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Value based healthcare beyond the clinical domain is the focus of this case study. We share NSW Health's experiences in achieving value through a focus on outcomes in non-clinical and clinical support services using examples that demonstrate key aspects across the commissioning cycle. These include: the importance of stakeholder engagement in the planning phase to later success; the critical role of non-clinical services in patient experience; the opportunity to facilitate value by introducing new approaches in business areas such as procurement; and the role of clinical supports such as digital enablement to facilitate outcome-focussed clinical models. Applying a value lens to non-clinical services can increase the potential benefits to patients, clinicians and the system. What is known about the topic? Value based healthcare is a way of making transparent and equitable decisions about resource allocation to deliver better outcomes for individuals, health services and the system. What does this paper add? This paper reflects on the opportunity to deliver value based healthcare beyond clinical models of care, including in non-clinical and clinical support services, using a commissioning approach. What are the implications for practitioners? The learnings shared through the case studies presented can be applied by practitioners to their own projects to support value based approaches across all aspects of health care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Millions of Australians use the private health system every year. They should receive safe, high-quality, value-based care. However, poor policy and inadequate regulation of medical technology is driving low-value care at great expense to consumers and the broader health system. Key drivers include the Prescribed List of Medical Devices and Human Tissue, gaps in quality and safety controls for devices being used, and marketing and conflicts of interest. All of these should be addressed to reduce low-value care in Australia's private health system, so consumers are protected from harm and limited health budgets are used effectively. What is known about the topic? With health expenditure rising unsustainably, there is a growing focus on ways to reduce low-value care to improve health outcomes and eliminate unnecessary costs. What does this paper add? This paper details drivers of low-value care in Australia's private health system and recommendations to overcome them. Drivers include the Prescribed List of Medical Devices, gaps in safety and quality controls, and conflicts of interest and marketing. What are the implications for practitioners? These insights are relevant to clinicians, researchers, policymakers, consumers and health business leaders with an interest in low-value care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Purpose: Effective use of data is critically important for the provision of health services. A large proportion of employees in health organisations work in non-clinical roles and play a major part in organisational information flows. However, their practice, data-related capabilities and learning needs have been rarely studied. The purpose of this paper is to investigate issues of capabilities and learning needs related to employees' interactions with data in non-clinical work roles. Design/methodology/approach: The study used a mixed-method approach. Qualitative methods were used to explore issues, and survey was administered to gather additional data. Findings: Data use and related capabilities at the workplace are highly contextual. A range of general, core and data-specific capabilities, underpinned by transferable skills and personal traits, enable successful interactions with data. Continuous learning is needed in most areas related to data use. Research limitations/implications: The study was conducted in a large public-health organisation in Australia, which is not representative of unique organisations elsewhere. The study has implications for the provision of health services, workplace learning and education. Practical implications: Findings have implications for organisational decisions related to data-use and workplace learning, and for formal education and lifelong learning. Originality/value: The study contributes to closing a research gap in understanding interactions with data, capabilities and learning needs of employees in non-clinical work roles. Capabilities continuum presented in this paper can be used to inform education, training and service provision. The workplace-based results contribute to theoretical considerations of capabilities required for work in technology-rich environments. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare the impact of Australian onshore and offshore immigration detention centres (IDCs) on detainees' health and health-care events. Design/methodology/approach: It uses data extracted from the Australian Government's quarterly health reports from 2014 to 2017. These reports contain a range of data about the health and well-being of detainees, including complaints/presenting symptoms and number of appointments and hospitalisations. To compare onshore and offshore data sets, the authors calculated the rate of health events per quarter against the estimated quarterly onshore and offshore detention population. They ran a series of two-proportion z-tests for each matched quarter to calculate median z- and p-values for all quarters. These were used as an indicator as to whether the observed differences between onshore and offshore events were statistically significant. Findings: The results suggest that adults detained onshore and offshore have substantial health needs, however, almost all rates were far higher in offshore detention, with people more likely to raise a health-related complaint, access health services and be prescribed medications, often at two to three times the rate of those onshore. Originality/value: This paper adds to a modest body of literature that explains the health of people detained in Australian IDCs. To the best of the authors' knowledge, this is the first paper to explore health service utilisation and a range of other variables found in the Australian Government's quarterly health reports. These findings bolster the evidence which suggests that detention, and particularly offshore detention is particularly harmful to health. [ABSTRACT FROM AUTHOR]

Background: This study examines the perceptions of the Australian public canvassed in 2021 during the COVID‐19 pandemic about their health system compared to four previous surveys (2008, 2010, 2012 and 2018). Methods: In 2021, a nationwide online survey was conducted with a representative sample of Australians (N = 5100) recruited via market research panels. The results were compared to previous nationwide Australian survey samples from 2018 (N = 1024), 2012 (N = 1200), 2010 (N = 1201) and 2008 (N = 1146). The survey included questions consistent with previous polls regarding self‐reported health status and overall opinions of, and confidence in, the Australian health system. Results: There was an increase in the proportion of respondents reporting positive perceptions at each survey between 2008 and 2021, with a significantly higher proportion of respondents expressing a more positive view of the Australian healthcare system in 2021 compared to previous years (χ2(8, N = 9645) = 487.63, p < 0.001). In 2021, over two‐thirds of respondents (n = 3949/5100, 77.4%) reported that following the COVID‐19 pandemic, their confidence in the Australian healthcare system had either remained the same (n = 2433/5100, 47.7%) or increased (n = 1516/5100, 29.7%). Overall, respondents living in regional or remote regions, younger Australians (< 45 years) and women held less positive views in relation to the system. In 2021, the most frequently identified area for urgent improvement was the need for more healthcare workers (n = 1350/3576, 37.8%), an area of concern particularly for Australians residing in regional or remote areas (n = 590/1385, 42.6%). Conclusions: Irrespective of disruptions to the Australian healthcare system caused by the COVID‐19 pandemic, Australians' perceptions of their healthcare system were positive in 2021. However, concerns were raised about inadequate workforce capacity and the cost of healthcare, with differences identified by age groups and geographical location. Patient or Public Contribution: Health consumer representatives from the Consumers Health Forum of Australia contributed to the co‐design, deployment, analysis and interpretation of the results of this survey. J.A. and L.W. from the Consumers Health Forum of Australia contributed to the development of the paper. [ABSTRACT FROM AUTHOR]

