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Objective: To evaluate the perceptions of the coronavirus disease 2019 (COVID-19) initiated workplace strategies implemented in radiation oncology departments across Australia. Methods: A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies on areas such as patient care, staff education, well-being, flexible working arrangements, and research. The survey was conducted from November 2020 to April 2021. Results: Out of 210 respondents from seven institutions, 45% reported burnout and 57% experienced work work-related stress. A significant majority of respondents were in favour of continued remote work (86%, 131/153). Radiation oncologists identified administrative or non-clinical work (92%, 34/37), telehealth clinics (32%, 12/37), or radiation therapy planning (22%, 8/37) as suitable for remote work. Additionally, 54% (21/39) of the radiation oncologists plan to use telehealth more frequently, with 67% (26/39) feeling more confident with the technology. The majority (81%, 171/210) of participants favoured continuation of hybrid in-person and virtual meetings. Virtual solutions were adopted for quality assurance activities (72%, 118/165) and 52% (60/116) indicated preference for ongoing utility of virtual platforms. However, 38% (79/210) of the respondents expressed concerns about the negative impact on junior staff training. Conclusion: These findings reveal a strong inclination towards technological advancements and remote work arrangements to enable flexible working conditions. Our study suggests the need for ongoing reforms, focusing on improving clinical service delivery efficiencies and enhancing job satisfaction among clinicians. What is known about the topic? During the coronavirus disease 2019 (COVID-19) pandemic there were significant adaptations required to the delivery of clinical care. What does this paper add? There is a strong preference for ongoing work from home arrangements, especially for administrative and non-clinical work. Most radiation oncologists feel more confident using telehealth and favour its ongoing use post-pandemic. Burnout and stress remain prevalent within the workforce. What are the implications for practitioners? There is a high demand among the radiation oncology workforce for adoption of technological advances to improve work satisfaction including remote access to enable flexible work arrangements. [ABSTRACT FROM AUTHOR]

Objective: In Australia, there is little evidence exploring why higher degrees by research (HDRs) are undertaken by surgeons. This study aims to describe the attitudes and experiences of surgical trainees and surgeons towards HDRs. Methods: A 23-question cross-sectional survey of surgical trainees and consultant surgeons from three Australian public hospitals was undertaken between August and December 2022. Data were analysed according to stage of career and HDR status and assessed using chi-squared test, with P < 0.05 considered significant. Results: Out of 270 participants, 72 (27%) completed the survey including 30 (42%) trainees and 42 (58%) consultants. Overall, 43 (60%) participants had completed or were undertaking a HDR, which was similar between trainees (n = 18) and consultants (N = 25; P = 0.968). A HDR was associated with more publications (P < 0.5). Respondents with a HDR were more likely to have a salaried academic position (50%) than those without (15%). There was no significant difference in academic appointments based on HDR attainment (P = 0.192). For surgical trainees, 93% rated the strengthening of resumes as the primary driver, compared with only 60% of consultants. For consultants, academic career aspirations and research interests were ranked the highest at 64% equally. Lack of time and competing nature of surgical training were equally ranked among all as the key barriers to completing a HDR. Conclusions: These results provide insight into the academic pursuits of surgeons with an understanding of the role HDRs play, including the different drivers for Masters and Doctorates. This is important for supporting future surgeons who seek to pursue research. What is known about the topic? The value of research is well-recognised as a crucial part of the surgical training pathway. Despite this, minimal contemporary evidence exists which explores the impact of higher degrees by research (HDR) on academic career pathways in the Australian context. What does this paper add? Contemporary evidence was obtained to understand why Australian surgeons undertake HDRs and how their completion impacts the surgical career pathway. What are the implications for practitioners? By understanding the role of HDRs in the surgical landscape, practitioners can ensure beneficial support for future academic surgeons is in place. [ABSTRACT FROM AUTHOR]

Objective: This study set out to present data on out-of-pocket payments for Medicare mental health services provided by general practitioners (GP), psychiatrists, clinical psychologists and other psychologists, to explore how much is spent on out-of-pocket payments for mental health; if any trends could be seen; and what variations exist across regions. Methods: We performed secondary analysis of publicly available data on Medicare-subsidised GP, allied health and specialist health care across Australia. We merged and interrogated data covering the period 2013–19 and 2019–21 to create a data set covering eight full years of Medicare mental health services, arranged by profession and by region. Results: Out-of-pocket payments for mental health care in Australia have been rising consistently over the period 2013–21, at a considerably faster rate than overall expenditure on mental health care. There is wide variation in out-of-pocket payments depending on where you live. Conclusions: The impact of out-of-pocket payments on community access to mental health care is growing. This has implications, especially in poorer communities, for access to care. This should be an important consideration taken as the Australian Government considers next steps in national mental health reform, including the Better Access Program, currently under evaluation. 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. [ABSTRACT FROM AUTHOR]

Objective: We set out to provide a benchmark assessment of allied health professionals' research capacity and culture in a national private health care organisation, including identifying barriers and facilitators to staff participation in research. Methods: All allied health professionals across 16 sites were invited to participate in an online survey, using the research capacity and culture tool from 9 May to 17 June 2022. Descriptive analysis of each demographic variable was expressed in frequencies and percentages. Differences between organisation, team and individual domains were analysed as ordinal data (scale 1–9), and a mean score and standard deviation were calculated. Results: The survey was completed by 182 allied health professionals across 16 sites, with an estimated response rate of 12%. Overall results identified low levels of research support or skills at organisational and team levels and moderate levels of skills at an individual level. Respondents were motivated to participate in research 'to develop skills', for 'improved job satisfaction' and 'career advancement'. Major barriers to participation in research were 'lack of time', 'lack of resources' and 'other work roles taking priority'. Conclusion: The current study fills a knowledge gap by reporting the research capacity and culture among allied health professionals in a national private healthcare organisation in Australia. This study suggests that allied health professionals in private healthcare organisations perceive less than adequate levels of support at the team and organisational levels compared to their public counterparts. However, the barriers and motivators to participate in research activities were consistent with public hospitals. 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. [ABSTRACT FROM AUTHOR]

Career pathways for Allied Health clinician researchers in Australia are currently underdeveloped. As these pathways are limited in structure, there are a wide variety of pathways that are 'cobbled together' by Allied Health professionals to combine clinical and research careers. This perspective piece summarises some of these pathways and discusses recommended improvements to create more streamlined career pathways, vital to Australia's research and patient care excellence. What is known about the topic? Allied Health professionals who wish to pursue a dual career as both a clinician and researcher face many barriers, including an unclear career pathway. What does this paper add? This paper outlines the varied career pathways that Allied Health clinician researchers follow, and outlines recommendations for improving the pathway at different stages. What are the implications for practitioners? Supporting improved clinician researcher career pathways in Australia requires input from multiple stakeholders at different stages of the pathway. [ABSTRACT FROM AUTHOR]

Objective: The climate crisis necessitates urgent decarbonisation. The health sector must address its large carbon footprint. In the present study, we sought healthcare thought leaders' views about a future environmentally sustainable health system. Methods: The present study was a qualitative exploratory study consisting of semistructured, in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the US and New Zealand. Audio recordings of the interviews were transcribed and analysed by matrix display and thematic analysis. Results: Overall, healthcare thought leaders believe that to reduce the carbon footprint of healthcare we need to look beyond traditional 'green' initiatives towards a more fundamental and longer-term redesign. Five main themes and one 'key enabler' (information communication technology) were identified. In this paper we draw on other relevant findings, but chiefly focus on the fifth theme about reshaping the role of healthcare within society and using the size and influence of the health sector to leverage wider health, environmental and societal benefits. Conclusions: These ideas represent potentially low-carbon models of care. The next step would be to pilot and measure the outcomes (health, environmental, financial) of these models. What is known about the topic?: The health sector needs to reduce its large carbon footprint. Traditional 'green' initiatives, such as recycling and improving energy efficiency, are insufficient to achieve the scale of decarbonisation required. What does this paper add?: Healthcare thought leaders surveyed in the present study suggested that we also consider other, non-traditional ways to achieve environmental sustainability. In this paper we discuss their ideas about adopting an anticipatory approach to healthcare using predictive analytics, and using the size and influence of the health sector to effect wider health and environmental benefits. What are the implications for practitioners?: Achieving an environmentally sustainable healthcare system is likely to require broad and fundamental (i.e. transformational) change to the current service model. Health practitioners throughout the sector must be closely engaged in this process. [ABSTRACT FROM AUTHOR]

