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Value-based healthcare has been described as the sustainable, equitable and transparent use of healthcare resources to achieve improved experiences and outcomes for people and communities. It is supported by all levels of government in Australia, with recent initiatives championing a shift away from traditional, clinician-centric care delivery to a more contemporary, value-based approach. To date, however, efforts in Queensland have focused on smaller scale siloed models of care and have not extended to the transformational change required to create equitable and sustainable healthcare delivery. The Queensland Health Allied Health Framework for Value-Based Health Care (the Framework) builds on contemporary frameworks with reference to the local context in Queensland and provides a structure and starting point for clinicians and managers to work together with consumers to transform services to focus on preventative health and wellbeing, shifting the focus of care to the community and sustainably improving the quality of care delivered. The Framework outlines key considerations for the design and implementation of new services, including understanding the care pathway, supporting an outcome driven workplace culture, measuring what matters and designing for outcomes. Several key lessons were learnt during the development of the Framework, including the importance of early and sustained consumer partnerships, of establishing a shared definition of value-based healthcare that enables integration across the care pathway and the need for leadership at all levels to actively support the change management process. While developed for Queensland public allied health services, the Framework is intended to be a system-wide tool relevant to all health professionals and services. What is known about the topic? Value-based healthcare provides an approach to restructure healthcare systems to improve health outcomes and the holistic experience of care for people and communities. What does this paper add? This paper details the development of a framework to support health services to transition to a value-based approach. What are the implications for practitioners? By reflecting on the diversity of health practitioners, managers and consumer experiences and the unique opportunities and challenges of individual healthcare services, the framework provides a structure and starting point for services to transition to value-based healthcare. This article belongs to the Special Issue: Value-Based Healthcare. [ABSTRACT FROM AUTHOR]

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

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

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 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]

Derris Lour. and Brachypterum (Wight & Arn.) Benth. (Leguminosae subfamily Papilionoideae) in Australia are revised on the basis of examination of fresh, dried and spirit-preserved specimens and phylogenetic analysis of plastid matK and nuclear internal transcribed spacer (ITS) sequence data. Three species of Derris and four species of Brachypterum are recognised as occurring in Australia. Two new Brachypterum species, namely Brachypterum nitidum W.E.Cooper and Brachypterum opacum W.E.Cooper, are described and illustrated. Notes on habitat, distribution and an identification key are presented for all species of both genera that occur in Australia. [ABSTRACT FROM AUTHOR]

A taxonomic revision of the Pultenaea setulosa species complex (Fabaceae, tribe Mirbelieae) is presented. Prior to this study, P. setulosa Benth. was broadly circumscribed as a single, morphologically variable species. Here, we present evidence supporting the recognition of 18 species, 14 of which are new to science. Pultenaea setulosa is recircumscribed as a morphologically uniform taxon endemic to the Marlborough region in south-east Queensland. We reinstate Pultenaea boormanii H.B.Will., Pultenaea campbellii Maiden & Betche and Pultenaea lapidosa Corrick from synonymy of P. setulosa and describe an additional 14 new species: Pultenaea acanthocalyx R.L.Barrett & Clugston, Pultenaea corrickiae R.L.Barrett, Orme & Clugston, Pultenaea estelleae R.L.Barrett & Clugston, Pultenaea farmeriana R.L.Barrett, Orme & P.H.Weston, Pultenaea hoskingii R.L.Barrett & Clugston, Pultenaea imminuta R.L.Barrett & S.F.McCune, Pultenaea murrayi R.L.Barrett, Pultenaea palssoniae R.L.Barrett & Clugston, Pultenaea praetermissa R.L.Barrett & Albr., Pultenaea purdieae R.L.Barrett & Clugston, Pultenaea renneri R.L.Barrett & Clugston, Pultenaea venusta R.L.Barrett & Orme, Pultenaea westonii R.L.Barrett & Clugston and Pultenaea woolcockiorum R.L.Barrett & Clugston. Sixteen of these species are endemic to New South Wales, one to Queensland and one to Victoria. All taxa are described and illustrated, and habitats and conservation status are discussed. Two additional related species, Pultenaea procumbens A.Cunn. and P. setigera A.Cunn. ex Benth. are recircumscribed. Pultenaea setigera is reinstated here, known from the type collection made in 1822 and is possibly extinct. Lectotypes are selected for the names Pultenaea boormanii, P. campbellii, P. procumbens, P. setigera and P. setulosa. [ABSTRACT FROM AUTHOR]

Introduction. Cancer screening programmes for cervical, breast, and colorectal cancer have successfully reduced mortality rates among target groups. However, a large proportion of women and men are unscreened. Aim. This review aims to provide an overview of the literature regarding the determinants of cancer screening participation among target groups in Queensland. Methods. Electronic databases were searched for studies on determinants of cancer screening participation in Queensland. Retrieved studies were screened, and eligible articles were selected for data extraction. Both peer-reviewed and grey literature studies were included. The determinants of cancer screening participation were classified according to the I-Change model. Results. Sixteen out of 75 articles were selected and analysed. Information factors, such as the lack of tailored strategies, determined cancer screening participation. Age, gender, cultural beliefs, fear and past experiences were the most reported predisposing factors to cancer screening participation. Lack of knowledge, misconceptions, low awareness, timely access to service, privacy and confidentiality were mainly reported awareness and motivation factors. Encouragement from health professionals, providing more information and interactions with communities would result in different effects on cancer screening participation among the target groups. Discussion. The I-Change model is a valuable tool in mapping the current determinants of cancer screening participation programs. Further research may be needed to fully understand the barriers and facilitators of cancer screening programs. [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]

