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Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting. Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken. Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death. Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce. The law supports good end-of-life clinical practice by facilitating health care that aligns with the values and goals of patients, including those residing in residential aged care facilities. GPs and nurses here reported broad-ranging legal concerns relevant to providing end-of-life care within aged care, including substitute decision makers/family members wanting to overrule Advance Care Directives, requests for futile or non-beneficial treatment and conflict about decision-making. Participants' concerns can inform end-of-life legal training for aged care GPs and nurses. [ABSTRACT FROM AUTHOR]

Objective: To describe change in costs to different funders over time for women giving birth in Queensland between 2012 and 2018. Methods: A whole-of-population linked administrative dataset was used that contained all health service use in Queensland for women who gave birth between 1 July 2012 and 30 June 2018 and their babies. Aggregated costs for mother and baby from pregnancy to 12 months postpartum were used to compare the change in costs to funders over time. Results: There was an increase in mean total cost to all funders per birth in the public system and private system from 2012 to 2018. North West Hospital and Health Service (HHS) had the highest mean total cost (in Australian dollars) in 2018 (A$42 353), while home births had the lowest (A$6105). For the majority of HHSs the proportion of births with a positive birth outcome (as defined by a composite outcome measure) has remained largely static or declined during this time period. Cairns and Hinterland HHS and Townsville HHS had the largest declines of 15% and 16% respectively, while mean total cost to all funders rose 36.39% and 46.41%, respectively. Conclusions: There has been an increase over time across Queensland in the cost of childbirth in public hospitals and in the private system, while the cost of home birth has remained static. For most HHSs this increase in cost is also associated with little change or a decline in the percentage of births with a positive outcome. Increases in cost are therefore not being translated into better outcomes for women and their babies. Routine performance monitoring of cost, quality and safety should be adopted to ensure the provision of high value maternity care in Australia. What is known about the topic? Public maternity care costs vary in Australia dependent upon place of birth, even after adjusting for clinical and demographic factors. What does this paper add? This paper compares the change in costs for mother and baby from birth through to 12 months for births across Queensland over time. Costs for maternity care have increased over time and higher-cost treatment does not necessarily result in better health outcomes. What are the implications for practitioners? Reporting of cost alongside clinical outcomes should be included in performance monitoring of public hospital maternity care. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate COVID-19 vaccine hesitancy, acceptance, and unmet informational needs in a cancer population during the first phase of the coronavirus disease 2019 (COVID-19) vaccination rollout in Australia. Methods: A cross-sectional survey was conducted in a large tertiary hospital in Queensland, Australia, between 10 May and 31 July 2021. The survey assessed health beliefs, experiences of the COVID-19 pandemic, COVID-19 vaccine hesitancy and informational needs. Results: COVID-19 was perceived to be a significant threat to both physical and mental health. While 57.9% (n = 110) of respondents believed the COVID-19 vaccines were safe and 64.2% (n = 122) believed they were effective, more than half (52.6%; n = 100) agreed that they worried about vaccine side effects. Most respondents (84.2%; n = 160) planned to receive the COVID-19 vaccine; however, feelings of hesitancy remained. There was a statistically significant association between those aged under 60 years (P = 0.003), those with previous vaccine hesitancy (P = 0.000), those who felt they had not received adequate information (P = 0.000) and vaccine hesitancy. Requested information pertained to interactions with cancer treatments, those with a history of blood clotting and information for those undergoing bone marrow transplantation. Conclusions: There is a need for tailored COVID-19 vaccine communication that is responsive to the concerns of people with cancer. This will be beneficial during current and future vaccination rollouts. What is known about topic? People with cancer are a COVID-19 vaccine priority group, as they are at increased risk of morbidity and mortality from this disease. There is currently a dearth of information regarding COVID-19 vaccine hesitancy, acceptance, or informational needs for this population. What does this paper add? This paper has shown that although vaccine refusal rates were low in this population, feelings of hesitancy remained. Women, those in younger age categories, those with previous vaccine hesitancy and those who felt they had not received adequate information had stronger vaccine hesitancy and higher refusal rates. What are the implications for practitioners? There is a need for tailored information and open communication regarding COVID-19 vaccines and people with cancer. There is an opportunity to build upon established relationships of trust between cancer patients and their clinicians. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods: We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results: In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion: Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission. What is known about the topic? Some people with mental health problems are brought in by police to an emergency department (ED). People brought in by police are recognised as having poorer health profiles compared to other arrival modes. What does this paper add? Several patient and clinical factors influence ED length of stay and hospital admission for people with a mental health problem brought in by police, indicating a need for targeted health care that addresses these factors. What are the implications for practitioners? This study justifies the need to develop specialised pre-hospital models of care and embed early assessment processes in an ED for people with mental health problems brought in by police. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore allied health professional (AHP) managers' implementation of the right to request part-time hours on return from maternity leave in Queensland Health (QH) hospitals. Methods: Qualitative data were collected via interviews with AHP managers from a cross-section of professions with variations in workforce size and gender composition. Interviews were audio recorded, transcribed and analysed thematically. Results: Twenty-one of a potential 40 AHP managers agreed to participate in the study (response rate 53%). The main finding was that the implementation of part-time work arrangements was being driven by regulation and work was being managed without complementary changes to established workplace practices or adequate organisational support. Conclusion: The use of regulatory instruments to implement part-time work in organisations without complementary work redesign, change management and organisational support suggests that there are significant barriers to this type of flexible working arrangement (FWA) becoming accepted workplace practice for AHPs in QH. A whole-of-organisation approach is needed to make FWA a reality. What is known about the topic?: Research has underlined the importance of implementation and management rather than simply the adoption of FWA policies. However, there have been few reports about AHP management of part-time hours on return from maternity leave. What does this paper add?: This paper provides information specifically about the management response to part-time work entitlements for AHP in QH. It indicates that managers are implementing part-time work because it is a regulatory requirement, but often without a substantive commitment to FWA complementary redesign of services or sufficient organisational support. What are the implications for practitioners?: Complementary work redesign measures and resources are needed to make workplaces genuinely flexible rather than just superficially consistent with regulatory requirements. [ABSTRACT FROM AUTHOR]

The aim of this study was to present the health and social characteristics of community-dwelling older people within the Cairns region who were identified by their GP as having complex care needs. This paper reports the subanalysis of baseline data from the Older Persons Enablement and Rehabilitation (OPEN ARCH) stepped wedge randomised controlled trial of an integrated model of care for community-dwelling older people. Data were analysed at the level of the participant and the level of the participant cluster (group of participants from the one GP). Median quality of life, as assessed by the EQ-5D, was higher for females than males (80 vs 70 respectively; P = 0.05) and for people living alone than living with family (80 vs 60 respectively; P = 0.0940). There was greater functional independence among non-Indigenous than Indigenous participants (median Functional Independence Measure scores of 122 vs 115 respectively; P=0.0937) and the incidence rate (95% confidence intervals) of presentation to the emergency department was sevenfold higher for Indigenous than non-Indigenous participants (11.47 (5.93-20.03) vs 1.65 (0.79-3.04) per 1000 person days respectively). Finally, 61.3% of participants required support to remain living in the community and 44% accessed allied health, with podiatry the most common intervention. The findings indicate that previous hospital utilisation is not a consistent indicator of complexity. Multimorbidity, cultural context and the living and caring situation are considered as matters of complexity, yet variation exists at the participant level. [ABSTRACT FROM AUTHOR]

