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Objective: Lifetime Health Cover (LHC) was introduced in mid-2000 to increase participation in private health insurance that includes hospital cover (PHI-HC) and improve the risk profile of PHI-HC participants. It initially achieved both objectives, but since 2001 the PHI-HC population has aged faster than the general population. The aim of this study was to determine if the excess ageing of the PHI-HC risk pool has been due to passive age-based adverse selection, an inherent risk of LHC. This study has potential implications for the retention of LHC. Methods: A descriptive population-level analysis of publicly available administrative datasets was performed. Data relating to PHI-HC were obtained from the Australian Prudential Regulatory Authority. National population data were obtained from the Australian Bureau of Statistics. Trends in demography, PHI-HC participation rates and LHC loading payments were analysed. Results: By 2021, age-based adverse selection had returned to the pre-LHC level. Based on the available data, this was due to passive age-based adverse selection not active age-based adverse selection. Specifically, it reflected the combination of an avoidable unintended consequence of the introduction of LHC (the over-representation, in 2001, of individuals aged 45–59) and one of LHC's intended effects (incentivisation of insured individuals to retain PHI-HC). Conclusions: This study supports the retention of LHC. Nonetheless, it highlights the risk of passive age-based adverse selection created by incentivising insured individuals to retain PHI-HC in the presence of distortions in the age distribution of the PHI-HC risk pool. Early targeted interventions are required when such distortions arise. What is known about the topic? Since the introduction of Lifetime Health Cover (LHC) in mid-2000, the participation rate for private health insurance that includes hospital cover (PHI-HC) has remained relatively stable, but the PHI-HC population has aged faster than the general population. What does this paper add? This paper makes a novel distinction between 'active' and 'passive' age-based adverse selection to explain LHC's role in the excess ageing of the PHI-HC risk pool. What are the implications for practitioners? Governments need to be vigilant for the emergence of distortions in the age distribution of the PHI-HC risk pool and respond with targeted interventions to normalise the age distribution, or risk problematic passive age-based adverse selection. [ABSTRACT FROM AUTHOR]

Objectives: Unwarranted clinical variations in radical prostatectomy (RP) procedures are frequently reported, yet less attention is given to the variations in associated costs. This issue can further widen disparities in access to care and provoke questions about the overall value of the procedure. The present paper aimed to delve into the disparities in hospital, medical provider and out-of-pocket costs for RP procedures in Australia, discussing plausible causes and potential policy opportunities. Methods: A retrospective cohort study using Medibank Private claims data for RP procedures conducted in Australian hospitals between 1 January 2015 and 31 December 2020 was undertaken. Results: Considerable variations in both medical provider and out-of-pocket costs were observed across the country, with variations evident between different states or territories. Particularly striking were the discrepancies in the costs charged by medical providers, with a notable contrast between the 10th and 90th percentiles revealing a substantial difference of A$9925. Hospitals in Australia exhibited relatively comparable charges for RP procedures. Conclusions: Initiatives such as enhancing transparency regarding individual medical provider costs and implementing fee regulations with healthcare providers may be useful in curbing the variations in RP procedure costs. What is known about the topic? Unwarranted clinical variations in radical prostatectomy procedures are well documented in the literature; however, variations in cost are less widely reported. What does this paper add? This paper aims to highlight the cost variations in radical prostatectomy procedures in Australia, discussing their plausible causes, implications and proposing potential policy opportunities. What are the implications for practitioners? Excessive fees imposed by medical providers may contribute to inequalities in healthcare access. Enhancing transparency of individual medical provider costs and implementing fee regulations may be useful in controlling unwarranted variations in procedure costs. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Objective: To scope how the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) has been applied to measure socio-economic status (SES) in peer-reviewed cardiovascular disease (CVD) research. Methods: The Joanna Briggs Institute's scoping review methodology was used. Results: The search retrieved 2788 unique citations, and 49 studies were included. Studies were heterogeneous in their approach to analysis using SEIFA. Not all studies provided information as to what version was used and how SEIFA was applied in analysis. Spatial unit of analysis varied between studies, with participant postcode most frequently applied. Study quality varied. Conclusions: The use of SEIFA in Australian CVD peer-reviewed research is widespread, with variations in the application of SEIFA to measure SES as an exposure. There is a need to improve the reporting of how SEIFA is applied in the methods sections of research papers for greater transparency and to ensure accurate interpretation of CVD research. What is known about the topic? A socio-economic status (SES) gradient is well established for cardiovascular disease (CVD). Research has generally applied two approaches to classifying SES: at an individual level using income, education or occupation data, and at an area level using a range of existing socio-economic information, including the Australian Bureau of Statistics (ABS) Socio-Economic Indexes for Areas (SEIFA). What does this paper add? This review examined how SEIFA has been applied to measure SES in Australian peer-reviewed CVD research and to identify any variations in research practice. What are the implications for practitioners? It is recommended that researchers provide a clear explanation in the methods section of research papers as to which SEIFA version and index was applied, how it was applied, at what spatial unit, and whether the spatial unit was an ABS or non-ABS unit. [ABSTRACT FROM AUTHOR]

What is known about the topic? Little is known about the state of mental health reform in Australia. This article describes the struggle to develop the systems of accountability necessary to assess national progress. What does this paper add? We provide some historical context regarding mental health reform and consider recent efforts in particular, before then describing current key opportunities. What are the implications for practitioners? Many people working in mental health are struggling to deliver quality services to Australians. This paper considers the broad policy issues which have led to this situation. This is useful for practitioners who can then better respond and participate in processes of systemic reform. Opportunities to engage now in key policy formulation are identified in the article. [ABSTRACT FROM AUTHOR]

Scope of practice regulation in medicine is crucial for ensuring patient safety, access to care and professional autonomy. This paper explores the impact of scope of practice regulation on healthcare delivery, professional responsibilities and patient outcomes. It discusses the variability in standards for safe practice, the challenges in defining boundaries between medical specialties and the recent controversies in cosmetic surgery practice. The paper also examines the potential benefits and drawbacks of rigorous scope of practice regulations, including their impact on clinical innovation, flexibility and access to care. Furthermore, it delves into the implications of defensive medicine and the consequences of restrictive regulations on patient care. The author proposes implementing a proactive, national, artificial intelligence-powered, real-time outcome monitoring system to address these challenges. This system aims to cover every patient undergoing a surgical procedure and could be gradually extended to non-surgical conditions, benefiting all key stakeholders in the health system. The paper emphasises the need for a balanced approach to scope of practice regulation to avoid stifling clinical innovation and professional autonomy, while ensuring patient safety and professional accountability. [ABSTRACT FROM AUTHOR]