The population is aging, with frailty emerging as a significant risk factor for poor outcomes for older people who become acutely ill. We describe the development and implementation of the Frail Older Persons' Collaborative Program, which aims to optimise the care of frail older adults across healthcare systems in Queensland. Priority areas were identified at a co-design workshop involving key stakeholders, including consumers, multidisciplinary clinicians, senior Queensland Health staff and representatives from community providers and residential aged care facilities. Locally developed, evidence-based interventions were selected by workshop participants for each priority area: a Residential Aged Care Facility acute care Support Service (RaSS); improved early identification and management of frail older persons presenting to hospital emergency departments (GEDI); optimisation of inpatient care (Eat Walk Engage); and enhancement of advance care planning. These interventions have been implemented across metropolitan and regional areas, and their impact is currently being evaluated through process measures and system-level outcomes. In this narrative paper, we conceptualise the healthcare organisation as a complex adaptive system to explain some of the difficulties in achieving change within a diverse and dynamic healthcare environment. The Frail Older Persons' Collaborative Program demonstrates that translating research into practice and effecting change can occur rapidly and at scale if clinician commitment, high-level leadership, and adequate resources are forthcoming. What is known about the topic? Providing frailty-focused care can improve outcomes, particularly by avoiding unnecessary admissions to hospital and reducing hospital-acquired complications, such as delirium and functional decline. Several evidence-based interventions exist that apply to specific points in the trajectory of older frail patients from hospital presentation to discharge and beyond, but these are not generally well integrated across the entire patient journey. What does this paper add? This paper describes a whole-of-healthcare system approach to improving care and outcomes for frail older people in Queensland. Rather than developing new care initiatives, the approach was taken to invest in pre-existing evidence-based interventions developed and validated in Queensland clinical settings and scale them across the state over 3 years. What are the implications for practitioners? This state-wide scale-up of evidence-based interventions has profiled how the healthcare system can be redesigned to implement models that better support vulnerable older people. [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]

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]

Age is an essential attribute in studies of animal development, survival and reproduction. Here we evaluate the age estimation technique of molar progression devised for kangaroos in 1965. We used 71 wild eastern grey kangaroos (Macropus giganteus) that were first captured and aged as pouch young at Wilsons Promontory National Park, Victoria, and subsequently found dead between the ages of 1 and 14 years. We expected that the original equation, derived from captive kangaroos in Queensland, would not estimate age correctly due to differences in diet and/or clinal variation in skull morphology. We found no difference in rate of molar progression between males (n = 44) and females (n = 27). Our overall regression of age on molar index (MI) was log10 (age, days) = 0.284 (MI) + 2.51 1, r² = 0.97. The slope of this equation was indistinguishable from that of the original one, meaning that molar progression in the wild was equivalent to that originally developed on captive kangaroos, despite likely differences in diet and morphology. [ABSTRACT FROM AUTHOR]

Australia's mammals are facing devastating effects from introduced predators such as cats and foxes. It is hypothesised that this may be because Australian mammals do not recognise some predators and are naïve to the threat they pose. We tested how wild-caught northern brown bandicoots (Isoodon macrourus) reacted to a variety of predators and their cues in captivity. These cues were live predators, taxidermied predators and predator faeces. Bandicoots spent less time feeding and took longer to begin feeding in the presence of a live dog. However, they did not display a significant difference in behaviours in the presence of any other predator cue when compared with the baseline. This suggests that bandicoots may perceive live dogs as a threat, and that the use of taxidermied predators and predator faeces may not elicit avoidance behaviours in bandicoots. Bandicoots may need to be trained to recognise and respond appropriately to some predator cues to maximise their chance of survival. [ABSTRACT FROM AUTHOR]

The velvet-leaf hibiscus, Hibiscus krichauffianus F.Muell. (Malvaceae subfamily Malvoideae), is predominantly associated with sand dunes in the Australian arid zone but the name is presently also applied to plants occurring in different habitats on the southern edge of the range, and in disjunct locations in Western Australia and eastern Queensland. We investigated the morphological and environmental variation within H. krichauffianus throughout the geographic range. As a result, we have identified two new species, H. verecundus McLay & Albr. and H. calcareus McLay & Albr.; coined a phrase name, H. sp. Belele (D.W.Goodall 3417) for a putative new taxon; and recircumscribed H. krichauffianus. We also assessed material collected when the protologue of H. krichauffianus was published in the late 1850s and selected a lectotype from the original material identified. The velvet-leaf hibiscus, Hibiscus krichauffianus. Our investigation of the Australian arid zone specialist Hibiscus krichauffianus resulted in the discovery of two new species, H. verecundus and H. calcareus , both of which are described here. We also recircumscribe and lectotypify H. krichauffianus, and raise a phrase name entity. Distribution maps, figures, a table of morphological differences and a key are provided to identify these species. (Image credit: Dave Albrecht.) [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]

Background: Australia, like many high-income countries, is experiencing a resurgence of infectious syphilis in pregnancy and congenital syphilis. Evaluations of public health notifications and clinical records suggest that healthcare systems may not be providing optimal care to women and their neonates. This study aims to explore the barriers to optimal management of syphilis in pregnancy and congenital syphilis to identify key areas for improvement. Methods: Between 2021 and 2022, 34 healthcare workers (HCW) practicing in south-east Queensland (SEQ) Australia were recruited to complete semi-structured interviews regarding their perceptions towards management of syphilis in pregnancy and congenital syphilis. Interviews were analysed thematically. Results: Thematic analysis identified four themes related to the management of syphilis in pregnancy. These included poor communication between disciplines, services, and teams from delivery through to management and post-delivery, lack of formal internal and external referral pathways, unclear and often complex maternal and congenital syphilis management procedures, and limited HCW knowledge of infectious syphilis in pregnancy and congenital syphilis. Conclusion: As congenital syphilis numbers continue to rise in SEQ, it is imperative that healthcare systems and HCWs identify and address gaps in the provision of health care. Syphilis in pregnancy can have life-long health impacts for mothers and babies and is on the rise in many high-income countries such as Australia. Healthcare providers are vital in improving outcomes for mothers and babies, but our findings show optimal management is hindered by poor communication, unclear guidelines, and knowledge deficits. To improve the provision of care offered it is important for healthcare systems address this multi-faceted issue. [ABSTRACT FROM AUTHOR]

The objective of this case study is to evaluate the effectiveness of the Wide Bay region coronavirus vaccination program in preventing hospitalisation for coronavirus disease 2019 (COVID-19). Population vaccination data and the vaccination status of patients hospitalised with confirmed COVID-19 have been used to evaluate preventable hospitalisations and risk reduction during and after a 2 month period following the outbreak of COVID-19 in Wide Bay after removal of public health measures in Queensland in December 2021. Wide Bay is a rural region of Queensland including K'Gari (formerly Fraser Island) to the east, the North Burnett farming region in the west and extending from the Fraser Coast to the Discovery Coast. Two local regional hospitals received and managed hospitalised COVID-19 patients. The region had, at this time, 171 365 people 20 years and older eligible for coronavirus vaccination. The risk reduction for hospitalisation of those receiving fewer than two vaccinations, two vaccinations and three vaccinations was calculated to determine the vaccination program effectiveness. The program achieved 90% effectiveness for people with two or more vaccinations (those with two vaccinations and those receiving boosters of third or more vaccination), and 97% effectiveness for those having received three vaccinations, in preventing hospitalisation for COVID-19 during the period. This translated into a significant risk reduction for hospitalisation for those receiving two or more vaccinations, preserving capacity to enable the health service to manage all cases locally. What is known about the topic? The real-world effectiveness of coronavirus vaccination program in preventing COVID-19 hospitalisation is 43–86% but this does not include regional programs and health services. What does this paper add? Individual absolute risk reduction for vaccinated local people was modest, but the overall local program effectiveness was substantial in preventing hospitalisations after removal of border quarantine. What are the implications for practitioners? Maintaining coronavirus vaccination programs in rural and regional areas is highly effective in preventing hospitalisations from COVID-19 after quarantine-based public health measures are removed. [ABSTRACT FROM AUTHOR]