Objectives: Access to medicinal cannabis is a timely and important issue in cancer care. Recent legislative changes in Australia have increased access to medicinal cannabis, but the views of people with cancer on this topic are poorly understood. The aim of this study was to explore the prevalence of the use of and attitudes towards medicinal cannabis among people with cancer. Methods: A cross-sectional study was performed using an anonymous, 15-item study-specific paper-based survey. The survey was administered over a 2-week period in August 2017 in the waiting rooms of a specialist cancer hospital. Results: In all, 339 patients completed the survey (mean (± s.d.) age 59 ± 15 years; 52% male). Fourteen respondents (4%) were currently using cannabis medicinally. Only one of these respondents had a prescription for their cannabis product. Most respondents would consider using a medicinal cannabis product if recommended by their doctor (n = 271; 80%). Conclusion: This study is the first of its kind to survey the use of and attitudes towards medicinal cannabis in a broad sample of Australian people with cancer. Few respondents were currently using cannabis for medicinal purposes, but an overwhelming majority were in favour of increasing access and would consider using a prescribed product. What is known about the topic?: Cannabis may have a wide variety of medicinal uses, particularly in the cancer setting. Currently, people with cancer in Victoria have limited access to medicinal cannabis despite recent legislative changes. What does this paper add?: In a general sample of people with cancer, few were using cannabis for medicinal purposes, but most were in favour of widening access and would consider using a product their doctor prescribed. What are the implications for practitioners?: Despite supporting access, patients indicated that the recommendations of doctors and increasing the evidence base are necessary requirements to their use of medicinal cannabis. [ABSTRACT FROM AUTHOR]

Objective: Ensuring sufficient qualified and experienced managers is difficult for public sector healthcare organisations in Australia, with a limited labour market and competition with the private sector for talented staff. Although both competency-based management and talent management have received empirical support in association with individual and organisational performance, there have been few studies exploring these concepts in the public healthcare sector. This study addresses this gap by exploring the perceived differences in demonstration of core competencies between average and higher-performing managers in public sector healthcare organisations. Methods: Mixed methods were used to define and measure a set of competencies for health service managers. In addition, supervisors of managers were asked to identify the differences in competence between the average and high-performing managers reporting to them. Results: Supervisors could clearly distinguish between average and higher-performing managers and identified related competencies. Conclusions: The consistent pattern of competence among community health and hospital public sector managers demonstrated by this study could be used to develop a strategic approach to talent management for the public healthcare sector in Australia. What is known about this topic?: Although there are validated competency frameworks for health service managers, they are rarely used in practice in Australia. What does this paper add?: This paper illustrates the perceived differences in competencies between top and average health services managers using a validated framework. What are the implications for practitioners?: The public health sector could work together to provide a more effective and efficient approach to talent management for public hospitals and community health services. [ABSTRACT FROM AUTHOR]

Background The 'Down to Test (DTT)' campaign is a sexually transmissible infection (STI) social marketing intervention delivered through outdoor music festival activations and supported by digital media communications in New South Wales, Australia. This paper investigates whether and how the tailored messages reached the intended audience. Methods Data was collected through three annual rounds of online surveys post campaign exposure, targeting young people (aged 15-29years) attending 14 music festivals in NSW from October 2017 to March 2020. Descriptive statistics, principal component analysis and multivariable logic regression were applied to identify the key client segment and factors associated with a strong intention for future STI screening. Results Of the 10044 participants with a valid urine specimen submitted, 261 (2.8%) tested positive for chlamydia. Altogether, 1776 participants (median age=22) self-completed the evaluation surveys online with more being female (73.4%) than male (26.2%). Participants were mostly Australian-born (89.5%), heterosexual (82.6%) and the majority being sexually active (96.7%). Rates of self-reported lifetime STI testing (70.4%) and intention for future STI screening ('definitely yes' in the next 12months, 39.0%) were also high. The most significant factor associated with future intention for STI testing is the Sexual Experience and Perception Factor (adjusted odds ratio [AOR]=2.02; 95%CI 1.76-2.32; P<0.001), followed by the Sexual Beliefs and Attitudes Factor (AOR=1.14; 95% CI 1.01-1.30; P<0.05). Conclusions The NSW state-wide DTT campaign has largely reached sexually active youth who are attentive to sexual health promotion messages and contributed to enhanced STI screening in a fun and peer-supportive environment. [ABSTRACT FROM AUTHOR]

Objective: This study investigated use of electronic medical records (eMRs) in a spinal cord injury rehabilitation unit and the implications for person-centred care. Methods: This exploratory mixed-methods study conducted 17.5 hours of observations of practitioner–patient encounters, 50 patient-experience surveys and 10 focus groups with 53 practitioners. Descriptive statistics and qualitative analysis were integrated into key themes. Results: Practitioners in this specialised setting were reconciling the emergent challenges of eMR in practice with the advantages of improved accessibility and documentation legibility. eMR increased task complexity and information retrieval, particularly for nurses. Some documentation was an uneasy fit with the specialised setting, disrupting informal communications and aspects of person-centred care. Conclusions: Technological change closely aligned with frontline practice brought expected and unexpected challenges that may resolve over time. Practitioners' persistence and adaptability demonstrated their commitment to person-centred care in the digital environment. The impact of this less visible work of professional discretion seemed to vary, primarily by discipline-specific roles, with nurses experiencing the greatest pressure. What is known about this topic?: Integrated electronic medical records (eMRs) bring benefits but challenge person-centred care. What does this paper add?: These first insights regarding frontline implementation of eMR in spinal injury rehabilitation suggest nursing challenges when seeking to fit specialised work into the generic eMR. However, most patients reported receiving person-centred care. What are the implications for practitioners?: Commitment to person-centred care appears to strengthen practitioners' perseverance with the eMR implementation challenges. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to better understand senior medical directors' perceptions of public reporting of hospital performance data, how public reporting affects institutional behavioural change towards quality improvement and how it could be improved. Methods: Interviews were undertaken with 17 medical directors representing 26 metropolitan and regional public hospitals in Victoria, Australia, between June and August 2016. Data were analysed thematically. Results: Medical directors are well placed to comment on clinical and administrative aspects of quality, safety and performance monitoring in public hospitals. Their responses largely suggested that public reporting of hospital performance data in Australia is immature and not fulfilling its potential. There was little consensus among informants around what public reporting is, who it is for or its purpose. Although public reporting was considered to have important functions for hospitals and consumers, it was generally considered to lack robustness and have underutilised potential to inform consumers, build trust and drive quality and performance improvements within hospitals. Conclusions: The next steps needed to advance public reporting of hospital performance data in Australia include engaging clinicians and patients in selection and development of metrics, improving timeliness of reporting, and improving communication of information so that it is accessible and meaningful for different audiences. What is known about the topic?: Public reporting of hospital performance data is a mechanism increasingly used in the Australian health system, but it has attracted little research. What does this paper add?: This paper reveals a lack of shared understanding among medical directors in Victoria, Australia, on what public reporting of hospital performance data is, who it is for and its purpose. The paper highlights the potential importance of public reporting of hospital performance data for rural and regional healthcare consumers and how it may be strengthened. What are the implications for practitioners?: Stronger systems of public reporting of hospital performance data have the potential to increase consumer engagement and improve hospital performance, quality and safety. Awareness of the discourse around public reporting of hospital performance data can increase practitioners' engagement in debate and development of reporting systems. [ABSTRACT FROM AUTHOR]