Objectives: Despite high levels of mental ill‐health amongst young people (aged 15–30), this group demonstrates low help‐seeking and high drop‐out from mental health services (MHS). Whilst shared decision‐making can assist people in receiving appropriate and effective health care, young people frequently report that they do not feel involved in treatment decisions. The current study focused on co‐design of a clinical education and participant information programme for the Brain and Mind Centre Youth Model of Care. This model, which articulates a youth‐focused form of highly personalised and measurement‐based care, is designed to promote shared decision‐making between young people and clinical service providers. Methods: We conducted workshops with 24 young people (16–31; MAge = 21.5) who had accessed mental health services. Participants were asked what advice they would give to young people entering services, before giving advice on existing materials. Workshops were conducted and transcripts were coded using thematic analysis by two lived experience researchers and a clinical researcher. Results: Young people found it empowering to be educated on transdiagnostic models of mental illness, namely clinical staging, which gives them a better understanding of why certain treatments may be inappropriate and ineffective, and thus reduce self‐blame. Similarly, young people had limited knowledge of links between mental health and other life domains and found it helpful to be educated on multidisciplinary treatment options. Measurement‐based care was seen as an important method of improving shared decision‐making between young people and health professionals; however, to facilitate shared decision‐making, young people also wanted better information on their rights in care and more support to share their expertise in their own needs, values and treatment preferences. Conclusions: These findings will inform the delivery of the further development and implementation of a youth‐specific clinical education and participant information programme for the BMC Youth Model. Patient or Public Contribution: Workshops were facilitated by researchers with lived expertise in mental ill‐health (A.H. and/or C.G.) and a clinical researcher (who has expertise as an academic and a clinical psychologist). A.H. and C.G. were also involved in conceptualisation, analysis, interpretation, review and editing of this paper. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Restraining and secluding health consumers for safety reasons continue to be used in psychiatric inpatient facilities even though they have no therapeutic value and have negative effects on consumers, families and staff.Six Core Strategies (6CS) for reducing seclusion and restraint have been developed to address this problem but there are very few effectiveness studies in inpatient adolescent psychiatric facilities. What the paper adds to existing knowledge: We used a mixed methods approach to evaluate the implementation of 6CS in an adolescent psychiatric facility. The implementation was successful. It eliminated the use of seclusion, substantially reduced the use of restraints and significantly reduced staff absenteeism.Using thematic analysis on feedback surveys, we identified five dominant themes that described consumers' and carers' experiences during their stay at the facility: communication, service delivery, flexibility, consistency and internal feeling states. What are the implications for practice: This study provides support for the feasibility of a comprehensive and broad‐based intervention program such as 6CS to reduce seclusion and restraint practices in inpatient mental health facilities.This study also demonstrates the value of using surveys to gather consumer and carer feedback and improve outcomes for service users. Introduction: Seclusion and restraint practices are routinely used in psychiatric facilities but are controversial for ethical, legal and safety reasons, and can cause significant harm to consumers, staff and organisations. Six Core Strategies (6CS) for reducing seclusion and restraint were developed to address this problem but very few studies have examined their effectiveness in adolescent settings. Aim/Question: To evaluate the implementation of 6CS in an adolescent inpatient psychiatric facility. Method: We retrieved archival data from an acute adolescent psychiatric ward that implemented the 6CS. Using a mixed methods approach, we evaluated outcomes on the use of seclusion and restraint, nursing staff sick leave and feedback surveys. Results: Findings showed an elimination of seclusion, and a significant reduction in restraint use and staff absenteeism in the 12 months after project implementation. Thematic analysis of feedback survey responses identified communication, service delivery, flexibility, consistency and internal feeling states as dominant themes in consumers' and carers' experience on the unit. Discussion: The 6CS is feasible and may be effective in reducing seclusion and restraint, which in turn may have a positive impact on staff wellbeing. Implications for Practice: Implementation of the 6CS with executive support, combined with staff and programmatic changes at a local level is recommended. [ABSTRACT FROM AUTHOR]

Secondary prevention efforts, which target risk and protective factors associated with harmful sexual behaviour (HSB) and seek to intervene early in the trajectory of HSB, are underdeveloped in Australia. This study explored design considerations for an online early intervention service for children and young people worried about their sexual thoughts and behaviours. A trauma-informed child right's framework underpinned the study, which involved 10 individual interviews with international experts in HSB, and one group interview (n = 3) with Australian practitioners. Analysis was carried out using thematic analysis. Results reflect design considerations in relation to: theoretical approaches; practice frameworks; service delivery components; and helpseeking challenges. Key tensions emerging from the results are discussed, including the need to move beyond binary constructions of victims and perpetrators. PRACTICE IMPACT STATEMENT: This paper has significant potential to influence practice in the field of harmful sexual behaviour prevention and response. The paper sets out the components of an early intervention online service for children and young people worried about their sexual thoughts and behaviours. The online service could be built and trialed for impact and efficacy in supporting children and young people not to sexually harm. It would be the first service of its kind in Australia and fill a gap in the current service delivery landscape. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present the results of a scoping review on the implementation of Article12 in health care. The scoping review will provide a summary and overview of the key concepts and published literature on this topic internationally. Article 12 of the United Nations Convention on the Rights of the Child (1989) states that children have a right to express their views, to have them heard and for their views to be given due weight in all matters that affect them. Despite increased calls for Article 12 to be given attention in health care, there is little evidence to suggest this has been well implemented and embedded in Australian health-care delivery. The scoping review was undertaken to provide a summary and overview of the key concepts and published literature on this topic internationally. Design/methodology/approach: A five-step methodological framework described by Arksey and O'Malley (2005) was used to undertake the scoping review. Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used as a guideline for undertaking the study selection. Findings: Children are still not routinely involved in health-care decision-making, are frequently left out of service planning and evaluation and the perception that they lack the capability to make rational decisions persists. Originality/value: While there has been a focus on research that investigates children's participation in health-care decision-making in recent years, there is little that directs attention specifically to the implementation of Article 12, particularly in Australian health care. Recommendations are made for further research in these areas. [ABSTRACT FROM AUTHOR]

Simple Summary: The current evidence regarding Indigenous* women and breast cancer in Australia shows lower prevalence but higher mortality rates. There are a range of reasons for this, including co-morbidities, lack of access to health services and low health information fluency. Perhaps most importantly, breast cancer health policy and service delivery practice do not meet the needs of Indigenous women in Australia, according to Indigenous women. Talking and listening to Indigenous women about breast cancer highlight that the solutions to improve breast cancer outcomes are available and that they are not complex. Indigenous women must be involved in the improvement of policy and practice in order for these outcomes to improve. *Terminology: We respectfully refer to Aboriginal and Torres Strait Islander people as "Indigenous". In Australia, the incidence rate of breast cancer is lower in Indigenous* women than non-Indigenous women; however, the mortality rate is higher, with Indigenous women 1.2 times more likely to die from the disease. This paper provides practical and achievable solutions to improve health outcomes for Indigenous women with breast cancer in Australia. This research employed the Context–Mechanism–Outcome (CMO) framework to reveal potential mechanisms and contextual factors that influence breast cancer outcomes for Indigenous women, stratified into multiple levels, namely, micro (interpersonal), meso (systemic) and macro (policy) levels. The CMO framework allowed us to interpret evidence regarding Indigenous women and breast cancer and provides nine practical ways to improve health outcomes and survival rates. [ABSTRACT FROM AUTHOR]

