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Australia is undergoing major aged care reforms, changing from the previous service provider‐driven approach to consumer‐directed care principles. In residential aged care, this has resulted in a significant reduction in government funding in order to support reform initiatives in home and community‐based care. There has been limited research on the impact of structural aspects of the reforms such as the effect of changes in funding focus. Using a qualitative descriptive research methodology, this study explores the impact of the reforms on staff at various levels of operational responsibility in residential aged care. Issues identified by participants centered on the capacity to deliver care in three areas, the impact of funding reduction, challenges in meeting increasingly complex needs of residents and their families, and new requirements for care roles within current limitations. This paper provides an insight into how and why operational issues have informed the findings of the current Australian Royal Commission into Aged Care Quality and Safety. It identifies areas of support for the aged care workforce that are crucial in fulfilling consumer‐focused care delivery. [ABSTRACT FROM AUTHOR]

Background: It seems to be a truth universally acknowledged that pathways to care for people with eating disorders are inconsistent and difficult to navigate. This may, in part, be a result of the complex nature of the illness comprising both mental and medical ill-health across a broad range of severity. Care therefore is distributed across all parts of the health system resulting in many doors into the system, distributed care responsibility, without well developed or integrated pathways from one part of the system to another. Efforts in many parts of the world to redesign health service delivery for this illness group are underway, each dependent upon the local system structures, geographies served, funding sources and workforce availability. Methods: In NSW—the largest populational jurisdiction in Australia, and over three times the size of the UK—the government embarked six years ago on a program of whole-of-health system reform to embed identification and treatment of people with eating disorders across the lifespan and across the health system, which is largely publicly funded. Prior to this, eating disorders had not been considered a 'core' part of service delivery within the health system, meaning many patients received no treatment or bounced in and out of 'doorways'. The program received initial funding of $17.6 million ($12.5 million USD) increasing to $29.5 million in phase 2 and the large-scale service and workforce development program has been implemented across 15 geographical districts spanning almost one million square kilometres servicing 7.75 million people. Conclusions: In the first five years of implementation there has been positive effects of the policy change and reform on all three service targets—emergency departments presentations, hospital admissions and community occasions of service as well as client hours. This paper describes the strategic process of policy and practice change, utilising well documented service design and change strategies and principles with relevance for strategic change within health systems in general. Plain English summary: This review outlines a $30 million health system reform to eating disorder treatment implemented by the NSW State Government six years ago which has seen large-scale service and workforce development across 15 geographical districts. This spans almost one million square kilometres and services 7.75 million people in Australia. The reform is very large in scale and is now in its second phase of implementation. Here outlined is the strategic process of policy and practice change of the entire reform and initial findings from an external review of phase one, which demonstrates positive effects on all three service targets—emergency departments presentations, hospital admissions and community occasions of service—including increased rates of treatment provision, improved perception of eating disorders amongst health professionals, improved pathway options and better communication within multidisciplinary teams. This type of whole-of-health system government led reform has relevance and learnings for health systems internationally. [ABSTRACT FROM AUTHOR]

