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Frailty is an important concept in the care of older adults. Over the past two decades, significant advances have been made in measuring frailty. While it is now well‐recognised that frailty status is an important determinant of outcomes from medical illnesses or surgical interventions, frailty measurement is not currently routinely integrated into clinical practice. In the community setting, it is uncommon for general practitioners to deliver frailty‐optimised care. In hospitals, there is substantial variability in how people living with frailty are managed. This variability is notable between and even within disciplines. Furthermore, gains from understanding frailty mechanisms and risk factors are not yet applied/implemented at scale to delay the progression of frailty in community‐dwellers. The Australian Frailty Network (AFN) is a national collaborative group of researchers, clinicians, non‐government organisations, consumers and policymakers, in which the engagement and active involvement of consumers has been embedded from the outset. The AFN aims to generate new knowledge to improve health outcomes, to ensure evidence‐based management is translated into clinical practice and to build capacity in multidisciplinary and translational frailty research. Here, we describe the development of the AFN, highlighting important milestones: (i) securing funding for the network and flagship elements; (ii) an inaugural summit to establish the strategic vision, values and scope with end‐users; (iii) sabbatical visits to learn from international examples; and (iv) developing the governance structure and an actionable plan encompassing consumer engagement, research, education and policy and practice to maximise impact. [ABSTRACT FROM AUTHOR]

Objective: Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision‐making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life‐sustaining treatments and care utilisation to inform their broader use in ACP studies. Methods: Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. Results: Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's =.31–.37, p <.001), and ACP engagement (r's = −.41 to −.37, p <.001) indicated convergent validity. Conclusion: A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. Patient or Public Contribution: The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life‐limiting conditions and five current or former care partners. [ABSTRACT FROM AUTHOR]

Consumer-directed care (CDC) is a policy solution for quality deficiencies in aged care where seniors accessing care services are empowered with full choice and flexibility over their service packages. Various programs have been developed using this policy approach around the world, and implementation has invoked a mixture of responses. While consumer organisations welcome a policy direction providing additional choice, there is a concern that this policy complicates the decision-making process, leading people to rely on "rules of thumb" (heuristics) that may not reflect their best interests. Behavioural science provides a lens for looking at heuristics and biases that may occur during complex decision making, particularly as people age. Objective. To explore the presence and influence of heuristics and biases on the decision-making processes of older people receiving home care services under a CDC model. Method. Qualitative systematic review involving systematic searching of PubMed, MEDLINE via Ovid, Embase via Elsevier, CINAHL via Ebsco, PsycINFO via Ovid, Web of Science, Scopus, and EconLit, from inception until 14th April 2022 was undertaken. Identified articles were deduplicated, screened, and extracted for information relevant to the research question using PRISMA guidelines. Data extraction considered descriptive data and metadata including study type, participants, overall objectives, chosen methodologies, and their relationship to the research question. The variety of study types prompted a thematic synthesis to achieve greater comprehension of the existing knowledge base. Results. Descriptive categories were analysed to reveal five themes relevant to the presence and influence of heuristics and biases in decisions made by older people when allocating home care resources. Principally, CDC is implemented to afford autonomy but is complicated by the decision-making environment. Choice and decision making are both specific to the individual, and the processes employed for decision making vary over the life-course. Decision quality can be improved through the identification and mitigation of complicating factors. More research is needed to understand how modifications can assist decision making and improve health outcomes. [ABSTRACT FROM AUTHOR]

Keywords: eHealth; Information management; Health financing; Health services research EN eHealth Information management Health financing Health services research 53 57 5 02/07/23 20230201 NES 230201 Focusing solely on financial measures is unlikely to deliver a comprehensive view of the value of digital health Digital health, which refers to the use of digital technology to provide and support health care services, promises to strengthen health systems worldwide and has been accelerated by the coronavirus disease 2019 (COVID-19) pandemic.[1] Amid the rapid digital transformation of health care,[[2]] the value of sizeable digital health investments remains unclear.[[3]] The investments required for digital health are often substantial and may come at a cost to existing health care delivery models. Conclusion Health care organisations are currently not measuring the true value of digital health implementations and, thus, digital investment may not be prioritised given the competing health care demands. With the burden on the health care system to continue service delivery with static resourcing, an ageing population and growing health inequities, digital health provides an unrivalled opportunity to improve care at scale. [Extracted from the article]