Background: People with an acquired brain injury (ABI) find it challenging to use social media due to changes in their cognition and communication skills. Using social media can provide opportunities for positive connection, but there is a lack of interventions specifically designed to support safe and successful social media use after ABI. Aims: To investigate the outcomes of completing a social media skills intervention and identify barriers and facilitators for future implementation. Methods & Procedures: The study used a mixed‐methods, pre‐post‐intervention design. A total of 17 adults with an ABI were recruited. Participants completed an intervention that included a short self‐guided course about social media skills (social‐ABI‐lity course), and then participated in a private, moderated Facebook group over a 12‐week period (social‐ABI‐lity Facebook group). Data were collected over this period through observation of group activity and weekly surveys. They were also collected on social media use and quality of life at pre‐intervention, post‐intervention and after 3 months. Participants provided feedback on the experience of participating in the programme via a post‐intervention interview. Outcomes & Results: At post‐intervention, there were significant improvements in confidence in using Facebook (p = 0.002) and enjoyment of using Facebook to connect with others (p = 0.013). There was no significant change in reported quality of life, although participants described the multiple benefits of connection they perceived from involvement in the group. Observational data and feedback interviews were informative about the feasibility and acceptability of the intervention. Conclusions & Implications: This pilot study provided preliminary evidence that an intervention comprising a short, self‐guided training course and a private, moderated Facebook group improved outcomes for people with ABI. Key recommendations for future implementation include embedding active peer moderators within groups and taking an individualized approach to delivery of the intervention. WHAT THIS PAPER ADDS: What is already known on the subject: Research has documented the challenges that people with ABI experience in using social media, and the difficulty for rehabilitation clinicians in providing appropriate support in this field. What this paper adds to existing knowledge: This pilot study reports the outcomes of people with ABI completing a short, self‐guided social media skills course and participating in a private, moderated Facebook group. After the intervention, participants reported significantly increased confidence and enjoyment in using Facebook, described the benefits of connection found in the groups, and suggested potential improvements for future implementation. What are the potential or actual clinical implications of this work?: With the growing use of social media for connection and participation, there is a professional obligation to address social media communication skills in cognitive–communication rehabilitation for people with ABI. The findings of this study will inform interventions and future research to assist people with ABI to build their social media skills for communication, social support and a sense of connection. [ABSTRACT FROM AUTHOR]

Aim: To explore the satisfaction and experiences of women and staff with the BSOTS in an Australian hospital. Design: Cross‐sectional descriptive survey. Methods: Surveys were distributed to women and staff between February and May 2022. Survey questions reflected satisfaction with triage and provision of care under the BSOTS system (for women) and confidence in using the BSOTS system and its impact on triage‐related care (for staff). Survey data were summarized using descriptive statistics, and qualitative responses were analysed using content analysis. Results: There were 50 women and 40 staff (midwives and doctors) survey respondents. Most women were satisfied with triage wait times, the verbal information they received and the time it took for them to receive care. Nearly all midwife participants indicated they had high knowledge and confidence in using the BSOTS. Most staff indicated that the BSOTS supported the accurate assessment of women and had benefits for women, staff and the hospital. Conclusion: The findings showed that women and staff were satisfied with receiving and providing care in a maternity triage setting under the BSOTS system. Implications for the Profession and/or Patient Care: Implementing standardized maternity triage approaches such as the BSOTS in health settings delivering care to pregnant women is recommended for improving flow of care and perceptions of care quality by women. Impact: Quality of maternity triage processes is likely to impact the satisfaction of women attending services and the staff providing care. The BSOTS was shown to improve maternity triage processes and was associated with satisfaction of women and staff. Maternity settings can benefit from implementing triage approaches such as the BSOTS as it standardizes and justifies the care provided to women. This is likely to result in satisfaction of women and staff engaged in maternity triage and improve the birth outcomes of women and babies. Reporting Method: The reporting of this paper has followed SQUIRE guidelines. Patient or Public Contribution: Women engaged with maternity services were participants in the study but did not contribute to the design, conduct or publication of the study. [ABSTRACT FROM AUTHOR]

Background: Trans and gender-diverse people visiting pharmacies may not always receive optimum care due to pharmacists' lack of knowledge and confidence to provide such care. This situation prompts a need for training. Objectives: This paper aimed to describe a guide to the design, implementation, and evaluation of a training program on transgender healthcare for pharmacists in Australia. Methods: The Implementation Mapping Framework provided a foundation for the design, implementation, and evaluation of this training program. Through active involvement in the program development, trans and gender diverse people and pharmacists guided the program design, ensuring alignment with the cultural, social, and healthcare contexts. Results: The needs analysis highlighted the necessity for training for pharmacists to improve their cultural awareness and pharmacotherapeutic knowledge about transgender healthcare. Applying a novel Gender Inclusivity in Pharmacy Framework, online modules—(1) Transgender healthcare—language, terminology, and key healthcare issues, (2) Gender-affirming therapies, and (3) Case studies in transgender healthcare—were developed to enable the implementation of a training program. Conclusion: The Implementation Mapping Framework and the Gender Inclusivity in Pharmacy Framework proved effective tools for providing an education program for pharmacists. [ABSTRACT FROM AUTHOR]

Introduction: Telepractice service delivery of allied health interventions to people with disability can potentially reduce access barriers and improve service equity. However, questions remain regarding telepractice functionality for people with disability. This study addressed questions related to how allied health clinicians and managers perceive telepractice as functioning in the provision of therapy services to people with disability. Methods: Thirteen interviews of allied health clinicians and managers from across Australia were conducted between 21 November and 22 February via MS teams. Qualitative methodology and critical realist theoretical paradigm underpin the study. Data analysis was completed using a reflective thematic analysis method and five themes were generated and described utilising an analytic metaphor. Results: The study themes were described in relation to a shopping for shoes analytic metaphor and the five themes included (1) a shoe for every foot, (2) planned purchases, (3) shoe on the other foot, (4) you need both shoes and (5) help choosing their shoes. In summary, the function of telepractice fits differently for each individual, similar to pairs of shoes. Conclusions: Telepractice has its own strengths and weaknesses and isn't a direct substitute for in‐person sessions, much like left and right shoes are similar but not the same. The results support participant perceptions that telepractice functions best as an adjunct to in‐person sessions through a flexible hybrid delivery model in the provision of therapy services to people with a disability. A strategy for improving perceived usefulness may involve positioning telepractice as unique with strengths and weaknesses, not replacing in‐person care. Patient or Public Contribution: The paper forms part of a larger codesign process which included customer and carer participants throughout the design and planning of the project, inclusion of a peer researcher, and the selection of the analytic metaphor including in the findings of this article production. [ABSTRACT FROM AUTHOR]

Allied health services in rural and remote hospitals often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and Aboriginal and Torres Strait Islander communities. Integration can support primary health care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. A remote health service, in collaboration with a University Department of Rural Health and community partners, developed a community rehabilitation and lifestyle service for adults who experience chronic disease, disability or were at risk of functional decline due to frailty. Using an integrated approach, this model of care improves access to specialist and primary healthcare services, delivers targeted group-based rehabilitation and preventative activities, and addresses community and workforce capacity to meet the needs of the remote community. This paper describes a remote primary health care, Integrated Allied Health Service Model, developed with a focus on the co-ordination and integration of care and resources between the health service, education and community. Remote communities require primary care services that are inclusive of allied health and can be responsive to individual and community needs. Services require a workforce and a service model that can be creative and flexible. The Service described, delivered both a novel service model that complemented the primary care services already being delivered, and focused on workforce and community capacity building. [ABSTRACT FROM AUTHOR]

