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There is an urgent and unmet need for specialist palliative care services in residential aged care. The Specialist Palliative Care in Aged Care (SPACE) Project aimed to improve palliative and end-of-life care for older people living in residential aged care facilities in Queensland. A representative working group developed a series of service principles around palliative care practice in aged care (comprehensive resident-focused care, streamlined service, and capacity building). Funding was allocated by population to the health services in Queensland to adapt and implement models of care aligned with these principles. SPACE successfully implemented a variety of decentralised models of care across Queensland. The critical elements for the success of SPACE were the use of an expert working group to define the core innovation, networking and implementation support from the central project team and community of practice, and adaptable models of care led by local facilitators. Lessons learned from this real-world case study could be adopted to guide and ensure the successful implementation and sustainability of future complex interventions in healthcare settings, both nationally and internationally. What is known about the topic? There is limited palliative care support for the 36% of Australians who die in residential aged care. What does this paper add? This paper describes the development of the Specialist Palliative Care in Aged Care (SPACE) Project, using locally tailored models of care to improve palliative and end-of-life care in aged care facilities across Queensland. What are the implications for practitioners? Critical elements for improving residents' palliative and end-of-life care included creation of an expert working group to define the innovation state-wide, a central project team that supported implementation, a community of practice, and local facilitation. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac rehabilitation (CR) provides evidence-based secondary prevention for people with heart disease (HD) (clients). Despite HD being the leading cause of mortality and morbidity, CR is under-utilised in Australia. This research investigated healthcare systems required to improve access to CR in rural and remote areas of North Queensland (NQ). Methods: A qualitatively dominant case study series to review management systems for CR in rural and remote areas of NQ was undertaken. Data collection was via semi-structured interviews in four tertiary hospitals and four rural or remote communities. An audit of discharge planning and CR referral, plus a review of community-based health services, was completed. An iterative and co-design process including consultation with healthcare staff and community members culminated in a systems-based model for improving access to CR in rural and remote areas. Results: Poorly organised CR systems, poor client/staff understanding of discharge planning and low referral rates for secondary prevention, resulted in the majority of clients not accessing secondary prevention, despite resources being available. Revised health systems and management processes were recommended for the proposed Heart: Road to health model, and given common chronic diseases risk factors it was recommended to be broadened into Chronic disease: Road to health. Conclusion: A Chronic disease: Road to health model could provide effective and efficient secondary prevention for people with chronic diseases in rural and remote areas. It is proposed that this approach could reduce gaps and duplication in current healthcare services and provide flexible, client-centred, holistic, culturally responsive services, and improve client outcomes. What is known about the topic? Cardiac rehabilitation is known to improve health outcomes and reduce hospitalisations, but referrals and attendance are low (30%). What does this paper add? A revised systems-based model for improved access to secondary prevention for people with heart and related chronic diseases in rural and remote areas of North Queensland is proposed: Chronic disease: Road to health. What are the implications for practitioners? A functional system from hospitalisation to local healthcare services has been designed to improve access to secondary prevention. Staff require support and education to improve skills, better manage care and improve job satisfaction. [ABSTRACT FROM AUTHOR]

Background: Cross-sectoral collaborations are considered necessary to address detrimental health, social, educational and economic outcomes that impact marginalised and disadvantaged populations. There is a strong relationship between the health of children and their educational attainment; good health promotes positive learning. This paper reports cross-sectoral executive and senior management level systems changes required to enable the design of a collaborative primary healthcare service model for children and young people in rural Australia. Methods: A descriptive qualitative design was used. Data were collected from executive and senior managers from three organisations (Education, Health and a University Department of Rural Health [ n = 6]) through individual semi-structured interviews. Data were analysed using an inductive, thematic approach. The study draws on Lewin's Model of Change. Results: Three overarching themes were generated from the data: an embedded challenge and experimental solutions; building a shared language and understanding; and the role of relationships and trust. Despite the unique geographical and social context of the study area, strategies emerged from the data on how a solution to an embedded challenge, through design of a primary healthcare model, was established and how the strategies described could be transferred and scaled to other rural and remote communities. Conclusion: Contextual differences make each rural and remote area unique. In this study, strategies that are described in the managing change literature were evident. The authors conclude that drawing on strong management of change principles could mean that a service model designed for one remote community might be transferrable to other communities. There is a strong relationship between children's health and their educational attainment. Poorer health, educational and social attainment are experienced by children and young people residing within the study area. Despite unique geographical contexts and demography, strategies that align strong leadership and effective management of change across three organisations were key and may make it possible to transfer a primary health care model designed to improve health and education outcomes for children and young people to other rural and remote communities. [ABSTRACT FROM AUTHOR]

Objective: To explain how the Primary Health Network commissioning model works, and factors likely to affect its success. Methods: The study focuses on the delivery of primary healthcare services by one Primary Health Network (PHN) in Australia. The qualitative case study is informed by a desk top review, interviews (n = 49) and observations with key stakeholders involved in commissioning and delivering primary healthcare services in the region. Results: The study provides several insights about the PHN model. First, conceptually, the PHN commissioning model is well suited to identifying and meeting local primary healthcare priorities, bringing together a range of stakeholders involved in healthcare provision. Second, although primary healthcare services are difficult to specify and measure, PHN staff use their content knowledge and experience, and relationships with providers and the community, to design services that meet the needs of consumers. Third, the success of this model may be undermined by short funding cycles and short lead-times, a focus on national rather than local priorities, and continual reductions in operational funding. This may result in more procedural forms of contract management, which may mean that changes in service need, provision and quality go unnoticed. Conclusions: This study shows that although clever in design, the PHN model may not meet its full potential. Given continual changes to the model, including funding, further independent research should be undertaken to understand how PHNs adjust and whether services continue to meet the needs of the local community. What is known about the topic? Primary Health Networks commission a range of services. Little is known about how the commissioning model works and what enables its success. What does this paper add? While elements of an effective model exist, this paper finds that the its effectiveness is contingent on stability, funding cycles, and sufficient resources to manage contracts. What are the implications for practitioners? This paper identifies the risks to the effective implementation of commissioning and how they may be addressed. [ABSTRACT FROM AUTHOR]

Objective: Clinicians across all health professions increasingly strive to add value to the care they deliver through the application of the central tenets of people-centred care (PCC), namely the 'right care', in the 'right place', at the 'right time' and 'tailored to the needs of communities'. This ideal is being hampered by a lack of a structured, evidence-based means to formulate policy and value the commissioning of services in an environment of increasing appreciation for the complex health needs of communities. This creates significant challenges for policy makers, commissioners and providers of health services. Communities face a complex intersection of challenges when engaging with healthcare. Increasingly, complexity is gaining prominence as a significant factor in the delivery of PCC. Based on the World Health Organization (WHO) components of health policy, this paper proposes a policy framework that enables policy makers, commissioners and providers of health care to integrate a model of complexity into policy, subsequent service planning and development of models of care. Methods: The WHO components of health policy were used as the basis for the framework. Literature was drawn on to develop a policy framework that integrates complexity into health policy. Results: Within the framework, complexity is juxtaposed between the WHO components of 'vision', 'priorities' and 'roles'. Conclusion: This framework, supported by the literature, provides a means for policy makers and health planners to conduct analyses of and for policy. Further work is required to better model complexity in a manner that integrates consumer needs and provider capabilities. What is known about the topic?: There is a growing body of evidence regarding patient complexity and its impact on the delivery of health services, but there is little consideration of patient complexity in policy, which is an important consideration for service provision. What does this paper add?: This paper presents an argument for the inclusion of patient complexity in health policy and provides a framework for how that might occur. What are the implications for practitioners?: The inclusion of patient complexity in policy could provide a means for policy makers to consider the factors that contribute to patient complexity in service provision decisions. [ABSTRACT FROM AUTHOR]