Objective: The harmful use of alcohol is a global issue. This study aimed to describe and compare the profiles, emergency department (ED) clinical characteristics, and outcomes of alcohol-related ED presentations (ARPs) and non-alcohol-related ED presentations (NARPs). Methods: A multi-site observational study of all presentations to four EDs between 4 April 2016 and 31 August 2017, was conducted. Routinely collected ED clinical, administrative and costings data were used. Classification of ARPs were prospectively recorded by clinicians. Analysis was performed at the presentation, rather than person level. Univariate tests were undertaken to compare demographics, ED clinical characteristics and outcomes between ARPs and NARPs. Results: A total of 418 051 ED presentations occurred within the 17-month study period; 5% (n = 19 875) were ARPs. Presentations made by people classified as ARPs were younger, more likely to be male, present on weekends or at night, and arrive by ambulance or police compared to NARPs. Compared with NARPs, ARPs had a longer median ED length of stay of over 20 min (95% CI 18–22, median 196 min vs 177 min, P < 0.001), a 5.5% (95% CI 4.9–5.3) lower admission rate (36% vs 42%, P < 0.001), and a AUD69 (95% CI 64–75) more expensive ED episode-of-care (AUD689 vs AUD622, P < 0.001). Conclusion: Clinically meaningful differences were noted between alcohol-related and non-alcohol-related ED presentations. The higher cost of care for ARPs likely reflects their longer time in the ED. The healthcare and economic implications of incidents of alcohol-related harm extend beyond the ED, with ARPs having higher rates of ambulance and police use than NARPs. What is known about the topic? The harmful use of alcohol is a major health issue globally contributing to morbidity and mortality. What does this paper add? The demographic profile, clinical characteristics, and outcomes of people presenting to emergency departments with alcohol-related harm differ to people arriving for other reasons. What are the implications for practitioners? Indicating alcohol as a cause of an ED presentation, as standard practice, may foster quality assurance/improvement activities. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to provide a detailed description of the flexible working arrangements (FWA) used by allied health professionals (AHP) on return from maternity leave. This is a crucial issue for staff management practices in a changing regulatory context. Methods: A retrospective convenience sample of AHP employed by Queensland Health (QH) in 2006, using deidentified payroll data, was analysed descriptively to determine employment status on return from maternity leave in 2006 to December 2014. A qualitative study that surveyed managers of AHP departments was subsequently undertaken to complement the data from the payroll study. Twelve managers, across six allied health professions in three hospitals in south-east Queensland were surveyed for this component. Results: The payroll study included 169 employees (138 full-time equivalent (FTE)), 61 of whom resigned over the study period. Of those who returned to work after the 2006 maternity event (n = 152), 92% (n = 140) initially returned part-time. At 31 December 2014, of the 108 staff working for QH, 77% (n = 83) were part-time. In total, 75.4 FTE positions were released over the 8-year period through reduced working hours and resignations. The perceptions of surveyed managers were consistent with the data from the payroll study. Conclusion: The study showed that most AHPs who took maternity leave returned to work part-time and remained part-time for an extended period. The data suggest that managers could permanently backfill a proportion of hours released due to FWA after maternity leave without major budgetary risk due to the need to accommodate existing employees' entitlements. However, this would require a significant policy change. What is known about this topic?: Current research on this topic has concentrated on the benefits of paid maternity leave, timing of return to work and use of FWA by employees on return to work after maternity leave. What does this paper add?: This paper presents the first comprehensive data on patterns of return to work and part-time hours following maternity leave for AHP employees. Access to a unique payroll dataset provided the opportunity to describe this for a cohort of AHP employees over a period of 8 years following a maternity event. A survey of AHP managers' experience with maternity leave and return to work arrangements supported the findings, underlining the associated difficulties with staff management. What are the implications for practitioners?: The hours released through resignations or reduced hours over this period of study suggest that management could backfill a proportion of released hours permanently, or at least offer temporary staff longer-term contracts, once an employee returns from maternity leave on reduced hours [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods: This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results: Supervisee's work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions: High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic?: There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add?: This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners?: Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice. [ABSTRACT FROM AUTHOR]

Objective: This study sought to compare costs for women giving birth in different public hospital services across Queensland and their babies. Methods: A whole-of-population linked administrative dataset was used containing all health service use in a public hospital in Queensland for women who gave birth between 1 July 2012 and 30 June 2015 and their babies. Generalised linear models were used to compare costs over the first 1000 days between hospital and health services. Results: The mean unadjusted cost for each woman and her baby (n = 134 910) was A$17406 in the first 1000 days. After adjusting for clinical and demographic factors and birth type, women and their babies who birthed in the Cairns Hospital and Health Service (HHS) had costs 19% lower than those who birthed in Gold Coast HHS (95% confidence interval (CI) –32%, –4%); women and their babies who birthed at the Mater public hospitals had costs 28% higher than those who birthed at Gold Coast HHS (95% CI 8, 51). Conclusions: There was considerable variation in costs between hospital and health services in Queensland for the costs of delivering maternity care. Cost needs to be considered as an important additional element of monitoring programs. What is known about the topic?: The Australian maternal care system delivers high-quality, safe care to Australian mothers. However, this comes at a considerable financial cost to the Australian public health system. It is known that there are variations in the cost of care depending upon the model of care a woman receives, and the type of delivery she has, with higher-cost treatment not necessarily being safer or producing better outcomes. What does this paper add?: This paper compares the cost of delivering a full cycle of maternity care to a woman at different HHSs across Queensland. It demonstrates that there is considerable variation in cost across HHSs, even after adjusting for clinical and demographic factors. What are the implications for practitioners?: Reporting of cost should be an ongoing part of performance monitoring in public hospital maternity care alongside clinical outcomes to ensure the sustainability of the high-quality maternal health care Australian public hospitals deliver. [ABSTRACT FROM AUTHOR]

Objective: The delivery of public out-patient services is an essential part of complex healthcare systems, but the contribution of public out-patient services is often ill defined and poorly evaluated. The aim of this study was to identify and better understand those factors that may affect the performance of out-patient services to provide health service managers, clinicians and executives with a conceptual framework for future decision-making processes. Methods: The present qualitative research involved five exploratory case studies. These case studies were conducted across two specialties at hospitals in the Metro North Hospital and Health Service in Queensland. Data were obtained from 38 interviews and 15 focus groups, and were analysed to identify common themes. Further analysis helped identify the most significant factors and build a conceptual framework for understanding the relationships between those factors and their effect on performance. Results: Across both specialties there were 10 factors (scheduling, performance, service framework, categorisation or prioritisation of patients, internal and external stakeholders, resources, service demand, culture, system challenges and medical stakeholders) identified that may affect the performance of out-patient services. These factors were condensed into five core domains: culture, stakeholders, resources, demand and system reform. Conclusion: Strategies to address the five core domains identified may provide a framework for sustainable improvement in the delivery of out-patient services. What is known about the topic?: The provision of specialist out-patient services is an essential element of health service delivery. Access to specialist services in the public sector is challenging because of the escalating demand associated with an increasing and aging demographic. The factors that may affect the delivery of out-patient services need to be addressed for long-term sustainable improvement. What does this paper add?: This paper provides a conceptual framework grounded in rigorous qualitative data analysis for understanding the internal and external factors that affect waiting times for specialist out-patient services. The results of this qualitative research indicate that there are five core domains that may influence waiting times in the public out-patient setting. When these domains are addressed at the strategic, tactical and operational levels, they have the potential to provide significant improvement in the delivery of out-patient services. What are the implications for practitioners?: This paper guides the attention of relevant stakeholders towards the five core domains identified (culture, stakeholders, resources, demand and system reform) that influence the performance of waiting times at the operational, tactical and strategic levels within the public hospital setting. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to determine the clinical activity profile of preregistration physiotherapy students during clinical placements and their clinical activity contribution to health service delivery. Methods: Clinical activity data for 2014 were obtained from five Queensland public sector hospitals providing preregistration physiotherapy students clinical education in three key clinical areas (cardiorespiratory, musculoskeletal and neurological) over four 5-week placement blocks. Data regarding the number of student occasions of service (OOS) and the length of the OOS (LOOS) were collected to determine the average OOS and LOOS per student in each clinical area. Results: Twenty weeks of student data were collected from each hospital in each clinical area, representing 29.1% of cardiorespiratory, musculoskeletal and neurorehabilitation student placements. Students completed 19 051 OOS. The average OOS per student per block for cardiorespiratory, musculoskeletal and neurorehabilitation placements was 98.3, 74.0 and 72.4 respectively. Two-way ANOVA revealed a main effect of weeks (F = 402.1, P < 0.001) and clinical area (F =1331.5, P < 0.001) for LOOS.In addition, an interaction was found between clinical placement week and clinical area for LOOS (F = 8.4, P < 0.001). Conclusions: Student clinical activity data are useful for understanding the student contribution to health services. Student contribution appears to increase throughout the clinical placement and consideration should be given to the clinical educator : student ratio to enhance overall student contribution. What is known about the topic?: Quantitative data describing physiotherapy student clinical care activity during placements are limited. What does this paper add?: This paper profiles physiotherapy student clinical care activity and the changes occurring over 5-week placements. What are the implications for practitioners?: Physiotherapy students provide clinical activity for health services that changes over their 5-week placement. Student clinical activity should be considered when responding to placement demand and planning service delivery. [ABSTRACT FROM AUTHOR]