Objective: Pharmacotherapeutic Follow-up is the Professional Pharmaceutical Care Service aimed at detecting Drug-Related Problems for the prevention and resolution of negative medicine outcomes. The Dader Method is considered a clear and simple tool to develop Pharmacotherapeutic Follow-up. This research aims to analyze the evolution of the international scientific production related to Pharmacotherapeutic Follow-up and the Dader Method to show the current situation of this Professional Pharmacy Assistance Service. In addition, from the data obtained, we give a critical perspective on the implementation of the Dader Method in Community Pharmacy, considering its advantages and disadvantages based on the published scientific literature. Methods: Using bibliometrics tools, indicators were obtained to analyze the international production of scientific articles on Pharmacotherapeutic Follow-up and the Dader Method during the period (1999-2022) through the Scopus database. Results: The results showed a growth in the international scientific production of publications on Pharmacotherapeutic Follow-up, obtaining 30,287 papers, placing the United States, the United Kingdom, Australia, Canada and Spain as the five most productive countries. The publication of 83 papers on the Dader Method places Spain with the highest number of publications, followed by other Spanish or Portuguese speaking countries, among which Brazil and Colombia have the most prominent number of published papers in Latin America. The most frequent international journal covering the topic of Pharmacotherapeutic Follow-up was the American Journal of Health-Pharmacy (12.4%), while on the Dader Method, the journal Pharmaceutical Care Spain (21.7%) is in the first position, followed by Farmacia Hospitalaria (8.4%). Conclusion: The publications on the Dader method highlighs the greater productivity of the University of Granada and the author María José Faus Dáder. The inclusion of patients in the PTF service using the Dader Method, is more frequent in the hospital context, and is based on the presence of defined chronic pathologies (mainly diabetes), polymedication or specialized care follow-up, with elderly population being the most represented in all cases. [ABSTRACT FROM AUTHOR]

People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic catapulted Telehealth to the forefront of Emergency Medicine (EM) as an alternative way of assessing and managing patients. This challenged the traditional idea that EM can only be practised within brick‐and‐mortar EDs. Many Emergency Physicians may find the idea of practising Telehealth in Emergency Medicine (TEM) confronting, particularly in the absence of training and clear practice guidelines. The purpose of the present paper is to describe the current use of TEM in Australasia, and outline the advantages and barriers in adopting this practice domain. [ABSTRACT FROM AUTHOR]

Background: Acute gastroenteritis is a highly contagious disease demanding effective public health and clinical care systems for prevention and early intervention to avoid outbreaks and symptom deterioration. The Netherlands and Australia are both top-performing, high-income countries where general practitioners (GPs) act as healthcare gatekeepers. However, there is a lower annual incidence and per-case costs for childhood gastroenteritis in Australia. Understanding the systems and policies in different countries can lead to improvements in processes and care. Therefore, we aimed to compare public health systems and clinical care for children with acute gastroenteritis in both countries. Methods: A cross-country expert study was conducted for the Netherlands and Australia. Using the Health System Performance Assessment framework and discussions within the research group, two questionnaires (public health and clinical care) were developed. Questionnaires were delivered to local experts in the Netherlands and the state of Victoria, Australia. Data synthesis employed a narrative approach with constant comparison. Results: In Australia, rotavirus vaccination is implemented in a national program with immunisation requirements and legislation for prevention, which is not the case in the Netherlands. Access to care differs, as Dutch children must visit their regular GP before the hospital, while in Australia, children have multiple options and can go directly to hospital. Funding varies, with the Netherlands providing fully funded healthcare for children, whilst in Australia it depends on which GP (co-payment required or not) and hospital (public or private) they visit. Additionally, the guideline-recommended dosage of the antiemetic ondansetron is lower in the Netherlands. Conclusions: Healthcare approaches for managing childhood gastroenteritis differ between the Netherlands and Australia. The lower annual incidence and per-case costs for childhood gastroenteritis in Australia cannot solely be explained by the differences in healthcare system functions. Nevertheless, Australia's robust public health system, characterized by legislation for vaccinations and quarantine, and the Netherland's well-established clinical care system, featuring fully funded continuity of care and lower ondansetron dosages, offer opportunities for enhancing healthcare in both countries. [ABSTRACT FROM AUTHOR]

This paper uses a drama-based method to illustrate the responses of healthcare and legal systems to women experiencing coercive control. This approach involved writing a play using the first-person narrative voice of a victim-survivor. We presented the play at the Stop Domestic Violence Conference (Gold Coast, Australia) in 2021. The central character, 'Kate', provided an embodied performance that enabled the conference participants to see, feel and understand experiences of coercive control from a personal perspective. We followed the trajectory of coercive control from the beginning of an intimate relationship to the time of separation. We showed how the process of coercive control escalates from love bombing, reproductive coercion, isolation, and technology-facilitated abuse until a point of police intervention. As Kate told her story, the conference audience witnessed the barriers and challenges faced by survivors of coercive control, and the emotional, financial, and psychological impacts that are intensified in geographically remote environments. They watched Kate navigate health and other systems meant to help women experiencing domestic and family violence, but that ultimately failed to deliver. Finally, the drama-based approach allowed us to present a feminist embodiment of coercive control and an innovative method for communicating inter-disciplinary research findings on domestic abuse. [ABSTRACT FROM AUTHOR]

Background: Mental health issues and parenting difficulties in the perinatal period are common, and have significant negative impacts on individuals, families, and broader society. Community-based peer support programs might be an effective adjunct to standard mental health interventions in perinatal mental health issues, specifically where low-cost interventions are required, or access to professional care is limited. Methods: A systematic review will be undertaken. Searches will be conducted on four electronic databases (Pubmed, Embase, Cinahl, and PsycINFO), using terms related to perinatal mental health and peer support. Literature will be screened by title and abstract and then by full text. Selected studies will be evaluated using the Quality Assessment with Diverse Studies (QuADS) tool. Data relevant to community-based perinatal peer support intervention characteristics and outcomes will be extracted, and synthesised narratively. Discussion: This review will contribute to the existing evidence about perinatal mental health peer support, by synthesising information about community-based interventions specifically. The findings will be used to inform the design, implementation, and evaluation of a community-based perinatal mental health peer support program in urban and rural/remote hospital and health services in Australia. Trial registration: Systematic review registration: CRD42023451568. [ABSTRACT FROM AUTHOR]

Purpose: Aboriginal and Torres Strait Islander People with a disability continue to experience barriers to service engagement such as mistrust of government services, lack of culturally appropriate support, marginalisation and disempowerment. This meta-synthesis reviews current literature regarding these experiences to explain why services are underutilised. Methods: The meta-synthesis was conducted using a meta-ethnographic approach to synthesise existing studies into new interpretive knowledge. The approach was supported by a search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Ten original research papers utilising a qualitative methodology were extracted. Synthesis of the articles revealed four concepts that were developed into a conceptual model. These include:1) History Matters; 2) Cultural Understanding of Disability Care; 3) Limitations to Current Service Provision; and 4) Delivery of Effective Services. Conclusions: Disability services do not adequately consider the cultural needs of Aboriginal and Torres Strait Islander People or communicate in a culturally appropriate manner. There are expectations that Aboriginal and Torres Strait Islander People acknowledge their disability in alignment with western definitions of disability in order to access services. More work is needed to align disability services with culturally appropriate support to provide better health outcomes. Aboriginal and Torres Strait Islander people with a disability continue to experience barriers to service engagement which must be addressed. An essential gap that must be filled in providing disability services to Aboriginal and Torres Strait Islander people is the acknowledgment of culture as a resolute influence on all client interactions with providers. A cultural model of disability may better align with the experiences of Aboriginal and Torres Strait Islander people than current medical and social models used in healthcare. Disability services need to align better with culturally appropriate support to provide better health outcomes for Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

