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Introduction: The shortfall in medical workers in rural and remote Australia has led to health discrepancies in these regions. The University of Wollongong's medical program was designed to encourage graduates to work in these regions to address this shortfall. Objective: To compare rural and regional locations of work and choices of speciality between University of Wollongong's graduates and graduates from all Australian universities. Design: We conducted a longitudinal analysis on data available from the Medical Schools Outcome database, with graduate exit surveys linked to registrations of location and speciality. Rural and remote locations were identified as MM2‐7 regions using the Modified Monash Model. In total, 716 graduates from the University of Wollongong and 26 915 graduates from all Australian medical schools completed the MSOD exit survey in 2010‐2021 and registered with the Australian Health Practitioner Regulation Agency in 2022. The main outcome was the relative likelihood (relative risk) of cohorts working in rural and regional areas and of cohorts choosing general practice as their speciality. Findings: University of Wollongong's medical graduates were 1.51 times or 51% more likely to work in regional or rural areas (RR 1.51, 95% CI 1.34 to 1.71, p < 0.0001). Respondents who were 10 or more years post graduation were 1.57 times or 57% more likely to specialise in general practice than all other Australian medical graduates (RR 1.57 95% CI: 1.40 to 1.79, p < 0.0001). Discussion: The University of Wollongong's medical school is producing graduates to meet Australia's rural health workforce needs. This may be due to a higher intake of rural students, and a higher percentage of students taking rural placements. Conclusions: Rural health workforce needs can be addressed through rural‐focussed education strategies. [ABSTRACT FROM AUTHOR]

Introduction: Addressing the imbalance of the health workforce between metropolitan and rural areas requires a clear understanding of trends in choices of work location of health care staff. Objective: Here, we provide an automated and highly reproducible protocol to examine the location of health care workers over multiple years using medical graduates as a case study. Design: Data linkage cohort study. The study cohort examined was University of Wollongong Medical graduates from 2010 to 2021 who were registered to practice in Australia. The main outcome measure was graduate location of practice in Modified Monash regsions MM1 or MM2–7 across multiple postgraduate years. This protocol used R Markdown. Findings: An automated and reproducible protocol was used to analyse choices of work location for the University of Wollongong's medical graduates. Over 90% of graduates were registered with AHPRA. Around 25%–30% of graduates were found to work in MM2–7 regions across their careers, exceeding the national average. Discussion: The protocol presented allows for a fast and reproducible analysis of work location by region for health care workers. This will allow comparisons of outcomes between universities or health professions. [ABSTRACT FROM AUTHOR]

Objectives: To assess the influence of geographic remoteness on health care utilization at end of life (EOL) by people with advanced cancer in a geographically diverse Australian local health district, using two objective measures of rurality and travel-time estimations to health care facilities. Methods: This retrospective cohort study examined the association between rurality (using the Modified Monash Model) and travel-time estimation, and demographic and clinical factors, with the receipt of >1 inpatient and outpatient health service in the last year of life in multivariate models. The study cohort comprised of 3546 patients with cancer, aged ≥18 years, who died in a public hospital between 2015 and 2019. Results: Compared with decedents from metropolitan areas, decedents from some rural areas had higher rates of emergency department visits (small rural towns: aRR 1.29, 95% CI: 1.07–1.57) and ICU admissions (large rural towns: aRR 1.32, 95% CI: 1.03–1.69), but lower rates of acute hospital admissions (large rural towns: aRR 0.83, 95% CI: 0.76–0.90), inpatient palliative care (PC) (regional centers: aRR 0.85, 95% CI: 0.75–0.97), and inpatient radiotherapy (lowest in small rural towns: aRR 0.07, 95% CI: 0.03–0.18). Decedents from rural and regional centers had lower rates of outpatient chemotherapy and radiotherapy use, yet higher rates of outpatient cancer service utilization (p < 0.05). Shorter travel times (10–<30 minutes) were associated with higher rates of inpatient specialist PC (aRR 1.48, 95% CI: 1.09–1.98). Conclusions: Reporting on a series of inpatient and outpatient services used in the last year of life, measures of rurality and travel-time estimates can be useful tools to estimate geographic variation in EOL cancer care provision, with significant gaps uncovered in inpatient PC and outpatient service utilization in rural areas. Policies aimed at redistributing EOL resources in rural and regional communities to reduce travel times to health care facilities could help to reduce regional disparities and ensure equitable access to EOL care services. [ABSTRACT FROM AUTHOR]