Although fauna crossing structures have been installed throughout the world, most studies have been of underpasses and overpasses. Canopy-bridges, however, have received much less attention. In addition, although exclusion fencing is used extensively, its effectiveness has rarely been assessed. Since 2015, Moreton Bay Regional Council (MBRC), in southern Queensland, Australia, has installed various mitigation structures at 21 sites. This study compared the use of different designs of canopy-bridge and assessed the effectiveness of exclusion fencing via camera monitoring and roadkill records. A total of 3151 detections of five arboreal species were made on the canopy-bridges at an average of 0.51 crossings per day for both rope cages and rope ladders and 0.64 on rope cages and 0.77 on rope ladders when a poorly used bridge of each type was excluded. A single aluminium ladder had 33 crossings (0.15 crossings per day) but was available for only a short time. Roadkill rates of all species declined by 84% at sites with underpasses and fencing compared to 93% at sites without, but only 39% at control sites. This may be due to the canopy-bridges or the addition of complementary infrastructure, such as signage, pavement stencilling and driver awareness. This paper aims to determine the most effective fauna rope crossing type and the benefits of fauna fencing, using images from cameras, as well as recorded roadkill and koala hits. Fauna movements were statistically similar on cage rope crossings and rope ladders. Roadkill rates of all species declined by 84% at sites with underpasses and fencing compared to 93% at sites without, but only 39% at control sites. This may be due to the canopy-bridges or the addition of complementary infrastructure, such as signage, pavement stencilling and driver awareness. [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]

Environmental context: Biosolids are nutrient-rich organic materials. They can be used as fertiliser and solid amendments in agriculture if treated according to regulatory requirements. If farming applications of biosolids decline due to potential pollution from their heavy metal content, an alternative to traditional methods of biosolid disposal is required. In this context, thermal processing of biosolids is an economically and environmentally suitable option to convert large quantities of biosolids into useful energy. Rationale: Due to more stringent environmental regulations and frequently required long-distance transportation, the traditional disposal of biosolids from wastewater treatment plants in landfills and farms is becoming unsustainable. A potentially economical and environmental option is the thermochemical conversion of biosolids into energy and value-added products. This paper describes the chemical composition and energy content of a representative biosolid sample collected from a major wastewater-treatment plant in Queensland, Australia. Methodology: The thermochemical behaviour and compositional changes in biosolids were investigated under a wide range of pyrolysis and gasification conditions using a horizontal tube furnace (HTF), a fixed-bed reactor and a thermogravimetric analyser (TGA). In terms of practical application of by-products, we describe mineral matter transformations in char and ashes during pyrolysis and volatilisation as well as under different gasification conditions. Results: HTF experiments revealed that at pyrolysis below 800°C, mainly organic species were released, while losses of inorganic elements (phosphorus, magnesium and zinc) occurred at higher temperatures. In-situ gasification behaviour of biosolid chars in the TGA reactor showed that the gasification reaction of biosolid chars occurred rapidly at temperatures above 720°C, regardless of the pyrolysis temperatures at which those chars were produced. Mineral matter transformations began at temperatures above 600°C, and mainly involved the transformation of amorphous phases into crystalline oxide and phosphide forms. Under gasification conditions, all crystalline phases appeared as different phosphates and alumino-silicates. Discussion: The methods described here provide different options for the disposal of biosolids from wastewater by adjusting and optimising thermochemical conversion processes. Environmental context. Biosolids are nutrient-rich organic materials. They can be used as fertiliser and solid amendments in agriculture if treated according to regulatory requirements. If farming applications of biosolids decline due to potential pollution from their heavy metal content, an alternative to traditional methods of biosolid disposal is required. In this context, thermal processing of biosolids is an economically and environmentally suitable option to convert large quantities of biosolids into useful energy. [ABSTRACT FROM AUTHOR]

Context: Forested wetlands occurring on fluvial sediments are among the most threatened ecosystems in south-east Australia. The first quantitative diagnosis of forested wetland types in NSW was completed in 2005. Since then, there has been a three-fold increase in survey data on coastal floodplains, vegetation classification systems have been developed in New South Wales, Queensland and Victoria, and methods for the assessment of ecosystem conservation risks have been adopted by the International Union for the Conservation of Nature (IUCN). Aims: To ensure an evidence base that can support conservation decisions and national conservation assessments, there is a need to review and update the classification of forested wetlands and integrate classification schemes across jurisdictions. Methods: We evaluated the efficacy of a multi-stage clustering strategy, applied to data from different sources with largely unknown methodological idiosyncrasies, to retrieve ecologically meaningful clusters. We assessed the veracity and robustness of the 2005 classification of forest wetlands as a framework for national risk assessments over an expanded range. Key results: We derived a quantitative, cross-jurisdictional classification of forested wetlands based on a synthesis of 5173 plot samples drawn from three states and identified the status of our units in relation to IUCN's Global Ecosystem Typology. Conclusions: Our analyses support the retention of the five legacy types which are the basis for threatened ecosystem listings under the NSW Biodiversity Conservation Act 2016 and Commonwealth Environment Protection and Biodiversity Conservation Act 1999. Implications: Our results will support revised assessments of current listings and facilitate their integration at state, national and global scales. This paper presents a revised broad-scale classification of forested wetlands occurring on floodplains in temperate subtropical south-east Australia and identifies relationships with vegetation types of finer thematic scale described in sub-regional classifications in Queensland, Victoria and New South Wales. Patterns in the distribution of forested wetland types are described using statistical models. [ABSTRACT FROM AUTHOR]