Introduction: In Australia, the available published literature demonstrated a spike in dispensed prescription medicines after the onset of the COVID‐19 pandemic that subsequently returned to expected levels. Smoking cessation medicines may not follow this pattern because quit attempts are influenced by a range of factors. Knowledge of whether dispensing of these medicines has changed since the pandemic is lacking. We explored the change in dispensing of publicly subsidised smoking cessation medicines since the pandemic. Methods: Australia's universal health‐care system provides access to government‐subsidised medicines via the Pharmaceutical Benefits Scheme and records of dispensed medicines are publicly available on a nationally aggregated level. We retrieved Pharmaceutical Benefits Scheme data from January 2016 to January 2021. We used interrupted time series modelling to quantify the impact of COVID‐19 on dispensing of nicotine replacement therapy (NRT) patches, varenicline and all smoking cessation treatments combined separately. Results: After an initial spike in medicines at the onset of the pandemic, the monthly rate of prescriptions dispensed for varenicline was predominantly within predicted ranges, while that of NRT patches was predominantly below predicted ranges. Discussion and Conclusions: There has been a differential change in the number of subsidised smoking cessation medicines supplied in Australia since the COVID‐19 pandemic, with varenicline prescriptions largely within, and NRT patches largely lower than, expected ranges. The reasons for the apparent change in dispensing of subsidised smoking cessation medicines are unclear. [ABSTRACT FROM AUTHOR]

Consumer‐directed care (CDC) programmes, in principle, provide consumers with choices around who provides care services to them, what services and when. However, literature around consumer behaviour of older adults, especially concerning the factors that may support home care choices, is sparse. The purpose of this study was to understand the decision‐making processes and spending preferences of community‐dwelling seniors assessed eligible for CDC home care services. We completed an explorative inquiry using a "think‐aloud" technique with eligible consumers in South Australia. The inquiry had two components. First, consumers used imitation money to simulate the purchase of home care supports while talking out loud their decision‐making processes. Then, semi‐structured interviews were completed to identify underlying thoughts that informed the decisions made and spending preferences. Fifteen consumers, mean age 82 years (range 70–94), participated. The most frequently prioritised choice was domestic assistance. However, choices were made based on a perceived hierarchy of need (due to limits placed on available budgets for care). Interview data revealed that the decision making and service preferences were also based on limited knowledge about what was available. Consumers revealed perceived value in purchasing expert advice to guide their choices and preference for relational not transactional service delivery. [ABSTRACT FROM AUTHOR]

COVID‐19 is one of the worst pandemics in recent human history, causing huge health, economic, and psychosocial damage. Since the pandemic hit, several unsubstantiated claims regarding exposure, transmission and management have been disseminated. Misinformation and associated public confusion now extend to the COVID‐19 vaccines, spanning from claims based on possible links between some vaccine types and rare blood clots, to baseless claims. As a result, the public's trust in COVID‐19 vaccines has been eroded, fuelling an already troubling trend of vaccine hesitancy. As medication experts and the most accessible healthcare providers, pharmacists are well equipped with the required skills and knowledge to improve COVID‐19 vaccine uptake by taking roles that range from dispelling myths, to providing reliable evidence‐based information, through to vaccine administration. This paper discusses public hesitancy to COVID‐19 vaccines, major contributing factors, and the role pharmacists can play in reducing hesitancy and increasing vaccine uptake. [ABSTRACT FROM AUTHOR]