Background: A dramatic decline in mental health of people worldwide in the early COVID-19 pandemic years has not recovered. In rural and remote Australia, access to appropriate and timely mental health services has been identified as a major barrier to people seeking help for mental ill-health. From 2020 to 2021 a care navigation model, Navicare, was co-designed with rural and remote communities in the Greater Whitsunday Region of Central Queensland in Australia. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to design and guide multiple aspects of a multisite study, The Bridging Study, to evaluate the implementation of Navicare in Australia. Methods: A community-engaged hybrid effectiveness-implementation study design will focus on the tailored implementation of Navicare at three new sites as well as monitoring implementation at an existing site established since 2021. Study outcomes assessed will include sustained access as the co-primary outcome (measured using access to Navicare mental health referral services) and Proctor's Implementation Outcomes of feasibility, acceptability, appropriateness, adoption, fidelity, implementation cost, and sustainability. Data collection for the implementation evaluation will include service usage data, community consultations, interviews, and workshops; analysed using mixed methods and guided by EPIS and other implementation frameworks. Pre-post effectiveness and cost-consequence study components are embedded in the implementation and sustainment phases, with comparison to pre-implementation data and value assessed for each EPIS phase using hospital, service, and resource allocation data. A scaling up strategy will be co-developed using a national roundtable forum in the final year of the study. Qualitative exploration of other aspects of the study (e.g., mechanisms of action and stakeholder engagement) will be conducted. Discussion: Our study will use tailoring to local sites and a community-engaged approach to drive implementation of a mental health care navigation service in rural and remote Australia, with expected benefits to mental healthcare access. This approach is consistent with policy recommendations nationally and internationally as building blocks for rural health including the World Health Organization Framework for Action on Strengthening Health Systems to Improve Health Outcomes. Trial registration: Prospectively registered on April 2, 2024, on the Australian New Zealand Clinical Trials Registry, no. ACTRN12624000382572. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386665&isReview=true. [ABSTRACT FROM AUTHOR]

Many children with developmental language disorder (DLD) have emotion recognition and regulation difficulties, but there are currently no known interventions enhancing emotional awareness in this population. This study explores the impact of parents' perspectives regarding children with DLD emotional understanding through a parent-led online emotion recognition (ER) intervention. Ten parents of children with DLD aged 6–11 participated in the study. A nonconcurrent multiple baseline design was employed, allowing for a rigorous analysis of changes in parental beliefs over time. Weekly data were collected through the Parents' Beliefs About Children's Emotions Questionnaire. Interviews were also conducted to gain deeper insights into parents' perceptions regarding the ER skills of their children. Results indicated that parents' beliefs about the need for guiding and supporting their child's ER skills increased over the intervention. Interviews also supported this, and three main themes were generated. The intervention program increased parents' awareness of (a) the importance of ER for children with DLD, (b) emotion-focused communication and engagement with their child, and (c) the integration of emotions into daily life. This study is the first known study that explores parents' beliefs about children with DLD ER skills, highlighting the importance of supporting parents through accessible interventions. [ABSTRACT FROM AUTHOR]

Purpose: LGBTQ people are less likely to seek support and face significant barriers in accessing affirmative family violence support services. Efforts to improve family violence service access must be grounded in the preferences of LGBTQ people themselves. Method: Data from a large nationwide Australian survey of the health and wellbeing of LGBTQ adults were analysed. 4,148 participants expressed a preference for family violence service provision. Multivariable logistic regressions were used to identify factors associated with preferences for family violence service provision, comparing mainstream services that are not known to be inclusive, mainstream services that are known to be LGBTQ-inclusive, and LGBTQ-specific services. Results: In total, 8.8% (n = 363) of participants indicated a preference for mainstream services, 57.5% (n = 2,383) for mainstream services that are known to be LGBTQ-inclusive and 33.8% (n = 1,402) for LGBTQ-specific services. Trans and non-binary identified people were more likely to prefer LGBTQ-specific services than cisgender participants, while bisexual, pansexual and asexual people were more likely to prefer mainstream LGBTQ-inclusive services. Participants with a regular general practitioner were more likely to prefer LGBTQ-inclusive services. Participants who had not felt supported the most recent time they reported an experience of family violence were more likely to prefer LGBTQ-specific services. Conclusion: Family violence and healthcare services require training in LGBTQ issues to provide inclusive and affirming care. The findings have implications for policy and practice in family violence care and illustrate an urgent need to reform the current narrative of family violence, which frequently excludes LGBTQ communities. [ABSTRACT FROM AUTHOR]

Background: Consumer involvement in health research is when patients, their families and caregivers work with researchers on research projects. Despite the growing expectation for health services to facilitate the involvement of consumers in research, the practical integration of this approach is an ongoing process, with limited research conducted into how Australian health services can support this practice. This study explored consumer perspectives on the barriers and solutions to enabling consumer involvement in research within an Australian tertiary hospital and health service, and staff perspectives on the solutions to facilitating consumer involvement. A prior survey had identified barriers to consumer involvement from the staff perspective. The broad aim was to inform the development of a framework to help promote consumer involvement in research within the health service. Methods: A Nominal Group Technique (NGT) was utilised with groups comprised of health service consumers and staff. Three health consumers were co-researchers in the full life-cycle of this study and are included as authors. Results: Ten consumers and 14 staff participated across three sessions ranging from one to three hours. For consumers, barriers to their involvement were grouped into seven domains: (1) lack of connection with researchers/research projects, (2) low research literacy, (3) structural barriers, (4) lack of acknowledgement, (5) implementation challenges, (6) inadequate information provision, and (7) representation concerns. Solutions to enabling involvement were grouped into five domains: (1) support to connect with researchers/research projects, (2) adequate information provision, (3) incentive for involvement, (4) acknowledgement, and (5) balanced representation. Staff ideas for solutions were grouped into five domains: (1) support to connect with consumers, (2) support to involve consumers, (3) access to funds to remunerate consumers, (4) more time to involve consumers, and (5) staff training. Conclusion: Through an NGT methodology, this study delivered a nuanced comprehension of perspectives on involving consumers in research from both health service consumers and staff. These findings serve as a foundation for identifying strategies that foster enhanced and refined relationships between consumers and researchers, advancing the collaborative landscape in health research. The findings from this project offer valuable strategies for researchers to better engage consumers in research and for consumer groups to enhance their involvement. Additionally, these insights could be used by other health services to advocate for essential resources. Plain English Summary: Consumer involvement in health research is when patients, their families, and caregivers work with researchers on research projects. While there is a growing expectation for health services to promote the involvement of consumers in health service research, it is still a work in progress, especially in Australia, where there hasn't been much research done on this topic. This study looked at what consumers and staff at an Australian hospital thought would hinder or help consumers to become involved in health research. The study used a method called the Nominal Group Technique (NGT), where groups of staff and consumers met for sessions ranging from one to three hours to share and prioritise their ideas. Consumers thought that barriers to their involvement included difficulty connecting with researchers or projects, not knowing much about research, and personal barriers to involvement (such as lack of childcare). They believed that better connection with researchers, information, incentives for involvement, and ensuring everyone's voices are heard were possible solutions. Staff also had ideas for solutions, like providing support to connect with consumers and more time for research activities. Overall, this study describes what consumers and staff think about working together on research. These findings can help develop strategies for building relationships between consumers and researchers, advancing collaborative efforts in health research. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic period (2020 to 2022) challenged and overstretched the capacity of primary health care services to deliver health care globally. The sector faced a highly uncertain and dynamic period that encompassed anticipation of a new, unknown, lethal and highly transmissible infection, the introduction of various travel restrictions, health workforce shortages, new government funding announcements and various policies to restrict the spread of the COVID-19 virus, then vaccination and treatments. This qualitative study aims to document and explore how the pandemic affected primary health care utilisation and delivery in remote and regional Aboriginal and Torres Strait Islander communities. Methods: Semi-structured interviews were conducted with staff working in 11 Aboriginal Community-Controlled Health Services (ACCHSs) in outer regional, remote and very remote Australia. Interviews were transcribed, inductively coded and thematically analysed. Results: 248 staff working in outer regional, remote and very remote primary health care clinics were interviewed between February 2020 and June 2021. Participants reported a decline in numbers of primary health care presentations in most communities during the initial COVID-19 lock down period. The reasons for the decline were attributed to community members apprehension to go to the clinics, change in work priorities of primary health care staff (e.g. more emphasis on preventing the virus entering the communities and stopping the spread) and limited outreach programs. Staff forecasted a future spike in acute presentations of various chronic diseases leading to increased medical retrieval requirements from remote communities to hospital. Information dissemination during the pre-vaccine roll-out stage was perceived to be well received by community members, while vaccine roll-out stage information was challenged by misinformation circulated through social media. Conclusions: The ability of ACCHSs to be able to adapt service delivery in response to the changing COVID-19 strategies and policies are highlighted in this study. The study signifies the need to adequately fund ACCHSs with staff, resources, space and appropriate information to enable them to connect with their communities and continue their work especially in an era where the additional challenges created by pandemics are likely to become more frequent. While the PHC seeking behaviour of community members during the COVID-19 period were aligned to the trends observed across the world, some of the reasons underlying the trends were unique to outer regional, remote and very remote populations. Policy makers will need to give due consideration to the potential effects of newly developed policies on ACCHSs operating in remote and regional contexts that already battle under resourcing issues and high numbers of chronically ill populations. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the implementation of a novel 50-bed continuous remote monitoring service for high-risk acute inpatients treated in non-critical wards, known as Health in a Virtual Environment (HIVE). We report the initial results, presenting the number and type of patients connected to the service, and assess key outcomes from this cohort. This was a prospective, observational study of characteristics and outcomes of patients connected to the HIVE continuous monitoring service at a major tertiary hospital and a smaller public hospital in Western Australia between January 2021 and June 2023. In the first two and a half years following implementation, 7541 patients were connected to HIVE for a total of 331,118 h. Overall, these patients had a median length of stay of 5 days (IQR 2, 10), 11.0% (n = 833) had an intensive care unit admission, 22.4% (n = 1691) had an all-cause emergency readmission within 28 days from hospital discharge, and 2.2% (n = 167) died in hospital. Conclusions: Our initial results show promise, demonstrating that this innovative approach to inpatient care can be successfully implemented to monitor high-risk patients in medical and surgical wards. Future studies will investigate the effectiveness of the program by comparing patients receiving HIVE supported care to comparable patients receiving routine care. [ABSTRACT FROM AUTHOR]