Student-led interprofessional health clinics offer valuable opportunities for student learning and meeting the health care needs of the community. This case study describes the operation of a new interprofessional student-led community health service over its initial 13-month period of operation. This case study also presents an overview of the service provision, student placement opportunities and focuses on the challenges associated with the service and the impact on future planning. What is known about the topic?: Interprofessional student-led clinics offer an opportunity to meet clinical placement demands and interprofessional training needs while also providing a community service. What does this paper add?: This case study adds to the limited literature around knowledge of service delivery and challenges in the operation of community-based student-led interprofessional health services; future planning to streamline processes is also addressed. What are the implications?: There may be relevance to other university–industry partnerships that intend to explore student-led interprofessional service operations designed to address placement shortages, student training and community needs. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to report on the rates of obstetric interventions within each hospital jurisdiction in the state of Queensland, Australia. Methods: This project used a whole-of-population linked dataset that included the health and cost data of all mothers who gave birth in Queensland, Australia, between 2012 and 2015 (n = 186 789), plus their babies (n = 189 909). Adjusted and unadjusted rates of obstetric interventions and non-instrumental vaginal delivery were reported within each hospital jurisdiction in Queensland. Results: High rates of obstetric intervention exist in both the private and public sectors, with higher rates demonstrated in the private than public sector. Within the public sector, there is substantial variation in rates of intervention between hospital and health service jurisdictions after adjusting for confounding variables that influence the need for obstetric intervention. Conclusions: Due to the high rates of obstetric interventions statewide, a deeper understanding is needed of what factors may be driving these high rates at the health service level, with a focus on the clinical necessity of the provision of Caesarean sections. What is known about the topic?: Variation in clinical practice exists in many health disciplines, including obstetric care. Variation in obstetric practice exists between subpopulation groups and between states and territories in Australia. What does this paper add?: What we know from this microlevel analysis of obstetric intervention provision within the Australian population is that the provision of obstetric intervention varies substantially between public sector hospital and health services and that this variation is not wholly attributable to clinical or demographic factors of mothers. What are the implications for practitioners?: Individual health service providers need to examine the factors that may be driving high rates of Caesarean sections within their institution, with a focus on the clinical necessity of Caesarean section. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of life-limiting conditions in children in Australia is unknown; such data are needed to inform health service planning for paediatric palliative care. The aim of this study was to estimate the prevalence of life-limiting conditions for children and young people aged 0–21 years living in Queensland, Australia. Methods: An observational study using linked administrative health data from the 2011 and 2016 calendar years was performed for all individuals with an International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification code relating to a life-limiting condition eligible for palliative care recorded against an admission to a public or private hospital and health service provider in Queensland or against a cause or underlying cause of death in the Queensland Registrar General Deaths. Results: The overall prevalence of life-limiting conditions per 10 000 population increased from 35.2 (95% confidence interval (CI) 34.2–36.2) in 2011 to 43.2 (95% CI 42.1–44.4) in 2016. This increase in prevalence was greatest for children <1 year of age and for those who identified as Aboriginal and Torres Strait Islander. Conclusion: This study has estimated the prevalence of life-limiting conditions for children and young people aged 0–21 years living in Queensland. Estimation of the number of children and young people with life-limiting conditions can inform health service planning for paediatric palliative care in Queensland. Future research is needed to identify the number of children and young people with life-limiting conditions who do not have an admitted episode. What is known about the topic?: Data from the UK indicate that the prevalence of life-limiting conditions among children and young people is increasing. However, such data are not available for the Australian population. Because prevalence data can be affected by population characteristics, it is important to establish country-specific epidemiological data rather than extrapolating data from other countries. Country-specific data can inform health planners and policy makers of the scale of the problem within a geographical and demographic context. This is essential for Australia given the diverse geographical and demographic characteristics and specific needs of Aboriginal and Torres Strait Islander peoples. What does this paper add?: This study is the first to provide an estimate of the prevalence of life-limiting conditions in children and young people aged 0–21 years in Queensland. Estimates include the prevalence of life-limiting conditions in children and young people who identify as being of Aboriginal and/or Torres Strait Islander descent. What are the implications for practitioners?: The prevalence of life-limiting conditions in Queensland is greater than previously thought. There is a need to grow both a generalist and specialist paediatric palliative care workforce in response to this increasing prevalence. The estimates of prevalence proportions from this study provide the foundation on which future health service activities can be built because they provide country-specific clinical and demographic characteristics. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to: (1) use local health data to examine potentially preventable hospitalisations (PPHs) as a proportion of total hospital separations and estimated costs to a large regional hospital in northern Queensland, including differences associated with Indigenous status; and (2) identify priority conditions and discuss issues related to strategic local primary health intervention. Methods: A cross-sectional analysis was conducted using Queensland Hospital Admitted Patient Data Collection data (July 2012–June 2014) restricted to 51 087 separations generated by 29 485 local residents. PPHs were identified from the International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification (ICD-10-AM) and procedure codes using National Healthcare Agreement definitions. Age-standardised separation rates were calculated using Australian 2001 reference population and associated economic costs were estimated using Australian-refined diagnosis related groups. Results: Eleven per cent (n = 5488) of all hospital separations were classified as PPH, and most were for common chronic (n = 2486; 45.3%) and acute (n = 2845; 51.8%) conditions. Because many acute presentations reflect chronic underlying disease, chronic conditions account for up to 76.5% of all PPHs. Age-standardised PPH rates were 3.4-fold higher for Indigenous than non-Indigenous people. Associated 2-year costs were AU$32.7 million, which was 10.7% of estimated total health care expenditure for hospital separations, and were higher for Indigenous (14.9%) than non-Indigenous (9.7%) people. Conclusions: High hospitalisation rates and costs for common preventable chronic conditions represent opportunities for primary healthcare interventions. In particular, community-level health services need to be more responsive to the needs of local Indigenous families. What is known about the topic?: PPH rates are used as a measure of timely access to quality primary health care, and are incrementally higher in regional and remote areas than in major cities. Investment in primary healthcare services has been shown to significantly reduce costs associated with avoidable hospitalisations. What does this paper add?: This study used local health data to identify the most common PPH conditions presenting to a large regional hospital in northern Queensland, including estimation of costs and differences associated with Indigenous status. Recommendations are made to strengthen primary healthcare and reduce hospital-related costs. What are the implications for practitioners?: Interventions to address high PPH rates should be tailored to meet the needs of the local population. Primary health strategies targeting common chronic conditions provide the greatest opportunity to reduce avoidable hospitalisations and costs in this regional area. Investment in collaborative, evidence-based interventions is recommended and justified, especially for Indigenous Australians. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to assess: (1) concordance between patient preferences stated in advance care plans (ACPs) and hospital care over the subsequent 12 months; (2) change in preferences over time; (3) justifications for discordant care; and (4) effects of ACP completion on hospital utilisation. Methods: A retrospective study was conducted of 198 patients with an ACP form registered with an ACP registry and tagged with a hospital unique record number. Data collected from ACP forms and hospital records comprised ACP completion and revisions, care preferences, patient characteristics and hospital care. Instances of care discordant with preferences were analysed as Type A (no ascertainable justification) and Type B (direct patient request or appropriate clinical indications). In a survivor subset, hospital utilisation was compared before and after ACP completion. Results: Mean (± s.d.) patient age was 79.5 ± 11.8 years. Patients had a mean (± s.d.) of 5.5 ± 2.5 comorbidities and 90 (46.4%) died within the 12 months after ACP completion. Most ACPs (130; 65.5%) were completed during index hospitalisation and 13 (6.5%) underwent revision, on average, 6.8 months later, all related to rescinding request for cardiopulmonary resuscitation. Hospital care was fully concordant for 154 (77.8%) patients, with 39 (22.2%) receiving 60 instances of discordant care (15 (25%) Type A, 45 (75%) Type B), mostly related to surgical procedures (20; 33%) and intravenous fluids or antibiotics (26; 43%). Patients receiving discordant care had higher mortality (77% vs 45%; P < 0.001) and more rapid response team activations (34% vs 13%; P = 0.001) at 12 months than patients with concordant care. Among the 108 confirmed survivors at 12 months after ACP completion, emergency department presentations and hospital admissions per patient had decreased by ≥50% (P < 0.001) and hospital days had decreased by 25% (P = 0.042) compared with the 12 months before ACP completion. Conclusion: Most patients completing an ACP received hospital care fully concordant with their stated preferences, with few revising their preferences over time. Discordant care mostly related to justified supportive treatments or surgical procedures. Among survivors, ACP completion was associated with decreased use of hospital care. What is known about the topic?: ACPs that list patient preferences and care goals relieve family and patient distress and uncertainty regarding future care decisions as death approaches, decrease unwanted medical interventions and hospitalisations, and are associated with more patients dying at home. However, uncertainty surrounds the extent to which in-patient care provided to patients' concords with preferences stated in ACPs, which preferences are most adhered to, and whether preferences change over time, warranting revision of ACPs. What does this paper add?: This retrospective study of 198 patients completing an ACP, of whom almost half died within the following 12 months, showed that more than 75% received hospital care fully concordant with their stated preferences and, for decedents, most died at their preferred place of death. Relatively few patients changed their documented preferences over time, and all changes were for less use of cardiopulmonary resuscitation (CPR). Instances of discordant care mostly related to the administration of supportive treatments or surgical procedures and most were justified on the basis of patient request or appropriate clinical indications. Among 108 survivors, the number of emergency department presentations and hospital admissions per patient at 12 months after ACP completion was half those seen in the 12 months before ACP completion, whereas hospital days per patient decreased by 25%. What are the implications for practitioners?: Encouraging patients with progressive chronic disease to complete an ACP reduces their risk of receiving care they do not want, reflected in decreased use of hospital care. Preferences stated in ACPs are mostly stable over time and, if changed, tend to become more conservative in terms of CPR. Conversely, preferences stated in the ACP do not, as circumstances change, bind patients or clinicians to withholding care that relieves symptoms or prevents major morbidity in the short term. [ABSTRACT FROM AUTHOR]