Introduction: Members of the public expect occupational therapists to provide evidence‐based practice. Participation in professional development activities is essential to update knowledge and acquire skills to enable delivery of evidence‐based assessment and intervention. Therapists commonly choose to participate in professional development through attending training workshops. Little is known about occupational therapists' preference of how continuing professional development training programmes should be designed and delivered. Methods: An online quantitative survey of occupational therapists working with older people in Australia, conducted June to September 2018, incorporated a discrete choice experiment to elicit and estimate preferences for professional development training when acquiring skills in delivering an evidence‐based intervention. A series of questions asked participants to choose one of two options for training, each differing in terms of attributes (level of recognition, mode of learning, follow‐up post‐training and cost to establish willingness to pay). Statistical analyses were conducted according to recommended practice in the field of choice‐modelling. Results: A total of 108 responses were received from occupational therapists practicing around Australia. Therapists reported a strong preference for receiving post‐training support to implement their new skills in practice and would be willing to pay an additional A$200 for training that included this option. They also highly regarded achieving 'certification' in their new skill (willing to pay an additional A$100) and having the opportunity to become a 'Master Trainer' in the future (willing to pay an additional A$200). Discussion: This study generates new knowledge about aspects of a professional development training programme that occupational therapists' value and aspects that they are willing to compromise on when acquiring new skills that they intend to use in their practice. These findings can influence the training programme design utilised by those working in implementation research and providers of continuing professional development for health professionals. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the cost‐effectiveness of a 12‐week Exercise Physiology (EP) program for people living in a residential aged care facility. Methods: A within‐study pre‐ and postintervention design to calculate incremental cost‐effectiveness ratios per quality‐adjusted life years gained. A health service provider perspective was used. Results: Fifty‐nine participants enrolled in a 12‐week program. The program cost was A$514.30 per resident. At a willingness‐to‐pay threshold of A$64 000, the likelihood of being cost‐effective of the program is approximately 60%, due to a small increase in participants' quality of life, as reported by care staff. The model showed great variance, depending on who rated the participants' quality of life outcomes. Conclusion: It is uncertain that a 12‐week EP program is cost‐effective based on the evidence of the current trial. However, it appears that a low‐cost program can produce small improvements for residents in care facilities. [ABSTRACT FROM AUTHOR]

Background: Healthcare decision‐makers worldwide are increasingly seeking to optimise allocation of resources to dementia and the incorporation of economic evaluations into randomised control trials provide definitive information for such decisions. Economic evaluations are rapidly increasing in number in dementia and standardisation of methods ensure comparability of economic evidence. Method: Core outcomes sets (COS) aim to provide international recommendations on outcome measurement in trials and currently there exists no COS for economic evaluations of dementia interventions. Our systematic searches identified over 100 economic evaluations of dementia interventions, and critical appraisal demonstrates opportunities for greater standardisation of applied economic methods. This study aims to agree standardised methods for economic measures of a) health outcomes and b) resource use that should be measured and reported in future trial‐based economic evaluation in dementia. Result: The COS for the economic evaluation of dementia interventions will be developed from two main steps: First, a systematic review (currently being finalised) extracts information on how costs and benefits are estimated, analysed and reported. All studies published before December 2022, and confirmed as trial‐based economic evaluation, are included. Included studies all contain economic measures and we will report participant characteristics (type of dementia, severity), study design and evaluation types, type of interventions, mode of data collection and instrument(s) used to derive the health outcomes and resource uses. Second, which speaks specifically to action research at AAIC 2023, we will conduct a Delphi consensus focus groups with economists who have collaborated with dementia‐trial teams. Data extracted during the systematic review will be presented to provide a basis for the consensus recommendations on measures commonly required for economic evaluation in dementia. In the case where consensus was not reached, we may conduct additional consensus exercises. We will also consider country contexts (high versus low‐middle income, or country‐level financing and reimbursement mechanisms) in finalising recommended COS of health and resource use measures. Conclusion: Findings from COS for economic evaluations of dementia intervention will be published in a dementia‐focused journal and more broadly communicated to a broad range of stakeholders. [ABSTRACT FROM AUTHOR]

Objective: The aim of this project was to assess the value for money of a modified unit within a residential aged care facility (RACF) for people requiring palliative care at the end of life. Methods: A three‐way comparison using a mixed‐method costing was used to estimate the per day cost of the unit compared to care in a palliative care unit within a hospital and a standard RACF bed. Results: The cost of the unit was estimated at $242 per day (2015 Australian dollars). The palliative care hospital bed cost $1,664 per day. The cost of a standard RACF bed was $123 per day, indicating that an additional $120 per day is required to provide the higher level of care required by people with complex palliative care needs. Conclusion: A modified RACF unit could provide substantial cost savings to the health budget for selected complex palliative care patients. [ABSTRACT FROM AUTHOR]