Self-determination informed policies are key to improved outcomes for Aboriginal health. Aboriginal leadership must be reflected throughout any public health reform process that affects Aboriginal communities. This paper presents a body of oral health policy work, undertaken under Loddon Mallee Aboriginal Reference Group's (LMARG's) leadership, as an exemplar of a self-determination informed change, that led to an amendment of an Australian state (Victoria) regulation – The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners [AHPs]) Regulations 2022. A summary of activities undertaken by LMARG, from advocacy to leading the submission, to amend the regulation, is provided. The amendment, now in place, authorises registered AHPs to obtain, possess, and administer fluoride varnish (FV) as a part of health services they provide. FV is a concentrated form of fluoride applied to tooth surfaces to prevent tooth decay. The practical implication of this amendment is delivery of a culturally appropriate integrated oral health promotion FV model that addresses mainstream dental access barriers commonly experienced by Aboriginal people. The model aims at upskilling an Aboriginal workforce to facilitate timely FV application to Aboriginal children. Self-determination informed policies are key to improved outcomes for Aboriginal health. The paper presents work on an oral health policy, undertaken under Loddon Mallee Aboriginal Reference Group's leadership on an Australian state (Victoria) regulation – The Drugs, Poisons and Controlled Substances Amendment (Registered Aboriginal and Torres Strait Islander Health Practitioners) Regulations 2022, as an exemplar of a self-determination informed change. The amendment translates to a culturally appropriate integrated oral health promotion model that addresses dental access barriers experienced by Aboriginal people. This article belongs to the Collection Access to Primary Health Care. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers. Methods: A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers. Results: The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%). Conclusion: Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy. What is known about the topic? Triage systems can be used to prioritise the order in which patients are treated in a pandemic, but the views of the general public on using chronic comorbidity as intensive care unit (ICU) triage criteria are unknown. What does this paper add? This Australian survey, conducted during the coronavirus disease 2019 pandemic, demonstrated that the majority of respondents perceived ICU triage methods based on comorbidity to be fair, but significant ethical issues exist. What are the implications for practitioners? It may be possible to develop an ICU triage protocol for future pandemics in Australia, but further research is required. [ABSTRACT FROM AUTHOR]

Introduction. Within primary health care policy, there is an increasing focus on enhancing involvement with secondary health care, social care services and communities. Yet, translating these expectations into tangible changes frequently encounters significant obstacles. As part of an investigation into the progress made in achieving primary health care reform in Aotearoa New Zealand, realist research was undertaken with those charged with responsibility for national and local policies. The specific analysis in this paper probes primary health care leaders' assessments of progress towards more collaboration with other health and non-health agencies, and communities. Aim. This study aimed to investigate how ideas for more integration and joinedup care have found their way into the practice of primary health care in Aotearoa New Zealand. Methods. Applying a realist logic of inquiry, data from semi-structured interviews with primary health care leaders were analysed to identify key contextual characteristics and mechanisms. Explanations were developed of what influenced leaders to invest energy in joined-up and integrated care activities. Results. Our findings highlight three explanatory mechanisms and their associated contexts: a willingness to share power, build trusting relationships and manage task complexity. These underpin leaders' accounts of the success (or otherwise) of collaborative arrangements. Discussion. Such insights have import in the context of the current health reforms for stakeholders charged with developing local approaches to the planning and delivery of health services. [ABSTRACT FROM AUTHOR]

This Perspective begins with a case study that raises two important questions: who is responsible for the existence of non-compliant Medicare billing, and who is responsible for eliminating it? In the discussion that follows, I argue, first, that the problem has been created by individual clinicians and by Medicare itself (i.e. the organisational structure that administers Medicare). Second, and more importantly, I argue that the ethical obligation to eliminate the problem extends more broadly to include both the government and the medical profession. What is known about the topic? The scale of non-compliant Medicare billing is contested. What does this paper add? This Perspective frames non-compliant Medicare billing (and denial of its existence) as a ubiquitous cultural problem. What are the implications for practitioners? Strategies aimed at reducing non-compliant Medicare billing need to target the normative behaviour of societal actors as well as individual practitioners. [ABSTRACT FROM AUTHOR]

Objectives: Accreditation to standards developed by the Royal Australian College of General Practice provides assurance to the community of the quality and safety of general practices in Australia. The objective of this study was to conduct an empirical evaluation of the 5th edition standards. Minimal empirically driven evaluation of the standards has been conducted since their publication in 2020. Methods: Data encompass consecutive Australian general practice accreditation assessments between December 2020 and July 2022 recorded from a single accrediting agency. Met and not met compliance (binary) scores for 124 indicators evaluated at the site visit were recorded. A subset of indicators derived from a selection of existing and consistently non-conformant indicators within each criterion was generated. Concordance between the indicator subset and the criterion was assessed to determine the predictive ability of the indicator subset in distinguishing practices who are conformant to the entire criterion. Results: A total of 757 general practices were included in the analysis. On average, 113.69 (s.d. = 8.16) of 124 indicators were evaluated as conformant at the site visit. In total, 52 (42%) indicators were required to obtain a true positive conformity rate above 95% for all criterions of the standards. For criterion 1 (General Practice 1) conformity to the entire criterion (nine indicators; >95% true positive rate) could be obtained by including 2/9 indicators (C1-1a and C1-2a). Conclusion: Our results identified that indicator non-conformity was driven by a small proportion of indicators and identifying a subset of these consistently non-conformant indicators predicted a true positive rate above 95% at the criterion level. What is known about the topic? Minimal empirical evaluation of the 5th edition standards for accreditation have occurred since their implementation. What does this paper add? Our findings suggest that more than half of the indicators currently do not adequately distinguish practices at the site assessment. What are the implications for practitioners? These findings may suggest that a review of individual indicators and the standards structure is required. [ABSTRACT FROM AUTHOR]

Objective: There is a need to undertake more proactive and in-depth analyses of general practice accreditation processes. Two areas that have been highlighted as areas of potential inconsistency are the self-assessment and surveyor assessment of indicators. Methods: The data encompass 757 accreditation visits made between December 2020 and July 2022. A mixed-effect multilevel logistic regression model determined the association between attempt of the self-assessment and indicator conformity from the surveyor assessment. Furthermore, we present a contrast of the rate of indicator conformity between surveyors as an approximation of the inter-assessor consistency from the site visit. Results: Two hundred and seventy-seven (37%) practices did not attempt or accurately report conformity to any indicators at the self-assessment. Association between attempting the self-assessment and the rate of indicator non-conformity at the site visit failed to reach statistical significance (OR = 0.90 [95% CI = 1.14–0.72], P = 0.28). A small number of surveyors (N = 9/34) demonstrated statistically significant differences in the rate of indicator conformity compared to the mean of all surveyors. Conclusions: Attempt of the self-assessment did not predict indicator conformity at the site visit overall. Appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What is known about the topic? There is a need to undertake more proactive and in-depth analyses of the general practice accreditation process and outcomes to improve the quality and safety within this healthcare sector. What does this paper add? Attempt of the self-assessment does not predict indicator conformity at the site visit overall, and appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What are the implications for practitioners? We present empirical evidence as to the consistency of assessment with general practice accreditation to inform future standards and (re)accreditation assessments. [ABSTRACT FROM AUTHOR]