This two-year (2016–2018) study aimed to identify what a good life is for Aboriginal people with disability in remote Central Australia and how service providers can support them to achieve a good life. This paper presents the findings that relate to barriers to delivering services for Aboriginal people with disability. In-depth interviews and focus groups were held with Aboriginal people with disability and their carers aged at least 18 years from the Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Lands and community organisations providing services there. The data were analysed using thematic analysis. There were 109 participants, of whom 47 were workers in service provider organisations and 62 were Aboriginal people. From the data, barriers to delivering services to support Aboriginal people to live a good life and solutions to overcome the barriers, were identified and described under the headings of environmental barriers and systemic issues. We discuss the policy implications of these findings with regard to addressing Indigenous disadvantage and how governments, service providers, communities, and Aboriginal people with disability and their families can work in partnership to address these barriers. Indigenous people with disability living in remote and very remote communities experience significant access and equity barriers to culturally responsive services that enable them to live a socially and culturally engaged life. Localised government and service provider disability policy approaches in Indigenous communities need to focus on both environmental and systemic issues. Greater investment in local remote communities is required to build the capacity of Indigenous families to support Aboriginal people with a disability to live a culturally and socially included life. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare researchers are under increasing pressure to demonstrate measurable and lasting improvement in clinical practice and healthcare policy as a result of their work. It is therefore important to understand the effectiveness of the research dissemination strategies used. The aim of this paper is to describe the pathways for research impact that have been achieved across several government-funded primary healthcare projects, and the effectiveness of these methods as perceived by their Chief Investigators.Methods: The project used an online survey to collect information about government-funded primary healthcare research projects. Chief Investigators were asked how they disseminated their findings and how this achieved impact in policy and practice. They were also asked to express their beliefs regarding the most effective means of achieving research impact and describe how this occurred.Results: Chief Investigators of 17 projects indicated that a number of dissemination strategies were used but that professional networks were the most effective means of promoting uptake of their research findings. Utilisation of research findings for clinical practice was most likely to occur in organisations or among individual practitioners who were most closely associated with the research team, or when research findings were included in educational programmes involving clinical practice. Uptake of both policy- and practice-related research was deemed most successful if intermediary organisations such as formal professional networks were engaged in the research. Successful primary healthcare researchers had developed critical relationships with intermediary organisations within primary healthcare before the initiation of the research and had also involved them in the design. The scale of research impact was influenced by the current policy environment, the type and significance of the results, and the endorsement (or lack thereof) of professional bodies.Conclusions: Chief Investigators believed that networks were the most effective means of research dissemination. Researchers who were embedded in professional, clinical or policy-focussed intermediary organisations, or had developed partnerships with clinical services, which had a vested interest in the research findings, were more able to describe a direct impact of their research. This suggests that development of these relationships and engagement of these stakeholders by primary healthcare researchers is a vital step for optimal research utilisation in the primary healthcare setting. [ABSTRACT FROM AUTHOR]

However, the disconnect between the schedule fee and the fees charged by providers still leaves patients vulnerable to open-ended out-of-pocket fees (Box). Keywords: Economics, medical; Health financing; Health policy; Health systems; Healthcare disparities; Socioeconomic status EN Economics, medical Health financing Health policy Health systems Healthcare disparities Socioeconomic status 294 297 4 04/18/23 20230415 NES 230415 Out-of-pocket fees create access barriers to health care, exacerbating health inequalities In Australia, 15% of all expenditure on health care comes directly from individuals in the form of out-of-pocket fees - this is almost double the amount contributed by private health insurers.[1] There is concern that vulnerable groups - socio-economically disadvantaged people and older Australians in particular, who also have higher health care needs - are spending larger proportions of their incomes on out-of-pocket fees for health care.[2] A 2019 study identified that one in three low income households are spending more than 10% of their income on health care.[3] This might create economic hardship, and individuals do forgo care,[4] with one in four Australians without a health care condition and up to one in two with certain health conditions avoiding care because of the cost.[4] Health care services in Australia are delivered through a mixture of public and private providers, with governments subsidising the costs of care but out-of-pocket fees remaining a significant component.[5] Australia is not unique in this, with similar systems in New Zealand, Ireland, France, Germany, the Netherlands, and the United Kingdom. 3 Callander EJ, Fox H, Lindsay D. Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system. [Extracted from the article]

Purpose: This study explores key governance, leadership and management activities that have impact on quality, risk and safety within Australian healthcare organisations. Design/methodology/approach: Current non-executive directors (n = 12) of public and private health boards were interviewed about contemporary approaches to fiduciary and corporate responsibilities for quality assurance and improvement outcomes in the context of risk and safety management for patient care. Verbatim transcripts were subjected to thematic analysis triangulated with Leximancer-based text mining. Findings: Boards operate in a strong legislative, healthcare standards and normative environment of quality and risk management. Support and influence that create a positive quality and risk management culture within the organisation, actions that disseminate quality and risk broadly and at depth for all levels, and implementation and sustained development of quality and risk systems that report on and contain risk were critical tasks for boards and their directors. Practical implications: Findings from this study may provide health directors with key quality and risk management agenda points to expand or deepen the impact of governance around health facilities' quality and risk management. Originality/value: This study has identified key governance activities and responsibilities where boards demonstrate that they add value in terms of potential improvement to hospital and health service quality care outcomes. The demonstrable influence identified makes an important contribution to our understanding of healthcare governance. [ABSTRACT FROM AUTHOR]