The World Health Organisation has called for the implementation of evidence‐based interventions that enhance function and capability in people with dementia. In response, the Boosting Dementia Research Initiative in Australia has funded a number of projects aimed at improving such outcomes for people with dementia and their caregivers. What is not known is the economic and societal outcomes of these projects and of program implementation to the Australian healthcare system. The purpose of this study was to identify the costs and benefits of implementing an evidence‐based reablement program within Australian health context. A well‐used methodology familiar to governments and decision‐makers was used to calculate the costs and benefits of implementing the program in Australia. Four different perspectives: market, private, efficiency (social) and referent group (key stakeholders) were considered in the cost–benefit evaluation. Almost A$6.2 million societal gain is presented through a social cost–benefit analysis. The referent (stakeholder) group analysis is used to demonstrate that people with dementia and their caregivers are the bearers of the costs and the Australian health and social care system gains the most from the program implementation. The results of this cost–benefit analysis suggest that there is a need to plan and provide subsidies or other financial incentives to assist people with dementia and their caregivers to engage in reablement programs in Australia; thus the whole society can be advantaged. Funding bodies and decision‐makers are urged to recognise the potential societal benefits that can be achieved from participating in such reablement programs. [ABSTRACT FROM AUTHOR]

Objective: To investigate the decision‐making processes applied by people with dementia and family carers participating in using health economic approaches to value dementia‐specific quality of life states. Methods: People with dementia (n = 13) and family carers (n = 14) participated in valuing quality of life states using two health economic approaches: Discrete Choice Experiment (DCE) and Best Worst Scaling (BWS). Participants were encouraged to explain their reasoning using a "Think Aloud" approach. Results: People with dementia and family carers adopted a range of decision‐making strategies including "anchoring" the presented states against current quality of life, or simplifying the decision‐making by focusing on the sub‐set of attributes deemed most important. Overall, there was strong evidence of task engagement for BWS and DCE. Conclusions: Health economic valuation approaches can be successfully applied with people with dementia and family carers. These data can inform the assessment of benefits from their perspectives for incorporation within economic evaluation. [ABSTRACT FROM AUTHOR]

Problem: The increasing specialisation of medical care in larger centres is contributing to the declining use of rural hospitals that are close to larger centres, risking bed closures or even facility closure. Design: An allied health‐led model of care supported by telehealth geriatrician services was developed and implemented in eight beds in a rural hospital to manage older patients needing geriatric evaluation and management. Setting: The project was set in Kilcoy Hospital, a small facility north of Caboolture in Queensland, Australia. The feeder hospital was Caboolture Hospital, the regional centre. Key measures for improvement: Occupancy rates at the rural hospital along with length of stay, discharge destination and functional independence measure. Strategies for change: A project officer was employed 1 day a week to facilitate the implementation of the new model of care. Training and education were provided to medical and nursing staff to understand and implement the geriatric evaluation and management model of care. Effects of change: Over the project time frame, 93 patients were successfully managed in the rural hospital with improved occupancy rates. Outcomes were as effective and safe as compared to the group managed at the regional centre. The model of care is now routine practice. Lessons learnt: Using excess capacity in rural hospitals by employing a geriatric evaluation and management approach is a viable strategy to address declining rural hospital usage. [ABSTRACT FROM AUTHOR]