Objectives: Voluntary assisted dying (VAD) legislation has now been passed in all Australian states. Although VAD has been operating in many settings worldwide for a considerable time, the specific costs associated with VAD seem unclear. The aim of this study was therefore to outline the common resource implications associated with VAD. Methods: A rapid literature review and grey literature search were undertaken. Results: We found a paucity of empirically informed detail regarding the actual costs required to implement VAD. Hence, we tabulated a list of potential costs that could be used for subsequent evaluation and a future research agenda. Conclusions: There is a lack of publicly available information related to the costs associated with implementing VAD. Given that this is a significant change in policy and many multidisciplinary practitioners may be directly or indirectly involved in VAD it is important that associated costs are clearly outlined so that appropriate resources can be allocated. What is known about the topic? Voluntary assisted dying (VAD) legislation has now been passed in all Australian states. Although VAD has been operating internationally for a considerable time, there have been calls for more data to understand the resources required to implement VAD. What does this paper add? We found a paucity of empirically informed detail regarding the actual costs required to implement VAD. Hence, we tabulated a list of potential costs that could be used for subsequent evaluation and outline a research agenda. What are the implications for practitioners? Given that a significant number of practitioners may be directly or indirectly involved in VAD it is important that associated costs are clearly outlined so that appropriate resource allocation can be considered. [ABSTRACT FROM AUTHOR]

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

The role of radiographers in healthcare has evolved significantly from operating imaging equipment to being essential in patient care and diagnosis. In Australia, radiographers play a crucial role in image interpretation, identifying and communicating significant findings to enhance patient outcomes. Preliminary image evaluation (PIE) allows radiographers to interpret images and ensure significant findings are noted, particularly in urgent situations, complementing diagnoses when radiologist reports are unavailable. Despite their potential, many radiographers lack empowerment, leading to delays and adverse patient outcomes. This underutilisation stems from a lack of support and systemic barriers. Radiographers, with their extensive expertise in imaging, are vital for ensuring patient safety and care quality. Policy changes are needed to integrate PIE into standard workflows, allowing radiographers to fully utilise their skills. Recognising and leveraging their expertise will enhance patient care, foster collaboration, and ensure radiographers contribute fully to the healthcare team, ultimately improving patient safety and care quality. What is known about the topic? Radiographers can form an essential role in preliminarily interpreting images and communicating critical findings to ensure timely patient care. What does this paper add? Unknown to many, the Medical Radiation Practice Board of Australia requires radiographers to take responsibility for patient care and communicate significant findings immediately to the treating team. This is executed via a system known as preliminary image evaluation. What are the implications for practitioners? Implementing preliminary image evaluation into local centres is an easy method to reduce diagnostic errors and ensure urgent findings are communicated in a timely manner. [ABSTRACT FROM AUTHOR]

The issue of regulation of scope of practice (SOP) has recently been highlighted through the highprofile case of New South Wales-based neurosurgeon, Mr Charles Teo and specifically the finding of 'unsatisfactory professional conduct' by the NSW Health Care Complaints Commission (HCCC) in Teo, Charles (2023) NSWMPSC 2 (12 July 2023). The HCCC decision went to two issues in Teo's practice: (1) his decision to perform a surgery not within the SOP of his profession [at 238]; and (2) his failure to gain patient informed consent for that surgery [at 245]. This paper explores the findings against Teo with respect to SOP and recommends a nuanced approach to the regulation of clinical innovation and SOP evolution. [ABSTRACT FROM AUTHOR]

Objective: This study explored approaches of government policymakers to health policy evaluation (HPE) in Australian rural and remote settings. Methods: Semi-structured interviews captured experiences and insights of 25 policymakers in the Northern Territory Department of Health. Data were thematically analysed using an inductive approach to coding and theme development. Results: We identified five main themes about HPE in rural and remote settings: (1) centring the rural and remote context; (2) balancing ideology, power and evidence; (3) working with community; (4) strengthening policy workforce capabilities in monitoring and evaluation; and (5) valuing evaluation through leadership. Conclusion: HPE is complex in any setting, however, policymakers navigate unique complexities in rural and remote health contexts. HPE can be enabled by developing policymaker and leadership capabilities in rural and remote settings and supporting co-design with communities. What is known about the topic? Rigorous HPE can be difficult in rural and remote settings. Policymakers often do not adapt evaluative design to suit complex implementation settings such as those in rural and remote Australia. What does this paper add? This paper characterises HPE experiences of Australian rural and remote health policymakers, indicating the need to tailor HPE to contexts and communities of rural and remote Australia. What are the implications for practitioners? Policymakers should incorporate community co-design into policy for contextually relevant HPE. Government agencies are responsible for developing workforce capacity for better HPE and embedding co-design in practice. [ABSTRACT FROM AUTHOR]

The landmark 2021 Resolution on Oral Health by the 74th World Health Assembly has elevated the importance of oral health into the global health policy agenda. This has led to the development and adoption of the World Health Organization (WHO) Global Strategy on Oral Health in 2022. It acknowledged the need to integrate oral health as part of universal health coverage (UHC), which is supported by national clinical leadership for oral health. Although Australia is a signatory WHO member state, it is yet to appoint a Commonwealth Chief Dental Officer to provide national clinical leadership. This commentary provides a background on the current issues on population oral health in Australia, an insight into the Australian oral healthcare system, and explores some of the challenges and learnings related to previous Commonwealth dental programs. This paper highlights why expertise in dental public health is required to steer national oral health policy that is focused on prevention and early intervention. A population oral health approach for UHC should be informed by evidence, prioritise and address oral health inequities, and be co-ordinated by national clinical leadership for oral health. What is known about the topic? Many countries, including Australia, currently do not provide universal access to affordable oral healthcare. There are significant oral health inequities that exist in Australia, particularly for priority populations who are at higher risk for oral diseases. What does this paper add? National clinical leadership on oral health is needed to implement evidence-based oral health policy. This commentary provides justification for the Australian Government to appoint a Commonwealth Chief Dental Officer. What are the implications for practitioners? Strengthening advocacy efforts by the public health practitioners and other stakeholders is important to promote oral health as a critical health issue for urgent action. [ABSTRACT FROM AUTHOR]

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

The Medicines Repurposing Program was launched on 1 March 2024. It provides a pathway for registering and subsidising off-label medicines of significant public health benefit but which sponsors have no financial incentive to pursue. This article provides a short overview and critical analysis of the program. One concern that emerges is that commercial sponsors still retain de facto veto power over which off-label uses are prioritised and so have the capacity to sway the process. Simple suggestions are proposed to help mitigate this risk. What is known about the topic? The Medicines Purposing Program (MRP) provides a pathway for non-industry actors to have off-label uses of medicines approved and funded if deemed to be of public benefit. What does this paper add? Commercial sponsors can easily sway the prioritisation and selection of candidates under the MRP in their favour, so strategies are recommended to counter this risk. What are the implications for practitioners? The MRP provides an opportunity for the medical community to directly nominate off-label medicines uses for approval and funding improving access to medicines, but only if commercial interests do not intervene. [ABSTRACT FROM AUTHOR]