Background: The unprecedented increase in telehealth use due to COVID-19 has changed general practitioners' (GP) and patients' engagement in healthcare. There is limited specific advice for effective communication when using telehealth. Examining telehealth use in practice in conjunction with perspectives on telehealth as they relate to communication allows opportunities to produce evidence-based guidance for optimal use of telehealth, while also offering practitioners the opportunity to reflect on elements of their communicative practice common to both styles of consultation. The objective of this research was to develop evidence-based resources to support effective, person-centred communication when GPs and patients use telehealth. This included examination of interactional practices of recorded telehealth consultations, exploration of GP and patient perspectives relating to telehealth, and identifying priorities for guidance informed by these analyses as well as participant co-design. Methods: This study involved recording telehealth consultations (n = 42), conducting patient surveys (n = 153), and interviewing patients (n = 9) and GPs (n = 15). These were examined using interaction analytic methods, quantitative analysis, and thematic analyses, to create a robust, integrated picture of telehealth practice and perspectives. The process of research translation involved a co-design approach, engaging with providers, patients, and policy makers to facilitate development of evidence-based principles that focus on supporting effective communication when using telehealth. Results: Three key themes relating to communication in telehealth were identified across the different analyses. These were relationship building, conversational flow, and safety netting. The draft best practice principles drawn from these themes were modified based on co-design feedback into five Best Practice Principles for Communication between GPs and Patients using Telehealth. Conclusions: Effective communication is supported through relationship building and attention to conversational flow in telehealth consultations, which in turn allows for safety netting to occur. In telehealth, GPs and patients recognise that not being co-present changes the consultation and use both intuitive and strategic interactional adjustments to support their exchange. The mixed-method examination of experiences through both a detailed analysis of telehealth consultations in practice and comparative exploration of GP and patient perspectives enabled the identification of principles that can support effective communication when using telehealth. Co-design helped ensure these principles are ready for implementation into practice. [ABSTRACT FROM AUTHOR]

Background: Racism in the healthcare system has become a burgeoning focus in health policy-making and research. Existing research has shown both interpersonal and structural forms of racism limiting access to quality healthcare for racialised healthcare users. Nevertheless, little is known about the specifics of racism in the inpatient sector, specifically hospitals and rehabilitation facilities. The aim of this scoping review is therefore to map the evidence on racial discrimination experienced by people receiving treatment in inpatient settings (hospitals and rehabilitation facilities) or their caregivers in high-income countries, focusing specifically on whether intersectional axes of discrimination have been taken into account when describing these experiences. Methods: Based on the conceptual framework developed by Arksey and O'Malley, this scoping review surveyed existing research on racism and racial discrimination in inpatient care in high-income countries published between 2013 and 2023. The software Rayyan was used to support the screening process while MAXQDA was used for thematic coding. Results: Forty-seven articles were included in this review. Specifics of the inpatient sector included different hospitalisation, admission and referral rates within and across hospitals; the threat of racial discrimination from other healthcare users; and the spatial segregation of healthcare users according to ethnic, religious or racialised criteria. While most articles described some interactions between race and other social categories in the sample composition, the framework of intersectionality was rarely considered explicitly during analysis. Discussion: While the USA continue to predominate in discussions, other high-income countries including Canada, Australia and the UK also examine racism in their own healthcare systems. Absent from the literature are studies from a wider range of European countries as well as of racialised and disadvantaged groups other than refugees or recent immigrants. Research in this area would also benefit from an engagement with approaches to intersectionality in public health to produce a more nuanced understanding of the interactions of racism with other axes of discrimination. As inpatient care exhibits a range of specific structures, future research and policy-making ought to consider these specifics to develop targeted interventions, including training for non-clinical staff and robust, transparent and accessible complaint procedures. [ABSTRACT FROM AUTHOR]