Objective. Telehealth has for many years been identified as a potential contributor to reducing healthcare access inequality. For these benefits to be realised, patients must be accepting and satisfied with the delivery of healthcare in this manner. Measuring patient satisfaction across a large geographical area is important to ensure that investments in telehealth are delivering the benefits that are intended. Methods. A brief survey was automatically issued on completion of a patient's telehealth appointment, requesting patient feedback on their experience and information on the location of where they participated in the appointment. These results were compared to an article review which sought examples of other patient satisfaction measures that compared rural and urban populations. Results. No significant correlations between survey responses and established demographic indices were found. When stratified by the Modified Monash Model band from which the patient participated in their telehealth appointment from, an ANOVA test determined that rurality was not a predictor of survey response. A review of articles found four articles that compared rural and urban satisfaction responses. Conclusion. No evidence of a patient's location influencing their satisfaction with telehealth was observed. This may be attributed to a variety of technical improvements introduced over the past 5-10 years that have made participating in telehealth appointments less technically demanding and more accessible. Telehealth is likely to be contributing to a reduction in healthcare access inequality in Queensland. [ABSTRACT FROM AUTHOR]

The genus Erythrophleum Afzel ex R.Br. is revised for Australia and three species are recognised, all previously included in E. chlorostachys (F.Muell.) Baill. Erythrophleum arenarium R.L.Barrett & M.D.Barrett is described as a new species to accommodate populations from desert sands of the Great Sandy Desert and Dampier Botanical Districts in north-western Australia, parapatric to the remaining species. Erythrophleum pubescens R.L.Barrett & M.D.Barrett is described as a new species spanning tropical Australia, and is sympatric with E. chlorostachys sensu stricto in the Northern Territory and adjacent areas of Western Australia and Queensland. Morphological examination has shown these three taxa to be consistently distinct across their respective ranges. Analyses of the nuclear ribosomal ITS1 region recovered three well-supported clades corresponding to the three morphologically defined species, and ITS1 has utility as a marker to separate sterile specimens. Erythrophleum pubescens is widespread in the Australian Monsoon Tropics, from the coast of Western Australia, near Derby, to Cape York Peninsula in northern Queensland. Erythrophleum chlorostachys is also widespread, from the eastern Kimberley Region, in Western Australia, to the Gulf of Carpentaria, in northern Queensland. A lectotype is chosen for Laboucheria chlorostachya F.Muell. Full descriptions, illustrations of key features and identification keys are provided for the three Australian species. A summary of the significant utilisation of Erythrophleum species is presented. [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 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]

This qualitative descriptive study explored health consumers' preferences for receiving nutrition care in Australian primary care. The study was underpinned by a constructivist research paradigm. Semistructured telephone interviews were conducted with 25 health consumers (age 19–78 years; 19 female) from across Australia between May and August 2020. Content analysis, using an inductive approach revealed emergent themes. was used to reveal emergent themes. Five themes were identified in the data: (1) health consumers want to receive nutrition care from a qualified person; (2) nutrition care is viewed as important, and health consumers want to receive it in a format that meets their needs; (3) nutrition care should be low cost and available to everyone; (4) nutrition care services should be conveniently located; and (5) health consumers want nutrition care to be offered frequently, across their lifespan. Health consumers have a clear idea of how they would like to receive nutrition care in the primary care setting, but reported challenges to receiving this care within the current system. New models of service delivery are needed to meet the needs of health consumers. Diet-related chronic diseases are the leading cause of death and disability worldwide, and primary care provides an ideal setting to provide nutrition care to people at risk of chronic disease. This paper provides health consumer views on how the nutrition care model should be tailored to meet patient needs. The findings highlight the need for practice and healthcare system change to the current model of nutrition care in Australia to better meet the needs of patients. [ABSTRACT FROM AUTHOR]

Environmental context: Dioxins have been found along the east coast of Australia in agricultural areas where there is no obvious source of dioxins. These dioxins have an unusual signature that does not match common industrial sources, but it has been suggested that they may be associated with pesticide use. This study found a strong correlation between dioxins with this unique signature and the amount of a kaolinitic clay in the sediments sampled. The presence, concentrations and profiles of 2,3,7,8-substituted polychlorinated dibenzo- p -dioxins and dibenzofurans (PCDD/Fs) in sediment were investigated in this study with the aim of determining whether dioxin-like compounds were present and, if found, a likely source could be deduced. The sampled catchment lies within an area of high conservation value. Sediments from seven lake sites were sampled as possible sinks for any contamination from historical pesticide use. PCDD/Fs were measured in all the lake sediments. The 2,3,7,8-substituted congener profile was dominated by octachlorodibenzo- p -dioxin (OCDD) with furans at or below the limit of detection, a profile that has been associated with kaolinitic clays from around the world. A strong and significant correlation was found between the total dioxin concentration and the percentage of kaolinitic clay in the sediments. The lack of furans in the 2,3,7,8-substituted PCDD/F profile indicates pesticides or pentachlorophenol (PCP) are unlikely to be the source in the catchment. Further, the concentration of total dioxins and OCDD tended to be higher than those measured outside the study area, even though, overall, the study area is likely to have had less pesticide use than the other intensive agricultural areas previously studied. The results presented in this paper indicate that caution should taken when attributing the presence of dioxins in soil and sediment to anthropogenic sources. Environmental context. Dioxins have been found along the east coast of Australia in agricultural areas where there is no obvious source of dioxins. These dioxins have an unusual signature that does not match common industrial sources, but it has been suggested that they may be associated with pesticide use. This study found a strong correlation between dioxins with this unique signature and the amount of a kaolinitic clay in the sediments sampled. [ABSTRACT FROM AUTHOR]

Background: Increasing rates of syphilis in pregnancy (SiP) in Australia and other high-income countries, has led to the resurgence of congenital syphilis. Suboptimal syphilis screening during pregnancy has been identified as a key contributing factor. Methods: This study aimed to explore, from the perspective of multidisciplinary healthcare providers (HCPs), the barriers to optimal screening during the antenatal care (ANC) pathway. Semi-structured interviews conducted with 34 HCPs across multiple disciplines practising in south-east Queensland (SEQ) were analysed through a process of reflexive thematic analysis. Results: Barriers were found to occur at the system level of ANC, through difficulties in patient engagement in care, limitations in the current model of health care delivery and limitations in the communication pathways across health care disciplines; and at the individual HCP level, through HCP knowledge and awareness of epidemiological changes in syphilis in SEQ, and adequately assessing patient risk. Conclusion: It is imperative that the healthcare systems and HCPs involved in ANC address these barriers to improve screening in order to optimise management of women and prevent congenital syphilis cases in SEQ. Over the past decade, the rates of syphilis in pregnancy and congenital syphilis are continuing to rise in south-east Queensland (SEQ). Screening for syphilis during antenatal care is an important factor for prevention. In our study, SEQ healthcare providers identified system-level and individual-level barriers that prevent adequate screening. It is important that these barriers be identified and addressed to improve screening to promote maternal health and prevent congenital syphilis in SEQ. [ABSTRACT FROM AUTHOR]