There is a growing population of people from refugee backgrounds settling in Australia. They have often been forced to flee from their homes in violent circumstances and may have spent many years in refugee camps with poor health support. There are multiple barriers to their effective access to health services. Community engagement with this community can be tokenistic and difficult to effect. This paper highlights the importance of developing a meaningful strategy for community engagement that is not 'one-size-fits-all', which is achieved over time. There is a rich resource available to health practitioners if engagement with refugee-background communities is managed according to the set of trauma-informed and structural principles outlined in this paper. [ABSTRACT FROM AUTHOR]

The Rohingya community living in the City of Canterbury-Bankstown in Sydney have been identified as a priority population with complex health needs. As part of ongoing work, AU$10 000 was provided to the community to address important, self-determined, health priorities through the Can Get Health in Canterbury program. Program staff worked with community members to support the planning and implementation of two community-led events: a soccer (football) tournament and a picnic day. This paper explores the potential for this funding model and the effect of the project on both the community and health services. Data were qualitatively analysed using a range of data sources within the project. These included, attendance sheets, meeting minutes, qualitative field notes, staff reflections and transcripts of focus group and individual discussions. This analysis identified that the project: (1) enabled community empowerment and collective control over funding decisions relating to their health; (2) supported social connection among the Australian Rohingya community; (3) built capacity in the community welfare organisation –Burmese Rohingya Community Australia; and (4) enabled reflective practice and learnings. This paper presents an innovative model for engaging with refugee communities. Although this project was a pilot in the Canterbury community, it provides knowledge and learnings on the engagement of refugee communities with the health system in Australia. The Rohingya Little Local provides an innovative model for engaging with marginalised communities. Although this project was a pilot, it provides knowledge and learnings on the engagement of refugee communities with the health system in Australia. This model is a promising and pragmatic approach to support community-led projects within place-based interventions. [ABSTRACT FROM AUTHOR]

Objective: Collaborative practice is critical to optimising patient outcomes in contemporary healthcare settings. Evidence suggests interprofessional learning is an effective way to develop teamwork capabilities, yet these skills are traditionally developed in professional silos, or not at all. This study evaluated the implementation of a team development program, the Team Management Systems (TMS) program, for allied health staff within a large metropolitan health service. Methods: A mixed-methods audit–quality improvement study was conducted, using Kirkpatrick's four-level evaluation model to structure evaluation of the program. Semistructured questionnaire and workforce survey data were retrieved immediately, 6 months and 1–2 years after training and applied to each level of the model (Reaction, Learning, Behaviour, Results). Results: In all, 886 staff participated in the TMS program from 2014 to 2018. High satisfaction with the program was observed. Knowledge of what constitutes effective teamwork improved significantly (P = 0.008) in TMS participants compared with a matched untrained cohort. Participants reported positive behaviour change and continued engagement with TMS principles 6 months after training. Perceived impact of the program on patient and/or organisational outcomes was evident, although less compelling than the changes to knowledge and behaviour. Conclusions: The TMS program yielded positive effects on staff satisfaction, knowledge, team dynamics and team behaviours. These findings demonstrate the significant value of such initiatives to enhance the capability and effectiveness of interdisciplinary healthcare teams. What is known about the topic?: Complex conditions, increasing comorbidities, specialisation and scarcity of resources mean healthcare workers need to work effectively in teams to achieve quality, safe, person centred patient care. There is some evidence of the effect of teamwork initiatives on knowledge or behaviour in specific clinical specialities, single services or single professions, but limited research is available regarding the effects of teamwork programs across multiple professions, including allied health professions, and on patient and organisational outcomes. What does this paper add?: This paper describes the effect of a large-scale teamwork program implemented across multiple professions, including enablers and barriers. It presents outcomes at all four levels of Kirkpatrick's evaluation model, including the less studied behaviour and results levels. What are the implications for practitioners?: This paper supports health service leaders to consider developing and implementing interprofessional teamwork programs to foster essential teamwork capabilities. Learning together about teamwork, across professional silos, will lead to collaborative, patient-centred care, which leads to safe, quality patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To describe the implementation of a model of integrated care for chronic disease in Western Sydney. This model was established on the basis of a partnership between the Local Health District and the Primary Health Network. Methods: The Western Sydney Integrated Care Program (WSICP) focuses on people with type 2 diabetes, chronic obstructive pulmonary disease and coronary artery disease or congestive cardiac failure. We describe the design of the program, the processes involved and some of the challenges and barriers to integration. Results: Early data indicate a high uptake of services, with some evidence of a reduction in hospital admissions and presentations to the emergency department. Conclusion: A model of integrated care has been successfully implemented and embedded into local practices. Preliminary data suggest that this is having an impact on the utilisation of hospital services. What is known about the topic?: There is evidence that integrated models can improve cost-effectiveness and the quality of clinical care for people with chronic disease. However, most integrated models are small scale, focus on very specific populations and generally do not engage both primary care and acute hospitals. What does this paper add?: This paper describes an effective partnership between state-funded hospital services in the WSLHD and the federally funded local Primary Health Network (PHN) of general practitioners. The paper outlines the design of the program and the structural, governance and clinical steps taken to embed integrated care into everyday clinical practice. In addition, preliminary results indicate a reduction in the use of hospital services by people who have received integrated care services. What are the implications for practitioners?: Involvement of both primary care and the public hospital system is important for a successful and sustainable integrated care program. This is a long and challenging process, but it can lead to positive effects not just for individuals, but also for the health system as a whole. [ABSTRACT FROM AUTHOR]

Objective: There is an impetus for the timely diagnosis of dementia to enable optimal management of patients, carers and government resources. This is of growing importance in the setting of a rising prevalence of dementia in an aging population. The Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referral to comprehensive memory services for dementia diagnosis, but in practice many patients may be diagnosed in other settings. The aim of the present study was to obtain evidence of the roles, effectiveness, limitations and accessibility of current settings and services available for dementia diagnosis in Australia. Methods: A literature review was performed by searching Ovid MEDLINE using the terms 'dementia' AND 'diagnosis OR detection'. In addition, articles from pertinent sources, such as Australian government reports and relevant websites (e.g. Dementia Australia) were included in the review. Results: Literature was found for dementia diagnosis across general practice, hospitals, memory clinics, specialists, community, care institutions and new models. General practitioners are patients' preferred health professionals when dealing with dementia, but gaps in symptom recognition and initiation of cognitive testing lead to underdiagnosis. Hospitals are opportunistic places for dementia screening, but time constraints and acute medical issues hinder efficient dementia diagnosis. Memory clinics offer access to multidisciplinary skills, demonstrate earlier dementia diagnosis and potential cost-effectiveness, but are disadvantaged by organisational complexities. Specialists have increased confidence in diagnosing dementia than generalists, but drawbacks include long wait lists. Aged care assessment teams (ACAT) are a potential service for dementia diagnosis in the community. A multidisciplinary model for dementia diagnosis in care institutions is potentially beneficial, but is time and cost intensive. New models with technology allow dementia diagnosis in rural regions. Conclusion: Memory clinics are most effective for formal dementia diagnosis, but healthcare professionals in other settings play vital roles in recognising patients with dementia and initiating investigations and referrals to appropriate services. What is known about this topic?: Delays in dementia diagnosis are common, and it is unclear where majority of patients receive a diagnosis of dementia in Australia. While the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referrals to services such as memory clinics for comprehensive assessment and diagnosis of dementia, such services may have limited capacity and may not be readily accessible to all. What does this paper add?: This paper presents an overview of the various settings and services available for dementia diagnosis in Australia including evidence of the roles, accessibility, effectiveness and limitations of each setting. What are the implications for practitioners?: This concerns a disease that is highly prevalent and escalating, and highlights the roles for practitioners in various settings including general practices, acute hospitals, specialist clinics, community and nursing homes. In particular, it discusses the potential roles, advantages and challenges of dementia diagnosis in each setting. [ABSTRACT FROM AUTHOR]