Aim: To gain an understanding of children's experiences of expressing their views and having them heard in Australian healthcare settings. Design: Child‐centred qualitative research. A deductive qualitative content analysis was undertaken. Methods: Data were collected from 20 Australian children and young people between the ages of 7 and 18 years old using the 'draw, write and tell' method. Results: Children's experiences of 'space' and 'voice', and therefore the opportunity to express their views in health care were, in the main, positive. At the same time, their experiences of 'audience' and 'influence', the situations in which those views are given due weight, were overwhelmingly described as negative. Conclusion: Australian paediatric health services appear to have responded to calls to provide children with the opportunity to express their views and thus are delivering on the elements of 'space' and 'voice', whereas the realisation of 'audience' and 'influence' has some way to go. Due weight is not always given to children's views. Implications for the Profession and/or Patient Care: The Lundy model can be used to facilitate a better understanding of the concept of voice, and the responsibility of health organisations in implementing the rights of children and young people, as articulated in Article 12. Impact: Children and young people have a right to express their views and have them heard in health care, but their experiences in Australian health care are unknown.While children's experiences of expressing their views in health care were mostly positive, their views are not always taken seriously or given due weight.This research impacts child health professionals in Australia and internationally. Reporting Method: The study is reported using the Standards for Reporting Qualitative Research (SRQR). Patient or Public Contribution: Members of the Youth Advisory Council of two tertiary children's hospitals were consulted and invited to become members of the research team. [ABSTRACT FROM AUTHOR]

Background Health service providers need to set their own research priorities to ensure investment of limited resources into projects relevant to their setting. Rural health services may face additional challenges in identifying research priorities if they comprise a research-naeïve workforce. This study examines the methods employed by one health service to identify research priorities across a multidisciplinary health service in regional Australia. Method A modified 3-round Delphi method was employed, with panellists from clinical divisions, management, and consumer groups. Modifications included delivery via etechnology; inclusion of a reference group; a large panel who were selected without prior consultation; provision for non-sequential engagement in rounds by panellists; and group level feedback between rounds. Results In total 270 panellists were enlisted from across the health service, representing all levels of management, clinicians with and without research experience, and consumers. Valid research priorities for the whole of service were successfully identified using the modified Delphi method. Conclusion This study demonstrates how a regional health service with minimal research experience, was able to utilise a modified Delphi methodology to facilitate research priority setting across a widespread and multidisciplinary health service. Modifications to the Delphi methodology and their utility within the research setting are discussed. [ABSTRACT FROM AUTHOR]

• Mentoring literature contains diverse, but as yet unclassified, mentoring relationship types. • Mentoring for young people young people transitioning out of care must address specific contextual needs and barriers. • More attention is needed in mentoring literature on the policy context and the nature of the gender and power in mentoring relationships. In Australia, out-of-home care (OoHC) is provided to safeguard children and young people unable to live with their families. Typically, this care stops at 18 years of age, leaving many young people without the relational support to find employment and stable accommodation. Mentoring is increasingly proposed as a way to support young people exiting care, though the types of mentoring and contextual factors vary considerably. This rapid review aims to identify key features of mentoring programs that support young people in OoHC. This paper utilised a rapid review methodology to survey the academic literature on mentoring programs with young people in OoHC. The authors conducted literature searches in October 2022 using a search string designed to provide targeted exposure to the literature. Articles were limited by year and location, with the specific search string and limitations applied to the Scopus database, and Proquest and Informit platforms. Utilising literature, we identified five overlapping models for mentor–mentee relationships into a provisional typology of five categories based on varying levels of formality and familiarity in the relationships: 'formal', 'natural', 'near-age', 'peer', and 'therapeutic'. In doing so, we identified seven important features of mentor–mentee relationships: shared experiences, relationship duration, boundaries and other relationships, identity and self-worth, educational contexts, power and participation, and role modelling. We identified four issues relating to mentoring in OoHC that are informed by the needs and barriers experienced by young people: training and support for mentors, unique challenges faced by young people in OoHC, transition out of care, and the matching process. Lastly, we established what might impact mentoring programs buy critically reflecting on the policy context and notions of empowerment. This rapid review of mentoring programs for care-experienced young people seeking employment offers valuable insights to inform future programs. The findings highlight diverse and unclassified mentoring relationship types, the absence of anticipated gender-specific findings, a lack of examination of the policy context, and a need for more robust conceptualisations of empowerment. [ABSTRACT FROM AUTHOR]

Introduction. The global prevalence of diabetes is a pressing public health concern. Over 400 million individuals live with the effects of the disease, predominantly in low- and middleincome countries. In Aotearoa New Zealand (NZ), over 300 000 people have diabetes, resulting in a population rate of 43.1 per 1000. Enabling nurses to prescribe diabetes medications enhances accessibility and improves health outcomes for large sections of the population. Aim. This rapid review was undertaken to investigate the influence of nurse prescribing on health care delivery for individuals with diabetes in NZ, Australia, the United Kingdom, and Canada, countries sharing comparable health care systems and multicultural backgrounds. Methods. The review protocol was published on PROSPERO. In November 2022, a search was conducted across multiple databases to locate relevant literature and resources constrained to the last decade (from January 2012 to November 2022). Utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, data extraction was systematically structured, while rigorous appraisal processes upheld selection quality. Results. Fifteen publications were identified as meeting predefined inclusion and exclusion criteria. The review of these articles revealed four main themes: the impact of nurse prescribing on clinical outcomes, levels of patient satisfaction, implications for health care service provisions, and identification of barriers and facilitators associated with nurse prescribing. Discussion. This report identifies outcomes of nurse prescribing, concluding it provides a potential avenue for enhancing access to and alleviating the burden on health care systems. [ABSTRACT FROM AUTHOR]

To review the application of telehealth guidelines developed by Bondini et al for clinicians to determine patient suitability for telehealth in an outpatient Chronic Wound Service, including the proportion of patients suitable for telehealth, type and mode of telehealth encounters. Retrospective, random convenience sample of patients attending the Chronic Wound Service in 2021. Fifty‐six patients were included, most with leg/foot wounds (93%), median age 74 [54–84], 64% male. Four patients at admission and 19 patients at review met criteria for telehealth. Six percent of encounters were telehealth; phone‐only (82%), unscheduled nursing reviews (77%) in patients with healing wounds. Thirty patients (54%) received at least one telehealth encounter. Telehealth occurred 35.6 days later in the admission than face‐to‐face encounters (p < 0.05, 95% CI 14.9–56.3). There was a significant relationship between patients receiving telehealth and meeting telehealth suitability criteria on reviews (X2 (1) = 19.6*, p < 0.001). Eighteen percent of patients required wound‐related hospitalisation during their outpatient admission. Telehealth guidelines identified patients suitable for telehealth, although the proportion of patients was small. Telehealth was mostly utilised for nurse‐led telephone calls in patients with improving wounds. Future research into use of telephone review for clinical standards of wound care is warranted. [ABSTRACT FROM AUTHOR]

Background: Poor quality sleep in hospitals may be problematic for patients, negatively impacting their recovery and wellbeing. This project aimed to investigate the effectiveness of codesign in addressing key issues affecting sleep disruption in the healthcare setting. Methods: Codesign with patients, staff and consumer representatives was conducted in an acute metropolitan tertiary public hospital in Sydney, Australia. Through a four‐stage process, a multimodal intervention to address and reduce the impact of sleep disruptions among hospital inpatients was created. Pre‐ and post‐intervention evaluation was used to determine changes in patient‐reported sleep disruption. Results: 'The HUSH Project' (Help Us Support Healing) intervention resulted from the codesign process, which included the provision of HUSH Sleep Packs (with earplugs, eye masks and herbal tea), patient information resources, and ward‐based Sleep Champions. Survey data from 210 patients revealed a statistically significant decrease in patient‐reported noise disturbances for patients in shared rooms following the 4‐week intervention period of the HUSH program. Conclusion: The HUSH Project demonstrated that a novel multimodal intervention may be valuable in reducing sleep disruption in hospitals. These findings also indicate the benefits of using codesign methodology to support improvement projects that seek to enhance patient experiences of care. Patient or Public Contribution: This project utilised codesign methodology, which involved significant contributions from patients and consumer representatives, from research conceptualisation into intervention design, implementation and project evaluation. [ABSTRACT FROM AUTHOR]