The purpose of this perspective article is to emphasise the importance of the 'First 2000 Days' policy of life from conception to age five, and to propose new directions in which the policy's implementation could be extended for the benefit of children and families. The proposed approach highlights principles of responsiveness, integration, sustainability and equity, specifying initiatives that embody the kind of innovation each principle aspires to. The article also proposes innovations in data collection and linkages that would strengthen the implementation of first 2000 days policies and frameworks. This perspective proposes a framework that could improve health systems implementation of services in the first 5 years of life, by proposing a well-coordinated continuum of services with integrated physical and digital solutions. This has the potential to transform how the health system monitors and responds to children and families' needs in the critical early years of life during and beyond the current pandemic. What is known about the topic? The 'First 2000 Days' policy is publicly available, it represents an important effort to highlight the importance of the first 5 years of life for a child's development. This policy and others like it have been broadly adopted around Australia. What does this paper add? This paper is a constructive critique of the policy that suggests greater responsiveness, integration, sustainability and equity. What are the implications for practitioners? This paper helps us understand how best to shape early childhood health services so they can be most effective. [ABSTRACT FROM AUTHOR]

Diagnostic imaging is increasingly being used in Australia to aid clinician diagnostic and therapeutic decision-making. There is concern that this increased use represents an overconsumption of inappropriate health services, which wastes finite resources and may cause direct or indirect harm to the patient. Australian health policies have primarily focused on increasing patient access to diagnostic imaging. While these policies address inequitable access and may lead to timely diagnosis and improved health outcomes, these benefits have not been weighed against the unintended harms. This perspective article will explore the unintended consequences of increasing access to diagnostic imaging as well as provide potential solutions to improve the effectiveness of policies in this area. What is known about the topic? When warranted, diagnostic imaging aids the diagnostic process by ruling in (or out) conditions that benefit from treatment and lead to improved patient outcomes. What does this paper add? This paper describes recent policies related to diagnostic imaging in Australia, discusses how increasing access may lead to unintended harms and create further inefficiencies in the system, and provides direction for future health policies in this area. What are the implications for practitioners? Addressing the inappropriate use of diagnostic imaging is crucial for the sustainability of the sector. [ABSTRACT FROM AUTHOR]

Objective: Healthcare delivery in Australia is managed at state and territory levels. This paper aims to compare the content and structure of publicly accessible Australian maternity service state and territory frameworks which guide the delivery of maternity care. Methods: A scoping review was conducted to identify publicly accessible Australian state and territory maternity service frameworks. A comparative content analysis was undertaken. Results: Six of the potential eight states and territories had locatable frameworks. Differences in both structure and content were found between frameworks. Variation exists between standalone maternity service frameworks and comprehensive clinical frameworks. Several jurisdictions align policy and ministerial directives in their frameworks outlining service delivery and guidance relating to maternal and/or neonatal transfer. Language referring to the assessment of maternity services and service risk varied. Conclusion: Consistency in structure, language, and a clear communication strategy embedded into each maternity service framework may improve the functioning and consistency of Australian maternity services at each level of the healthcare system. What is known about this topic? Limited evidence or analysis exists of the content of different maternity service framework documents in each Australian state and territory, despite a body of discourse and critical review regarding the previous national maternity service framework. What this paper adds? Similarities and differences in Australian maternity service frameworks are examined, providing insights into maternity operations and prioritised policy across differing jurisdictions. What are the implications for practitioners? Analysis of Australian maternity service frameworks highlights opportunities where jurisdictional governance documents can be strengthened or unified in the absence of an agreed national maternity service framework. [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]

Objectives: To assess whether compliance with the nationally endorsed Optimal Care Pathways is evident in 75% of patients treated with curative intent treatment and if this compliance was impacted by the COVID-19 pandemic (hereinafter COVID-19). Methods: This retrospective study included patients undergoing curative treatment with radiotherapy in head and neck (HN), breast, lung and gastrointestinal malignancies between January 2019 and June 2021 in a single NSW outer metropolitan cancer service. For care delivered within the remit of cancer services, the primary outcome measure was the proportion of patients whose treatment complied with the Optimal Care Pathways recommended time frame. Secondary outcome measures included evaluating the effect of COVID-19 on the proportion of patients being treated within the recommended time frame. Results: There were n = 733 eligible patients across the five tumour streams with the majority being breast cancer patients comprising 65% (n = 479) of the cohort, followed by HN cancer patients (n = 125, 17%). None of the tumour subsites abided by the 75% compliance rate. Oesophageal cancer patients had the lowest compliance rate of 4% (P < 0.001), with a similarly low compliance rate for rectal cancer patients at 33% (P = 0.002). None of the hypothesis tests to assess for detriment in treatment time during COVID-19 were statistically significant (P > 0.05). Conclusion: Despite the availability of best practice guidelines, there is limited compliance throughout all cancer subtypes, which has not been negatively influenced by COVID-19. Improved awareness of the Optimal Care Pathways, and implementation of the associated infrastructure and systems, are required to support compliance. What is known about the topic? The Optimal Care Pathways are the only nationally endorsed guideline that provides key timeframes from diagnosis to commencement of treatment and beyond for 25 different tumour subtypes. What does the paper add? There is limited compliance throughout the entire care pathway, with limitations in data availability to benchmark the entire pathway. These compliance rates were not affected by COVID-19. What are the implications for practitioners? Adjustments should be made to incorporate the Optimal Care Pathways into cancer service performance, with robust data collection mechanisms, to ensure patients across Australia receive equitable cancer care. [ABSTRACT FROM AUTHOR]

Objective: Falls in hospital are a significant public health issue and patients with communication disability have unique risk factors that have the potential to contribute to falls. The aim of this study is to determine how the content of hospital falls policies relate to patients with communication disability and to identify gaps in policy that need to be addressed. Methods: A scoping review and content analysis of (a) policies and related documents, from a target health service in Victoria, Australia, and all relevant Australian state and territory health departments, and (b) national guidelines was performed. Data were analysed for content relating to inclusion of patients with communication disability. Results: Communication disability is not captured as a risk factor for a fall in assessment tools. When included, aspects of communication disability were often conflated with cognitive impairments. There was little guidance for staff on adapting falls prevention education to suit the needs of patients with communication disability and limited identified role for speech pathologists. Conclusion: This study suggests that a patient's communication disability is not visible in hospital falls policies and guidelines. What is known about the topic? Falls prevention is an important part of the national health policy agenda and there is extensive literature informing hospital policy and guidelines. What does the paper add? This study provides insights into how hospital falls policies and guidelines relate to the assessment of risk, and prevention of falls in people with communication disability. What are the implications for practitioners? The results suggest that a patient's communication disability is not considered in falls risk assessment, or prevention plans. Communication disability should not be a barrier to engaging patients in this process. [ABSTRACT FROM AUTHOR]

What is known about the topic? Sonographers are well-known for their diagnostic roles in medical ultrasound though many have significant exposure to a range of interventional procedures. What does this paper add? Some sonographers are trained and qualified in these, including performing ultrasound-guided musculoskeletal injections. What are the implications for practitioners? A number of barriers exist for sonographers to use these skills to potential within the Australian healthcare system. [ABSTRACT FROM AUTHOR]