The aim of the present case study is to illustrate the outcomes of a dedicated allied health (AH) research position within a large Queensland regional and rural health service. The secondary aim of the case study is to describe the enabling and hindering mechanisms to the success of the role. Semistructured interviews were conducted with the Executive Director of Allied Health and the current AH research fellow incumbent within the health service. A focus group was also undertaken with six stakeholders (e.g. clinicians, team leaders) who had engaged with the research position. Outcomes of the AH research fellow included clinical and service improvements, enhanced research culture and staff up-skilling, development of research infrastructure and the formation of strategic research collaborations. Despite being a sole position in a geographically expansive health service with constrained resources, key enabling mechanisms to the success of the role were identified, including strong advocacy and regular communication with the Executive. In conclusion, the case study highlights the potential value of an AH research position in building research capacity within a large non-metropolitan health service. Factors to facilitate ongoing success could include additional research and administrative funding, as well as increased use of technology and team-based research. What is known about the topic?: Dedicated research positions embedded within health care settings are a well cited strategy to increase research capacity building of allied health professionals (AHPs). However the majority of these positions are within metropolitan health settings and unique challenges exist for these roles in regional and rural areas. Few studies have described the impact of dedicated AH research positions within regional health centres or the factors which facilitate or hinder their role. What does this paper add?: Dedicated research positions within a non-metropolitan Australian health service may have a positive impact on AH clinical services, research culture, staff upskilling, research infrastructure and research collaborations. Key enabling mechanisms to support the role may include advocacy from higher level management, strong networks and communication channels. Additional research and administrative funding, the use of technology and team based research may enhance sustainability of such roles. What are the implications for practitioners?: AH research positions have potential value in building research capacity within a large non-metropolitan health service. Health managers and researchers should be aware of the unique challenges to these roles and consider mechanisms that may best enhance and sustain outcomes of the positions including: the development of infrastructure (i.e. technology, website of resources), networks, and communication strategies (i.e. regular meetings with leadership and promotion internally). [ABSTRACT FROM AUTHOR]

Objective. There is limited evidence about how legal frameworks that underpin end-of-life decisions are applied in practice. This study aimed to identify how end-of-life decisions are made and documented in emergency departments and intensive care units. The secondary aim was to explore the extent to which the legal processes featured in these decisions. Methods. A retrospective chart audit of 85 adult patients who died in the emergency departments and intensive care units of a Queensland health service was undertaken. Quantitative data were analysed and reported using descriptive statistics. Qualitative textual data were analysed using inductive content analysis. Results. Nearly all admissions were unplanned (97.6%), and most patients (74.1%) were admitted from home. Only one patient had an advance health directive, although all had an eligible substitute decision-maker. The qualitative analysis revealed two main concepts -- 'healthcare professionals choreograph the end of life' and 'patients and families are carried on an unplanned journey'. Conclusions. There was limited documentation related to the application of the legal framework in these decisions. Healthcare professionals relied on their clinical judgment about what was in the best interest of the patient. It was common for there to be a substantial effort to achieve consensus in decision-making which coincidentally complied with the law. [ABSTRACT FROM AUTHOR]