Objective: In response to escalating alcohol and other drug (AOD)-related emergency department (ED) presentations, a tertiary Melbourne hospital embedded experienced AOD clinical nurse consultants in the ED on weekends to trial a model for screening, assessment and brief intervention (BI). The aim of the present study was to evaluate the relative contributions of AOD to ED presentations and to pilot a BI model. Methods: Using a customised AOD screening tool and a framework for proactive case finding, screened participants were offered a comprehensive AOD assessment and BI in the ED. Immediate effects of the intervention were evaluated via the engagement of eligible individuals and a self-administered 'intention to change' survey. Results: Over the 32-month pilot, 1100 patients completed a comprehensive AOD assessment, and 95% of these patients received a BI. The most commonly misused substances were, in order, alcohol, tobacco, amphetamine-type stimulants, gamma-hydroxybutyrate and cannabis. Thirty-two per cent of patients were found to be at risk of dependence from alcohol and 25% were found to be at risk of dependence from other substances. Forty per cent of the people assessed reported no previous AOD support or intervention. On leaving the ED, 78% of participants reported an intention to contact community support services and 65% stated they would change the way they used AOD in the future. Conclusion: This study of a pilot program quantifies the relative contribution of AOD to ED presentations and demonstrates that hospital EDs can implement a feasible, proactive BI model with high participation rates for people presenting with AOD-related health consequences. What is known about the topic?: Clinician-led BI for high-risk consumption of alcohol has been demonstrated to be effective in primary care and ED settings. However, hospital EDs are increasingly receiving people with high-risk AOD-related harms. The relative contribution of other drugs in relation to ED presentations has not been widely documented. In addition, the optimal model and effects of AOD screening and BI programs in the Australian ED setting are unknown. What does this paper add?: This paper describes a 'real-life' pilot project embedding AOD-specific staff in a metropolitan Melbourne ED at peak times to screen and provide BI to patients presenting with AOD-related risk and/or harms. The study quantifies the relative contribution of other drugs in addition to alcohol to ED presentations and reports on this model's much higher levels of patient engagement in receiving BI than has been reported previously. What are the implications for practitioners?: This study demonstrates the relative contribution of drugs, in addition to alcohol, to ED presentations at peak weekend times. Although BI has been well proven, the pilot project evaluated herein has demonstrated that by embedding AOD-specific staff in the ED, much higher rates of patient engagement, screening and BI can be achieved. [ABSTRACT FROM AUTHOR]

Objective. Health service managers and policy makers are increasingly concerned about the sustainability of innovations implemented in health care settings. The increasing demand on health services requires that innovations are both effective and sustainable; however, research in this field is limited, with multiple disciplines, approaches and paradigms influencing the field. These variations prevent a cohesive approach, and therefore the accumulation of research findings, in the development of a body of knowledge. The purpose of this paper is to provide a thorough examination of the research findings and provide an appropriate theoretical framework to examine sustainability of health service innovation. Methods. This paper presents an integrative review of the literature available in relation to sustainability of health service innovation and provides the development of a theoretical framework based on integration and synthesis of the literature. Results. A theoretical framework serves to guide research, determine variables, influence data analysis and is central to the quest for ongoing knowledge development. This research outlines the sustainability of innovation framework; a theoretical framework suitable for examining the sustainability of health service innovation. Conclusion. If left unaddressed, health services research will continue in an ad hoc manner, preventing full utilisation of outcomes, recommendations and knowledge for effective provision of health services. The sustainability of innovation theoretical framework provides an operational basis upon which reliable future research can be conducted. What is known about the topic? Providers of health services are rapidly implementing innovations in an effort to provide effective health care. Little research has been conducted to evaluate the sustainability of these health service innovations. What does this paper add? This paper aims presents an integration and synthesis of the current body of knowledge to provide a theoretical framework to evaluate the sustainability of health service innovation. What are the implications for the practitioner? An improved body of knowledge surrounding the sustainability of health service innovations generated from research will consequently result in more appropriate use of resources and improved provision of health services. [ABSTRACT FROM AUTHOR]

Since the Productivity Commission released its research report Australia's Health Workforce in 2005, there has been a significant increase in government funding and policy capacity aimed at health workforce reform and innovation in Australia. This research paper presents the results of semistructured interviews with three key stakeholders in health policy formation in Australia: (1) The Honourable Lindsay Tanner, former Federal Minister for Finance and therefore 100% shareholder of Medibank Private on behalf of the Commonwealth; (2) The Honourable Daniel Andrews, former Victorian Minister for Health and current Victorian Opposition Leader; and (3) The Honourable Jim McGinty, former Minister for Health and Attorney General of Western Australia and current inaugural Chair of Health Workforce Australia. The paper examines key issues they identified in relation to health workforce policy in Australia, particularly where it intersects with industrial relations, and conducts a comparative analysis between their responses and theoretical methodologies of policy formation as a means of informing a reform process. [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]

Objective. The objective of this paper is to present and provide justification for a framework to improve evidence-informed management decision-making among health service managers. Three research questions informed the study: How have different perspectives influenced how evidence has been defined? What are the barriers to the practice of evidence-informed decision-making (EIDM)? What are the factors that may encourage the application of evidence to guide management decision-making processes? Methods. A literature review was conducted to identify studies that examined the practice of EIDM among health service managers. Information relevant to the three research questions was collectively analysed, compared and contrasted based on their relevance to the EIDM process. Conclusion. Several factors have played different but significant roles in affecting the practice of EIDM among health service managers. Although interaction between these factors is complex, the framework developed in this paper may guide the development of strategies to encourage and improve the utilisation of evidence in management decision-making process. What is known about the topic? EIDM has been promoted as a mechanism for improving the quality of management decisions, and hence better service delivery, effectiveness and efficiency. Previous studies have explored and discussed various factors that may affect the practice of EIDM amongst health service managers. However, a greater understanding of how these factors interact is required so that relevant strategies to promote the increased use of EIDM can be developed. What does this paper add? The paper clarifies 'evidence' from the view of both managers and members of the research community. It discusses factors that may affect the practice of EIDM among health service managers and develops a framework to for better understanding of how these factors interact and affect practice at various levels. The framework will guide the development of strategies to encourage the utilisation of evidence among health service managers. What are the implications for practitioners? To encourage the practice of evidence-informed decision-making amongst health service managers, multi-level changes in the system, organisation and individual levels are required. To maximise the benefit and relevance of research evidence, managers should be actively involved in setting research agendas and guiding the appropriate presentation of research findings to meet the needs of potential readers. [ABSTRACT FROM AUTHOR]

The article presents a list of research papers on wildfires including "A Mathematical Model for Predicting Fire Spread in Wildland Fuels," "How to Predict the Spread and Intensity of Forest and Range Fires," and "Field Procedures for Verification and Adjustment of Fire Behavior Prediction."

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: The aims of this study were to identify: (1) whether an after-hours emergency department (ED) collaborative care service using primary contact physiotherapists (PCPs) improves treatment times for musculoskeletal and simple orthopaedic presentations; and (2) differences in orthopaedic referral rates and analgesia prescription for patients managed by PCPs compared with secondary contact physiotherapists. Methods: A prospective observational study was conducted of diagnosed, matched patients seen in a 4-day week after-hours ED primary contact physiotherapy service in a tertiary referral ED. Patients presenting with a musculoskeletal or simple orthopaedic diagnosis reviewed by a physiotherapist as either the primary or secondary physiotherapy contact between 1630 and 2030 hours from Saturday to Tuesday were included in the analysis. Outcome measures collected included ED length of stay, orthopaedic referrals in the ED, follow-up plan on discharge from the ED and analgesia prescriptions. Results: There were no adverse events, missed diagnoses or re-presentations for any patients managed by an ED PCP. Mean (± s.d.) treatment time for patients seen by an ED PCP was 130 ± 76 min, compared with 240 ± 115 min for those seen by a secondary contact physiotherapist (P < 0.001). There were significant differences between patients managed by PCP versus secondary contact physiotherapists, with decreases of 20.4% for referrals to orthopaedics in the ED, 21.2% for orthopaedic clinic referrals on discharge and 8.5% in analgesia prescriptions for patients managed by an ED PCP (P < 0.001). In addition to these reductions, there was a 17.5% increase in general practitioner referrals on discharge for patients managed by an ED PCP (P < 0.001). Conclusion: An after-hours ED physiotherapy service is a safe service that reduces ED treatment times, as well as analgesia prescriptions and orthopaedic referrals for patients managed by a PCP. What is known about the topic?: PCPs are capable of providing safe and effective care to patients in the ED who present with musculoskeletal complaints. Patients managed by physiotherapists as the primary contact require fewer X-rays and have reduced treatment times. What does this paper add?: Compared with previously published articles, this study demonstrates similar reductions in ED treatment times in an after-hours setting for patients managed by an ED PCP. However, this was achieved by physiotherapists who have less reported experience. Furthermore, this study found that management of patients by PCPs resulted in a reduction in the amount of analgesia prescribed and orthopaedic input required for these patients. What are the implications for practitioners?: PCPs can be trained to operate in the ED with minor or no prior ED experience while facilitating reductions in the amount of analgesia prescribed, orthopaedic referrals required (in ED and on discharge) and reducing treatment times for patients. [ABSTRACT FROM AUTHOR]