The advertising of regulated health services to consumers is strictly regulated in Australia. The advertising prohibitions within the National Law that ban the use of testimonials relating to services provided by health practitioners have caused controversy, garnering mixed reactions from the health professions, health consumers and other stakeholders. Advertising that misleads health consumers may promote unnecessary and inappropriate engagement in health services and may therefore negatively affect consumers' ability to exercise autonomous decisions relating to their care. This article considers policy implications relating to advertising with a focus on the use of testimonials, particularly those that are online. Although there would seem to be appetite for amending the current legislative framework, there is uncertainty as to the form change may take and the effect this could have. What is known about the topic?: Testimonials relating to health care are a prohibited form of advertising, but a form still used by non-regulated health providers and those who are regulated but who are either ignorant of the law or defiant of its requirements. Views are split as to whether the restriction on consumer reviews of regulated health services is reasonable; frequently, arguments are put forward stating that the status quo inhibits consumers' ability to discuss their care. Other jurisdictions outside Australia permit the use of patient reviews and testimonials. What does this paper add?: This paper discusses the greater policy implications of the current restrictions within the National Law and analyses the arguments placed forward by different stakeholders from the health professions and those that consume health services. The ethical and market arguments surrounding advertising and testimonials are examined. Suggestions are then made as to the deficits in knowledge that presently exist relating to this area and the actions required before future policy may be developed. What are the implications for practitioners?: Practitioners should be aware of the current restrictions upon advertising within regulated health services. This paper develops an understanding of the complex arguments surrounding advertising and testimonials in health care, as well as when testimonials may be permitted and not subject to the current regulations. Before any amendment to the current legislation is actioned, regulators should consider instead the need to develop an evidence-based approach to understanding the effects of health advertising on the decision making of healthcare consumers. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the effect of a therapeutic equivalence program (TEP) in achieving financial sustainability from 2010–11 to 2014–15. Methods: A TEP was introduced at Monash Health in 2006–07. Therapeutic medicine classes for inclusion were selected by stakeholder consensus and a preferred medicine for each class was chosen based upon therapeutic equivalence and cost considerations. New patients were commenced on a preferred medicine, but patients already prescribed another medicine from the same therapeutic class were not automatically switched to the preferred medicine. Data was obtained retrospectively from the pharmacy dispensing system, including the purchasing and issuing of all medicines from the preferred medicine classes. The prescribing patterns for preferred and comparator medicines were used as a measure of acceptance of the TEP, along with the savings produced by the program. Results: Over the 5-year evaluation period, 18 therapeutic classes were targeted, including seven new classes. Six therapeutic classes from the 11 included in the TEP before 2010–11 were removed throughout the evaluation period when the comparative economic benefits were no longer present. The use of all preferred medicines increased following implementation and a total of AU$7.38 million was saved from 2010–11 to 2014–15 and AU$10.54 million across 2006–07 to 2014–15. Conclusions: This paper provides an update on the progress of the TEP at Monash Health and outlines additional learnings gained. The market dynamics for pharmaceuticals means ongoing maintenance and review of the therapeutic medicine classes targeted is important to enable continued economic benefits. What is known about the topic?: There is continued and increasing focus on efficient, cost-effective and financially sustainable medication management. There is limited information available on strategies that can be implemented at a health service level. What does this paper add?: The TEP has resulted in sustained savings. The market dynamics for pharmaceuticals means ongoing maintenance and review of the therapeutic classes targeted is important to enable continued economic benefits. What are the implications for practitioners?: TEP is a process of genuine disinvestment. Identification and resolution of critical factors in the success of the program may assist implementation at other health services. [ABSTRACT FROM AUTHOR]

The Voluntary Assisted Dying Act 2017 (Vic) will come into force in June 2019, becoming the first law in Australia in 20 years to permit voluntary assisted dying (VAD). This paper considers how other Australian states and territories are likely to respond to this development. It analyses three key factors that suggest that law reform is likely to occur in other parts of Australia: (1) the growing international trend to permit VAD; (2) social science evidence about how VAD regimes operate; and (3) changes to the local political environment. The paper argues that these three factors, coupled with the effect of Victoria changing its law, suggest that other VAD law reform is likely to occur in Australia. It also considers the different types of laws that may be adopted, including whether other states and territories will follow the very conservative Victorian approach or adopt more liberal models. What is known about the topic?: Despite sustained law reform efforts in parliaments across the country, Victoria is the first Australian jurisdiction to pass a law permitting VAD in 20 years. What does this paper add?: This paper addresses likely future trends in VAD law reform in Australia. Drawing on international developments, a growing body of social science evidence about how VAD regimes work in practice, and evidence about a changing local political environment, the paper argues that other states and territories in Australia will also enact laws about VAD. What are the implications for practitioners?: The legalisation of VAD has significant implications for health professionals, health administrators and health systems. Understanding how reform may occur and what legal models may be considered supports participation in the law reform process and preparation for likely change. [ABSTRACT FROM AUTHOR]

Many countries across the world have legislated for their constituents to have control over their death. Commonalities and differences can be found in the regulations surrounding the shape and practices of voluntary assisted dying (VAD) and euthanasia, including an individual's eligibility and access, role of health professions and the reporting. In Australia there have been perennial debates across the country to attempt legislative change in assisting a terminally ill person to control the ending of their life. In 2017, Victoria became the first state to successfully legislate for VAD. In describing the Victorian process that led to the passage of legislation for VAD, this paper examines the social change process. The particular focus of the paper is on the vital role played by a multidisciplinary ministerial advisory panel to develop recommendations for the successful legislation, and is written from their perspective. What is known about the topic?: VAD has not been legal in an Australian state until legislation passed in Victoria in 2017. What does this paper add?: This paper describes how the legislation was developed, as well as the significant consultative and democratic processes required to get the bill to parliament. What are the implications for practitioners?: In documenting this process, policy makers and others will have an understanding of the complexities in developing legislation. This information will be useful for other Australian jurisdictions considering similar legislative changes. [ABSTRACT FROM AUTHOR]