Background: Physiotherapy private practitioners represent a growing proportion of Australia's primary care workforce; however, they face significant barriers in integrating seamlessly within interprofessional teams. Historically, the landscape of primary care in Australia has been one where many physiotherapists work in monoprofessional private practice facilities at dispersed locations, potentially limiting collaborative and coordinated care. The aim of this study was to investigate strategies recommended by physiotherapists to promote effective interprofessional collaborative practice (IPCP) within the Australian private practice setting. Methods: Using interpretive description as the guiding methodological framework, semi-structured interviews were conducted with 28 physiotherapists in 10 private practice sites in Queensland, Australia. Results: Data analysis produced three themes that characterised physiotherapy private practitioners' recommendations to improve IPCP: (a) the need for improved funding and compensation, particularly addressing the limitations of the Medicare Chronic Disease Management program; (b) the development of integrated and secure digital communication systems to facilitate better information exchange; and (c) prioritising professional development and training to enhance collaboration. Conclusions: This research lays the groundwork for informed policy making to advance person-centred care and support the integration of services in the Australian healthcare system. The findings from this study indicate that promoting effective IPCP in physiotherapy private practice requires a comprehensive strategy that addresses systemic funding and compensation issues, enhances digital communication systems and optimises interprofessional education and training. Physiotherapists working in primary care are becoming increasingly important members of interprofessional healthcare teams. This research outlines key strategies from the perspective of Queensland physiotherapy private practitioners, including reforming funding structures, leveraging digital communication and improving education and training initiatives, to promote effective interprofessional collaborative practice. The insights from this study underscore the broader complexities within Australia's healthcare system and emphasise the need for strategic changes to achieve collaboration in ensuring optimal patient care. [ABSTRACT FROM AUTHOR]

Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth. However, there is little information about GPs' understanding of their role in postpartum care and how it is undertaken. This cross-sectional survey of GPs in Southern Queensland, conducted between February and July 2013, describes the involvement of GPs in postpartum care. GPs were posted a 52-item questionnaire adapted from a previous Victorian GP study and were telephoned 2 weeks later. GPs completed the survey on paper or online. The response rate was 17.4% (163 GPs). Approximately 39% were uncertain whether women were happy with the GP-provided postpartum care. GPs' recommendations for the timing of postpartum reviews were inconsistent within and across birthing sectors and consultations took longer than anticipated. Developing guidelines around the timing and appropriate length of postpartum consultations could assist GPs in providing appropriate care for mothers and infants. [ABSTRACT FROM AUTHOR]

The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access. Methods. A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use. Results. Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31–0.36, P < 0.05) than English-speaking people. Among those using telehealth, people requiring interpreter services were 13% less likely to use videoconference than phone (OR adjusted 0.87, 95% CI 0.77–0.98, P < 0.005). Conclusion. There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this. [ABSTRACT FROM AUTHOR]

Objective. This paper describes the effects of a maternity consumer representative training program on participants' confidence to fulfil this role and engagement in representative activities. Methods. The present study was a descriptive, pre-post evaluation design with a 3-month follow-up. Fifty-eight people completed the program and 55 agreed to participate in the evaluation. Participants completed questionnaires to assess confidence to undertake consumer representative roles and reported on their engagement with consumer activities. Results. Participants' perceived confidence to function in the role of consumer representative differed significantly before and after the workshop (F(2,18) = 7.057, P < 0.001), as did confidence in decision making (F (2,16) = 7.615, P = 0.005), confidence in negotiating outcomes and liaising with key people (F(2,18) = 7.154, P = 0.005), and confidence in making use of relevant networks (F (2,18) = 4.319, P = 0.029). There was a decline in confidence at 3 months, with confidence at this time no longer significantly different from that at the time of recruitment. Engagement with consumer organisations increased by 45% compared with rates at commencement of the project. Conclusions. The program enhanced participants' confidence to fulfil a maternity consumer representative role but was not sustained. Further research is needed as to how to best support maternity consumer representatives and assess their contribution to promoting woman-centred care. [ABSTRACT FROM AUTHOR]

Objective. To report on the accuracy of reports of diabetes-related major amputations, rates per 100 000 people and trends over the 10-year period from 1998-99 to 2007-08 in Far North Queensland. Methods. Three data sources were cross-checked. Poisson regression was used to calculate the percentage change in trends in diabetes amputation hospitalisations over the period. Results. There was a discrepancy of 6 (3.7%) in 161 cases over 10 years. The number of diabetes-related hospitalisations for major lower limb amputation did not show a significant trend during this period, with an annual percentage change of -0.32%, P = 0.915. Conclusion. Amputation data in Far North Queensland were accurate. There was a modest reduction in the hospitalisation rate for major lower limb amputation over the 10-year period, demonstrating the need for improvements in the organisation of care. [ABSTRACT FROM AUTHOR]

Objective. This paper presents the findings of research which explored how International Medical Graduates (IMGs) understand and integrate with the allied health system in relation to multidisciplinary care. Methods. An open-ended, exploratory qualitative design comprised of thirty (n = 30) open-ended, in-depth interviews with IMGs employed in a public hospital in Queensland, Australia. Results. Many IMGs have no experience with allied health support in their country of origin. Multidisciplinary collaboration is a new concept for IMGs integrating into the Australia healthcare system. Learning about the allied health system, including how to work effectively within the context of the multidisciplinary team, is an important topic that needs to be addressed as a matter of priority. Conclusions. There is a strong need to focus on improving strategies for integrating IMGs into the allied health system. In particular, IMGs require information to help them understand the roles and referral processes associated with interfacing with the allied health system. INSET: What is known about the topic?. [ABSTRACT FROM AUTHOR]

Objective. The provision of medicines through state public hospitals is comparatively restrictive compared with the federally funded Pharmaceutical Benefits Scheme (PBS). Individual states are progressively moving towards statewide medicines formularies. Although a statewide formulary has existed in Queensland for some time. The effects of hospital formularies on medicines utilisation and policy in Australia has not been quantified. Thus, the aim of the present study was to quantify the effects of the Queensland Health List of Approved Medicines (LAM) on medicines utilisation in Queensland at a state and PBS-purchasing level and describe the implications for medicines policy. Methods. This study used a quasi-experimental design with an interrupted time series (with control for PBS) examining utilisation effects of medicines within the therapeutic classes of proton pump inhibitors and non-vitamin K oral anticoagulants with LAM listing or delisting. Results. The LAM was demonstrated to be highly effective at controlling utilisation within Queensland Health purchasing. Effects on PBS utilisation were evident, resulting in increases in generic utilisation (where available) and associated reduced total costs both within Queensland Health and to the PBS. The full benefit is likely underestimated due to limitations in the PBS datasets. Conclusion. The LAM is a highly effective state medicines policy tool with demonstrable effects on PBS utilisation. With increased use of statewide medicines formularies, this will be an increasingly relevant aspect of Australia's overall medicines policy. [ABSTRACT FROM AUTHOR]

Objective. To explore measures of potentially avoidable general practitioner (PAGP)-type presentations to the emergency department (ED) of a large regional hospital in northern Queensland. Methods. Linkage of an ED administrative dataset to a face-to-face patient survey of local residents (n = 1000); calculation of Australian Institute of Health and Welfare (AIHW) and Australasian College of Emergency Medicine (ACEM) measures of PAGP-type presentations to the ED; and exploration of these measures with patient-perspective linked data. Results. PAGP-type presenters to the ED were younger in age (median age in years: total cohort: 49; AIHW 38, P, 0.001; ACEM 36, P, 0.001); with the odds of having a chronic condition being less likely for AIHW PAGP-type presenters than other ED presenters (OR (95% CI) 0.54 (0.38-0.77): P = 0.001)) after adjustment for age. PAGP-type presenters nominated reasons of convenience rather than urgency as their rationale for attending the ED, irrespective of measure. The number of PAGP-type presentations to the ED identified by the AIHW measure was more than three-fold higher than the ACEM measure (AIHW: n = 227; ACEM: n = 67). Influencing factors include the low proportion of ED attendees who had a medical consultation time of ,1 h at this hospital site (1-month survey period: 17.8%); and differences between the patient self-report and EDadministrative record for 'self-referral to the ED' (Self-referred: Survey 71% vs EDIS 93%, P, 0.001). Conclusions. Identification of PAGP-type presentations to the ED could be enhanced with improvements to the quality of administrative processes when recording patient 'self-referral to the ED', along with further consideration of hospital site variation for the length of medical consultation time. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Health consciousness highlights the readiness of individuals to undertake health actions and take responsibility for their health and the health of others. AIM: To examine the health consciousness of Australians and its association with health status, health-care utilisation and sociodemographic factors. METHODS: This quantitative cross-sectional study was a part of a larger project aiming to engage the general public in health-care decision-making. Adults from Queensland and South Australia (n = 1529) were recruited to participate by a panel company. The questionnaire included the Health Consciousness Scale (HCS), health status, health-care utilisation, sociodemographic and socioeconomic variables. RESULTS: The health consciousness of Australians was relatively low (mean score = 21), compared to other international administrations of the HCS, and further investigations revealed that more health-conscious people tended to live in South Australia, be female and single, experience poorer physical and mental health and were more frequent users of health-care services. DISCUSSION: The general approach to health in this sample of the Australian public may reflect 'here and now' concerns. It appears that an attitude of 'she'll be right, mate' prevails until a change in an individual's health status or their exposure to the health system demands otherwise. These findings need to be investigated further to see if they are confirmed by others and to clarify the implications for primary health programmes in Australia in redressing the public's apparent apathy. [ABSTRACT FROM AUTHOR]