Objective: This study sought to estimate and observe the risks imposed on patients as they travel to hospital for referred treatment. Factors such as distance and remoteness were compared to understand how they affect this risk. Methods: This study focused on Queensland residents attending specialist out-patient appointments in a Queensland public hospital throughout 2016. Deidentified information on all recipients of a specialist out-patient appointment in 2016 (n = 2 946 584) were included in the study. This study also contained a theoretical component: using a data model to estimate the number of fatalities that could be expected from a travelling population of this size and complexity. The modelling results were compared with the frequency of actual fatalities among individuals travelling to receive treatment, as determined by a review of the Queensland Police Road Database. The data model and empirical values from police reports were used to independently measure what risk, if any, individuals travelling to obtain specialist out-patient treatment are exposed to. Differences between the model and observed values were evaluated using statistical tests. Results: A direct relationship between increasing remoteness and travel risk was established in both the model and observed data (CV(RMSD) = 0.660773). Conclusion: Fatal risk is present in any road journey regardless of distance, duration or the purpose of travel. Individuals living in regional and remote Queensland are exposed to a larger risk than those living in the major cities of Queensland when travelling to obtain public health care. What is already known on this subject?: Road safety remains one of Australia's most serious public health issues, with 1295 road-related fatalities recorded throughout Australia in 2016. Although the potential dangers of road travel are well understood, extended journeys by road to attend hospital appointments are often undertaken despite available alternatives to travel in some instances. What this paper adds?: Travelling to attend medical appointments exposes a patient to a small but potentially catastrophic risk that can be observed in state road crash data. This risk is measurably greater for individuals in regional Queensland. What are the implications for practitioners?: Clinical models of care that reduce patient travel may represent a new standard in patient safety when of the risks associated travel are considered. [ABSTRACT FROM AUTHOR]

Objective: This research explores Nurse Managers' (NMs') influence on workplace learning. The facilitation of staff learning has implications for the role of NMs, who are responsible for the quality and safety of patient care. However, this aspect of their work is implicit and there is limited research in the area. Methods: This paper discusses the findings from one hospital as part of a broader philosophical hermeneutic study conducted in two public hospitals over a 20-month timeframe. NMs participated in interviews, a period of observation, follow-up interviews and a focus group. Transcribed data was thematically analysed. Eraut's 'Two triangle theory of workplace learning' was used to interpret participants' accounts of how they facilitated workplace learning. Findings: The analysis found that NMs worked to positively influence staff performance through learning in three domains: orientating new staff, assessing staff performance and managing underperformance. Conclusions: This study purports that NMs influence workplace learning in ways that are seldom recognised. A more conscious understanding of the impact of their role can enable NMs to more purposefully influence workplace learning. Such understanding also has implications for the professional preparation of NMs for their role in the context of workplace learning, facilitating learning for change and enabling the advancement of quality and safety in healthcare. [ABSTRACT FROM AUTHOR]

ObjectiveTo describe the implementation of a model of integrated care for chronic disease in Western Sydney. This model was established on the basis of a partnership between the Local Health District and the Primary Health Network.MethodsThe Western Sydney Integrated Care Program (WSICP) focuses on people with type 2 diabetes, chronic obstructive pulmonary disease and coronary artery disease or congestive cardiac failure. We describe the design of the program, the processes involved and some of the challenges and barriers to integration.ResultsEarly data indicate a high uptake of services, with some evidence of a reduction in hospital admissions and presentations to the emergency department.ConclusionA model of integrated care has been successfully implemented and embedded into local practices. Preliminary data suggest that this is having an impact on the utilisation of hospital services.What is known about the topic?There is evidence that integrated models can improve cost-effectiveness and the quality of clinical care for people with chronic disease. However, most integrated models are small scale, focus on very specific populations and generally do not engage both primary care and acute hospitals.What does this paper add?This paper describes an effective partnership between state-funded hospital services in the WSLHD and the federally funded local Primary Health Network (PHN) of general practitioners. The paper outlines the design of the program and the structural, governance and clinical steps taken to embed integrated care into everyday clinical practice. In addition, preliminary results indicate a reduction in the use of hospital services by people who have received integrated care services.What are the implications for practitioners?Involvement of both primary care and the public hospital system is important for a successful and sustainable integrated care program. This is a long and challenging process, but it can lead to positive effects not just for individuals, but also for the health system as a whole. [ABSTRACT FROM AUTHOR]

In response to rising healthcare costs, healthcare payers across the globe have been experimenting with performance-based payment models that link payments to providers with the quality of care that they provide. Community pharmacy in Australia has yet to be significantly affected by these changes. Initial steps have been taken to fund quality-linked interventions by pharmacists, such as the provision of medicines in dose administration aids, but funding for dispensing prescriptions remains solely based on a fee-for-service model. At the foundation of any performance-based payment model are measures that, in aggregate, reflect the quality of care that is provided. Patient adherence to prescription regimens can be correlated with the counselling provided by pharmacists and, as such, can serve as the measure on which a performance-based payment model for dispensing can be constructed. Experience in the US suggests per-prescription payments to a pharmacy can be increased or decreased by a small, yet meaningful, amount based on a measure of the level of adherence of patients of the pharmacy. The current dispensing payment model in the Australian Pharmaceutical Benefits Scheme may be able to be modified in a similar manner to support provision by pharmacists of improved quality of care. What is known about the topic?: Dispensing in community pharmacy in Australia is currently remunerated on a fee-for-service basis that carries no incentive to deliver an enhanced performance that could lead to improved quality of care. What does this paper add?: Several countries have introduced alternative payment models that link the level of funding to the quality of services provided by healthcare practitioners, and potentially to patient outcomes. Counselling is an integral aspect of pharmacists' dispensing and, based on the principle that counselling improves adherence, which improves outcomes, remuneration paid to a pharmacy for dispensing could be adjusted in relation to the level of adherence demonstrated by patients of the pharmacy. What are the implications for practitioners?: Pharmacists would be incentivised through quality-linked dispensing remuneration to provide enhanced counselling and other inputs that lead to improved patient outcomes and health system benefits. [ABSTRACT FROM AUTHOR]