Objective: The study examined if, when and how select allied health professional standards currently articulate the Health LEADS Australia themes. Methods: Eighteen allied health professional standards were searched to locate references to leadership. Data were extracted and analysed inductively, deductively and thematically as a meta-synthesis. Frequencies were counted, with subanalysis by professional area, classification level, competency type and level of cognition. Results: There were 953 direct and indirect leadership statements. Only two leadership definitions were located, for pharmacists and dentists. The principal theme 'Leadership' only appeared in 18 (2%) statements from the total dataset that made direct references to leadership, which were mostly vague and unclear. The remaining indirect references to leadership are reported as four overarching themes: Self-leadership (n = 289 statements; 30%); Leadership With and of Others (n = 263; 28%); Improvement and Change Leadership (n = 223; 23%); and Health Reform Leadership (n = 139; 15%). Conclusion: Health leadership was not easily recognisable in the allied health practice standards examined. With some refinement and alignment with a contemporary leadership framework, professional standards could play a critical role in preparing allied health graduates to support the ongoing health system reform required to improve health and well-being outcomes in the future. What is known about the topic?: Leadership is essential at all health system levels, and leadership frameworks can usefully guide leadership development. However, little is known about allied health leadership compared with other clinical groups, and their contributions to directional changes in health system reform may be overlooked. What does this paper add?: This paper presents results of an analysis of where and how 18 allied health disciplines align with the Australian Health LEADS framework, and where greater clarity or alignment is needed. What are implications for practitioners?: Reinstatement of a national health leadership framework, such as the Australian Health LEADS framework, to articulate the need for and capabilities of leadership to enable innovation and support reform across all professional groups working in health care, including medical, nursing and allied health is required. A recognised national leadership framework could guide the revisions to allied health practice standards and coupled with a co-design process involving practitioners and professional associations, further development and incorporation of leadership competencies in a consistent manner would be enabled. Furthermore, alignment of allied health education and professional development with a national health leadership framework may strengthen allied health leadership graduate outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to explore policy paths towards private health insurance (PHI) reform that might reduce out-of-pocket costs, restore public confidence and allow insurers to finance value-based care. Methods: This study used thematic analysis of semi-structured interviews with informed opinion holders, including a politician, three former senior public servants and an industry lobbyist. Critical analysis of peer reviewed and grey literature was also conducted. Results: PHI regulation is contributing to unexpected out-of-pocket expenses and low-value care. Modification of existing tax incentives would be incapable of significantly increasing PHI coverage. Regulatory reform could restore confidence among policy holders by promoting value-based care, wherein health outcomes are measured and incentivised with remuneration. Conclusions: Targeted relaxation of out-of-hospital restrictions should be explored to promote value-based competition and facilitate bundled payments for chronic disease management and community services. To address out-of-pocket diagnostic and procedural costs, insurers should have more responsibility for private specialist's fees, including by financing the entire provider's bill through insurance and redirecting the Medicare Benefits Schedule fee to the insurer. What is known about the topic?: Healthcare expenditure and out-of-pocket costs have grown rapidly, while confidence and depth of coverage in private health insurance has declined, as has the fiscal appetite for expanding public financing for health care. What does this paper add?: This paper outlines the regulatory and policy factors that are contributing to low-value care and unmet expectations from insurance policy holders. It also maps the strategic terrain of the non-government health sector and considers feasible policy options for reforming the PHI industry that do not increase drawings on the public purse. What are the implications for practitioners?: An appreciation of the ongoing challenges to financing value-based care provision will inform key stakeholders, including policymakers and health service providers, as reforms are debated and implemented. [ABSTRACT FROM AUTHOR]

Objective: This scoping review maps the approach undertaken by nurses to influence the implementation of artificial intelligence in health care. It also provides evidence of how frequently nurses drive the implementation of artificial intelligence, and how often nurses collaborate within the technical team. Methods: A systematic search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was undertaken from 24 July to 22 August 2020 to identify six records that met the inclusion criteria. Results: Nurses influenced the implementation of artificial intelligence in health care by: problem solving; articulating contextual needs and priorities; providing real-world insight and solutions; providing examples of implementation; and determining end user satisfaction. There was one instance of nurses driving implementation, and four instances of nurses collaborating with a technical team approach. Conclusion: The expertise of nurses must be sought to ensure artificial intelligence can effectively meet the highly context-specific demands of the healthcare environment. What is known about the topic? Nurses have reported negative impacts that AI can have when they are not included in the implementation process. What does this paper add? This scoping review has identified the extent of nursing influence on the design, development and implementation of AI. What are the implications for practitioners? There are many potential avenues of nursing research to explore such as; the impact of nurse involvement in AI, what depth of nurse involvement is needed and whether clinical immersion of developers results in improved usability, and smoother implementation of AI technologies. [ABSTRACT FROM AUTHOR]

There has been a growth in Australian school-based nurses to address the inequities confronted by vulnerable students and school populations. Failure to address inequities can be evidenced in intergenerational poverty, poorer health and educational attainment and diminished life opportunities. School-based nurses are ideally located to advocate for public health policies and programs that address social determinants that detrimentally affect the health of school populations. However, school-based nurses can confront professional and speciality challenges in extending their efforts beyond individual student advocacy to effect change at the school population level. Guidance is required to redress this situation. This paper describes public health advocacy, the professional and speciality advocacy roles of school-based nurses and the barriers they confront in advocating for the health of school populations and strategies that can be used by key stakeholders to enhance school-based nursing public health advocacy efforts. School-based nurses who are competent, enabled and supported public health advocates are required if we are to achieve substantial and sustained health equity and social justice outcomes for vulnerable school populations. School-based nurses are ideally located to advocate for services and policies to address the health inequities experienced by vulnerable school populations. However, these nurses can confront barriers that limit their capacity to embed health advocacy into their practice and to meaningfully effect change. Guidance is required to redress this situation. School-based nurses who are competent and supported health advocates are required to achieve substantial and sustained health equity and social justice outcomes for vulnerable students and school populations. [ABSTRACT FROM AUTHOR]

Voluntary assisted dying is a major social policy issue with significant implications for the health system, health and medical professionals and the wider community. Voluntary assisted dying is now lawful in Victoria in limited circumstances, and other states are likely to follow Victoria and legalise the practice. In the same way that we expect the making of health policy and the provision of health care to be evidence based, so too should we should expect evidence-based law making from our parliamentarians on this important topic. What is known about the topic?: The importance of evidence when making health policy and providing evidence-based medical care is well accepted. Australian states are actively considering laws about voluntary assisted dying. What does this paper add?: This paper argues that evidence-based law making by parliamentarians is needed as they deliberate proposed voluntary assisted dying laws. There has been limited recognition of the value of evidence-based approaches in the discipline of law. What are the implications for practitioners?: A failure by parliaments to adequately consider evidence can lead to suboptimal law making. When this occurs about important health issues, such as voluntary assisted dying, it leads to problematic regulatory frameworks for patients, health professionals and health systems. [ABSTRACT FROM AUTHOR]

Person-centred primary care is a priority for patients, healthcare practitioners and health policy. Despite this, data suggest person-centred care is still not consistently achieved - and indeed, that in some areas, care may be worsening. Whole-person care is the expertise of the medical generalist - an area of clinical practice that has been neglected by health policy for some time. It is internationally recognised that there is a need to rebalance specialist and generalist primary care. Drawing on 15 years of scholarship within the science of medical generalism (the expertise of whole-person medical care), this discussion paper outlines a three-tiered approach to primary care redesign; describing changes needed at the level of the consultation, practice set up and strategic planning. The changing needs of patients living with complex chronic illness has already started a revolution in our understanding of healthcare systems. This paper outlines work to support that paradigm shift from disease-focused to person-focused primary healthcare. [ABSTRACT FROM AUTHOR]