Introduction. This paper demonstrates the use of a Quality Framework and Implementation Template to review processes for improving the quality and safety of opiate prescribing for chronic non-malignant pain (CNMP). Escalating use of prescription opiates for chronic pain is of national and international concern, with major implications for personal and public health as well as for patient safety and health service quality and safety. Objectives. This paper uses opiate prescribing for CNMP as a worked example to illustrate use of the Quality Framework for self-directed quality improvement in smaller specialist medical or community-based practices. Methods. An Implementation Template, comprising a series of focussed questions derived from the Quality Framework, was applied to one specific quality improvement activity arising from clinical practice (opiate prescribing for CNMP). This helped the practice team understand current systems and processes, identify actual and potential problems, and find possible solutions to institute interventions for change. Conclusion. The template approach to quality activity is very applicable within smaller specialist or community health service settings, enabling such health services to focus on their own quality improvement activities and address topics of importance to the practice in a systematic and productive manner. What is known about the topic? There are complex interactions and activities to be considered when undertaking quality improvement within community practice. Repeat opiate prescribing for CNMP is a significant issue for practices and patients. What does this paper add? This paper examines the specific case of improvements to quality and safety of repeat prescribing of opiates for CNMP in small clinics and other community-based health services. This example shows how users may utilise an Implementation Template to perform a systematic and comprehensive review of their systems and processes in relation to any chosen aspect of practice-based quality improvement activity. Services could apply these same principles to any topic of interest, or practice and/or organisational activity, to undertake systematic quality improvement. What are the implications for practitioners? The Implementation Template was designed for use by clinical practice teams. It will be helpful for practices that wish to undertake a quality improvement activity but lack the knowledge of how to proceed. Use of the template approach provides practice teams with the means to ensure that they consider the area of concern from all angles, and helps to uncover areas that might not otherwise have been considered. [ABSTRACT FROM AUTHOR]

Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination.Methods: An online survey investigating Australian GPs' chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis.Results: Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6-8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1-6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1-4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2-3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance.Conclusion: Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe timelines and challenges encountered in obtaining ethics and governance approvals for an Australian multicentre audit study involving 100 public (n = 22) and private (n = 78) sites from three health sectors and all eight Australian states and territories. Methods: We determined and compared the processes, documentation and number of business days required to prepare applications and obtain research ethics and governance approvals. Results: In total, the full ethics and governance process (calculated from the date the first application was started to the date the final approval was granted) took 203 business days (79% of the study timeline). Standard risk ethics applications (n = 4) took a median of 17 business days (range 3–35 days) to prepare and 32 business days (range 17–67 days) to be approved; expedited ethics applications (n = 4) took a median of 5 business days (range 1–20 days) to prepare and 10 business days (range 1–44 days) to be approved. Governance approvals (n = 23) took a median of 27 business days (range 4–63 days) to prepare and 20 business days (range 4–61 days) to be approved. Challenges included the lack of a nationwide single-site ethical review process, the extensive time required to duplicate content across applications, variability in application requirements and submission systems, and contract negotiations. Conclusion: Further improvements are needed to reduce duplication and increase the efficiency of Australian ethics and governance review processes. What is known about the topic?: The process for obtaining ethics approval for multicentre research has been streamlined through the introduction of single-site ethics review. However, the process of gaining ethics and governance approvals for national multicentre research continues to be time-consuming, resource-intensive and duplicative. What does this paper add?: This is the first study to examine the challenges of obtaining ethics and governance approvals for a non-interventional multicentre study involving three health sectors (hospital, aged care, general practice), both private and public services and all eight Australian jurisdictions. Previous examinations of Australian multicentre studies have considered only one health sector, focused on the public system and/or were not national in scope. What are the implications for practitioners?: Researchers and funders need to be aware of the considerable time, resources and costs involved in gaining research ethics and governance approvals for multicentre studies and include this in budgets and study timelines. Policy makers and administrators of ethics and governance review processes must address barriers to conducting multicentre research in Australia. [ABSTRACT FROM AUTHOR]

Objective. This paper explores the body of knowledge around Indigenous health research and aims to outline what roles are appropriate for non-Indigenous researchers within Indigenous health research in Australia. Methods. Aliterature review was conducted using CINAHL, PubMed and Scopus in May2015. The search terms were 'non-Indigenous researchers' AND 'Indigenous health research' and other combinations of these terms. Additional documents were sourced by hand using the reference lists of key articles. Results. Seven thematic categories were identified: (1) Closing the Gap: implications for research; (2) history of Indigenous research; (3) developing Indigenous research using a capacity-building approach; (4) the cultural interface between Western paradigms and Indigenous knowledge; (5) ethical Indigenous research; (6) culturally safe Indigenous research; and (7) positive roles for non-Indigenous researchers in Indigenous research. Conclusion. It is important that non-Indigenous researchers become more aware of culturally appropriate ways in which to undertake Indigenous research and to ensure that the research undertaken is safe, ethical and useful for participants. Fostering partnerships between non-Indigenous academic organisations and researchers and Indigenous health researchers is an important development that can promote and enhance the emerging field of Indigenous inquiry. Actively contributing to capacity building with Indigenous researchers and research initiatives is a key role that non-Indigenous researchers and academic institutions can have in improving Indigenous health. Self-determination through health research capacity building and evidence-based advocacy may provide the most useful outcomes for Indigenous people. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to gain an understanding of the factors associated with unplanned hospital readmission within 28 days of acute care discharge from a major Australian health service. Methods: A retrospective study of 20 575 acute care discharges from 1 August to 31 December 2015 was conducted using administrative databases. Patient, index admission and readmission characteristics were evaluated for their association with unplanned readmission in ≤28 days. Results: The unplanned readmission rate was 7.4% (n = 1528) and 11.1% of readmitted patients were returned within 1 day. The factors associated with increased risk of unplanned readmission in ≤28 days for all patients were age ≥65 years (odds ratio (OR) 1.3), emergency index admission (OR 1.6), Charlson comorbidity index >1 (OR 1.1–1.9), the presence of chronic disease (OR 1.4) or complications (OR 1.8) during the index admission, index admission length of stay (LOS) >2 days (OR 1.4–1.8), hospital admission(s) (OR 1.7–10.86) or emergency department (ED) attendance(s) (OR 1.8–5.2) in the 6 months preceding the index admission and health service site (OR 1.2–1.6). However, the factors associated with increased risk of unplanned readmission ≤28 days changed with each patient group (adult medical, adult surgical, obstetric and paediatric). Conclusions: There were specific patient and index admission characteristics associated with increased risk of unplanned readmission in ≤28 days; however, these characteristics varied between patient groups, highlighting the need for tailored interventions. What is known about the topic?: Unplanned hospital readmissions within 28 days of hospital discharge are considered an indicator of quality and safety of health care. What does this paper add?: The factors associated with increased risk of unplanned readmission in ≤28 days varied between patient groups, so a 'one size fits all approach' to reducing unplanned readmissions may not be effective. Older adult medical patients had the highest rate of unplanned readmissions and those with Charlson comorbidity index ≥4, an index admission LOS >2 days, left against advice and hospital admission(s) or ED attendance(s) in the 6 months preceding index admission and discharge from larger sites within the health service were at highest risk of unplanned readmission. What are the implications for practitioners?: One in seven discharges resulted in an unplanned readmission in ≤28 days and one in 10 unplanned readmissions occurred within 1 day of discharge. Although some patient and hospital characteristics were associated with increased risk of unplanned readmission in ≤28 days, statistical modelling shows there are other factors affecting the risk of readmission that remain unknown and need further investigation. Future work related to preventing unplanned readmissions in ≤28 days should consider inclusion of health professional, system and social factors in risk assessments. [ABSTRACT FROM AUTHOR]