Objectives: In determining whether new health technologies should be funded, health technology assessment (HTA) committees prefer explicit to implicit methods of analysis in enhancing transparency and consistency of decision making. The aim of this study was to develop and pilot a multicriteria decision analysis (MCDA) framework for the Queensland Department of Health HTA program committee, which weighted decision making criteria according to their perceived importance as determined by group consensus. Methods: The criteria used in the MCDA framework were identified by reviewing the five unweighted criteria used in the existing process, consultation with committee members and literature review. Criteria were clearly defined and ordinal categories of lowest to highest preferred were assigned against which technology submissions would be rated. Criteria weights were determined through a discrete choice experiment (DCE) survey of committee members using validated software. Mean weighted technology scores were then used to guide deliberative discussions in determining final funding decisions. Results: The MCDA framework created one additional criterion to the previous five. The criteria and their mean weights identified through the DCE survey were clinical benefit and safety (27.2%), quality of evidence (19.2%), implementation capacity (16.9%), innovation (15.4%), burden of disease and clinical need (13.3%) and societal and ethical values (8.0%). Criterion weights varied considerably between individual committee members, with one criterion having a difference of 36.9% between the highest and lowest preference weights. Following deliberative discussions, all but one of 10 submissions were awarded funding. The submission not supported received the third lowest score through the MCDA model. Conclusions: This pilot application of an MCDA framework, as a complement to committee deliberation, conferred greater transparency and objectivity on HTA assessment of technologies. The framework converted an implicit, unweighted review process to one that is more explicit, flexible in weighting importance and pragmatic. What is known about the topic?: HTA programs involve complex decision-making processes requiring the consideration of multiple criteria. Explicit methods of analysis that use weighted criteria according to their relative importance enhance transparency and consistency of decision making by HTA committees, and are preferred to implicit reviews using unweighted criteria. What does this paper add?: This article describes the development and piloting of an MCDA framework that aims to improve transparency, objectivity and consistency of funding decisions of the Queensland HTA committee. Criteria were identified through a review of current processes, committee discussions and a literature review, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) quality of evidence system. Criteria were weighted using a discrete choice experiment involving committee members. Using weighted criteria, mean technology scores were calculated and incorporated into deliberative discussions to determine funding decisions. What are the implications for practitioners?: The MCDA framework described here converted a more implicit, unweighted process to one that was more pragmatic, explicit and flexible in scoring HTA submissions. This framework may be useful to other HTA programs and could be expanded to resource allocation decision making in many other healthcare settings. [ABSTRACT FROM AUTHOR]

Rothermel's wildland surface fire model is a popular model used in wildland fire management. The original model has a large number of parameters, making uncertainty quantification challenging. In this paper, we use variance-based global sensitivity analysis to reduce the number of model parameters, and apply randomised quasi-Monte Carlo methods to quantify parametric uncertainties for the reduced model. The Monte Carlo estimator used in these calculations is based on a control variate approach applied to the sensitivity derivative enhanced sampling. The chaparral fuel model, selected from Rothermel's 11 original fuel models, is studied as an example. We obtain numerical results that improve the crude Monte Carlo sampling by factors as high as three orders of magnitude. [ABSTRACT FROM AUTHOR]

Over the past half century, medical care has become less institutionalised, more autonomous, equitable and less costly. This has led to a shift from hospital-based delivery to community care. This paper examines the experiences of Canberra-based carers following this shift using interview data from a longitudinal qualitative study of 32 informal carers of a spouse with cancer. Cancer patients experienced poorly coordinated care. When carers observed the effects of errors and miscommunication on patients, they felt compelled to coordinate patient care. Interview data suggest that informal carers of cancer patients are relied upon to manage patient care at home and in hospitals, but are not supported in undertaking this responsibility. This implies that carers should be a far more central focus in cancer care reform strategies. What is known about the topic? Shifts in Australian models of care mean much of the care-work associated with cancer has moved from hospitals to home. Little is known about the implications of this shift on carers of cancer patients, a population at high risk of stress, depression and anxiety. What does this paper add? This study offers a rare qualitative approach to understanding the experiences of carers of spouses with cancer in Canberra-based hospitals. Their accounts suggest that cancer carers are relied on to coordinate care for their spouse on a long-term basis at home, in hospitals and across multiple medical modalities. What are the implications for practitioners? This high reliance on an informal caregiving population with a well-documented risk of stress, anxiety and depression suggests that strategic changes need to be made to support carers. As states and territories begin to implement cancer care coordinators as part of a cancer reform strategy, carers should be a central focus. [ABSTRACT FROM AUTHOR]

Objectives. To analyse the short- and long-term costs and benefits of alternative models of primary care for the management of patients with type 2 diabetes in Australia. The models of care reflect differential uptake of primary care-based incentive programs, including reminder systems and involvement of practice nurses in management. This paper describes our study protocol and its progress. Methods. We are undertaking an observational study using a cluster sample design that links retrospective patient data from a range of sources to estimate costs and intermediate outcomes (such as the level of glycosylated haemoglobin (HbA1c)) over a 3-year time horizon. We use the short-term data as a basis to estimate lifetime costs and benefits of alternative models of care using a decision analytic model. Initial report. We recruited 15 practices from a metropolitan area (Adelaide) and allocated them to three models of care. Three hundred and ninety-nine patients agreed to participate. We use multilevel analysis to evaluate the association between different models of care and patient-level outcomes, while controlling for several covariates. Discussion/conclusions. Given the large amount of funding currently used to maintain primary care-based incentives in general practices in Australia, the results of this study generate the knowledge required to promote investment in the most cost-effective incentives. What is known about the topic? Collaborative models of care can improve the outcomes in patients with chronic diseases such as type 2 diabetes (T2D), and the large amount of funding is currently used to maintain primary care-based initiatives to provide incentives for general practices to take a more multidisciplinary approach in management of chronic diseases. What does this paper add? There are few model-based studies of the cost-effectiveness of alternative models of care defined on the basis of the uptake of financial incentives within Australian primary care settings for diabetes management. Using routinely collected data, this project evaluates the effectiveness of alternative models of care and estimates long-term costs and benefits of various models of care. What are the implications for practitioners? This study explores opportunities for the use of linked, routinely collected data to evaluate clinical practice, and identifies the optimal model of care in management of patients with T2D, with respect to differences in long-term costs and outcomes. [ABSTRACT FROM AUTHOR]

How often, as clinicians, do we see a really clever idea implemented in the workplace? In rural health in particular, creative work-around solutions are relatively commonplace. However, the evaluation and promotion of these ideas is less so, and this leads to lost opportunities for perpetuating these clever ideas. This paper explores one rural clinician's experience of what can happen if, instead of appreciating and complementing a great idea, that step of evaluating the great idea is taken. A reflective narrative was created, beginning with a corridor conversation ('What a great idea! Someone should evaluate that. . .'), continuing through a formal research project and ending with the impact of that project and the way its findings were communicated and implemented. The narrative outlines the effect of evaluating one great idea at the individual, workplace, organisational, state and national levels. Clinicians are well placed to identify great ideas in practice. Making the decision to evaluate these ideas can lead to personal growth, professional discovery and organisational benefits. With motivation and organisational support, who knows where evaluation may lead?. [ABSTRACT FROM AUTHOR]

This paper presents a series of improvements to the quantitative modelling of burned areas in Europe under historical climate. The Standalone Fire Model (SFM) based on a state-of-the-art large scale mechanistic fire modelling algorithm is used to reproduce historical burned areas reported in the two publicly available datasets - European Forest Fire Information System (EFFIS) and Global Fire Emissions Database (GFED). The most recent versions of these sources allow a broader validation of SFM's modelled burned areas at a country level. Our analysis is carried out for the years 2000-2008 for 17 European countries utilising both EFFIS and GFED datasets for model benchmarking. We suggest improving the original model by modifying the fire probability function reflecting fuel moisture. This modification allows for a dramatic improvement of accuracy in modelled burned areas for a range of European countries. We also explore in detail a pixel-level parametrisation of firefighting efficiency in SFM along with modifications of the biomass map. In comparison with the aggregated country-level approach, the advantages of the finer calibration are quite minor for the most recent version of the GFED dataset. Overall, the annual burned areas modelled by this improved SFM version are in good agreement with historical observations. [ABSTRACT FROM AUTHOR]

Managing chronic diseases is an important issue for older adults to pursue healthy aging. Prior studies have found that self-management has positive results. A better understanding of the self-management behaviours of older adults with chronic diseases and different activities of daily living abilities will lead to effective support and assistance. This qualitative study used interview data from Chinese older adults with chronic diseases to compare self-management behaviours between different activities of daily living groups. A self-management behavioural model was constructed that included three behaviours: self-monitoring, self-evaluating and self-intervening. The similarities and differences in these behaviours between three types of older adults (i.e. energetic, self-care and semi self-care) were identified. Study findings enrich the research on self-management behaviour from a patient perspective, providing insights for older adults and care providers in understanding and supporting chronic disease self-management. [ABSTRACT FROM AUTHOR]