Objective. Fostering a research culture and enhancing research capacity within the workforce is essential for any health service aiming to provide evidence-based care. This study aims to explore the research culture and capacity in a community health service setting and provide a comparison to previous published research in other health service settings. Methods. Participants were invited to complete a survey consisting of demographics and the Research Capacity and Culture (RCC) tool. Median and interquartile ranges were calculated for each RCC item and compared to three Australian and one international comparison. Results. A total of 73 staff members from Metro North Community and Oral Health service participated. The team-level scores for the RCC were overall the lowest. Comparison to previously published research using the RCC indicated marginally higher scores for individual-level items in our study across all domains. Individual-level items were very weak to weakly correlated with the team and organisation-level RCC items. Strong to very strong correlations were found between a majority of the team and organisation-level items. Conclusions. Team-level scores were substantially lower when compared to individual and organisational levels. The item 'team leaders that support research' was positively correlated with various organisation-level items, indicating that if the respondent perceived the team leader as a low supporter of research the respondent perceived several organisation items also poorly. As an important stakeholder in enabling research in a health service, organisations should investigate the challenges experienced by team leaders in facilitating research and the support or training they may need. [ABSTRACT FROM AUTHOR]

Objective. Examine the distribution of funding for suicide prevention in Australia from 2021-22 to 2026-27. Methods. Government websites were reviewed to locate budget documents related to suicide prevention funding. Information was extracted on the program/service to be funded, and the funder entity, duration, and year allocation. Extracted data was reviewed to identify commonly targeted sub-populations. Results. The majority of suicide prevention-related funding was allocated to aftercare for persons who have attempted suicide, consistent with the effectiveness of these services, followed by programs targeting the general population. Little funding was allocated to other specific sub-populations, such as young people and Aboriginal and Torres Strait Islander peoples. The amount of funding allocated to suicide prevention varied across jurisdictions, which is only partially explained by suicide rates. Conclusions. There is a need for greater investment in care for specific sub-populations who are at higher risk of suicide. This study provides a baseline for comparing future investments in suicide prevention in Australia. [ABSTRACT FROM AUTHOR]

Background: The health and economic burden of antimicrobial resistance (in Australia is significant. Interventions that help guide and improve appropriate prescribing for acute respiratory tract infections in the community represent an opportunity to slow the spread of resistant bacteria. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. Methods: A cluster randomised trial was conducted comparing two parallel groups of 27 urban general practices in Queensland, Australia: 13 intervention and 14 control practices, with 56 and 54 general practitioners (GPs), respectively. This study evaluated an integrated, multifaceted evidence-based package of interventions implemented over a 6-month period. The evaluation included quantitative and qualitative components, and an economic analysis. Results: A multimodal package of interventions resulted in a reduction of 3.81 prescriptions per GP per month. This equates to 1280.16 prescriptions for the 56 GPs in the intervention practices over the 6-month period. The cost per prescription avoided was A$148. The qualitative feedback showed that the interventions were well received by the GPs and did not impact on consultation time. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. Conclusions: A multimodal package of interventions to enhance rational prescribing of antibiotics is effective, feasible and acceptable in general practice. Investment in antimicrobial stewardship strategies in primary care may ultimately provide the important returns for public health into the future. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. We demonstrated that the implementation of a multimodal package of interventions for acute respiratory tract infections in general practice resulted in a reduction of prescriptions and were well received. Providing GPs with a choice of tools might enhance their uptake and support for antimicrobial stewardship in the community. [ABSTRACT FROM AUTHOR]

Barriers to healthcare experienced by Australian autistic adults have not been previously explored. We conducted a cross-sectional investigation of barriers to healthcare and associated factors from a subtle realism perspective. Perceived barriers to healthcare were obtained from the Barriers to Healthcare Checklist Short-Form (BHC). A total of 263 autistic and 70 non-autistic individuals completed the BHC. On average, autistic adults reported more barriers to healthcare (4.58) than non-autistic adults (0.76). Gender diversity, higher levels of generalised anxiety, greater global disability and less satisfaction with social support contributed to the experience of barriers to healthcare in autistic participants in regression modelling. Australian autistic adults face substantial barriers to healthcare. Understanding these barriers provides an opportunity to develop approaches to improve access; such as co-designing a healthcare access roadmap for autistic adults, with co-designed policies and practices which advocate for the needs of autistic adults. This study looked at how Australian autistic and non-autistic adults experience barriers to healthcare. We asked autistic and non-autistic adults to complete the Barriers to Healthcare Checklist Short-Form (BHC). We analysed data from 263 autistic adults and 70 non-autistic adults. We found that autistic adults experienced more barriers to healthcare than non-autistic adults. Gender diversity, feeling more anxious, having greater disability and feeling unsatisfied with social support contributed to barriers to healthcare in autistic participants. We recommend interventions such as developing and implementing a national action plan, similar to the National Roadmap for Improving the Health of People with Intellectual Disability (2021) to reduce barriers and address unmet healthcare needs of Australian autistic adults. We also recommend working with autistic adults to develop new policies and strategies, implementing environmental adaptations to health care facilities, and increasing Autism education opportunities for health professionals to address gaps in knowledge. [ABSTRACT FROM AUTHOR]

INTRODUCTION This research is a continuation of the authors past contributions on this important subject, that has included the first comprehensive analysis of the composition and characteristics of health service managers in Australia, in terms of their service, qualifications and other important attributes. OBJECTIVES This article contains an analysis of the number and characteristics of health service managers in relation to health services provided in Australia in 2006 compared with that of 2021. DESIGN Design of the analyses follows specifications set by the authors for tabulations prepared by the Australian Bureau of Statistics (ABS) from the censuses of population conducted by ABS in 2006 and 2021. The analysis of health service managers in terms of growth in numbers and change in their characteristics will be reviewed. FINDINGS A substantial increase was found in the number of health service managers in relation to the population and people employed. Also, there have been considerable changes in the characteristics and qualifications of health service managers during the 15-year period. The study also reported on the nature of the changes in hospitals and medical and other health services, and the surge in the number of managers in medical and other services, that in 2021 outnumbered those in hospitals. IMPLICATIONS The findings are relevant to policy development aimed at improving the health status of the population. There were implications as well to the planning of health services, training of their labour force and related educational resources. An agenda is also put forward for additional research in view of its findings. [ABSTRACT FROM AUTHOR]

Many countries, including Australia, have established a national scheme that supports the recognition of a single ethical review for multi-centre research conducted in publicly funded health services. However, local site-specific governance review processes remain decentralised and highly variable. This short report describes the ethics and governance processes required for a negligible risk national survey of physiotherapy-led airway clearance services in Australia. We detail inconsistencies in research governance document preparation and submission (platforms, processes, forms and signatories) and report the time cost and likely impact of these inconsistencies on health services research outcomes. Processes and strategies that facilitated success in this project are identified and summarised as helpful hints to other researchers looking to embark on negligible risk research in public health facilities. [ABSTRACT FROM AUTHOR]