Background: Neisseria gonorrhoeae (NG) can lead to serious reproductive and sexual health outcomes, and the annual number of NG notifications in Australia increased steadily from 10 329 in 2010 to 29 549 by 2020. Australian populations most affected are urban men who have sex with men and First Nations peoples living in remote areas, and a resurgence in urban heterosexuals has been observed since 2012. Methods: A case series analysis of Queensland NG isolates (2010–15) exploring temporal trends and antimicrobial resistance by demographic and geographic distribution and genotype was performed. Proportions describe age, sex, strain, genogroup (NG multi-antigen sequence typing), region, swab site, antimicrobial sensitivity and isolate rates per 100 000 population. Dominant genogroups were identified. Results: Among 3953 isolates, the median age was 25 years (IQR 20–34 years) and most (n = 2871/3915, 73%) were men. Brisbane city (68.8) and Far North Queensland (54.1) excluding Cairns showed the highest rates. Forty-six genogroups were documented, seven (G2992, G6876, G1415, G4186, G5, G1407 and G6937) comprised half of all isolates. The predominant male genogroup was G2992 (16%), and G6876 (20%) for females; G5 was predominantly male from 2010 to 2011, but equal in both sexes from 2012 to 2015. Conclusion: Considerable temporal, geographical and demographical diversity was observed in Queensland NG isolates, which has public health implications. Certain genogroups are more transient than others, and evidence suggests bridging from male-dominant networks to heterosexual networks. Molecular surveillance can enhance tracking the epidemiology and movement of NG in Australia, highlighting the necessity of genotyping to expose potentially prevalent strains circulating in undetected or underrepresented networks by current screening methods. Our 5-year Queensland study demonstrates the potential for molecular surveillance to track the changing epidemiology, movement and antimicrobial resistance of Neisseria gonorrhoeae in Australia. This is increasingly important, because potential prevalent gonococcal strains are not captured well by current methods, and we found evidence of bridging from male-dominant networks to heterosexual networks, which has serious implications for current public health practise. Genotyping is also necessary to monitor the transiency of dominant genogroups to allow a more targeted and tailored approach to treatment. [ABSTRACT FROM AUTHOR]

Fire alters habitat structure, thereby influencing fauna reliant on specific habitat features, particularly those with low dispersal capability such as reptiles. We quantified reptile responses to fire regimes in subtropical open eucalypt forests of southeast Queensland, Australia, with differing fire histories to isolate fire parameters that may alter reptile communities. We sampled 15 unique fire regimes from three sites. Active reptile searches and habitat assessments were completed at 74 plots to determine the influence of fire frequency, time since fire and fire type on reptile composition. The combination of fire parameters and habitat variables were key predictors of reptile communities within models. We identified a negative relationship for overall abundance and Lygisaurus foliorum with fire frequency, and higher species richness and abundances of two species in top disposal burn sites. Shrub and tree cover percentage were important predictors of three individual species. Concinnia martini also exhibited a negative response to time since fire. These results highlight the need to consider multiple fire parameters when explaining reptile community responses to fire owing to mixed responses and varied habitat preferences. Detailed recording and consideration of applied fire regimes should support adaptive management in relation to planned burning to support biodiversity outcomes. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to map the geographic distribution of tertiary hospitals in Australia’s most populous cities. Good access to hospital facilities improves the health and welfare of a community. The use of geographic information system (GIS) technology can assist in understanding spacial accessibility to services. Methods. Using Quantum GIS, a geodatabase was constructed to incorporate hospital locations and demographic distribution data throughout Australia’s 20 most populous cities. Data on the population’s age groups were integrated into the geodatabase to investigate the distribution of age groups and their utilisation of access to emergency departments in tertiary public health care. Overall this study reported the geospatial distribution of 89 tertiary hospitals and the demographics of the population in areas around these hospitals. Results. The majority of hospitals were located in the three most populated cities of New South Wales (NSW), Sydney, Wollongong and Newcastle, which contain a total of 32 hospitals, with 23 (72%) of the hospitals in Sydney. There were 7.8, 24.0, 53.4 and 81.0% of the population in NSW within 1.5, 3, 6 and 50 km of the hospitals, respectively. The second-highest number of hospitals was in Victoria (n = 22), with 18 (82%) hospitals located in Melbourne. This was followed by Queensland (n = 14), with eight (57%) hospitals located in Brisbane. Conclusions. The results indicate that 82.2% of the Australian population lives within a 50 km radius of a tertiary hospital, with NSW having higher age distribution percentages than the other states. The results of this study could be used to locate and improve areas of need with a high burden of disease and low accessibility to healthcare services. [ABSTRACT FROM AUTHOR]

Digital transformation of Australian hospitals is occurring rapidly. Although the clinical community has had limited ability to influence high-level decision making and investments into digital health technologies, as these technologies increasingly transform the way patients are cared for, the clinical community must influence the digital health agenda and be an integral part of the decision-making process. This case study details the process and lessons learnt during the development of the state-wide consensus statement detailing the clinical requirements for digital health initiatives to form the Queensland Digital Health Clinical Charter. To the best of our knowledge, Queensland is the first Australian jurisdiction to create a Digital Clinical Charter to be specifically referenced in the investment in and governance of digital health in hospitals. By developing this clinical charter for digital health, and in articulating the needs of clinicians, a clinical framework will be added to both the decision-making process around the investments in digital health and the definition and realisation of the expected benefits from these sizable investments. What is known about the topic?: Digital transformation of healthcare is occurring rapidly. The clinical community has had limited ability to influence high-level decision making and investments into these digital health technologies. Tension currently exists between the clinical community who must use the new digital technologies and the technical groups that govern the introduction of the new technologies. This tension can be manifest as clinicians refusing to adopt new systems, safety concerns and an inability to reach consensus on direction. There are few peer reviewed publications addressing this tension between the clinical community and technical providers. What does this paper add?: This paper is the first attempt to create a list of clinical requirements for digital transformation that crosses professional streams and is endorsed by the state-wide executive leadership team to inform the acquisition and governance of digital health technologies. What are the implications for practitioners?: Clinicians can feel excluded and marginalised during the decision-making process for new digital technologies, despite the fact that they are often using these technologies to deliver hands-on care to patients. This charter clearly articulates the requirements of clinicians for digital transformation and has been endorsed by the executive leadership team of Queensland Health. The charter adds a clinical framework to be referenced during the decision-making process around the investments in digital health, and the definition and realisation of the expected benefits from these sizable investments. As the digital landscape in public hospitals evolves, clinicians are becoming increasingly reliant upon digital technologies. It is critical that clinicians have a strong effect on technology acquisition and governance to maximise the quality and efficiency of the care they provide. [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: Long specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a medical specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on medical specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on medical specialist out-patient waitlists. Method: Using a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on medical specialist out-patient waitlists. Results: In all, 10 634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without medical specialist consultation across the service models. Conclusions: Allied health primary contact services provide safe, effective and timely care. The impact on medical specialist out-patient waitlists varied depending on service model and pathway characteristics. What is known about this topic?: Most studies of allied health primary contact services have focused on the management of patients on orthopaedic specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of medical specialists. What does this paper add?: This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various medical specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed. What are the implications for practitioners?: Health service managers should consider allied health primary contact services as a viable option to increase specialist out-patient capacity. Service model characteristics that maximise impact on medical specialist out-patient waitlist management are highlighted to inform resource allocation. [ABSTRACT FROM AUTHOR]