People with spinal cord damage (SCD) report a high level of GP use. There is a dearth of research investigating factors that contribute to GP identification and retention for people with SCD. Furthermore, a GP satisfaction measure developed specifically for people with SCD is non-existent. This preliminary study sought to identify factors contributing to GP identification and retention. A total of 266 people with SCD primarily based in Queensland, Australia, completed a cross-sectional survey that aimed to fill these knowledge gaps. Descriptive statistics and correlational analyses clarified the factors contributing to GP identification and GP retention respectively. An exploratory factor analysis utilising the principal components analysis method clarified a set of items that could underpin key domains for a SCD-specific GP satisfaction measure. The findings confirm that knowledge about SCD, physically accessible services, and trust are seminal considerations aligned with GP identification and retention for people with SCD. A dearth of research investigates GP satisfaction among people who have experienced neurotrauma, with specific measures of GP satisfaction being non-existent. This study identifies the factors contributing to GP retention for people with spinal cord damage and establishes domains for a GP satisfaction measure, and model of GP satisfaction. The findings clarify that knowledge of condition and trust are factors important to include in a future measure and model. [ABSTRACT FROM AUTHOR]

In Australia, people from culturally and linguistically diverse backgrounds often face inequitable health outcomes and access to health care. An important, but under-researched, population is people of Latin American descent. A cross-sectional study obtained clinical data on Latin American Spanish-speaking patients from Brisbane's south-west. Extracted data included demographic characteristics, risk factors, chronic disease and service use. A total of 382 people (60.5% female, 39.5% male), mainly from El Salvador and Chile and predominantly older people (70% over 50 years), were identified. Compared with the general Australian population, the proportion of people with dyslipidaemia, diabetes, arthritis and musculoskeletal, mental health disorders and being obese or overweight was high. There was also a higher use of the 20–40 min general medicine consultation than in the general population. The proportion of patients receiving health promotion and chronic disease management activities was higher than in other reports. However, there were gaps in the provision of these services. The study shows an ageing population group with significant risk factors and an important burden of chronic disease and comorbidity. Addressing inequalities in health for culturally and linguistically diverse populations demands improvements in healthcare delivery and targeted actions based on a solid understanding of their complex health needs and their health, social and cultural circumstances. [ABSTRACT FROM AUTHOR]

There is now evidence linking antibiotic burden in infancy and subsequent risk factors for cardiometabolic disease. In this study we assessed the metabolic health of a community-based cohort of Aboriginal Australians aged 15–25 years and retrospectively examined their early childhood antibiotic burden to identify a possible link between the two. Metabolic health data were extracted from electronic files of 433 participants in prior Young Persons Checks between 2013 and 2016. More than one-third were overweight or obese. Males had more metabolic syndrome than females (20.6% vs 10%; P = 0.03). Metabolic syndrome was twice as common in the 20- to 25-year age group than in the 15- to 19-year age group (19.8% vs 9.7%; P < 0.001). A subsequent medical chart review focused on childhood infections and the antibiotic burden of participants in the Young Persons Check from birth to 15 years of age. Nearly 75% were prescribed antibiotics during their first 2 years of life and 29% were exposed four or more times. Childhood antibiotic burden decreased with age. This population of Aboriginal adolescents and young adults has high rates of antibiotic exposure in childhood and metabolic abnormalities. We did not find a correlation between the two within the cohort, potentially demonstrating a ceiling effect. [ABSTRACT FROM AUTHOR]

Objective. To investigate agreement with the National Health and Medical Research Council (NHMRC) definition of collaboration in maternity care by care providers, and to examine their preferences for models of care in order to shed light on the lack of success in implementing collaborative practice. Methods. Maternity care providers completed a survey in Queensland. The final sample consisted of 337 participants, including 281 midwives (83.38%), 35 obstetricians (10.39%), and 21 general practitioners (6.23%). Results. Ninety-one percent of the participants agreed with the NHMRC definition of collaboration: Midwives (M = 5.97, s.d. = 1.2) and doctors (obstetricians and general practitioners: M = 5.7, s.d. = 1.35) did not differ significantly in their level of agreement with definition (t (332) = -1.8, P = .068). However, 72% of doctors endorsed a doctor-led model of care, whereas only 6.8% of midwives indicated agreement with it. Fewer (56%) doctors agreed with the midwife-led model of care, whereas 99.3% of midwives endorsed it. Conclusion The concept of collaboration does not recognise the different interpretations by midwives and doctors of its impact on their roles and behaviours. Successful collaborative practice requires the development of guidelines that recognise these differences and specify the communication behaviour that would assist midwives and doctors to practice collaboratively. [ABSTRACT FROM AUTHOR]

Resettled refugees in Australia have been shown to exhibit a high prevalence of limited health literacy and are at greater risk of mismanaging their medication and not being able to access the healthcare services they need. The aim of the current study is to explore the barriers to accessing medicines and pharmacy services in Queensland, Australia, among resettled refugees from Africa; this research was conducted from the perspectives of healthcare professionals and people who help the refugees to resettle in their adopted country (resettlement workers). A 'generic qualitative' approach was used in this study. In-depth interviews were conducted among healthcare professionals (two GPs, nine pharmacists and three nurse practitioners) and resettlement workers. Participants were recruited via a purposive snowball sampling method in the cities of Brisbane and Townsville, Queensland, Australia. Twenty-four in-depth interviews were conducted; 14 with healthcare professionals. Three key themes emerged from the data: (1) Communication Barriers; (2) Navigating the Health System; and (3) Belief Systems and Culture. Perceptions of those 'at the coalface' – healthcare professionals and people who are responsible for assisting refugees to resettle in Australia – provide insight into the language and cultural challenges experienced by resettled refugees from Africa regarding access to the Australian health system, including medicines and pharmacy services. [ABSTRACT FROM AUTHOR]

Clozapine is a high-risk medication with restrictions that may increase consumer treatment burden. Shared care may improve access, reduce burden and promote primary care management. However, knowledge about the consumer experience of clozapine treatment within a shared-care setting has not been previously reported to the authors' knowledge. The aim of this study was to explore the consumer experience within the shared-care setting. This mixed-methods study examined consumers' experiences with a clozapine shared-care program in an urban setting in Queensland, Australia. Eligible consumers (n = 35) participated in a semi-structured interview, including a survey. Analysis was descriptive and thematic. Ten (28.6%) consumers participated. Survey results found a strong belief in the necessity for clozapine, with a low level of reported treatment burden and minimal adverse effects. Four themes were identified from the interviews: (i) understanding of illness and recovery; (ii) positive outcomes of treatment; (iii) acceptance of treatment burden; and (iv) communication pathways. Participants reported positive experiences in the clozapine shared-care program, citing clozapine's efficacy and the GP relationship as key benefits, however communication between clinicians and consumers must be enhanced to reduce risk of suboptimal treatment and adverse drug events. [ABSTRACT FROM AUTHOR]