Background: Gambling is a growing public health issue in Australia. However, limited research has examined the role of primary health care and social services in routine screening for gambling harm in Australia. This research aimed to explore the enablers and barriers to implementing a co-designed gambling screening model in Fairfield, New South Wales – an area with high gambling expenditure. Methods: A co-designed gambling screening and referral model for GP and community-based organisations was implemented in Fairfield in 2020. Follow-up interviews were conducted with nine health care professionals who implemented the screening in 130 patients. Thematic analysis generated key barriers and enablers for implementation of this model. Results: Key enablers for the screening model implementation included structural factors (alignment of the screening model with current work), process factors and staffing factors (staff empowerment). However, we also noted process factors as a barrier to implementation, particularly the referral pathway following screening. Other barriers included social and structural factors, such as the complexity of gambling harm and project funding. Conclusions: Embedding routine screening in primary and community care settings can play a role in treating, reducing and preventing gambling-related harm, and reducing stigma in Fairfield and beyond. Additionally, screening models such as this provide health systems with clear evidence on the level of gambling harm in their community (particularly important in culturally and linguistically diverse communities who are underrepresented in research). This evidence is important for addressing system-level drivers of harm and advocating for political reform to reduce the impact of gambling on communities. Primary healthcare and community services are important settings for gambling harm screening, and more broadly can contribute to the prevention and treatment of gambling harm in communities. However, there has been limited research on how screening can be embedded into routine practice. This pilot research identifies the enablers and barriers to implementing a co-designed screening model in local primary care settings. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to investigate allied health professionals' (AHPs') perspectives preand post-implementation of an electronic medical record (EMR) in a tertiary health service in Australia and examine factors influencing user acceptance. Methods. Data were collected preand post-EMR implementation via cross-sectional online surveys based on the Unified Theory of Acceptance and Usage of Technology (UTAUT). All AHPs at a large tertiary hospital were invited to complete the surveys. Data analysis included descriptive analysis, Mann--Whitney U tests for pre-post item- and construct-level comparison and content analysis of free-text responses. The theoretical model was empirically tested using partial least squares structural equation modelling. Results. AHPs had positive attitudes toward EMR use both pre- and post-implementation. Compared to pre-implementation, AHPs felt more positive post-implementation about system ease of use and demonstrated decreased anxiety and apprehension regarding EMR use. AHPs felt they had adequate resources and knowledge to use EMR and reported real-time data accessibility as a main advantage. Disadvantages of EMR included an unfriendly user interface, system outages and decreased efficiency. Conclusions. As AHPs increase EMR system familiarity, their positivity towards its use increases. An understanding of what influences AHPs when implementing new compulsory technology can inform change management strategies to improve adoption. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the service distribution and models of rural outreach by specialist doctors living in metropolitan or rural locations. Methods: The present study was a national cross-sectional study of 902 specialist doctors providing 1401 rural outreach services in the Medicine in Australia: Balancing Employment and Life study, 2008. Five mutually exclusive models of rural outreach were studied. Results: Nearly half of the outreach services (585/1401; 42%) were provided to outer regional or remote locations, most (58%) by metropolitan specialists. The most common model of outreach was drive-in, drive-out (379/902; 42%). In comparison, metropolitan-based specialists were less likely to provide hub-and-spoke models of service (odd ratio (OR) 0.31; 95% confidence interval (CI) 0.21-0.46) and more likely to provide fly-in, fly-out models of service (OR 4.15; 95% CI 2.32-7.42). The distance travelled by metropolitan specialists was not affected by working in the public or private sector. However, rural-based specialists were more likely to provide services to nearby towns if they worked privately. Conclusions: Service distribution and models of outreach vary according to where specialists live as well as the practice sector of rural specialists. Multilevel policy and planning is needed to manage the risks and benefits of different service patterns by metropolitan and rural specialists so as to promote integrated and accessible services. [ABSTRACT FROM AUTHOR]

Objective: The aims of the present paper were to: (1) review the research literature that contributes to an understanding of the role of volunteer home visiting programs in supporting the health and well being of families with young children; and (2) propose a conceptual model outlining service pathways for families in need of additional support. Methods: Anintegrative literature review method was used, with a mix of electronic and manual search methods for the period January 1980-January 2014. Forty-five studies were identified that met the inclusion criteria for review and were coded according to themes developed a priori. Results: There is little formal research that has examined the effectiveness of volunteer home visiting programs for supporting family health and well being. The available research suggests that volunteer home visiting programs provide socioemotional support through structured social relationships; however, there is limited empirical evidence to explicate the factors that contribute to these outcomes. Conclusion: In recognition of the importance of peer support fornewparents, the not-for-profit sector has been involved in providing volunteer home visiting services to families for decades. However, the body of research to support this work is characterised by methodological limitations, and rigorous evidence is limited. What is clear anecdotally and qualitatively from the existing research is that parentswhoare in need of additional support value engagement with a community volunteer. These structured social relationships appear to fulfil a service need within the community, helping build bridges to support social networks, and thus complementing professional services and relationships. Overall, structured social relationships in the form of volunteerhomevisiting programs appear to provide an important pathway to support family health and well being. Findings from the existing research are mixed and often characterised by methodological limitations, pointing to a need for further rigorous research. [ABSTRACT FROM AUTHOR]

This paper examines the response of a regional body, the Institute for Urban Indigenous Health (IUIH), coordinating Aboriginal community controlled health organisations (ACCHOs) in south-east Queensland, to research evidence as they prioritise and plan services in response to internal economic and organisational factors, as well as external policy change. An event-based analysis of a quarterly management meeting of the IUIH allowed an exploration of how the IUIH uses a range of evidence to respond to the challenges faced within the Aboriginal community controlled health sector. The study identified three distinct but interconnected processes: (1) identifying evidence for change; (2) exploring and reframing this evidence; and (3) the application of this evidence at different levels of policy and practice. These processes were evident in each of the three major agendas addressed during the meeting, namely navigating current political change, reforming the ACCHO business model and reframing the available evidence for advocacy. The result has been the emergence of a new service delivery model, in which evidence supports accountability, change management, self-sufficiency and attempts to redefine community control. [ABSTRACT FROM AUTHOR]

Introduction. Primary care is under pressure to achieve accessible, equitable, quality health care, while being increasingly under resourced. There is a need to understand factors that influence quality improvement (QI) to support a high-performing primary care system. Literature highlights the impact of context on QI but there is little primary care research on this topic. Aim. This qualitative case study research seeks to discover the contextual factors influencing QI in primary care, and how the relationships between contextual factors, the QI initiative, and the implementation process influence outcomes. Methods. The Consolidated Framework for Implementation Research was used to frame this qualitative study exploring primary care experiences in depth. Six sites were selected to provide a sample of rural, urban and Kaupapa Māori settings. Qualitative data was collected via semi-structured interviews and compared and contrasted with the organisational documents and data provided by participants. Results. Cases reported success in achieving improved outcomes for patients, practices, and staff. Strong internal cultures of 'Clan' and 'Adhocracy' typologies supported teamwork, distributed leadership, and a learning climate to facilitate iterative sensemaking activities. To varying degrees, external network relationships provided resources, knowledge, and support. Discussion. Organisations were motivated by a combination of patient/community need and organisational culture. Network relationships assisted to varying degrees depending on need. Engaged and distributed leadership based on teamwork was observed, where leadership was shared and emerged at different levels and times as the need arose. A learning climate was supported to enable iterative sensemaking activities to achieve success. [ABSTRACT FROM AUTHOR]

Objective. This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25 000 people across Australia, and presents the findings of this process. Methods. Health departments and the national government's websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives. Results. In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to generate an accurate national picture. The nature of information about maternity services held centrally by jurisdictions varied, and different frameworks were used to describe minimum requirements for service levels. Service networks appeared to be based on a combination of individual links, geography and transport infrastructure. Conclusions. The lack of readily available centralised and comparable information on rural and remote maternity services has implications for policy review and development, equity, safety and quality, network development and planning. Accountability for services and capacity to identify problems is also compromised. [ABSTRACT FROM AUTHOR]