The National Safety and Quality Health Service Standards requires health service compliance by 2013 and covers several areas including governance arrangements, partnerships with consumers and eight key clinical processes. Nurses in Australia comprise 62% of the hospital workforce, are the largest component and hence play a critical role in meeting these standards and improving the quality of patient care. Several of the standards are influenced by nursing interventions, which incorporate any direct-care treatment that the nurse performs for a patient that may be nurse or physician initiated. The ability for nurses to undertake these interventions is influenced by the hours of care available, the skill mix of the nursing workforce and the environment in which they practice. Taking into consideration the predicted nursing shortages, the challenge to successfully implement the National Safety and Quality Health Service Standards will be great. This paper examines the role of nursing in the delivery of the National Standards, analyses the evidence with regard to nursing-sensitive outcomes and discusses the implications for health service decision makers and policy. What is known about the topic? The National Safety and Quality Health Service Standards have been endorsed for implementation by the Australian Health Ministers. Compliance with the National Safety and Quality Health Service Standards is required by Health Services in 2013. Nurses play a critical role in providing high-quality patient care and meeting accreditation standards. A decline in nursing standards is associated with inadequate staffing levels and skill mix and a lack of effective leadership and results in an increase in patient mortality. What does this paper add? The role of nurses in achieving compliance with the standards is discussed. We demonstrate that the capacity for nurses to undertake interventions is influenced by prevailing workforce characteristics. Significant nursing shortages have been identified as possible challenges to successfully implementing the National Safety and Quality Health Service Standards. What are the implications for practitioners? Practitioners need to review nursing hours of care, skill mix and the practice environment as part of the actions required to achieve the National Quality and Safety Standards. The Australian Commission on Safety and Quality in Health Care has the opportunity to take the lead by including such indicators in the measurement of hospital performance. [ABSTRACT FROM AUTHOR]

Objective. In Australia, 25% of international medical graduates (IMGs) make up the medical workforce. Concern is expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs' education. Although there is literature alluding to difficulties IMGs face with undertaking the Australian Medical Council (AMC) examination, there is little research detailing this experience. We therefore explored IMGs' reflections on facilitators and barriers in undertaking the AMC examination. Methods. After ethics approval, in-depth telephone interviews were conducted with 30 IMGs selected from a hospital in Queensland. Data were coded and analysed using thematic analysis principles. Results. Two facilitating themes were identified: ability to sit for the first part of the examination in country of origin; and having access to resources such as bridging courses and study groups. Three themes represented barriers: not understanding procedural steps; financial issues; and lack of information on examination content and standards. Conclusion. The themes provide new insights and add depth to existing literature that can be used to improve procedural processes and education for IMGs towards successful outcomes in the AMC examination. What is known about the topic? There is concern expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs education. The Australian work that is available only depicts educational experience of fellowships or education and training strategies after IMGs have passed their AMC examination. What does this paper add? The findings indicate that the process of sitting for the AMC examination is perceived as one of the major difficulties associated with entering and integrating into the Australian health system. The findings indicate a range of practical, financial and resource problems faced by IMGs attempting to sit for the AMC examination. What are the implications for practitioners? The detailed accounts from IMGs about their experience with undertaking the AMC examination will provide up-skilling program coordinators with the information they need to better assist IMGs to prepare for the examination. The provision of appropriate medical training and educational support will contribute to more effective integration of IMGs into the healthcare system. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to determine whether there is an association between having research culture in a health service and better organisational performance. Methods. Using systematic review methods, databases were searched, inclusion criteria applied and study quality appraised. Data were extracted from selected studies and the results were synthesised descriptively. Results. Eight studies were selected for review. Five studies compared health services with high versus low levels of research activity among the workforce. Three studies evaluated the effect of specific interventions focused on the health workforce. All studies reported a positive association between research activity and organisational performance. Improved organisational performance included lower patient mortality rates (two of two studies), higher levels of patient satisfaction (one of one study), reduced staff turnover (two of two studies), improved staff satisfaction (one of two studies) and improved organisational efficiency (four of five studies). Conclusions. A stronger research culture appears to be associated with benefits to patients, staff and the organisation. [ABSTRACT FROM AUTHOR]

Background: The Family Community-based Assistance Resourcing and Education Program (FCP) is a nurse home visiting program that was introduced in Queensland two decades ago to redress health inequalities for infants from families experiencing specific social stressors. Locally adapted versions of this home visiting program are still in use, but have not been evaluated. This study examined child health nurse perceptions of the adapted FCP in one regional Queensland health service. Methods: A qualitative descriptive exploratory study using two focus groups (conducted May 2019) with Child Health Nurses who delivered the FCP was conducted. Transcripts of digital recordings were analysed using Braun and Clarke's (2006) six-step framework for guided thematic analysis. Results: A total of 16 Child Health Nurses participated in the study, with a mean of 10 years' experience with the program. Data analysis generated 12 themes organised under three domains: 'Establishing the relationship with families', 'What works in practice' and 'We could do it better'. Participants cited flexibility, expert input and in-home delivery as key program benefits. However, narrow eligibility criteria, poor screening for perinatal anxiety and resourcing constraints were identified as limitations. Conclusions: This study is the first to measure Child Health Nurses' perceptions of an adapted FCP. It sheds light on their 'practice wisdom', including the program's ability to meet the needs of families with social vulnerabilities. The study supports prior calls for home visiting programs to be evaluated against clearly stated program intentions. Participant insights have been shared to inform practice and program implementation both locally and as part of Queensland's First 2000 Days health service delivery reform agenda. Home visiting programs can improve outcomes for infants and families at risk of suboptimal health and developmental outcomes. However, there is limited evidence regarding the efficacy of current programs in use in Queensland. This study analyses Child Health Nurse perceptions of one such program, with findings confirming the need for active monitoring of program outcomes against their stated objectives. [ABSTRACT FROM AUTHOR]

Objective. The objective of this research is to appraise current practice in hospitals against the ‘Framework to achieve value in healthcare’ (the Framework) and to identify additional contributory factors that support or hinder its application. Methods. A multi-site case study was undertaken with five hospitals in Australia, the USA and UK using purposeful sampling to identify hospitals to participate. Data collection took place between September and November 2022. The hospitals included in the study had Process Improvement (PI) programs of more than 5 years duration, with strong executive engagement and broad outcomes measurement, including financial benefits. All hospitals were acute public hospitals or private, not for profit. Results. All hospitals indicated current practice according to Steps 1–5 for some part of their PI programs. All hospitals indicated that they were more likely to include financial benefits measurement for activities aimed specifically at improving cost rather than reducing non-value adding activities or improving the value of clinical care. Step 5 (reinvestment of cost savings) of the Framework is dependent on the accomplishment of Step 4 (measurement and realisation of financial benefits) and the contributory elements are important in supporting hospitals to utilise the Framework. Conclusions. The ‘Framework to achieve value in healthcare’ provides a practical guide for hospitals to reduce non-value adding activities, improve the value of clinical care and reduce costs. Further research is indicated to establish its reliability in hospitals in other countries and hospitals that do not have an established PI program. [ABSTRACT FROM AUTHOR]