Objective: This study examined Gold Coast staff and patient experiences with the rapid expansion of a virtual model of chronic disease management during the COVID-19 pandemic. Methods: The study undertook a survey of enrolled patients (n = 24) and focus groups with clinical and administrative staff (n = 44) delivering chronic disease programs at Gold Coast Health in Queensland. The study also examined routinely collected activity data for the chronic disease programs before COVID (January–February 2020) and for the first 3 months of the COVID-19 response (March–May 2020). Results: Chronic disease programs continued to provide similar numbers of appointments over the COVID-19 response period, but there was a marked increase in the proportion of appointments that were delivered virtually, either by telephone or video conference. Most patients were satisfied with their virtual care experiences and felt that their health care needs were met. Conclusions: The COVID-19 response provided an opportunity to learn and further develop models of virtual care. Staff and patients were generally supportive of continuing to include virtual appointments in the future. Ongoing concerns were predominantly around the support available to patients and staff to ensure they are trained and equipped to manage the technology and new mode of communicating. What is known about the topic?: Emerging evidence suggests that virtual models of health care delivery, such as telephone and video consultations and remote patient monitoring, can be safe and cost-effective alternatives to traditional face-to-face chronic disease management programs. Virtual care is associated with equal or improved clinical outcomes, as well as efficiency improvements, such as reduced failure to attend rates. What does this paper add?: The increasing burden of chronic disease across Australia, as well as the need to minimise the risk of vulnerable patient groups attending in-hospital appointments where it is safe and appropriate to do so, means that expanding the delivery of virtual chronic disease management will become increasingly necessary. The results of this study provide an opportunity to learn from a rapid rollout of virtual care for these staff and patient groups and will help inform advances in this area. What are the implications for practitioners?: Existing evidence, demographic pressures and the COVID-19 pandemic response all point to virtual care as a viable and safe alternative to traditional models of chronic disease management. The lessons presented here provide more detailed guidance on the support that staff and patients require to ensure virtual care is a seamless and safe alternative or adjunct to traditional chronic disease management programs. [ABSTRACT FROM AUTHOR]

The aim of this study was to learn from trainees separating from the Queensland Rural Generalist Pathway (QRGP) the reasons and circumstances around their decision so as to improve the efficiency of the program and experience of trainees. Forty-one QRGP trainees who separated without achieving a Rural Generalist (RG) end point to training were interviewed regarding their reasons for separation and thoughts on improving the program. The mean period of time enrolled in the QRGP was 2.87 years. Broadly, the cohort divided into those separating for specialist training, those moving into non-RG general practice and those undecided. Separation for specialist training tended to occur during prevocational years and that to general practice later in the program before trainees had completed advanced skill training. Female trainees were over-represented among trainees separating without completing training. This cohort provided their opinions on the strengths of the QRGP and possible improvements. Understanding and addressing the reasons for early separation suggested several strategies to improve the efficiency of the QRGP in selecting and retaining trainees. Lessons learned included the value of employer-provided coordinated prevocational placements and training, potential benefits of guiding rural-interested medical graduates who ultimately enter other specialist training and the need for greater liaison with external Australian General Practice Training administration organisations to coordinate transition of trainees. There is a need to further address accessibility of advanced training for all trainees. What is known about the topic?: Policies to generate RG medicine programs are now present in most state jurisdictions and nationally in Australia, with reports of successes appearing. However, little information is available regarding non-completion of trainees selected. What does this paper add?: As programs grow in number and throughput, lessons learned from those choosing not to complete will inform the selection and management of trainees to improve the efficiency of these programs. This paper provides lessons learned by the QRGP regarding trainees not completing the program to inform the selection and management of trainees to make the program more efficient. What are the implications for practitioners?: RG programs may facilitate retention or efficient separation of trainees by addressing potential reasons for separation at relevant times in the program. [ABSTRACT FROM AUTHOR]

Ground pearls (Hemiptera: Margarodidae), so called for their shiny spherical cyst stage, are important root-feeding pests of a broad range of plants predominantly belonging to the family Poaceae. In the tropical and subtropical regions of eastern Australia, ground pearl species cause significant damage on sugarcane and turf grasses and have been identified at multiple sites of pasture dieback in Queensland. The potential impact of ground pearls on pasture production in Australia and elsewhere is largely unknown. This paper reviews Australian and international literature on the biology and management of this poorly understood group of pests. Ground pearls have several features that make control difficult, including a resilient cyst which provides resistance to drought and excessive moisture, a relative impermeability to insecticides, and ease of dispersal through movement of soil. Ground pearls can also modulate the period of encystment to survive adverse environmental conditions, with some species capable of surviving for years while disassociated from a host. No insecticide effectively controls ground pearl cysts. Biological control agents have been identified for some species; however, these pathogens are relatively ineffective on subterranean ground pearl cysts. Cultural control methods such as cultivation and fallowing have helped to reduce ground pearl populations in sugarcane. In turf, practices that maintain plant health such as adequate irrigation and nutrition can mask signs of ground pearl infestation. The paucity of research conducted on the biology and impact of ground pearls represents a constraint to improving management of this pest. Ground pearls are important pests of a broad range of plants predominantly belonging to the grass family (Poaceae). In eastern Australia, they cause significant damage on sugarcane and turf grasses, and have recently been found in pasture situations in Queensland, but their impacts are unknown. This work reviews Australian and international literature on the biology and management of ground pearls, finding that relatively little research has been undertaken and several knowledge gaps remain. [ABSTRACT FROM AUTHOR]

