MBS) to compare health services activity data provided by different health professionals before and after COVID-19 (from January 2019 to June 2020). Results: There was variation in access to different health services by patients with chronic conditions during COVID-19. The introduction of telehealth facilitated continuity of general practitioner (GP) services, with a high level of satisfaction among patients. Changes in medicines regulation, including the home delivery of medications, enabled timely access to medications for patients. The use of telehealth was less common for specialist and particularly allied health services. Dental check-ups that are important for the management of some chronic conditions were disrupted the most during COVID-19. Conclusion: The findings of this study suggest that the policy measures introduced in Australia provided an opportunity to maintain multidisciplinary care for patients with chronic diseases during COVID-19. GPs, as core members of the primary healthcare team, as well as pharmacy and pathology services, were highly accessible. Telehealth was less accessed for chronic care services provided by specialists and allied health professionals. What is known about the topic?: Access to multidisciplinary care is critical to ensure continuity and quality of care for patients with chronic health conditions. Evidence suggests disruptions in health services can occur during pandemics. To continue access to routine care, the Australian Government introduced several policy initiatives during COVID-19 to enhance access to multidisciplinary care. What does this paper add?: Telehealth policy was particularly effective in facilitating patients' access to general practice services during COVID-19 particularly those services that did not need physical examinations. This policy complemented changes in medicines regulations that enabled timely and convenient access to medications for patients with chronic conditions. Allied health services, as important elements of multidisciplinary care, were more likely to be disrupted during COVID-19. What are the implications for practitioners?: Continuation of telehealth services is likely to enhance access to general practice services. The acceptability and use of telehealth for allied health services may require more flexibility, and training for both practitioners and patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the acceptability of a novel, integrated general practitioner (GP)–paediatrician model of care, aiming to reduce referrals to hospitals and improve primary care quality. Methods: A pre-post study was conducted with five general practice clinics in north-west Melbourne. Over 12 months, 49 GPs and 896 families participated in the intervention that included weekly to fortnightly paediatrician–GP co-consultation sessions at the general practice, monthly case discussions and telephone or email clinical support for GPs. GPs and families completed surveys or interviews at three time points (before the intervention, after running the model for 4 months and at the end of the implementation). Non-identifiable consultation data were extracted from general practice medical records. Results: All GPs found the model acceptable. Although not significant, there was a trend towards a lower proportion of referrals to private paediatricians after the intervention (from 34% to 20%) and emergency departments (from 19% to 12%). Outpatient clinic referrals remained steady, and then increased as the paediatrician left the clinics (31% vs 47% before and after the intervention respectively). Unnecessary prescribing of acid suppression medications decreased by 20% (from 29% to 9%). GPs reported improved confidence in paediatric care (88% vs 100% before and after the intervention respectively). Families reported increased confidence in GP care (78% vs 94% before and after the intervention respectively). Model cost estimates were A$172 above usual care per child seen in the co-consultations. Conclusions: This novel model of care is acceptable to GPs and families and may improve access and quality of paediatric care. What is known about the topic?: A GP–paediatrician integrated model of care appears effective in reducing hospital burden in England, but has not been implemented in Australia. What does this paper add?: This pilot, an Australian first, found that a GP–paediatrician integrated model of care is feasible and acceptable in Australia's primary healthcare system, improves GP confidence and quality of paediatric care, may reduce paediatric referrals to outpatient clinics and emergency departments and improves family confidence in, and preference for, GP care. What are the implications for practitioners?: This model may reduce hospital burden and improve quality in GP paediatric care while potentially producing cost savings for families and the healthcare system. [ABSTRACT FROM AUTHOR]