Background: Non-traumatic lower limb amputation rates are rising worldwide, resulting in increased hospitalisations and use of rehabilitation services. This study aimed to identify key comorbidities associated with prolonged length of stay or decreased functional gain for episodes receiving inpatient rehabilitation following non-traumatic lower limb amputation. Methods: Prospectively collected data submitted to the Australasian Rehabilitation Outcomes Centre were analysed. The cohort comprised episodes for patients (aged ≥18 years) discharged from inpatient rehabilitation between 1 July 2013 and 30 June 2018 following a non-traumatic lower limb amputation. Results: The cohort included 5074 episodes with an average age of 66.3 years and the majority being male (71.7%). Comorbidities affecting the ability to participate in rehabilitation were reported for 65.4% of episodes, most commonly diabetes mellitus (50.3%), cardiac disease (33.5%), and respiratory disease (10.1%). These comorbidities were associated with a prolonged length of stay and reduced functional improvement. Conclusion: This study showed comorbidities contribute to prolonged length of stay and poorer functional outcomes among those undergoing inpatient rehabilitation following non-traumatic lower limb amputation. Future research should focus on strategies to address these comorbidities to help improve patient outcomes and reduce healthcare costs. What is known about the topic? It is known that the presence of comorbidities contributes to lower limb amputation; however, the effect that comorbidities have on inpatient rehabilitation outcomes is not well reported. What does this paper add? This study identified five comorbidities (diabetes mellitus, cardiac disease, respiratory disease, renal failure with dialysis, and mental health problems) associated with prolonged length of stay and decreased functional outcomes following inpatient rehabilitation for non-traumatic lower limb amputation. What are the implications for practitioners? Our findings suggest practitioners should focus on strategies to address these comorbidities to help improve functional outcomes, reduce length of stay, and reduce healthcare costs. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is the leading cause of mortality in peritoneal dialysis (PD) patients. Infection is known to increase the risk of cardiovascular events (CVE); however, no studies have examined the association between PD peritonitis and CVE. Aim: To examine peritonitis as a risk factor for CVE in PD patients. Methods: This retrospective cohort study included all adults undertaking PD for ≥3 months in one Australian health district from 2001 to 2015. Baseline characteristics and peritonitis event information was obtained from the Australian and New Zealand Dialysis and Transplant registry. The Centre for Health Research Illawarra Shoalhaven Population facilitated data linkage using ICD10 coding to capture CVE information. Results: A total of 211 patients was included, with median age of 66 years (interquartile range 54.49–74.45); 64% were male. Peritonitis occurred in 114 (54%) patients and 65 (30.8%) patients experienced a CVE. Identified risk factors for CVE included: cerebrovascular disease (hazard ratio (HR) 2.72, 95% confidence interval (CI) 1.36–5.47), diabetes (HR 2.41, 95% CI 1.47–3.96), coronary artery disease (HR 1.67, 95% CI 1.01–2.77) and age (HR 1.03, 95% CI 1.01–1.06). There was no significant increase in risk of CVE following peritonitis (HR 1.37, 95% CI 0.81–2.32, P = 0.24), even when accounting for age, cerebrovascular disease, diabetes and existing coronary artery disease (HR 1.32, 95% CI 0.78–2.23, P = 0.30). Conclusions: We did not find an increase in the risk of CVE following a peritonitis episode in PD patients. This result may be due to small sample size or rapid peritonitis treatment mitigating cardiovascular risk. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess 15-year trends in unplanned readmissions in an Australian regional health service. Methods: Drawing on data held in the Illawarra Health Information Platform (IHIP), this longitudinal retrospective study of adults admitted to hospital between 2001–02 and 2015–16 assessed rates of unplanned all-cause readmissions within 30 days ('early') and 1–6 months ('late') following discharge. Rates were compared over time and between patient groups. Results: Age-adjusted early readmission rates declined over the 15 years by an average of 1.3% per annum, whereas late readmission rates increased by an average of 0.6% per annum. Together, there was an overall decline in readmission rates. The entire decline in early readmission rates and a reversal of the increasing trend in late readmission rates occurred since 2010–11. Similar trends occurred across age groups, but were most pronounced among those aged ≥75 years. Conclusions: The decline in readmissions since 2010–11 suggests that the region has achieved improvements in discharge planning and in continuity between hospitals and community-based care. These improvements have occurred across broad patient groups. The longitudinal and linked data held in the IHIP provides a unique opportunity to examine patterns of service utilisation at a regional level. What is known about the topic?: Published reports of longitudinal trends in readmissions are typically limited by short study periods and narrow criteria used to define study populations and readmissions. Australian longitudinal data suggest rates of early readmission have remained relatively unchanged in recent years, despite the focus on readmission rates as a metric to assess the quality and continuity of care. What does this paper add?: This unique longitudinal study reports on long-term readmission trends over 15 years to hospitals within a single geographic area, with trends reported for both early (30-day) and late (1- to 6-month) readmissions by age group and major diagnostic categories. The findings reflect more complex patterns than are typically reported in cross-sectional and more limited longitudinal studies. What are the implications for practitioners?: The results suggest improvements at a regional level that may be associated with care during the initial hospitalisation and discharge (reflected particularly in early readmissions) and in the community (reflected particularly in late readmissions). Future investigations will explore specific patient groups and the effects of specific initiatives, services and models of care to better predict those at risk of readmission and to inform translation locally and further afield. The relationship between readmissions and the use of ambulatory services (primary care, emergency department and out-patient) also warrants further investigation. [ABSTRACT FROM AUTHOR]