Aboriginal Community Controlled Health Services deliver holistic and culturally appropriate primary health care to over 150 communities in Australia. Health promotion is a core function of comprehensive primary health care; however, little has been published on what enables or challenges health promotion practice in an Aboriginal Community Controlled Health Service. Apunipima Cape York Health Council (Apunipima) delivers primary health care to 11 remote north Queensland communities. The workforce includes medical, allied health, Aboriginal and Torres Strait Islander health workers and health practitioners and corporate support staff. This study aimed to identify current health promotion practices at Apunipima, and the enablers and challenges identified by the workforce, which support or hinder health promotion practice. Sixty-three staff from across this workforce completed an online survey in February 2015 (42% response rate). Key findings were: (1) health promotion is delivered across a continuum of one-on-one approaches through to population advocacy and policy change efforts; (2) the attitude towards health promotion was very positive; and (3) health promotion capacity can be enhanced at both individual and organisational levels. Workforce insights have identified areas for continued support and areas that, now identified, can be targeted to strengthen the health promotion capacity of Apunipima. [ABSTRACT FROM AUTHOR]

Australia has seen a significant increase in people aged over 65 years accessing general practice services over the last decade. Although people aged 65 years and over comprise14%of the total population, this age demographic accounts for the largest proportion of general practitioner (GP)-patient encounters. Access to general practice is important for older Australians as the burden of chronic disease increases with age. A geographic information system, ArcGIS, was used to assess geographic access to general practice for older people residing in the regional Queensland towns of Mackay, Townsville and Cairns. Geographic units with high proportions of over 65-year-old people were spatially analysed in relation to proximity to geomapped general practices with a 2-km buffer zone. Modelling of changes in access was performed with the strategic location of a new general practice where gaps existed. Geographic access to general practice for the older population was poorest in Cairns despite a high population density. Addition of a single, strategically placed general practice in Cairns markedly improved access. Socioeconomic analysis suggested that general practices were appropriately located in areas of greatest need. Geographic information systems provide a means tomap population characteristics against service locations to assist in strategic development and location of future health services. [ABSTRACT FROM AUTHOR]

Governments invest heavily in health promotion strategies to improve physical health behaviours. However, the dietary and physical activity practices of many Australians fail to meet minimum levels for health, leading to the unacceptably high prevalence of chronic and complex illness. Health literacy is known to impact on health behaviour, and to be related to health knowledge; however, no studies have specifically examined knowledge of physical health behaviours in an Australian context. We assessed knowledge of physical health behaviours in 1244 adults in Queensland, Australia. Almost two-thirds of respondents had a 'Good' knowledge of physical health behaviour. People with 'Good' knowledge of physical health behaviours were more likely to be female, educated beyond secondary school, be employed and have an annual household income of >$52000 (P<0.05). People with 'Low' knowledge of physical health behaviours were significantly more likely to report insufficient intake of vegetables and have at least one chronic illness (P<0.05). Binary logistic regression shows low daily intake of vegetables to have the strongest association with low knowledge of physical health behaviours. Given the association between health knowledge and health literacy, assessment of the knowledge of physical health behaviours may provide considerable insight into the effectiveness of future health promotion interventions. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to determine whether a 1-day basic life support (BLS) training program can significantly increase emergency response readiness for primary school children. Methods. One hundred and seven children aged 11-12 years completed a program led by surf lifesaving instructors. A 50-item quiz was administered 1 week before and 1 and 8 weeks after training. Results. Significant improvements were gained in knowledge of cardiopulmonary resuscitation (CPR; P < 0.001), the response sequence for emergency situations (DRSABCD action plan) and various emergency scenarios, including choking (P < 0.001) and severe bleeding (P < 0.001). Knowledge and understanding were retained at the 8-week follow-up. Students reported increased confidence in assisting others after training, consistent with previous studies. Conclusions. A 1-day training program can significantly increase BLS knowledge and confidence to provide assistance in an emergency situation. Findings reinforce the value of school-based training that provides a general foundation for emergency response readiness. [ABSTRACT FROM AUTHOR]

This study explored current physiotherapy practice trends for management of children who are overweight or obese. The professional needs of physiotherapists working with this population were also assessed, including the perceived need for physiotherapy clinical guidelines for prevention and management of children with obesity. Across-sectional survey design was used, with questionnaires purposefully distributed through 13 key physiotherapy services throughout Australia. Snowball sampling resulted in completed questionnaires from 64 physiotherapists who provided services to children. Half (n = 33,52%)of respondents provided services specifically to overweight or obese children. Of those providing services, one-quarter had prior training specific to working with this population. Most used multi-disciplinary models (n = 16, 76%) and provided under 5 h of obesity-related services each week (n = 29, 88%). Half (n = 16, 49%) used body mass index as an outcome measure but more (n = 25, 76%) used bodyweight. Only 14 (42%) assessed motor skills. The majority of respondents (n = 57, 89%) indicated a need for physiotherapy guidelines to best manage overweight and obese children. Professional development priorities included: 'Educating children and families', 'Assessment methods' and 'Exercise prescription' for overweight and obese children. This data provides workforce intelligence to guide future professional training and inform development of clinical guidelines for physiotherapists in prevention and management of children with obesity and related chronic disease. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to investigate the incidence of and patient outcomes associated with frequent patient moves. Methods: In a prospective cohort study, any bed move and the reason for the move were documented. Patients were assessed on admission for anxiety, social support and delirium. Adverse events, length of stay and satisfaction were recorded. Patients moved three or more times were compared with those moved less than three times. Results: In all, 566 patients admitted to a tertiary referral hospital were included in the study. Of these, 156 patients (27.6%) were moved once, 46 (8.1%) were moved twice and 28 (4.9%) were moved at least three times. Those moved three or more times were almost threefold more likely to have an adverse event recorded compared with those moved fewer times (relative risk (RR) 2.75; 95% confidence interval (CI) 1.18, 6.42; P = 0.02) and to have a hospital stay twice as long (RR 7.10; 95% CI 2.60, 11.60; P = 0.002). Levels of satisfaction and anxiety were not affected by frequent moves and there was no effect on delirium. Conclusion: Frequent bed moves affect patient safety and prolong length of stay. [ABSTRACT FROM AUTHOR]