Objective: This study reports on the characteristics of individuals conducting health service research (HSR) in Australia and New Zealand, the perceived accessibility of resources for HSR, the self-reported impact of HSR projects and perceived barriers to conducting HSR. Methods: A sampling frame was compiled from funding announcements, trial registers and HSR organisation membership. Listed researchers were invited to complete online surveys. Close-ended survey items were analysed using basic descriptive statistics. Goodness of fit tests determined potential associations between researcher affiliation and access to resources for HSR. Open-ended survey items were analysed using thematic analysis. Results: In all, 424 researchers participated in the study (22% response rate). Respondents held roles as health service researchers (76%), educators (34%) and health professionals (19%). Most were employed by a university (64%), and 57% held a permanent contract. Although 63% reported network support for HSR, smaller proportions reported executive (48%) or financial (26%) support. The least accessible resources were economists (52%), consumers (49%) and practice change experts (34%); researchers affiliated with health services were less likely to report access to statisticians (P < 0.001), economists (P < 0.001), librarians (P = 0.02) and practice change experts (P = 0.02) than university-affiliated researchers. Common impacts included conference presentations (94%), publication of peer-reviewed articles (87%) and health professional benefits (77%). Qualitative data emphasised barriers such as embedding research culture within services and engaging with policy makers. Conclusions: The data highlight opportunities to sustain the HSR community through dedicated funding, improved access to methodological expertise and greater engagement with end-users. What is known about the topic?: HSR faces several challenges, such as inequitable funding allocation and difficulties in quantifying the effects of HSR on changing health policy or practice. What does this paper add?: Despite a vibrant and experienced HSR community, this study highlights some key barriers to realising a greater effect on the health and well-being of Australian and New Zealand communities through HSR. These barriers include limited financial resources, methodological expertise, organisational support and opportunities to engage with potential collaborators. What are the implications for practitioners?: Funding is required to develop HSR infrastructure, support collaboration between health services and universities and combine knowledge of the system with research experience and expertise. Formal training programs for health service staff and researchers, from short courses to PhD programs, will support broader interest and involvement in HSR. [ABSTRACT FROM AUTHOR]

Electronic health records (EHRs) have been widely adopted in Australian public sector healthcare and will remain an ongoing, essential data system. However, recent substantial data breaches from hacked business data systems in Australian enterprises, as well as international healthcare providers, mean that EHR data breaches are increasingly likely in Australia. Risks include medical identity theft and extortion attempts based on threats to release sensitive patient information. Hacking is now a foreseeable additional risk of medical treatment. Risk mitigation for the consequences of data breaches needs to be considered, as well as support for patients (and families) and healthcare workers. This includes identity theft protection services, cybersecurity insurance, and psychological support. [ABSTRACT FROM AUTHOR]

Objective Although Australia's service and policy context differs from that of the US, studies have highlighted potential for individual placement and support (IPS) to support competitive employment outcomes for people with severe and persistent mental illness. The aim of the present study was to explore why the model is not yet widely available.Methods A document analysis was conducted to discern reasons for challenges in implementation of IPS practice principles within the Australian service context.Results The document analysis illustrated that although policy acknowledges the importance of increasing employment rates for people with severe and persistent mental illness, consistent measures, change indicators, direction and time frames are lacking in policy and strategy documentation. Further, IPS principles are not consistently evident in guiding operational documentation that government-funded Disability Employment Services (DES) programs are mandated to adhere to.Conclusions For IPS to be readily implemented, it is necessary for government to offer support to agencies to partner and formal endorsement of the model as a preferred approach in tendering processes. Obligations and processes must be reviewed to ensure that model fidelity is achievable within the Australian Commonwealth policy and service context for programs to achieve competitive employment rates comparable to the most successful international programs. [ABSTRACT FROM AUTHOR]

The impact of poorly written policies in healthcare is enormous, with the potential for significant economic and personal costs. Our local health district embarked on a major revision of policy document development that sought to reframe the process of policy development using health literacy principles. This included mandatory policy development changes that require policy to be written in plain language, at a readability level of grade 10--12. Staff training in plain language writing was undertaken. Consumer and staff feedback was incorporated in policy development. Four elements were critical to this process: effective leadership, effective instruction, practical support, and evidencedriven decisions. Staff responses to the revised processes were overwhelmingly positive and resulted in improved policy readability. The involvement of consumers in policy development has evolved. From this study, we have learned how to improve the governance of policy documents. It is possible for health literacy principles to be embedded in the development and revision of these documents. [ABSTRACT FROM AUTHOR]