Objective: The aim of this research was to explore the experiences of general practice in delivering Australia's coronavirus disease 2019 (COVID-19) vaccine, and the impact on practice finances and workforce. Methods: Eighteen semi-structured interviews with owners and practice managers of general practices in Greater Sydney between June and August 2021 were conducted. Results: Practices reported early enthusiasm for the vaccine rollout and engaged in large-scale staffing and infrastructure adaptations to manage increased vaccination workload. Although some practices reported increased income related to vaccination, nearly all reported increased costs. Lack of timely and transparent communication between primary care and policymakers was a major concern for practices. Conclusions: The success of Australia's COVID-19 vaccine rollout relied on the goodwill of general practices. Participation in the COVID-19 vaccine rollout resulted in increased stress, increased administration workload, and reduced financial viability for many practices. What is known about the topic? Most of Australia's general practices participated in the COVID-19 vaccination program. What does this paper add? Practices rapidly managed large-scale adaptation and capital costs to participate in the vaccine program. Practices reported increased patient activity, administrative workload and stress, and most reported worsening financial position through the vaccine rollout. What are the implications for practitioners? The COVID-19 vaccine program may have long-term impacts on primary care finances and workforce, and on the willingness of practices to participate in future reform. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of telehealth policy changes on general practitioner (GP) consultation activity in Australia, during the coronavirus disease 2019 (COVID-19) pandemic, from January 2019 to December 2021. Methods: An interrupted time-series analysis was conducted to analyse the impact of two major policy changes, introduced through the Medicare Benefits Schedule (MBS), on GP consultation (in-person, videoconference, telephone) activity. The first policy change was the introduction of additional COVID-19 telehealth funding through the MBS on 30 March 2020. The second policy change was the limitation on telephone consultation length to under 20 min on 1 July 2021. The rate of GP telehealth provision and activity was compared between pre-and post-intervention periods, separated by these MBS policy changes. Results: After the first policy change, there was a significant increase in telehealth provision, with a simultaneous decrease in in-person consultations (P < 0.0001). However, telehealth provision decreased in the months following this first policy change (P < 0.0001), while in-person activity increased. After the second policy change, the initial videoconference provision increased (P < 0.0001). However, all telehealth activity decreased afterwards. In the months following the second policy change, the decrease in monthly activity for in-person (P = 0.700), telephone (0.199) and videoconference (P = 0.178) consultations was not significant. Conclusions: The introduction of additional telehealth funding and limitations on telephone consultation length encouraged the initial provision and growth of telehealth services. However, these policy changes did not sustain the long-term upward trajectory of telehealth activity. Telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services. What is known about the topic? The COVID-19 pandemic was a catalyst for increased telehealth provision by general practitioners (GPs). Since COVID-19, the Australian Government have invested in telehealth by increasing reimbursement opportunities through the Medicare Benefits Schedule (MBS) and making multiple telehealth policy changes. What does this paper add? This study examined the impact of MBS telehealth policy changes on GP consultation activity in Australia over 3 years during COVID-19. What are the implications for practitioners? Telehealth funding is necessary for service viability. However, funding alone is unlikely to encourage increased videoconference use and is unlikely to promote long-term telehealth provision. Future telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged the mental health of communities worldwide, with the triple pressures of financial insecurity, lockdowns, and worry about the infection. Australia rapidly deployed resources to protect the mental wellbeing of the community through supplementing existing services, supporting at-risk groups, investing in social supports, embracing technology, and supporting the health workforce. This paper describes the Australian Government's investment in mental health during the COVID-19 pandemic in relation to the 10 priority areas identified in Australia's National Mental Health Pandemic Response Plan. The COVID-19 pandemic and associated public health measuresgenerated substantial and ongoing challenges for the mental health and wellbeing of Australian communities. Australian Government funded initiatives were rapidly instituted between different levels of government and with community mental health organisations. These policy actions aimed to provide agile responses to promote community resilience and strengthen services for vulnerable groups, including older people, those with existing mental health conditions, Aboriginal and Torres Strait Islander peoples, and health and essential service providers. [ABSTRACT FROM AUTHOR]

Background: The impact of colonisation, dispossession and marginalisation on the health of Aboriginal and/or Torres Strait Islander peoples (hereafter respectfully referred to as Aboriginal people) is well documented. Aboriginal people continue to practice traditional healing, and in recent years have initiated numerous community-based healing programs around Australia. The Closing the Gap policy has also resulted in numerous community health programs. Despite these program and policy responses, Aboriginal people continue to experience persistent health disparities. The role of Aboriginal Elders in shaping Aboriginal health has yet to be a focus of research attention. This paper reports on a study that examined the contributions of Elders to the healing of Aboriginal people in a remote Tasmanian community. Methods: Our co-designed participatory action research methodology was undertaken with eight community Elders. Results: Analysis of qualitative data derived through interviews and yarning circle discussions revealed an emerging theme of community healing; with Elders undertaking a suite of therapeutic practices, and promoting cultural values to strengthen Aboriginal identity, community cohesion and connections to Country. The Elders identified healing as an essential process in response to intergenerational trauma, racism and marginalisation. Conclusions: The findings inform policy stakeholders to consider the wisdom and voice of Elders in addressing Aboriginal community healing. The Closing the Gap policy framework has made little impact in addressing Aboriginal health disparities. However, Aboriginal Elders are quietly leading the way in community healing; represented by a suite of therapeutic practices and the promotion of cultural values to strengthen Aboriginal identity, community cohesion and connections to Country. Elders provide stakeholders with a culturally embedded framework to advance the health and well-being of Aboriginal people. [ABSTRACT FROM AUTHOR]

Understanding of the benefits of consumer-led health policy, practice, research and education has been developing for decades. However, barriers to genuine, non-tokenistic consumer leadership remain across the health sector. While recent calls to align Australian consumer engagement practices with those in the UK and elsewhere may sound progressive, doing so would be problematic for three reasons. First, Australia has been at the forefront of consumer leadership scholarship and advocacy for decades, and we should not ignore the work consumers and allies have done in improving our health systems. Second, although there have been positive outcomes from consumer engagement and inclusion practices (as often required in other jurisdictions), they are open to tokenism and continue to position consumers' experiential expertise as 'lesser' compared to other health sector stakeholders' knowledge. Last, compared to consumer leadership, engagement or inclusion are 'lower bars' for health professionals to aim for. If we settle for engagement or inclusion in cases where consumer leadership would have been possible, then we lose not only our position at the forefront of consumer leadership, but also the expertise of consumers. Three propositions are provided: (1) we should support consumer-led development policy for consumer leadership in health, (2) we should ensure consumer leadership in oversight over as well as conduct of health and medical research, (3) we should encourage honest claims about the extent to which projects or initiatives are led by or with consumers. What is known about the topic? Health policy, practice, research and education led by consumers benefits from their experiential expertise. What does this paper add? We should be careful of settling for consumer engagement or involvement, and continue pushing for consumer leadership to realise these benefits. What are the implications for practitioners? The health sector should make space for consumer leadership across initiatives, services and systems. Our health systems should enable us to foster non-tokenistic partnerships with consumers and engage only in honest reporting about the level of involvement of consumers in research. [ABSTRACT FROM AUTHOR]