Objective. Allied health (AH) includes many diverse professions, each with a unique contribution to healthcare, making it possible to consider these professions as person oriented (PO) or technique oriented (TO). This paper explored the personality traits of AH professionals from the perspective of both the PO or TO orientation and the individual professions. Methods. AH professionals (n = 562) provided demographic data and completed the Temperament and Character Inventory. Examination of the literature and a consultation process resulted in nine professions classified as PO and 10 classified as TO. Multivariate analyses compared levels of personality traits and demographic variables between the PO (n = 492) and TO (n = 70) groups, and the professions within the groups. Results. Professionals in the PO group showed significantly higher levels of traits that emphasise person orientation attributes, such as being sociable, empathic and cooperative, compared with AH professionals in professions with an emphasis on TO. Conclusions. Trends in personality traits among AH professionals were congruent with the PO and TO aspects of their chosen profession. This supports the usefulness of the PO and TO concepts in describing AH professions and may provide new clues for policy aiming to enhance job satisfaction, retention and career development. [ABSTRACT FROM AUTHOR]

Many Australians have limited access to health-care services due to a range of barriers, including geographic distance and restricted mobility, which telehealth can potentially address. This paper reviews the current and potential use of video consultation in primary health care in Australia, drawing on international literature. There is substantial evidence of high patient satisfaction, but many studies have methodological limitations. Overall, evidence of effectiveness and cost-effectiveness is weak. There is reasonable evidence for diagnosis, home care and specialist consultations by GPs with patients present. Two telehealth initiatives using video consultation are briefly presented. Both provide evidence that video consultation has a valuable role to play, but does not obviate the need for face-to-face consultations. Video consultation challenges traditional professional roles, particularly those of nurses, and can improve health workers' skills and job satisfaction. More fundamentally, telehealth challenges the traditional distinction between primary and secondary care. This can be a source of resistance but may ultimately be one of its strengths. Appropriately targeted video consultation has much potential to improve the delivery of primary health care in Australia, particularly in rural and remote regions. [ABSTRACT FROM AUTHOR]

Practice nurses in Australia are now funded to facilitate chronic condition management, including self-management support. Chronic disease management requires an established rapport, support and proactivity between general practitioners, patients and the practice nurses. To achieve this, training in shared decision making is needed. e-Learning supports delivery and achievement of such policy outcomes, service improvements and skill development. However, e-learning effectiveness for health care professionals' is determined by several organisational, economic, pedagogical and individual factors, with positive e-learning experience linked closely to various supports. This paper reinforces previous studies showing nurses' expanding role across general practice teams and reports on some of the challenges of e-learning. Merely providing practice nurses with necessary information via web-based learning systems does not ensure successful learning or progress toward improving health outcomes for patients. [ABSTRACT FROM AUTHOR]

A qualitative study was conducted to explore in-depth issues relating to the health costs of chronic illness as identified in a previous study. A key theme that emerged from interviews carried out was the benefits and challenges of private health insurance (PHI) membership, and choices older Australians with multimorbidity make in accessing health services, with and without PHI. This is the focus of this paper. Semistructured interviews were conducted with 40 older people with multiple chronic conditions. Data were analysed using content analysis. Key motivators for maintaining PHI included: fear of an inability to access timely health care; the opportunity to exercise choice in service provider; a belief of being 'better off' both medically and financially, which was often ill-founded; and the core values of self reliance and independence. Most described financial pressure caused by rising PHI premiums as well as other out-of-pocket health related expenses. Many older people who can ill afford PHI still struggle to maintain it, potentially at the cost of their quality of life, based on beliefs about costs of health care that they have never properly assessed. The findings highlight the degree to which people whose resources are constrained are prepared to go to maintain access to private hospital care. Attention should be given to assisting older people to make informed and valid choices of health insurance derived from the facts, rather than being based on fear and assumptions. [ABSTRACT FROM AUTHOR]

This paper discusses a health promotion intervention that sets out to develop local capacity to address chronic disease risk factors in a remote Australian community. Community focus groups, and researcher and community discussions, aimed to determine the community's health concerns and build a partnership for community action. The journey from conception to reality was difficult for a number of reasons that are described here. Despite these difficulties, a range of outcomes included the establishment of an organisational structure that involved a local health promotion committee as the principal decision-maker the establishment of a grants scheme to support locally determined initiatives and the formal incorporation of a community Health Promotion Committee (HPC) that ensured the sustainability of activities beyond the funded project period. The HPC is still coordinating health promotion activities. The promotion of community ownership of health promotion activities is a complicated process, given that time, resources, expertise and community involvement require a much longer-term commitment than that currently imposed by many funding bodies. [ABSTRACT FROM AUTHOR]

Objectives. To describe current and planned processes and outcome measures to address implementation of the six end-of-life actions in the National Safety and Quality Health Service (NSQHS) Standards (2nd edn) and explore associated barriers and enablers. Methods. This study used an exploratory mixed methods national survey of acute healthcare facilities between September 2018 and March 2019. This study involved public and private facilities (N = 765) that provided end-of-life care, which are required to be accredited to the NSQHS Standards. Participants include those responsible for reporting implementation of end-of-life care actions at a facility providing end-of-life care. Participants were asked what processes and outcome measures were implemented or being planned to address the end-of-life care actions, and the associated barriers and enablers. Results. Fifty respondents (6.5% response rate) from across Australia contributed data, reporting greater confidence in addressing Actions 5.16: Clinicians have access to Specialist Palliative Care Services; 5.17: Advance care plans can be received from patients and stored in medical records; and 5.18: Supervision and support is available for workforce providing end-of-life care. Barriers associated with the actions that were the most challenging to address included: competing clinical priorities, and insufficient resources to provide best practice end-of-life care; and the burdensome nature of conducting audits. Enablers included: (1) local, jurisdictional, and national strategic plans and policies; (2) support from Specialist Palliative Care Services; (3) access to resources and data; (4) standardised approaches to implementation and measuring outcomes; and (5) clinician, consumer and community engagement and education on end-of-life care. Conclusion. Enablers and barriers in implementing the six end-of-life care actions were identified. Respondents reported that high-level support and direction, system-wide approaches, practical clinical support, and widespread community and clinician engagement would enable their facility to better address the end-of-life actions. [ABSTRACT FROM AUTHOR]

Reforms that grow the capabilities of the health workforce are critical to improving outcomes for populations residing in rural and remote areas of Australia. Nurses are central to improving the accessibility of health care for populations in these areas. The Australian Government's recent release of The National Rural and Remote Nursing Generalist Framework 2023-2027 is timely for identifying opportunities to strengthen the rural and remote nursing workforce. Further consideration of how the nursing workforce can be supported to translate aspects of the framework into practice is required. To achieve this, it is necessary to identify strategies to support registered nurses to develop capabilities stipulated within the framework. A logical vehicle for this translation is through the continued support of the Australian Government's Rural Health Multidisciplinary Training program, which includes an established network of 19 University Departments of Rural Health. Leveraging from this national network that is geographically expansive and has a long-term strategic impetus for growing the rural and remote nursing workforce, provides an opportunity for translating aspects of the framework at a national scale. [ABSTRACT FROM AUTHOR]