Background/aim: Randomised trials have demonstrated that occupational therapy can delay functional decline, improve quality of life and increase leisure participation in people with dementia. However, surveys conducted with occupational therapists suggest that clinical practice does not reflect the type of intervention shown to be effective in research studies. Case note audits can be used to quantify practice and demonstrate how and where provision of care could improve without the potential bias associated with self‐report. Method: A total of 87 occupational therapy case notes were audited from different service contexts in two states in Australia. The case notes were reviewed against criteria including duration of service, assessments conducted and interventions used. Descriptive statistics were used to present the data and examine associations between intervention, age of the person with dementia and whether or not the person lived alone. Results: Services tended to be short‐term with an average of 2.1 consultations per referral. The most common assessments related to home safety, falls risk and function. Intervention most commonly focussed on referrals to other services, environmental modification advice and assistive device prescription. Conclusion: This audit reveals that current occupational therapy practice for people with dementia focusses on assessment and management of risk and is usually limited to a couple of consultations. Future work should seek to evaluate if such approaches to care are effective for people with dementia. [ABSTRACT FROM AUTHOR]

Abstract: With the ageing of the world's population comes significant implications for nearly all sectors of society, including health and aged care spending. Health and aged care systems need to respond to the increasing need for services for older people. Occupational therapy is concerned with maintaining a person's functional independence and well‐being from preventative and treatment perspectives. The aim of this systematic review was to identify the costs and outcomes of occupational therapy for people with cognitive and/or functional decline. The searches for this review were conducted on 23 September 2016 and updated on 20 April 2017. Full economic evaluation studies, partial economic evaluations, randomised trials reporting estimates of resource use or costs associated with intervention(s) and comparator(s) and studies with pre‐ and post‐intervention cost comparators were included. Thirteen studies met the inclusion criteria. The type and duration of occupational therapy intervention in the included studies varied, ranging from one‐off assessments through to systematic multicomponent programmes. Results suggested that structured occupational therapy interventions which comprised of multiple consultations and engaged caregivers delivered better functional and economic outcomes. [ABSTRACT FROM AUTHOR]

Aim To estimate the cost-effectiveness of the Mitii training system for improvements in upper limb function for children with unilateral cerebral palsy (CP). Mitii is a web-based programme delivered at home with set-up and monitoring by therapists. Method A randomized controlled trial was conducted comparing the Mitii training programme to usual care. The Assessment of Motor and Process Skills (AMPS) and Canadian Occupational Performance Measure (COPM) were collected for each child at baseline and 20 weeks. Responders to training were characterized as those who met a minimally important difference on either the AMPS (0.3 logits) or COPM (2 points). Costs of the intervention were calculated by quantifying the equipment and staff cost. A cost per responder was calculated for each of the outcome measures. Results A total of 102 participants (52 males, 50 females) were included in the analysis. There were significantly more responders in the training group on both the AMPS motor and process scales and the COPM performance and satisfaction scales. The cost per responder for the Mitii programme ranged from AU$3078 to AU$4191 depending on the scale used. Interpretation The cost of delivering the Mitii training system is modest relative to the improvements in function. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effectiveness of a suicide bereavement support service in reducing adverse health and social outcomes for people bereaved by suicide. Retrospective cross-sectional design, comparing clients of the service with a control group of bereaved people who had not had contact with the program. Participants were assessed on quality of life, psychological distress, suicidality, health care usage, and productivity. Clients have significantly lower levels of suicidality. There was a trend to higher quality of life and lower psychological distress. Clients had slightly higher productivity and lower health care service usage than the control group, although these differences were not statistically significant. This article demonstrates that an intervention program for people bereaved by suicide can be effective at reducing suicidality and may have a positive effect on other health and social outcomes. [ABSTRACT FROM AUTHOR]

Aim: To identify the level of uptake of occupational therapists' home environmental audit recommendations by older community dwellers and the factors that contribute to adherence. Methods: Design and setting: Cohort nested within an RCT that compared two models of care for fall prevention located in Brisbane, Australia. Participants: Community-dwelling older people >60 at risk of falls (n = 80). Interventions: An environmental audit and recommendations by an occupational therapist. Results: Of the recommendations made, 55% were completed by 6 months. Increasing number of comorbidities was a significant predictor of adherence with recommendations. Recommendations requiring external providers were more likely to be completed than those relying on the client or family member. Conclusion: Occupational therapists need to consider a wide range of intrinsic and extrinsic factors, which may contribute to adherence with home modifications. [ABSTRACT FROM AUTHOR]