Personal recovery is central to Australian mental health standards, but promoting recovery-oriented practice remains a wicked problem (ie complex, with definitions and appropriate interventions impacted upon by context and values), with limited evidence regarding effective implementation. This case study re-examines a statewide initiative to enhance recovery-oriented practice in older people's mental health services in New South Wales from the perspective of complex adaptive systems. The initiative consisted of three key strategies: (1) statewide collaborative leadership and practice resources; (2) locally determined and led improvement projects; and (3) evaluating, disseminating and sustaining initiative outcomes. Published outcomes of the initiative, related policy and benchmarking materials and author reflections are used to propose lessons for other services and policy makers. From a systems perspective, a relatively small investment from a state policy unit to enhance a facilitating environment resulted in the emergence of local leaders and voluntary participation of services within 80% of local health districts without funding incentives. Local leaders and activities informed statewide policies and models of care to sustain practice change. Limitations included variability in project scopes and the involvement of people with lived experience, as well as the level of refinement in change management approach. Self-audit and consumer-rated experience suggest resilience of practice and culture change. The outcomes are consistent with conceptualisations of mental health services being complex adaptive systems requiring distributive leadership. Established mechanisms encouraging statewide cooperation between clinicians, service managers and policy makers may have been significant facilitators of engagement in practice change. What is known about this topic?: Recovery remains an important concept for older people with mental ill health, with implementation of recovery-oriented practice a wicked problem. What does this paper add?: Central policy investment in a collaborative facilitatory environment can stimulate the emergence of local leadership and investment in actions to enhance recovery orientation. As predicted by complex adaptive systems theory, the impact of the leaders developed may be broader than the sum of individual project outcomes. What are the implications for practitioners?: A start where you can message can engage and enable leaders in feasible and locally relevant changes consistent with a statewide strategy. This may be a feasible approach to improving recovery orientation in mental health care services for and beyond older people, with potential implications for addressing other wicked problems in health care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to understand, from the perspective of policy makers, who holds the responsibility for driving evidence-based policy to reduce the high burden of cardiovascular disease (CVD) in rural Australia. Methods: Qualitative interviews were conducted with policy makers at the local, state and federal government levels in Australia (n = 21). Analysis was conducted using the Conceptual Framework for Understanding Rural and Remote Health to understand perceptions of policy makers around who holds the key responsibility in driving evidence-based policy. Results: At all levels of government, there were multiple examples of disconnect in the understanding of who is responsible for driving the generation of evidence-based policy to reduce CVD in rural areas. Policy makers suggested that the rural communities themselves, health services, health professionals, researchers and the health sector as a whole hold large responsibilities in driving evidence-based policy to address CVD in rural areas. Within government, there was also a noticeable disconnect, with local participants feeling it was the federal government that held this responsibility; however, federal government participants suggested this was largely a local government issue. Overall, there seemed to be a lack of responsibility for CVD policy, which is reflected in a lack of action in rural areas. Conclusion: There was a lack of clarity about who is responsible for driving evidence-based policy generation to address the high burden of CVD in Australia, providing one possible explanation for the lack of policy action. Clarity among policy makers over shared roles and leadership for policy making must be addressed to overcome the current burden of CVD in rural communities. What is known about the topic?: Rural health inequalities, such as the increased burden of CVD in rural Australia are persistent. Such health inequalities are unjust, with global theory suggesting political processes have facilitated, in part, the inequalities. With similar examples observed internationally in rural areas, little is known about the influence of the perspectives of policy makers regarding who is responsible for addressing health issues in rural areas, in the government context. What does this paper add?: This paper provides empirical evidence, for all levels of government in Australia, that there is a lack of clarity in policy roles and responsibilities to address the unequal burden of CVD in rural Australia, at all levels of government. The paper provides evidence to support the urgent need for clarity within government around policy stakeholder roles. Without such clarity, it is unlikely that national-level progress in addressing rural health inequalities will be achieved in the near future. What are the implications for practitioners?: Addressing ambiguity around who is responsible for the development of evidence-based policy to address the high burden of CVD in rural areas must be a high priority to ensure health disparities do not persist for future Australian generations. The results reported here are highly relevant to the Australian context, but also reflect similar findings internationally, namely that a lack of clarity among policy stakeholders appears to contribute to reduced action in addressing preventable health inequalities in disadvantaged populations. This paper provides evidence for policy makers and public health professionals to advocate for clear policy roles and direction in rural Australia. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the effect of the frequency of general practitioner (GP) visitation in the 12 months before a 21% consumer copayment increase in the Pharmaceutical Benefits Scheme (PBS; January 2005) on the reduction or discontinuation of statin dispensing for tertiary prevention. Methods: The study used routinely collected, whole-population linked PBS, Medicare, mortality and hospital data from Western Australia. From 2004 to 2005, individuals were classified as having discontinued, reduced or continued their use of statins in the first six months of 2005 following the 21% consumer copayment increase on 1 January 2005. The frequency of GP visits was calculated in 2004 from Medicare data. Multivariate logistic regression models were used to determine the association between GP visits and statin use following the copayment increase. Results: In December 2004, there were 22 495 stable statin users for tertiary prevention of prior coronary heart disease, prior stroke or prior coronary artery revascularisation procedure. Following the copayment increase, patients either discontinued (3%), reduced (12%) or continued (85%) their statins. Individuals who visited a GP three or more times in 2004 were 47% less likely to discontinue their statins in 2005 than people attending only once. Subgroup analysis showed the effect was apparent in men, and long-term or new statin users. The frequency of GP visits did not affect the proportion of patients reducing their statin therapy. Conclusions: Patients who visited their GP at least three times per year had a lower risk of ceasing their statins in the year following the copayment increase. GPs can help patients maintain treatment following rises in medicines costs. What is known about the topic?: Following the 21% increase in medication copayment in 2005, individuals discontinued or reduced their statin usage, including for tertiary prevention. What does this paper add?: Patients who visited their GP at least three times per year were less likely to discontinue their statin therapy for tertiary prevention following a large copayment increase. What are the implications for practitioners?: This paper identifies the important role that GPs have in maintaining the continued use of important medications following rises in medicines costs. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods: An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results: Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions: Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic?: Refugee health after resettlement is poor, yet health service use is low. What does this paper add?: Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals' knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners?: The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods: A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils' Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results: There were 545 283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20 935 dentists, 101 066 medical practitioners, 363 040 nurses/midwives, 28 370 pharmacists and 31 872 psychologists. During the study period there were 12 616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P < 0.01), age (P < 0.01) and country of birth (P < 0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions: The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject?: Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add?: This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners?: Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study was to evaluate changes in the inclusion of pertinent information on electronic discharge summaries (eDS) after implementation of a revised template and electronic medical record (EMR) workflow. Methods. A retrospective medical record audit of eDS at three metropolitan hospitals was undertaken for adult inpatient encounters in June 2021 (pre-intervention, n = 100) and June 2022 (post-intervention, n = 100). The eDS were evaluated against 16 components listed in the Australian National Guidelines for the OnScreen Display of Discharge Summaries. Nine components were further broken down to between two and 11 sub-components. Sub-analysis compared a hospital with full EMR to pooled results from hospitals with hybrid EMRs. Components and sub-components were evaluated for inclusion only; accuracy or relevance of the information was not assessed. Results. Inclusion of three out of 16 components (presentation details: 47% vs 62%, problems and diagnosis: 61% vs 86% and recipient details: 82% vs 93%) and eight out of 36 sub-components (discharge destination, principal diagnosis, history of presenting complaint, infection risk, pressure injury, screening and/or diagnosis of delirium and GP phone number and address) was higher in the postintervention group (all P < 0.05). Reduced eDS information inclusion in the post-intervention group was observed for discharge date and falls risk only (both P < 0.05). Reporting of falls history decreased at the hospital with full EMR (71% vs 20% P < 0.001) but not at hospitals utilising hybrid EMRs (24% vs 30% P = 0.5). Conclusion. The intervention was associated with improved inclusion of pertinent information as described in the Australian National Guidelines for the On-Screen Display of Discharge Summaries. [ABSTRACT FROM AUTHOR]