From an organisational point of view, professional support is an important aspect of clinical governance and a tool for maximising service delivery quality. As a key factor in staff retention and recruitment, access to professional support is also regarded as an important tool for facilitating workforce growth in a competitive health workforce market. While some work units provide appropriate professional support such as in-service, professional supervision is a key challenge for a large organisation employing many health professionals to ensure equitable and relevant access to finite professional support resources. The goal of this paper is to describe the Professional Support Program designed and implemented by Queensland Health. This program seeks to support professionals who may not previously have had optimal engagement in professional support and to enhance the quality of professional support activities available. Evaluation indicates that the Professional Support Program has been successful in facilitating participation in, and quality of professional support activities. [ABSTRACT FROM AUTHOR]

In this paper, we investigate homeowner preferences and willingness to pay for wildfire protection programs using a choice experiment with three attributes: risk, loss and cost. Preference heterogeneity among survey respondents was examined using three econometric models and risk preferences were evaluated by comparing willingness to pay for wildfire protection programs against expected monetary losses. The results showed that while nearly all respondents had risk seeking preferences, a small segment of respondents were risk neutral or risk averse. Only respondents who had personal experience with the effects of wildfire consistently made trade-offs among risk, loss and cost and these respondents were willing to pay more for wildfire protection programs than were respondents without prior experience of the effects of wildfire. The degree to which people with prior experience with the effects of wildfire can effectively articulate an economic rationale for investing in wildfire protection to other members of their own or other communities facing the threat of wildfires may influence the overall success of wildfire protection programs. [ABSTRACT FROM AUTHOR]

In recent years, advances in computational power have led to an increase in attempts to model the behaviour of wildland fires and to simulate their spread across landscape. The present series of articles endeavours to comprehensively survey and précis all types of surface fire spread models developed during the period 1990-2007. The present paper surveys models of a simulation or mathematical analogue nature. Most simulation models are implementations of existing empirical or quasi-empirical models and their primary function is to convert these generally one-dimensional models to two dimensions and then simulate the propagation of a fire perimeter across a modelled landscape. Mathematical analogue models are those that are based on some mathematical concept (rather than a physical representation of fire spread) that coincidentally represents the spread of fire. Other papers in the series survey models of a physical or quasi-physical nature, and empirical or quasi-empirical nature. Many models are extensions or refinements of models developed before 1990. Where this is the case, these models are also discussed but much less comprehensively. [ABSTRACT FROM AUTHOR]

Background. We analysed the impact of increased antiretroviral therapy (ART) on HIV epidemiology and healthcare costs in Australia during the 'Treatment-as-prevention' and 'Undetectable equals Untransmissible (U=U)' eras. Methods. We conducted a retrospective modelling analysis between 2009 and 2019 to calculate the potential impact of early initiation of ART and treatment-as-prevention on HIV among gay and bisexual men (GBM). The model incorporates the change in the proportion diagnosed, treated, and virally suppressed, as well as the scale-up of oral HIV pre-exposure prophylaxis (PrEP) and the change in sexual behaviour during this period. We simulated a baseline and a no ART increase scenario and conducted a costing analysis from a national health provider perspective with cost estimates in 2019 AUD. Results. Increasing ART use between 2009 and 2019 averted an additional 1624 [95% percentile interval (PI): 1220-2099] new HIV infections. Without the increase in ART, the number of GBM with HIV would have increased from 21 907 (95% PI: 20 753-23 019) to 23 219 (95% PI: 22 008-24 404) by 2019. HIV care and treatment costs for people with HIV increased by $296 (95% PI: $235-367) million AUD (assuming no change in annual healthcare costs). This was offset by a decrease in the lifetime HIV costs (with 3.5% discounting) for those newly infected of $458 (95% PI: $344-592) million AUD, giving a net cost saving of $162 (95%: $68-273) million AUD (and a benefits-to-cost ratio of 1.54). Conclusions. Increasing the proportion of Australian GBM on effective ART between 2009 and 2019 likely resulted in substantial reductions in new HIV infections and cost savings. [ABSTRACT FROM AUTHOR]

Objective. The Child Dental Benefits Schedule (CDBS) was introduced in 2014, and its aim was to support access to dental care for eligible children in Australia. Dental caries, and pulp and periapical diseases were the major dental reasons for children’s hospitalisations. This study investigated if the availability of the CDBS had any effects on hospitalisation rates in Australian children. Methods. This study was a retrospective analysis of Medicare data from the Australian Government and the hospitalisation data from The Australian Institute of Health and Welfare (AIHW) from 2008 (6 years before the commencement of the CDBS) to 2020 (6 years after the commencement of the CDBS). Results. Although the hospitalisation rate trend was reducing before the CDBS started (2008–14), this reduction was not statistically significant. The reduction of hospitalisation rates was higher after the commencement of the CDBS (2014–20) and was statistically significant, but the regression model analysis showed a positive correlation between the CDBS and hospitalisation rate. The analysis without ‘abnormal’ year data (2019–20, COVID-19 pandemic year) supported no statistically significant decrease in hospitalisation rate after the commencement of the CDBS in 2014 until 2019. Conclusion. Although the CDBS is improving access to dental care for eligible children, any possible effects the CDBS might have on hospitalisations are not yet evident. [ABSTRACT FROM AUTHOR]

A unique opportunity to engage in research capacity-building strategies for health practitioners arose within public sector health services during the negotiations for an industrial agreement. A research capacity-building initiative for health practitioners that is allied health, oral health and scientist practitioners was funded and the components of this initiative are described. The initiative was implemented using a research capacity-building framework developed from a review of the literature and stakeholder consultations. The framework included leadership and governance, support to researchers and translation of evidence into practice and was contextualised to public health environments. There were several phases of implementation. An evaluation of the preliminary phase of establishing research positions and research activity was conducted and several successes of the capacity-building strategies were identified. These successes (e.g. solid partnerships with universities) are discussed, as are future concerns, such as sustainability of the initiative in a tighter fiscal context. [ABSTRACT FROM AUTHOR]

Access to appropriate health and social care is challenging for vulnerable populations. We used a 'pop-up' delivery model to bring community-based services in contact with communities with poor access to health and social care. Our aim was to examine whether pop-up events improve access to essential health and social support services for selected vulnerable communities and increase collaboration between community-based health and social services. Set in south-eastern Melbourne, two pop-up events were held, one with people at risk of homelessness attending a community lunch and the other with South Sudanese women helping at-risk youth. Providers represented 20 dental, housing, justice, employment and mental health services. We made structured observations of each event and held semi-structured interviews with consumers and providers. Pre-post surveys of managers assessed acceptability and perceived impact. We reached 100 community participants who had multiple needs, particularly for dentistry. Following the events, participants reported increased knowledge of services and access pathways, community members spoke of increased trust and partnerships between service providers were fostered. The pop-up model can increase provider collaboration and provide new options for vulnerable populations to access needed services. 'Bringing the service to the person' is a compelling alternative to asking consumers to negotiate complex access pathways. Vulnerable communities have the greatest need for primary care but experience disproportionate barriers to service access. We trialled a pop-up health service delivery model in two vulnerable communities in metropolitan Melbourne. Our evaluation suggests that the model was feasible and has the potential to both improve access for vulnerable communities and promote collaboration between service providers, adding to the evidence base regarding mobile and outreach projects for vulnerable communities. [ABSTRACT FROM AUTHOR]

A mathematical model is presented for predicting the maximum potential spot fire distance from an active crown fire. This distance can be estimated from the height of the flame above the canopy top, wind speed at canopy-top height and final firebrand size (i.e. its residual size on alighting), represented by the diameter of a cylinder of woody char. The complete model system comprises several submodels or components: a model for the height and tilt angle of the wind-blown line-fire flame front, a simplified two-dimensional model of the wind-blown buoyant plume from the fire, an assumed logarithmic wind speed variation with height, and an empirically based model for the burning rate of a wooden cylinder in cross flow, which represents the firebrand. The trajectory of the burning particle is expressed analytically from where it leaves the lower boundary of the plume until it enters the canopy top. Adding the horizontal distance of this flight to that of the point where the particle can no longer be held aloft by the plume flow gives a spotting range that depends on the final diameter of the burning particle. Comparisons of model output with existing information on crown fire spotting distances has initially proved encouraging but further evaluation is warranted. A model system has been developed for estimating the maximum potential spotting distance from an active crown fire as a function of firebrand particle diameter on alighting, based on three simple inputs, namely, canopy-top height, free flame height (i.e. flame distance above the canopy-top height), and the wind speed at the height of the canopy. [ABSTRACT FROM AUTHOR]