Almost exactly 10 years after the publication of 'Call for a national plan for rare diseases' in this journal, the Federal Government launched the National Strategic Action Plan for Rare Diseases (the Action Plan) on the 26th of February 2020, in the lead up to Rare Disease Day on the 29th of February - a rare day for rare diseases. The Action Plan is the culmination of effective advocacy by Rare Voices Australia (RVA) and other stakeholders in the rare disease (RD) sector. RVA is the peak body for Australians living with a RD. The organisation works collaboratively with RD organisations, researchers and clinicians. Since the initial call for a RD plan, a number of health-care initiatives and policy changes have gathered apace including expanded antenatal and newborn screening, the increasing application of next generation sequencing and advances in gene and cell therapeutics. The development of new models of care, diagnostic and treatment pathways, and communities of practice have started to ease the considerable burden and inequitable access to care experienced by RD patients and their families. However, much work remains to be done. The Action Plan outlines the actions to bring about the best possible health and well-being outcomes for Australians living with RD. It is centred around three pillars - awareness and education, care and support, research and data - and will be delivered against the principles of person centredness, equity, and sustainable systems and workforce. [ABSTRACT FROM AUTHOR]

Purpose: High demand for speech-language pathology services is reflected in long waiting lists. Waiting can be active or passive and has implications for stakeholders, including consumers, professionals, and organisations. The present study explored experiences and perspectives regarding waiting for speech-language pathology services through analysis of stakeholders' written submissions to an Australian Government Senate Inquiry. Method: Written submissions (n = 337) were screened for terms related to waiting. Included submissions (n = 133) were written by organisations (36.8%), speech-language pathologists (29.3%), parents (27.8%), individuals with communication and/or swallowing difficulties (5.3%), and others. Result: Inductive thematic analysis identified three themes. (1) Duration. Consistently described as long. (2) Consequences. Consumers' consequences included: burden on physical health, finances, time, emotional wellbeing, and relationships, reduced continuity of care, and increased intervention needs. Professional consequences included: stress and burnout impacting job satisfaction, and reduced effectiveness. Societal consequences included: social and ethical burden, and a drain on health and legal systems. (3) Actions. Consumers advocated and sought alternatives (e.g. threats to harm their child, relocation to a capital city), professionals implemented service delivery and policy actions, and organisations lacked effective system-wide strategies. Conclusion: Existing services did not appear to meet stakeholders' needs. Action is needed to improve speech-language pathology waiting lists and access to services, and minimise possible consequences for stakeholders. [ABSTRACT FROM AUTHOR]

There has been a shift towards provision of mental health care in community‐based settings in Australia. However, hospitals continue to care for people in acute mental health wards. An increasing proportion of the people in wards are admitted involuntarily, subject to restrictions of movement to minimize risk of harm to self and others. In response to concerns about the safety of people absconding from care, Queensland Health introduced a policy requiring all acute mental health wards in the State to be locked. In response, the Queensland Mental Health Commission funded a project to understand the impact of this policy and develop evidence‐based recommendations regarding provision of least restrictive, recovery‐oriented practices in acute wards. Facilitated forums were conducted with 35 purposively selected participants who identified as consumers, carers, or staff of acute mental health hospital wards, to test the acceptability, feasibility, and face validity of a set of evidence‐informed recommendations for providing least restrictive, recovery‐oriented practices. Participant responses were recorded, and data were analysed through an inductive, thematic approach. A recovery‐oriented approach was supported by all stakeholders. Reducing boredom and increasing availability of peer support workers were considered key to achieving this. Focusing less on risk aversion was reported as central to enabling true Recovery Orientation. This project enabled recognition of the perspectives of consumers, carers, and staff in the consideration of evidence‐informed recommendations that could be implemented to provide least restrictive care in the context of locked doors. [ABSTRACT FROM AUTHOR]