Background: Patients from culturally and linguistically diverse (CALD) backgrounds often have unmet healthcare coordination needs. We aimed to evaluate the acceptability, utilisation and perceived benefits of the Mater CALD Health Coordinator Service (M-CHooSe), a pilot, nurse-led, general practice co-located, healthcare coordination service for patients from CALD backgrounds. Methods: M-CHooSe began in March 2020 at five Brisbane (Queensland) sites. Process and service user data were collected over 12 months at one site. A survey evaluated primary healthcare professionals' perceived benefits of the service. Another survey of M-CHooSe nurses examined indicators of service complexity. Results: In total, 206 individuals accessed M-CHooSe over the 12-month period. Commonly delivered services included health service advocacy, chart reviews and health system navigation, including addressing social determinants. M-CHooSe nurses reported frequently performing tasks such as following up with external health services and performing health and social care system coordination. M-CHooSe benefits reported by primary healthcare professionals included better patient access to external health services and improved patient understanding of their conditions and treatments. Conclusion: Patients were accepting of referrals to M-CHooSE. Primary healthcare professionals also reported a variety of benefits to themselves and their patients because of M-CHooSe. M-ChooSe highlights the potential of a healthcare coordination service for multicultural patients to improve healthcare equity, accessibility, and system efficiency. This project demonstrates the potential value of coordination services to increase patient access and uptake of existing health and social care services for modern Australian communities, thus improving the efficiency and effectiveness of our health system. Further investigations, including user experience, opinions and cost analyses, will be required to confirm the promising benefits of embedding M-CHooSe into usual care. People with multicultural or refugee backgrounds are more likely to have poorer long-term health outcomes compared to natively born people, and experience barriers accessing health care. We piloted a multicultural healthcare coordinator service and demonstrated that it was acceptable to patients and primary healthcare practitioners, well-utilised and demonstrated good outcomes. The service has the potential to reduce healthcare inequities if implemented into ongoing primary care services. [ABSTRACT FROM AUTHOR]

Objective: There is much interest in examining the use of medicines and their real-world benefits and harms using routinely collected data sources such as patients' electronic medical records in hospitals in order to optimise use and health outcomes. This study aimed to describe the process and challenges involved in obtaining ethical approval and research governance authorisation for a research project that started on 7 December 2018 in Queensland and make recommendations for improving the process. Methods: There were three aspects: (a) ethics approval; (b) governance – site-specific assessment (SSA); and (c) governance – Public Health Act (PHA) Application Assessment. Results: The process to satisfy all requirements took more than 1 year (371 days); ethics took 16 days and PHA approval 16 days. The major hurdle was the SSA, which took 98–274 days across five sites. The main issues were opaqueness in processes and inconsistences in approach leading to considerable frustration. Discussion: It is recommendeded that Research Governance Offices should be clear on the process and requirements. All Local Hospital Networks (LHN, Hospital and Health Services in Queensland) should develop and adopt a standardised low and negligible risk SSA approval process. Frustration of government officials and researchers led the National Health and Medical Research Council to streamline ethics approval processes, but the same cannot be said for the governance process. It is appreciated that LHN processes were developed for good and valid reasons, but the onerous and inconsistent application of these processes hinder timely and relevant research. It is time for action: follow the success of the ethics process to redesign governance. What is known about the topic?: Researchers are interested in examining the use of medicines and their real-world benefits and harms using routinely collected data sources such as patients' electronic medical records in hospitals in order to optimise use and health outcomes. There are challenges in obtaining ethical approval and research governance authorisation for research projects. What does this paper add?: We identified that the main hurdle was obtaining site-specific agreements across numerous hospital sites. What are the implications for practitioners?: We recommend that Research Governance Offices should be clear on the process and requirements. All Local Hospital Networks (LHN, Hospital and Health Services in Queensland) should develop and adopt a standardised low and negligible risk SSA approval process. The ethics approval process has been streamlined in recent years so we need to follow this success to redesign governance. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated multiple computed tomography (CT) workforce models to identify any implications on efficiency (length of stay, scan frequency and workforce cost) and scanning radiographer interruptions through substituting or supplementing with a trained CT assistant. Methods: The study was conducted in a CT unit of a tertiary Queensland hospital and prospectively compared four workforce models, including usual practice: Model 1 used an administrative assistant (AA) and one radiographer; Model 2 substituted a medical imaging assistant (MIA) for the AA; Model 3 was usual practice, consisting of two radiographers; and Model 4 included two radiographers, with a supplemented MIA. Observational data were collected over 7 days per model and were cross-checked against electronic records. Data for interruption type and frequency, as well as scan type and duration, were collected. Annual workforce costs were calculated as measures of efficiency. Results: Similar scan frequency and parameters (complexity) occurred across all models, averaging 164 scans (interquartile range 160–172 scans) each. The median times from patient arrival to examination completion in Models 1–4 were 47, 35, 46 and 33 min respectively. There were between 34 and 104 interruptions per day across all models, with the 'assistant role' fielding the largest proportion. Model 4 demonstrated the highest workforce cost, and Model 2 the lowest. Conclusion: This study demonstrated that assistant models offer similar patient throughput to usual practice at a reduced cost. Model 2 was the most efficient of all two-staff models (Models 1–3), offering the cheapest workforce, slightly higher throughput and faster examination times. Not surprisingly, the additional staff model (Model 4) offered greater overall examination times and throughput, with fewer interruptions, although workforce cost and possible role ambiguity were both limitations of this model. These findings may assist decision makers in selecting the optimal workforce design for their own individual contexts. What is known about the topic?: Innovative solutions are required to address ongoing health workforce sustainability concerns. Workforce substitution models using trained assistants have demonstrated numerous benefits internationally, with translation to the Australian allied health setting showing promise. What does this paper add?: Building on existing research, this study provides clinical workforce alternatives that maintain patient throughput while offering cost efficiencies. This study also quantified the many daily interruptions that occur within the CT setting, highlighting a potential clinical risk. To the best of our knowledge, this study is the first to empirically test the use of allied health assistants within CT. What are the implications for practitioners?: Role substitution in CT may offer solutions to skills shortages, increasing expenditure and service demand. Incorporating appropriate assistant workforce models can maintain throughput while demonstrating implications for efficiency and interruptions, potentially affecting staff stress and burnout. In addition, the assistant's scope and accepted level of interruptions should be considerations when choosing the most appropriate model. [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]

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]