Background/Study Context: This longitudinal study was conducted between 1994 and 2004 in a cohort of southern Taiwan community-living older residents. The study aims to explore the trajectories of disability and how these patterns differed between respondents who survived and those who died during data collection phases; this study also investigated how health status change and social service use predicted the different trajectories of disability. Methods: Disability, chronic disease, depression, and social service usage data were collected over six waves. Clusters of disability were used to define a categorical response variable. Baseline levels and new occurrences of chronic disease and depression and the frequency of social service use during this period were chosen as the predictors of disability trajectories. Results: Changes in levels of disability during the aging process were identified. Different trajectories clearly reflected heterogeneity within disability clusters and between surviving and nonsurviving respondents. This study highlighted that hypertension and depression were predictors of increased disability among both surviving and nonsurviving respondents, whereas diabetes was only found to be a strong predictor of increased disability for the nonsurviving respondents. In addition, this study found that use of social services such as personal care, homemaker-household, and physical therapy were significantly associated with an increase in disability, whereas use of recreational services seemed to be associated with a decrease in disability. Conclusions: These findings identify disability to be a highly dynamic process, which can be characterized into different trajectory clusters (e.g., no, mild, and major disability clusters). A greater awareness of these trajectories could be used to better target strategies to prevent and/or manage disabilities in an aging population. [ABSTRACT FROM AUTHOR]