The prevalence of health risk behaviours and associated poor physical health is high in people with severe mental illness. Mental health service guidelines and policies stipulate that mental health services should address physical health of people who access services. This study reports results from a large, interdisciplinary, cross‐sectional study exploring mental health clinicians' (n = 385) views of role legitimacy in physical health service provision. All disciplines reported that mental health clinicians have a role to play in addressing the physical health of consumers. Among mental health clinicians, psychiatrists and mental health nurses received higher endorsement than allied health clinicians in relation to the provision of physical health care, with primary care providers including general practitioners also ranking highly. As community mental health services routinely appoint allied health staff to case management roles, a challenge for services and a challenge for clinicians are to ensure that physical health and the effects of medication are monitored appropriately and systematically. Online and telephone support services received relatively lower endorsement. As the availability of nonface to face services increases, there is a need to explore their utility in this population and where appropriate promote their uptake. [ABSTRACT FROM AUTHOR]

Issue Addressed: Australian efforts to tackle the burden from chronic diseases through prevention have included numerous strategies, committees, policies and programs. This research reflects on this changing landscape, with focus on the most recent, and most significant, investment and subsequent disinvestment in preventive health, the National Partnership Agreement on Preventive Health (NPAPH). The purpose is to better understand the place of the NPAPH in Australia's prevention landscape, explore views from senior health department personnel on the NPAPH and identify lessons for the future.Methods: Individual and small group semi-structured interviews were undertaken with 19 senior public health managers and program implementation staff from State and Territory health departments across Australia. A grounded theory approach was used to generate themes relevant to the research.Results: Participants reflected positively on the NPAPH, mostly that it established a strong platform for the national roll out of programs supporting healthy lifestyles, it created core infrastructure that elevated the rigour and sophistication of prevention activities and it was achieving or on the way to achieving its desired outputs. However, despite promising potential, governance arrangements over chronic disease prevention were not clearer either throughout or post the NPAPH. While partnerships between State and Territory governments, as well as with other sectors, were seen as a strength of the NPAPH, many viewed the role of the Commonwealth in the NPAPH as limited to funding.Conclusion: Longer term investment in, and leadership for, chronic disease prevention is necessary. The NPAPH built on positive reforms at the time, creating opportunities for implementing programs at scale, building workforce capacity and improving evaluations. Early termination of the NPAPH meant potential return on investment was unrealised, new partnerships could not always be sustained and the prevention workforce was again under threat. Furthermore, responsibility for prevention, which was never clear, became even more opaque. SO WHAT?: The NPAPH, as a national initiative for achieving improvements to the prevention of chronic disease, was a welcome investment. Disinvestment in the NPAPH, as well as other promising reforms of the time, led to a loss of credibility in outcomes focussed funding collaborations as well as missed opportunities for the future health and wellbeing of the Australian population. Australia needs a recommitment at all levels of government to investment and action in prevention and a restoration of funding in prevention commensurate with the size of the health burden. [ABSTRACT FROM AUTHOR]

Background: Health systems globally promote appropriate prescribing by healthcare providers and safe and effective medicine use by consumers. Rx for Change, a publicly available database, provides access to systematic reviews regarding best practices for prescribing and using medicines. Despite the value of the database for improving prescribing and medicine use, its use remains suboptimal. This study aimed to develop a training program for five medicine-focused organisations in Canada and Australia to facilitate the use and understanding of the Rx for Change database.Methods: Four steps were undertaken: 1) key informant interviews were completed across all organisations to understand the knowledge user perspective; 2) a directed content analysis was completed of the interview transcripts and proposed training was developed; 3) a second round of feedback on the proposed training by knowledge users was gathered; and 4) feedback was integrated to develop the final training.Results: Sixteen key informant interviews with knowledge users were conducted. Themes for training content included the scope of, navigation and strategies for using Rx for Change (generic content) and practical examples on incorporating evidence within their workplace context (tailored content). The final training consisted of an informational video, a 60-minute face-to-face workshop and two post-training reminders.Conclusions: A method of engaging knowledge users in the development of a training program to improve the use of an on-line database of systematic reviews was established and used to design training. Next steps include the delivery and evaluation of the training. [ABSTRACT FROM AUTHOR]