Objective. The processes of research ethics and research governance are core to the conduct of research in health. Each aims to facilitate research that is both ethical and practical in order to produce new knowledge about the health system and improve the lives of those who use it. However, our experience has demonstrated that the process of obtaining ethical approval for a low-risk and low-resource research project was severely confounded by the multiple layers of research governance in operation at hospitals in Queensland (Qld) and New South Wales (NSW). Methods. We analysed our own experience of gaining research governance approval with the aim of improving governance processes for multicentre research projects. Our project aimed to interview and survey one person at each of 57 hospitals in NSW and 18 in Qld. We recorded and compared the steps, documents and time-frame related to research governance approval at each of these research sites. Results. We found that the progress of our project was significantly impeded by the multiple steps related to research governance processes in hospitals. Research governance approval took an average of 160 days in NSW and 316 in Qld. There was inconsistency between hospitals regarding documentation and significant duplication of documentation already approved through ethical review processes. The necessity for separate research contracts for all Qld research sites also added to research delays. Conclusion. Based on our experiences we make recommendations about changes to research governance including clarification of responsibility, reform of areas of duplication and inconsistency, time limitations for approval and, in Qld, reform of financial and legal oversight. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to assess the unmet need for palliative and other end-of-life care, as well as the sociodemographic and diagnostic factors associated with suboptimal access, among residents in an Australian region. Methods. A cross-sectional descriptive and analytical study was performed using non-identifiable linked data from four administrative and two clinical datasets. The study population comprised 3175 patients aged 15 years who died in hospital in 2016 and 2017. The main outcome measures were the proportion of decedents potentially benefitting from endof- life care and receiving end-of-life care. Results. An estimated 74.8% of decedents needed palliative or other end-of-life care in the year before death. Approximately 13.3% did not receive any end-of-life care despite its potential benefit. The highest proportions with 'unmet need' were decedents with chronic obstructive pulmonary disease (31.0%) and heart failure (26.3%). Adjusting for sociodemographic and diagnostic factors, access was lowest among those aged,65 years (adjusted odds ratio (aOR) 0.44; 95% confidence interval (CI) 0.31-0.64) and those with heart failure (aOR 0.58; 95% CI 0.47-0.72). Conclusions. Estimates of need and access provide a sound basis for planning local palliative and end-of-life care services. These methods can be used on an ongoing basis to monitor service delivery. [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]

Considerable research has been undertaken over the past two decades to apply remote sensing to the study of fire regimes across the savannas of northern Australia. This work has focused on two spatial scales of imagery resolution: coarse-resolution NOAA-AVHRR imagery for savanna-wide assessments both of the daily distribution of fires ('hot spots'), and cumulative mapping of burnt areas ('fire-scars') over the annual cycle; and fine-resolution Landsat imagery for undertaking detailed assessments of regional fire regimes. Importantly, substantial effort has been given to the validation of fire mapping products at both scales of resolution. At the savanna-wide scale, fire mapping activities have established that: (1) contrary to recent perception, from a national perspective the great majority of burning in any one year typically occurs in the tropical savannas; (2) the distribution of burning across the savannas is very uneven, occurring mostly in sparsely settled, higher rainfall, northern coastal and subcoastal regions (north-west Kimberley, Top End of the Northern Territory, around the Gulf of Carpentaria) across a variety of major land uses (pastoral, conservation, indigenous); whereas (3) limited burning is undertaken in regions with productive soils supporting more intensive pastoral management, particularly in Queensland; and (4) on a seasonal basis, most burning occurs in the latter half of the dry season, typically as uncontrolled wildfire. Decadal fine-resolution fire histories have also been assembled from multi-scene Landsat imagery for a number of fire-prone large properties (e.g. Kakadu and Nitmiluk National Parks) and local regions (e.g. Sturt Plateau and Victoria River District, Northern Territory). These studies have facilitated more refined description of various fire regime parameters (fire extent, seasonality, frequency, interval, patchiness) and, as dealt with elsewhere in this special issue, associated ecological assessments. This paper focuses firstly on the patterning of contemporary fire regimes across the savanna landscapes of northern Australia, and then addresses the implications of these data for our understanding of changes in fire regime since Aboriginal occupancy, and implications of contemporary patterns on biodiversity and emerging greenhouse issues. [ABSTRACT FROM AUTHOR]

Diet is central to the management of type 2 diabetes (T2D) and better outcomes are achieved when the dietary intervention is delivered by a dietitian. Yet, many people with T2D never see a dietitian. It has been proposed that doctors prefer to provide the dietary advice themselves or rely on medication to treat their patients instead of referring them to a dietitian. This study aimed to collect the opinions and perspectives of doctors with regard to the dietary management of people with T2D in Australia. GPs and physicians treating people with T2D were recruited to participate in semistructured interviews conducted over the telephone. Inductive thematic analysis of content was conducted. Five GPs and seven physicians participated in the study. The qualitative analysis identified four main themes: the importance and role of diet in the management of T2D; the perceived value of dietetic care; access to dietetic services; and patients' motivation to consult a dietitian. All participants acknowledged the importance of diet in the treatment of T2D and all but one preferred to refer patients to a dietitian for nutritional management. Among the reported barriers to accessing dietetic services were: specialist physicians' lack of access to the national referral scheme for chronic conditions; patients' financial circumstances; and inadequacy of the number of subsidised sessions. It is important to facilitate and subsidise access to dietetic services through existing mechanisms by increasing the number of visits on the chronic disease management scheme and providing referral rights to specialist physicians. [ABSTRACT FROM AUTHOR]

Background HIV pre-exposure prophylaxis (PrEP) has been rapidly implemented in Australia, initially through restricted access in demonstration studies, and then through prescribing across sexual health clinics and general practice settings. In 2018, PrEP was publicly subsidised for people with Medicare (universal health insurance for citizens, permanent residents and those from countries with reciprocal arrangements). There is little research examining the experiences of PrEP providers in Australia, and existing research has been primarily conducted before public subsidy.Methods: In this qualitative study, we examine the challenges that have emerged for PrEP-providing clinicians after public subsidy for PrEP was introduced. We conducted 28 semi-structured interviews in 2019-20 with PrEP providers in two Australian states, and analysed data thematically. Participants included general practitioners (GPs), sexual health nurses and sexual health physicians.Results: Sexual health services have been reconfigured to meet changing patient demand, with an emphasis on ensuring equitable financial access to PrEP. Restrictions to nurse-led PrEP frustrated some participants, given that nurses had demonstrated competence during trials. GPs were believed to be less effective at prescribing PrEP, but GP participants themselves indicated that PrEP was an easy intervention, but difficult to integrate into general practice. Participants expressed discomfort with on-demand PrEP.Conclusions: Our findings indicate that supporting ways for patients without Medicare to access PrEP inexpensively, advocating for nurse-led PrEP, and developing guidelines adapted to general practice consultations could ensure that PrEP is delivered more effectively and equitably. Additionally, PrEP providers require encouragement to build confidence in providing on-demand PrEP. [ABSTRACT FROM AUTHOR]

Adolescence is often a time when risk-taking behaviours emerge and attendance at primary health care is low. School-based health services can serve to improve access to health care. Clinicians play a key role in improving adolescents' health literacy and capacity to make informed care decisions. Australia's national digital health record, My Health Record (MHR), has posed significant challenges for both clinicians and adolescents in understanding impacts on patient privacy. Guidance is required on how best to communicate about MHR to adolescents. This exploratory qualitative study aims to examine adolescents' understanding of MHR, clinicians' knowledge of MHR and their use of MHR with adolescents. Focus groups with students, school health and well-being staff and semistructured interviews with GPs and nurses were undertaken in one regional and one urban secondary school-based health service in Victoria. Transcripts from audio recorded sessions were examined using thematic analysis. Resulting themes include minimal understanding and use of MHR, privacy and security concerns, possible benefits of MHR and convenience. The results suggest opportunities to address gaps in understanding and to learn from adolescents' preferences for digital health literacy education. This will support primary care clinicians to provide best-practice health care for adolescents. Adolescents face increasingly complex challenges in navigating health care in the digital age. Adolescence is also the time when many risk-taking behaviours emerge and attendance at primary health care is low. This study explored the awareness and use of a national digital health record by Australian adolescents and clinicians in school-based health services. We identified privacy and security concerns, gaps in understanding and direct benefits that can guide digital health literacy. [ABSTRACT FROM AUTHOR]