The objective of this case study was to examine and evaluate the retention of medical graduates for a hospital and health service partnering with a university to deliver a rural medical program. Eight cohorts of the Griffith Rural Medical Longlook program were followed for workforce outcomes, including both rural and local workforce outcomes for the Darling Downs Hospital and Health Service (DDHHS) and the region. The DDHHS partnered with Griffith Health for capital investment in the region, creating three main campuses in rural generalist hospitals and augmented resources in other rural health facilities. Most (60%) medical graduates placed for a year or more on the Longlook program chose regional internships in Queensland, including 31% who chose internship in the DDHHS. Students spending 2 years on the program in the DDHHS were more likely to remain for local internship (odds ratio (OR) 5.7) and to be practicing locally after internship (OR 3.3). Local retention of medical graduates from the partnership between the Faculty of Health at Griffith University and the DDHHS to establish and conduct the Rural Medical Longlook Program includes resourcing and utilisation of spare training capacity in rural generalist hospitals and in addressing junior medical workforce recruitment. What is known about the topic?: Rural medical programs improve choice of regional centres for early career placements. Rural longitudinal integrated clerkships (LICs) are effective in influencing regional choices for early medical career placements. What does this paper add?: This was a case study on the local retention of medical graduates for health services sponsoring rural medical programs. LICs are sustainable in rural generalist hospitals to increase clinical training capacity. There is evidence for longer rural placements improving rural retention, specific for rural LICs. Longer LICs are more effective in influencing regional internship choices and regional retention, as well as local internship choice and local retention. What are the implications for practitioners?: Investment in increasing clinical training capacity in rural generalist health facilities can produce significant retention of medical graduates for the junior medical workforce. Retaining students in the regional health service for longer periods increases the likelihood of retention upon graduation. [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: Meeting the demand for clinical placements in an environment of increasing university cohort growth and changes in health service delivery models is challenging. This paper describes the outcomes of a quality review activity designed to gain key stakeholder perspectives on the enablers and barriers to sustaining effort to placement provision and reports on: (1) measures used to determine the effect of a jurisdiction-wide initiative in clinical education for five allied health professions; (2) outcomes of data related to key factors affecting placement supply and demand; and (3) qualitative perspectives from management, workforce and university stakeholders on placement sustainability. Methods: This study reviewed clinical placement, staff full-time equivalent numbers, university program and student cohort data for five allied health professions from 2013 to 2016. In addition, qualitative response data from key stakeholder surveys was analysed thematically. Results: In the study period, the rate of growth in placement offers did not match that of university program student numbers and full-time equivalent staff numbers. All stakeholders agreed that sustaining placement provision is enabled by collaboration, continuation of management support for dedicated clinical education staff, a focus on clinical education capacity building activities, outcome data reporting and statewide profession-specific governance, including leadership positions. Collaborations and networks across health and education sectors were reported to enhance efficiency, minimise duplication, streamline communication and support information and resource sharing within and across professions and stakeholders, ultimately sustaining placement provision. Identified barriers to sustainability centred on resourcing and the continued increasing demand for placements. Conclusion: Sustaining pre-entry student placements requires stakeholder flexibility and responsiveness and is underpinned by collaboration, information and resource sharing. Dedicated clinical education positions were highly valued and seen as a key contributor to placement sustainability. What is known about the topic?: The increasing demand for student placements and strategies used to enhance placement capacity are well known. To date, there have been limited studies investigating cross-sectoral trends and health service enablers and barriers to sustaining responses to placement demand. What does this paper add?: This paper describes outcomes of a clinical placement capacity building initiative within public health services, developed from a unique opportunity to provide funding through an industrial agreement. It presents key allied health staff and university partner perspectives on enablers to sustaining placement supply in an environment of increasing placement demand. What are the implications for practitioners?: This paper demonstrates that key enablers for the sustainability of placement provision are collaboration between university and health sectors, continuation of management support for dedicated clinical education staff, outcome data reporting and statewide profession-specific governance and leadership. It supports current practices of profession-specific and interprofessional clinical education resource and strategy development and the sharing of expertise for sustained placement provision. [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: Allied health structures and leadership positions vary throughout Australia and New Zealand in their design and implementation. It is not clear which organisational factors support allied health leaders and professionals to enhance clinical outcomes. The aim of this project was to identify key organisational contexts and corresponding mechanisms that influenced effective outcomes for allied health professionals. Methods: A qualitative realist evaluation was chosen to describe key aspects of allied health organisational structures, identify positive outcomes and describe how context and processes are operationalised to influence outcomes for the allied health workforce and the populations they serve. Results: A purposive sample of nine allied health leaders, five executives and 49 allied health professionals were interviewed individually and in focus groups, representing nine Queensland Health services. Marked differences exist in the title and focus of senior allied health leaders' roles. The use of a qualitative realist evaluation methodology enabled identification of the mechanisms that work to achieve effective and efficient outcomes, within specific contexts. Conclusions: The initial middle range theory of allied health organisational structures in Queensland was supported and extended to better understand which contexts were important and which key mechanisms were activated to achieve effective outcomes. Executive allied health leadership roles enable allied health leaders to use their influence in organisational planning and decision-making to ensure allied health professionals deliver successful patient care services. Professional governance systems embed the management and support of the clinical workforce most efficiently within professional disciplines. With consistent data management systems, allied health professional staff can be integrated within clinical teams that provide high-quality care. Interprofessional learning opportunities can enhance collaborative teamwork and, when allied health professionals are supported to understand and use research, they can deliver positive patient and business outcomes for the health service. What is known about the topic?: A collective allied health organisational structure encourages engagement of allied health professionals within healthcare organisations. Organisational structures commonly include management and leadership strategies and service delivery models. Allied health leaders in Queensland work across a range of senior management levels to ensure adequate resources for sufficient suitably skilled professional staff to meet patient needs. What does this paper add?: Literature to date has described how allied health professionals operate within organisational structures. This paper examines key aspects of allied health management, governance and leadership, together with mechanisms that support allied health professionals to deliver effective clinical and business outcomes for their local community. What are the implications for practitioners?: Health service executives and allied health leaders should consider supporting executive allied health leadership roles to influence strategic planning and decision-making, as well as to deliver outcomes that are important to the health service. When allied health leaders implement integrated professional and operational governance systems, executives described allied health professionals as influential in supporting team-based models of care that add value to the business and improve outcomes for patients. When allied health leaders use consistent data management, executives reinforced the benefit of aligning activity data with financial costs to monitor, recognise and reimburse appropriate clinical interventions for patients. When allied health leaders support allied health workforce capability through educational and research opportunities, clinicians can use research to inform their clinical practice. [ABSTRACT FROM AUTHOR]