Objective. Intravenous thrombolysis with tissue plasminogen activator (tPA) improves patient outcomes in acute ischaemic stroke. Because its benefit is time-dependant, treatment delays must be minimised. The aim of the present study was to review patient characteristics, timeliness of tPA delivery and clinical outcome in patients receiving t-PA in a tertiary hospital stroke unit in Queensland, and to compare the findings with those of other Australian studies. Methods. The present study was a retrospective study conducted between 1 January 2010 and 31 December 2012. Information was collected regarding demographics, stroke characteristics, timeliness of tPA delivery, clinical outcome, safety outcome and protocol deviation. Results. Of 490 patients admitted with ischaemic stroke, 57 (11.6%) received tPA. Compared with other studies, the patients in the present study had more severe stroke (median National Institutes of Health Stroke Scale (NIHSS) score), more cardioembolic strokes and more patients receiving tPA between 3 and 4.5 h of symptoms onset. Median symptom onset to treatment time was 175 min and median door to needle time was 97 min. At 3 months, 21.1% of patients had died and 41.5% had a favourable outcome (modified Rankin scale≤2). Symptomatic intracerebral haemorrhage occurred in 5.3% of patients and protocol deviations occurred in 21.1%. Overall, delivery and outcomes of tPA at the Princess Alexandra Hospital were comparable to those reported in other Australian studies of usual care. Several challenges and strategies for optimal thrombolysis were identified, with supporting evidence from selected Australian sites. Conclusion. The proportion of eligible stroke patients who receive tPA in a timely manner remains less than ideal at our centre. More accurate patient selection and reductions in treatment delays serve as targets for quality improvement efforts that have broad applicability. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to investigate a change in physiotherapy provision from a 5- to 7-days-a-week service on both physiotherapy and hospital length of stay (LOS) after total knee (TKR) and total hip (THR) replacement. Methods. A retrospective analysis of a clinical database was conducted for patients who received either a TKR or THR between July 2010 and June 2012 in one regional hospital. Results. There was a significant decrease in physiotherapy LOS from 5.0 days (interquartile range (IQR) 5.0-6.0 days) for a 5-day physiotherapy service, to 5.0 days (IQR 4.0-5.0 days) for 7-day physiotherapy service (U = 1443.5, z = -4.62, P = 0.001). However, hospital LOS was not reduced (P = 0.110). For TKR, physiotherapy LOS decreased significantly by 1 day with a 7-day physiotherapy service (U = 518.0, z = -4.20, P = 0.001). However, hospital LOS was again no different (P = 0.309). For THR there was no difference in physiotherapy LOS (P = 0.060) or hospital LOS (P = 0.303) between the 5- and 7-day physiotherapy services. Where physiotherapy LOS was less than hospital LOS, delayed discharge was due primarily to non-medical issues (72%) associated with hospital organisational aspects. Conclusions. Increasing the provision of physiotherapy service after TKR provides an increase in physiotherapy sessions and has the potential to reduce hospital LOS. To be effective this must align with other administrative aspects of hospital discharge. [ABSTRACT FROM AUTHOR]

Objectives. The aims of the present study were to identify predictors of admission and describe outcomes for patients who arrived via ambulance to three Australian public emergency departments (EDs), before and after the opening of 41 additional ED beds within the area. Methods. The present study was a retrospective comparative cohort study using deterministically linked health data collected between 3 September 2006 and 2 September 2008. Data included ambulance offload delay, time to see doctor, ED length of stay (LOS), admission requirement, access block, hospital LOS and in-hospital mortality. Logistic regression analysis was undertaken to identify predictors of hospital admission. Results. Almost one-third of all 286 037 ED presentations were via ambulance (n = 79 196) and 40.3% required admission. After increasing emergency capacity, the only outcome measure to improve was in-hospital mortality. Ambulance offload delay, time to see doctor, ED LOS, admission requirement, access block and hospital LOS did not improve. Strong predictors of admission before and after increased capacity included age >65 years, Australian Triage Scale (ATS) Category 1-3, diagnoses of circulatory or respiratory conditions and ED LOS >4 h. With additional capacity, the odds ratios for these predictors increased for age >65 years and ED LOS >4 h, and decreased for ATS category and ED diagnoses. Conclusions. Expanding ED capacity from 81 to 122 beds within a health service area impacted favourably on mortality outcomes, but not on time-related service outcomes such as ambulance offload time, time to see doctor and ED LOS. To improve all service outcomes, when altering (increasing or decreasing) ED bed numbers, the whole healthcare system needs to be considered. [ABSTRACT FROM AUTHOR]

Objective. To examine the use, management, documentation and complications for intravascular devices in cardiac, medical and surgical inpatients. Methods. A point prevalence survey was undertaken in a large tertiary hospital in Queensland. Descriptive statistics were used to analyse data. Results. Of the 327 patients assessed, 192 (58.7%) had one or more devices in situ. Of the 220 devices, 190 (86.4%) were peripheral venous catheters, 25 (11.4%) were peripherally inserted central catheters and five (2.3%) were central venous catheters. Sixty-two of 220 devices (28.2%) were in situ without a clear purpose, whereas 54 (24.7%) had one or more complications, such as redness, pain, tracking, oedema or oozing. There was no documentation on the daily patient care record to indicate that a site assessment had occurred within the past 8 h for 25% of the devices in situ. Conclusions. The present study identified several problems and highlighted areas for improvement in the management and documentation for intravascular devices. Ongoing education, promoting good clinical practice and reauditing, can be applied to improve the management of devices. [ABSTRACT FROM AUTHOR]

Introduction. For women with a lower uterine incision without indication for repeat Caesarean section (CS), vaginal birth for their next pregnancy is a safe option. Although these women should be encouraged to consider vaginal birth after a Caesarean section (VBAC) it is not consistently supported in practice. There is relatively little information on the extent to which maternal preference, birthing decisions and outcomes match best available evidence. Aim. To describe current VBAC rates for women in Queensland, Australia and compare this to safe, achievable VBAC rates reported in national and international studies. Method. Perinatal data from 2004 to 2011 were reviewed to determine current VBAC rates following a primary CS for women birthing in Queensland. These were compared with VBAC rates reported in the literature. Results. Queensland has a high overall CS rate and high repeat CS rate compared with the national average. In 2010, Queensland VBAC rates for next birth following primary CS were 14% (range 13-21% public sector, 7-11% private hospitals). This is substantially lower than achievable Australian rates of 24% and international rates. Conclusion. Low VBAC rates reflect low numbers of women commencing labour in a pregnancy subsequent to a primary CS. There is unexplained variation in VBAC rates between maternity facilities. Clinical reviews to support evidence-based practice are warranted. [ABSTRACT FROM AUTHOR]

Objective. Allied health professionals (AHPs) in maternity and neonatology services are essential for quality care and outcomes, reflected in the minimum service delivery requirements in the Queensland Health clinical services capability framework (CSCF). However, allied health (AH) capacity across the Southern Queensland Health Service Districts (SQHSD) is not known. The aim of this project was to redress this knowledge gap to inform ongoing service planning and delivery. Methods. Maternity and neonatal AH clinicians in all birthing facilities in SQHSD were surveyed between October and December 2011 to investigate AHP staffing, practices and models of care. The professions surveyed included dietitians, occupational therapists, physiotherapists, psychologists, social workers and speech pathologists. Results were grouped per question, with stratification by CSCF and/or profession. Results. Fifty-five valid surveys from the 16 facilities were received. All professions were represented. Gaps in maternity AH services were identified. Awareness and use of evidence-based practices were more likely to be reported where higher full-time equivalents (FTE) were allocated. Conclusion. Very low staffing levels have been recorded in all Maternity and Neonatology Services AHPs in the SQHSD. Gaps exist between actual and recommended CSCF staffing standards across all levels and professions. The results indicate that profession-specific support networks for AHPs have positive effects in the spreading of information, and continued promotion, support and involvement in these profession-specific networks is suggested for all facilities. [ABSTRACT FROM AUTHOR]

Objective Information regarding the availability of suicide-prevention programs in Australia is sparse and rather difficult to obtain. This study aimed to report and describe suicide and/or self-harm-prevention programs in Queensland. Methods Programs were classified by type of intervention, predominant type of program, setting of delivery and targeted population-at-risk. Results Sixty-six organisations were identified, providing a total of 101 suicide-prevention programs. The majority of programs operated at the prevention or treatment level, with less than half providing continuing (long-term) care. The programs targeted 12 different risk groups and were most frequently delivered within community settings. Conclusions The findings show a diverse distribution of activities across the levels of prevention and different risk populations. This survey demonstrates the existence of remarkable gaps in coverage and provision of programs for specific high-risk groups. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the differences in health status and use of health services among a group of refugee men in South-east Queensland. Topics covered include the levels of subjective health status reported by participants, the poor health status reported by men living in urban areas and the need for programs that facilitate refugees' access to primary health care.