Background Patient-delivered partner therapy (PDPT) is a method for an index patient to give treatment for genital chlamydia to their sexual partner(s) directly. In Australia, PDPT is considered suitable for heterosexual partners of men and women, but is not uniformly endorsed. We explored the policy environment for PDPT in Australia and considered how PDPT might become a routine option.Methods: Structured interviews were conducted with 10 key informants (KIs) representing six of eight Australian jurisdictions and documents relevant to PDPT were appraised. Interview transcripts and documents were analysed together, drawing on KIs' understanding of their jurisdiction to explore our research topics, namely the current context for PDPT, challenges, and actions needed for PDPT to become routine.Results: PDPT was allowable in three jurisdictions (Victoria, New South Wales, Northern Territory) where State governments have formally supported PDPT. In three jurisdictions (Western Australia, Australian Capital Territory, Tasmania), KIs viewed PDPT as potentially allowable under relevant prescribing regulations; however, no guidance was available. Concern about antimicrobial stewardship precluded PDPT inclusion in the South Australian strategy. For Queensland, KIs viewed PDPT as not allowable under current prescribing regulations and, although a Medicine and Poisons Act was passed in 2019, it is unclear if PDPT will be possible under new regulations. Clarifying the doctor-partner treating relationship and clinical guidance within a care standard were viewed as crucial for PDPT uptake, irrespective of regulatory contexts.Conclusion: Endorsement and guidance are essential so doctors can confidently and routinely offer PDPT in respect to professional standards and regulatory requirements. [ABSTRACT FROM AUTHOR]

Many Australian adults with type 2 diabetes mellitus (T2DM) do not follow recommended self-management behaviours that could prevent or delay complications. This exploratory study aimed to investigate the factors influencing self-management of T2DM in general practice. Semi-structured qualitative interviews were conducted with patients with T2DM (n = 10) and their GPs (n = 4) and practice nurses (n = 3) in a low socioeconomic area of Sydney, New South Wales, Australia. The interviews were analysed thematically using the socio-ecological model as a framework for coding. Additional themes were derived inductively based on the explicitly stated meaning of the text. Factors influencing self-management occurred on four levels of the socio-ecological model: individual (e-health literacy, motivation, time constraints); interpersonal (family and friends, T2DM education, patient-provider relationship); organisational (affordability, multidisciplinary care); and community levels (culture, self-management resources). Multi-level strategies are needed to address this wide range of factors that are beyond the scope of single services or organisations. These could include tailoring health education and resources to e-health literacy and culture; attention to social networks and the patient–provider relationship; and facilitating access to affordable on-site allied health services. [ABSTRACT FROM AUTHOR]

Accredited Exercise Physiologists (AEPs) prescribe exercise and physical activity interventions for people living with type 2 diabetes mellitus (T2DM). During initial consultations, AEPs face the challenge of collecting enough information to facilitate behaviour change and adherence to treatment recommendations. The objective of this research is to explore the initial consultation practices of AEPs with clients living with T2DM and resultant recommendations provided to clients to promote long-term adherence. This study was an exploratory descriptive qualitative study. Twenty-one AEPs who currently practice in the Townsville Region participated in focus groups or semi-structured interviews. Data were analysed using a thematic and triangulation approach. Results revealed that an interview style consultation is standard practice, which varied based on experience of the AEP. Interviewing techniques facilitating behaviour change were under-utilised, especially among less-experienced AEPs who focused on the medical information. Assessment of the psychosocial wellbeing of the client living with T2DM by AEPs was limited. AEPs recommended that group exercise sessions yielded greater success for clients adopting physical activity. It is recommended that new graduate AEPs develop greater confidence in strategies of gathering information to facilitate behaviour change in clients with T2DM. A mentorship program could ensure the continued development of new graduate AEPs through the transfer of knowledge and skills. [ABSTRACT FROM AUTHOR]

In 2016, hepatitis C direct-acting antivirals (DAAs) became available in Australia. A group of general practitioners (GPs) were surveyed twice to assess hepatitis C knowledge and management; 191/1000 (19.1%) responded at baseline, 164/938 (17.5%) at follow up. Participants' mean Knowledge score increased: baseline 5.75 (95% CI 5.61-5.91), follow up 6.09 (95% CI 5.95-6.22; P <0.01). At follow up, 36/163 (22%) had prescribed DAAs compared with 23/187 (12%) at baseline (χ2(1) = 5.95, P = 0.02); however, 67/150 (45%) were unsure of treatment eligibility for people who inject drugs. Additional support for GPs is warranted to ensure optimal hepatitis C management in primary care. [ABSTRACT FROM AUTHOR]

Many countries and health systems are pursuing integrated care as a means of achieving better outcomes. However, no standard approaches exist for comparing integration approaches across models or settings, and for evaluating whether the key components of integrated care are present in different initiatives. This study sheds light on how integrated care is being implemented in Australia, using a new tool to characterise and compare integration strategies at micro, meso and macro levels. In total, 114 staff from a purposive sample of 38 integrated care projects completed a survey based on the Rainbow Model of Integrated Care. Ten key informants gave follow-up interviews. Participating projects reported using multiple strategies to implement integrated care, but descriptions of implementation were often inconsistent. Micro-level strategies, including clinical-professional service coordination and person-centred care, were most commonly reported. A common vision was often described as an essential foundation for joint work. However, performance feedback appeared under-utilised, as did strategies requiring macro-level action such as data linkages or payment reform. The results suggest that current integrated care efforts are unevenly weighted towards micro-level strategies. Increased attention to macro-level strategies may be warranted in order to accelerate progress and sustain integrated care in Australia. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Delays in access to affordable medicines: putting policy into perspective" in the 2012 issue of this periodical, "Australian Health Review," is presented.

Objective. The aim of the present study was to develop a positive organisational scholarship in health care approach to health management, informed by health managers and health professionals' experiences of brilliance in health care delivery. Methods. A sample of postgraduate students with professional and/or management experience within a health service was invited to share their experiences of brilliant health services via online discussions and a survey running on the SurveyMonkey platform. A lexical analysis of student contributions was conducted using the individual as the unit of analysis. Results. Using lexical analysis, the examination of themes in the concept map, the relationships between themes and the relationships between concepts identified 'care' as the most important concept in recognising brilliance in health care, followed by the concepts of 'staff' and 'patient'. Conclusions. The research presents empirical material to support the emergence of an evidence-based health professional perspective of brilliance in health management. The findings support other studies that have drawn on both quantitative and qualitative materials to explore brilliance in health care. Pockets of brilliance have been previously identified as catalysts for changing health care systems. Both quality, seen as driven from the outside, and excellence, driven from within individuals, are necessary to produce brilliance. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods. The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results. Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion. Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the present study was to assess the relationship between and the effect of the 4-h target or National Emergency Access Target (NEAT) on the time-to-analgesia (TTA), as well as the provision of analgesia in an adult emergency department (ED). Methods. The present study was a pilot descriptive explorative retrospective cohort study conducted in a public metropolitan ED. Eligible presentations for analysis were adults presenting with a documented pain score of ≥4 out of 10 between 1 and 14 September 2014. Triage Category 1, pregnant, chest pain and major trauma cases were excluded from the study. As a result, data for 260 patients were analysed. Results. Of 260 patients, 176 had analgesia with a median TTA of 49 min. Increased NEAT compliance did not significantly decrease TTA. However, when the factors that affected the provision of analgesia were analysed, an association was demonstrated between Admitted and Short Stay NEAT performance and the provision of analgesia. The likelihood of receiving analgesia at all increased as Admitted and Short Stay NEAT compliance improved. Conclusion. NEAT is a significant health policy initiative with little clinical evidence supporting its implementation. However, as the Admitted NEAT compliance increases, the probability of receiving analgesia increases, demonstrating a possible link between hospital function and clinical care provision that needs to be explored further. [ABSTRACT FROM AUTHOR]