Wildfires, which are uncontrolled fires spreading readily over vast areas, are usually the result of human negligence, arson or lightning. There are cases of fires close to electrical distribution lines for which the network has been blamed. In the present paper, the risk of a wildfire breaking out owing to the temperature of molten metal particles that are possibly created on bare conductors of low-voltage networks in short-circuit faults (unless they are interrupted by the protection systems) is examined. Thus, a mathematical model is proposed for the estimated temperature rise of those molten metal particles ejected from bare conductors of low-voltage overhead lines. Moreover, this model can be applied to medium- or high-voltage networks. The model takes into account the weather conditions and particles' height above the ground. Further, an arithmetic example for an incandescent particle ejected from aluminium conductors of a low-voltage network is given. According to this example, there is no risk of dead leaves or wood catching fire owing to this particle. [ABSTRACT FROM AUTHOR]

Robert May was the leading theoretical ecologist of his generation. He started his career as a theoretical physicist and began the transition to ecology soon after completing a post-doctoral fellowship at Harvard. His mathematical analysis of the stability of ecological communities challenged orthodox views and spawned a new research agenda. He demonstrated that many different patterns of population fluctuations, including chaotic behaviour, could arise from simple mathematical models. Together with R. M. Anderson he transformed the mathematical modelling of infectious diseases. All of his work was characterised by his remarkable ability to reduce complex problems to their essential simplicities. His achievements were recognised by the award of numerous major international prizes. May also served as government chief scientific advisor (UK) between 1995 and 2000, and as president of the Royal Society between 2000 and 2005. Lord (Robert) May (1936–2020) was an Australian physicist-turned-ecologist— he 'blundered into the field' in the late 1960s. Using simple mathematical analyses, he modelled population fluctuations and the spread of infectious diseases, and the operation of the banking system. He was the UK Government Chief Scientist (1995–2000) and President of the Royal Society of London (2000–2005). In 2001, he was appointed to the House of Lords as an independent 'cross-bencher' and made significant contributions to Select Committees dealing with technical and economic matters. [ABSTRACT FROM AUTHOR]

As the population ages, so does the prevalence of dementia, a condition in which timely advance care planning (ACP) is recommended. This study explored the barriers and enablers of ACP for Australian GPs caring for people with dementia. Semi-structured qualitative telephone interviews informed by the theoretical domains framework (TDF) were conducted with 16 GPs from the south-east region of metropolitan Melbourne. The most prevalent domains of the TDF were: (1) environmental context and resources; (2) beliefs about consequences; and (3) social/professional role and identity. Further thematic analysis found that: (1) ACP was felt to be within the scope of general practice, but more so before the onset of dementia because lack of confidence in capacity assessment acted as a barrier once a diagnosis was made; (2) beliefs about the perceived benefits of ACP motivated GPs to engage patients in ACP; and (3) doctors felt that patients were often reluctant to discuss ACP, especially in the time-pressured context of the standard consultation. This study's use of the TDF provides direction for potential interventions to alleviate challenges faced by Australian GPs with ACP in dementia. Improving ACP in general practice may require a focus on public health campaigns to educate patients about the benefits of ACP before the onset of dementia. GPs' difficulty assessing a patient's decisional capacity may be addressed through skills development workshops. Advance care planning (ACP) leads to better outcomes for patients and is particularly relevant for people with dementia who eventually lose the capacity to take part in their own medical treatment planning. This study found that GPs see themselves as having an important role in ACP for those with dementia, but are hindered by barriers at the patient, practitioner and system level. The results of this study have implications for improving the quality of care for patients with dementia by increasing the uptake of ACP. [ABSTRACT FROM AUTHOR]

Objective. The primary aims of this study were to explore: (1) manifestations of socio-environmental models of allied health support provision in the disability sector; and (2) narrative experiences of individual allied health professionals in the disability sector. Methods. A narrative qualitative study using interviews from a purposive sample of two allied health professionals working in the disability sector explored manifestations of socio-environmental models of allied health support provision and their experiences from case examples. The key informants had more than 10 years of experience in the disability support services setting. Results. Seven key themes exploring manifestations of socio-environmental models of allied health professional practice in the disability sector emerged: (1) dignity of risk; (2) models of care; (3) considerations when working in the supported person's environment; (4) goal-oriented work; (5) informed choice and informed consent; (6) reactive and flexible plans; and (7) training and education role. Conclusions. Socio-environmental models of allied health support provision in the disability sector focus on empowering people with disability to achieve their goals. This may require displacement of cultural norms within the allied health professions. [ABSTRACT FROM AUTHOR]

The aim of this cross-sectional study was to understand patients' perceived importance of clinic- and clinician-related factors and contextual characteristics that shape the importance ratings for factors patients consider when accessing oral health care. This study was conducted at Griffith University Dental Clinic, Gold Coast, Australia. Patients answered a self-administered questionnaire on demographics and perceived need for attendance, which constituted the explanatory variables. In the second part of the questionnaire, patients were asked to rate the importance of 17 items related to the provision and quality of oral health services using a five-point scale. Exploratory factor analysis (EFA) was conducted to determine the dimensionality of the questionnaire. The questionnaire was completed by 298 patients. The importance of some of the clinician-related factors, such as 'concern for patients' and 'access to specialist care', were associated with sex, age and employment status. EFA revealed a two-factor structure, which consisted of items related to clinician characteristics and clinic environment characteristics. Female participants had higher importance scores for clinic environment characteristics (mean (±s.d.) 38.00 ± 4.86 vs 35.45 ± 6.30; P < 0.05) and clinician characteristics (32.39 ± 2.85 vs 31.33 ± 3.39; P < 0.05) than male participants. In conclusion, various clinician- and clinic-related aspects were considered important for the provision and quality of oral health services, with the importance of these factors associated with some contextual characteristics. Application of Andersen's behavioural model of health services use provided a framework that offers important insights into patient beliefs and perceptions towards oral health services and can serve as a baseline for future studies in dental clinics across Australia. It is important to assess patient-rated importance of factors related to the provision of oral health services and contextual characteristics that determine the ratings of importance so that the utilisation of oral health services can be improved. This study explored the contextual characteristics that determine a patient's importance ratings for clinic- and clinician-related factors. The findings provide future directions for changes to improve the delivery and utilisation of oral health services. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to evaluate the cost-effectiveness of the Australian Contraceptive ChOice pRoject (ACCORd) intervention. Methods. An economic evaluation compared the costs and outcomes of the ACCORd intervention with usual care (UC). Data from the ACCORd trial were used to estimate costs and efficacy in terms of contraceptive uptake and quality of life. Rates of contraceptive failure and pregnancy were sourced from the literature. Using a Markov model, within-trial resultswere extrapolated over 10 years and subjected to univariate sensitivity analyses. Model outputs were expressed as the cost per quality-adjusted life years (QALY) gained and cost per unintended pregnancy resulting in birth (UPB) avoided. Results. Over 10 years, compared with UC, initiating contraception through the ACCORd intervention resulted in 0.02 fewer UPB and higher total costs (A$2505 vs A$1179) per woman. The incremental cost-effectiveness of the ACCORd intervention versus UC was A$1172 per QALY gained and A$7385 per UPB averted. If the start-up cost of the ACCORd intervention was removed, the incremental cost-effectiveness ratio was A$81 per QALY gained and A$511 per UPB averted. The results were most sensitive to the probability of contraceptive failure, the probability of pregnancyrelated healthcare service utilisation or the inclusion of the costs of implementing the ACCORd intervention. Conclusions. From a health system perspective, if implemented appropriately in terms of uptake and reach, and assuming an implicit willingness to pay threshold of A$50 000 the ACCORd intervention is cost-effective. [ABSTRACT FROM AUTHOR]