Objective. This study evaluated whether the satisfaction of patients attending a physiotherapy-led postarthroplasty review out-patient clinic was non-inferior to that of patients attending traditional surgeon clinics. Methods. Using a modified nine-item Visit-Specific Satisfaction Instrument (VSQ-9), 50 patients attending the physiotherapy clinic and 50 patients attending surgeon clinics were surveyed. Sample means (± s.d.) were calculated for each domain of the VSQ-9. Non-inferiority testing was performed using 95% confidence intervals (CIs) of the adjusted mean difference to examine whether normalised patient satisfaction scores in the physiotherapy group were no worse than those in the surgeon group. Results. Both groups were satisfied (overall domain; 100% of both groups rated good-excellent). Based on mean item score, there was strong evidence that the satisfaction of the physiotherapy group was non-inferior to that of the surgeon group (adjusted mean difference (physiotherapy - surgeon) in mean score 5.1 (95% CI -0.3, 10.4). Furthermore, the mean differences in all but one of the nine domains were in favour of the physiotherapy group in this study. Conclusion. The satisfaction of patients attending a physiotherapy arthroplasty review clinic is not inferior to that of patients attending traditional surgeon clinics. [ABSTRACT FROM AUTHOR]

Objective: Staff turnover remains a significant financial burden across the healthcare sector. Traditional approaches to recruitment continue to prioritise competency-based outcomes over the cultural fit of applicants. This brief case study sought to evaluate the effectiveness of a new recruitment intervention on allied health staff attrition rates at the Royal Melbourne Hospital, Australia. Methods: The study used a single-site, prospective, mixed-methodology research design. Staff attrition rate, defined as the number of staff who ceased employment within 12 months of starting (both voluntarily and involuntarily), was selected as the primary outcome measure. Baseline data were collected in the 12 months before intervention roll out. Data were supplemented by surveying staff on interview panels and by feedback from consumer interview panel members. Results: Descriptive analysis revealed that there was a decrease in the overall staff attrition rates following the introduction of the new recruitment model. Survey data revealed that interviewers rated the new recruitment strategy as more effective than traditional approaches. Several unique benefits associated with the inclusion of consumer advocates were also identified. Conclusion: A behaviourally grounded recruitment approach to allied health improves overall staff attrition over traditional competency-based models. [ABSTRACT FROM AUTHOR]

This article highlights the dearth of accurate evidence available to inform the National Disability Insurance Scheme (NDIS) regarding the extent and nature of neurocognitive disability amongst homeless Aboriginal and Torres Strait Islander people. Without accurate prevalence rates of neurocognitive disability, homeless Aboriginal and Torres Strait Islander people are in danger of not being counted by the NDIS and not receiving supports to which they are entitled. Addressing this knowledge gap is challenged by a range of factors, including: (1) the long-term effect of profound intergenerational disenfranchisement of Aboriginal and Torres Strait Islander people; (2) Aboriginal and Torres Strait Islander cultural perspectives around disability; (3) the generally unrecognised and poorly understood nature of neurocognitive disability; (4) the use of research methods that are not culturally safe; (5) research logistics; and (6) the absence of culturally appropriate assessment tools to identify prevalence. It is argued that an accurate evidence base that is informed by culturally safe research methods and assessment tools is needed to accurately guide the Commonwealth government and the National Disability Insurance Agency about the expected level of need for the NDIS. Research within this framework will contribute to the realisation of a truly inclusive NDIS. [ABSTRACT FROM AUTHOR]

Objective. This study examined data recorded by one urban publicly funded opioid-replacement therapy clinic (from 2009 to 2011) to identify whether these data could be used to inform the rostering of clinicians more effectively to improve access to treatment. Methods. Data analysis incorporated descriptive and inferential methods. Results. There were trends in the times of the year consumers seek opioid-replacement therapy, similarity and differences between gender requests for treatment and variation in consumer wait time on triage. Conclusions. National reporting of opioid-replacement therapy triages would help gain a better understanding of the number of people in need of treatment. If opioid-replacement therapy providers monitored consumer triages, they could roster more effectively, have gender-specific clinicians available, acknowledge and inform consumers of wait time on triage and allow re-orientation of services to lower wait time. [ABSTRACT FROM AUTHOR]