Rural primary care services have the potential to play a major role in reducing the gap in cardiovascular disease (CVD) outcomes between rural and metropolitan Australians, particularly in men at high risk of CVD. The aim of this study was to explore the self-reported behaviours and satisfaction with their general practice/practitioner of men at high risk of CVD, and attitudes of rural primary care clinicians regarding the role of primary care in CVD prevention. This observational research was addressed through survey questionnaires with rural men at high risk ofCVDand semi-structured interviews with rural primary care clinicians. Fourteen rural primary care practices from towns with populations less than 25 000 participated. One hundred and fifty-eight high-risk men completed the questionnaire. Their responses demonstrated poorly controlled risk factors despite a willingness to change. Alternatively, rural primary care clinicians (n = 20) reported that patients were unlikely to change and that illness-based funding models inhibited cardiovascular preventive activities. Australians living in rural areas have worse CVD outcomes. In addition, there is a disparity in the assumptions of health providers and male patients at high risk of CVD in rural areas. This necessitates innovative rural primary care models that include a blended payment system that incentivises or funds preventive care alongside an emphasis on lifestyle advice, as well as an explicit strategy to influence clinician and patient behaviour to help address the disparity. [ABSTRACT FROM AUTHOR]

Background Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission.Methods: Baseline CT and NG laboratory data (2009-2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of individuals re-tested after an initial CT or NG diagnosis at <2 months (not recommended), 2-4 months (recommended) and 5-12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used.Results: There was a total of 2054 people diagnosed with CT and/or NG in the study period; 14.9% were re-tested at 2-4 months, 26.9% at 5-12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2-4-month (16.9% v. 11.5%, P<0.01) and 5-12-month (28.9% v. 23.5%, P=0.01) periods. Women aged 25-29 years had a significantly higher level of re-testing 5-12 months post-diagnosis than females aged 16-19 years (39.8% v. 25.4%, P<0.01). There was a total of 858 people re-tested at 2-12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P<0.01).Conclusions: Just under half the individuals diagnosed with CT or NG were re-tested at 2-12 months post-diagnosis; however, only 15% were re-tested in the recommended time period of 2-4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics. [ABSTRACT FROM AUTHOR]

The author calls on the conservation readership to produce papers on introduced birds. He enumerates the reasons for research on introduced birds including their frequent occurrence in suburban habitats and because of the perception that they are less interesting biologically. The author also includes an idea for an online competition ran by the Australian Broadcasting Corporation to find a new national mascot in Australia.

Objective. The aim of the present study was to develop, implement and explore the effects of a program in advance care planning (ACP) within a tertiary hospital general medicine service. Methods. Before-after exploratory mixed-methods analysis was conducted of an ACP program comprising seven components designed to overcome well-documented barriers to ACP in clinical practice. The results of pre-ACP program audits performed in June 2014 were compared with those of post-ACP audits performed over 5 months from July to November 2014. The main outcome measure was the number of advance care plans completed in patients considered eligible for ACP based on a life expectancy of 12 months or less as assessed by two prognostication instruments. Questionnaire surveys ascertained staff perceptions of ACP and the usefulness of training and resources in ACP. Results. Pre-ACP program analysis of 166 consecutive patients deemed eligible for ACP revealed that only 1% had a documented advance care plan. Following ACP implementation, 115 of 215 (53%) potentially eligible patients were considered able to participate in ACP discussions and were approached to do so before discharge, of whom 89 (77.4%) completed an advance care plan, whereas 26 (23.6%) declined. This equated to an overall completion rate for all potentially eligible patients of 41% compared to 1% pre-ACP (P < 0.001). Major barriers to ACP perceived by at least 30% of questionnaire respondents included the reluctance of patients and family to discuss ACP, insufficient time to initiate or complete ACP, patient and/or family factors that rendered ACP impractical, inadequate communication skills around end-of-life issues, confusion about who was primarily responsible for conducting ACP and difficulty using ACP documentation forms. Enabling factors included dedicated ACP workshops, facilitator and resource packages for staff, and ACP brochures for patients and family. Conclusion. A multifaceted ACP program in a general medicine service led to completion of an advance care plan in more than three of four patients considered eligible for, and who participated in, ACP. However, although program components were tailored to overcome known barriers to ACP, staff indicated ongoing difficulties, with less than half of ACP-eligible patients completing advance care plans. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Long-acting reversible contraceptives are an effective means of preventing unwanted pregnancies and associated negative consequences. The Sexual Health and Family Planning Association of Australia has called for efforts to address barriers to the uptake of long-acting reversible contraceptives (LARCs) in Australia, where LARC uptake is thought to be low, though comprehensive data describing use and associated factors is scarce. The aims of this study were to describe patterns of prescriptions for the etonogestrel-releasing subdermal implant (SDI) in Australia, 2008-2012, and associated factors.Methods: Records of prescriptions written through Australia's Pharmaceutical Benefits Scheme from 2008 to 2012 were obtained, including patient age and geographic location. Direct, age-standardised rates (ASR) of prescriptions were calculated for each year and location, with multivariate analysis used to examine associations between prescription rates and patient age, location and proximity to family planning clinics (FPC) or Aboriginal Medical Services (AMS).Results: ASR of prescriptions rose ~6% per year (OR 1.06, 95%CI: 1.05-1.06) from 13.05 per 1000 (2008) to 15.76 per 1000 (2012; P<0.01). Rates were highest among 15- to 19-year-olds, increasing from 20.81 (2008) to 29.09 per 1000 (2012: P<0.01) and lowest among 45- to 49-year-olds, increasing from 3.37 to 3.73 per 1000 (P<0.01). ASR by location were significantly higher in regional than metropolitan areas.Conclusions: This is the first analysis of SDI prescriptions across all ages and regions of Australia. Uptake of SDI in Australia is increasing but remains low. Significant associations were found between prescription rates and patient age and residence in regional/remote areas. [ABSTRACT FROM AUTHOR]

Unlabelled: Background We aimed to determine the impact of a chlamydia (Chlamydia trachomatis) education program on the knowledge of and attitudes towards chlamydia testing of practice nurses (PNs).Methods: A cross-sectional survey was conducted at baseline and 6-12 months following recruitment with PNs in the Australian Chlamydia Control Effectiveness Pilot. Likert scales were analysed as continuous variables (scores), and t-tests were used to assess changes in mean scores between survey rounds and groups.Results: Of the 72 PNs who completed both surveys, 42 received education. Epidemiology knowledge scores increased significantly between surveys in the education group (P<0.01), with change in knowledge being greater in the education group compared with the non-education group (P<0.01). Knowledge of recommended testing scenarios (P=0.01) and retesting following treatment (P<0.01) increased in the education group. Attitudes to testing scores improved over time in the education group (P=0.03), with PNs more likely to want increased involvement in chlamydia testing (P<0.01). Change in overall attitude scores towards testing between surveys was higher in the education group (P=0.05). Barriers to chlamydia testing scores also increased in the education group (P=0.03), with change in barriers greater in the education vs the non-education group (P=0.03).Conclusion: The education program led to improved knowledge and attitudes to chlamydia, and could be made available to PNs working in general practice. Future analyses will determine if the education program plus other initiatives can increase testing rates. [ABSTRACT FROM AUTHOR]