Background: Effective management of warfarin therapy is often challenged by its complex pharmacology and preventable adverse events. One strategy to ensure safe warfarin use is provision of comprehensive warfarin education to patients. Aim: To review the provision of warfarin education to hospital patients prescribed warfarin and to describe patient characteristics that may impact on warfarin education. Method: A prospective study was undertaken at 2 large Australian metropolitan hospitals. Provision of warfarin education was identified by auditing the medication charts and clinical notes of hospitalised older patients (≥ 65 years). Patients were also interviewed to confirm whether they recalled receiving warfarin education during their hospital stay. Results: Data were collected for 96 patients with a mean age of 74 (SD 13) years. Most patients (78%) were admitted to medical wards, were taking warfarin for atrial fibrillation (56%), and had started warfarin prior to admission (54%). 36% of patients had provision of warfarin education documented in medication charts and clinical notes, and in most cases warfarin education was provided by a pharmacist. Of the 68 patients available for interview, only 47% recalled receiving warfarin education; in the majority of cases they cited pharmacists as providers of the education. Conclusion: There is a need to improve documentation and provision of warfarin education to hospital patients. [ABSTRACT FROM AUTHOR]

While ‘public health medicine’ is a specialised field, most medical practitioners practice ‘public health’ to some extent, e.g., undertaking preventative screening tests or advising individuals about lifestyle interventions. While requirements to demonstrate capability in public health are common to medical education around the world, medical programs face a challenge to integrate public health education and promote health advocacy in an environment where the doctor: patient relationship is at the core of learning. Students who spend part of their medical education working within general practice or community settings have an opportunity to observe and identify issues of public health importance, and to see how they impact at both a personal and a population level. This paper aims to illustrate how a year-long research project can provide an opportunity for medical students to learn about public health issues and methods to investigate them. Analysis was undertaken of the research topics chosen by eight successive cohorts of medical students, representing 519 students, who successfully completed a research project. Over half of the student research projects (51.8%) directly related to Australian national health priority areas of dementia, obesity, arthritis and musculoskeletal conditions, asthma, diabetes, mental health, injury prevention and control, cardiovascular health and cancer control, and a further 28.5% of projects had a specific public health focus, within domains that include lifestyles and health, communicable disease, and healthy growth and development. Researching public health topics in the community setting represents a practical way to engage medical students in learning about public health, and can help to develop their potential to become ‘clinician researchers’, investigating and understanding issues relevant to their communities. [ABSTRACT FROM AUTHOR]

Abstract: This longitudinal study was conducted between 1994 and 2004 in a cohort of Southern Taiwan community-living elderly residents. The study aims to explore the trajectories of depression and how these patterns differed between respondents who survived and those who died during data collection phases; this study also investigated how health status change and health/social service use predicted the different trajectories of depression. Eight hundred and ten participants had completed all six waves of the survey or were followed-up at each wave until death in the prospective study in Kaohsiung City. Depressive symptoms were evaluated by the Short Psychiatric Evaluation Schedule (SPES). Changes in levels of depression during the ageing process were identified. Different trajectories clearly reflected heterogeneity within depression and the association with mortality. The study highlighted that diabetes, gastrointestinal problems, heart disease and disability, whether at baseline or as new occurrences, were predictors of health decline. High uses of health/social services were also predictive of increased depression. These findings identified depression as a highly dynamic process, characterized by different trajectories of depression between states of no, mild and severe depression. Greater awareness of these various trajectories should potentially improve the prevention and/or management strategies of depression. [Copyright &y& Elsevier]

Abstract: This study aimed to examine the effect of health-related service use on the development of functional disability in an older adult Taiwanese cohort. The sample population consisted of 871 participants without Instrumental Activities of Daily Living (IADL) disabilities, 1061 participants without Activities of Daily Living (ADL) disabilities and 817 participants without IADL and ADL disabilities at baseline. The onset of IADL and ADL disabilities were estimated as the follow-up survey year that these functional disabilities were first noted, or the follow-up survey year that the participant was noted as having died. A Cox proportional hazards model, with time-dependent covariates, was used to analyze the association between the time of onset of the functional disabilities and the health-related service use, after controlling for age, gender, education, marital status and time varying chronic disease status. This study found that an increase in the number of services used by the participants resulted in fewer IADL and ADL disabilities. Furthermore, participants who attended recreational programs, regular health examinations, and who received the information assistance and meal preparation were significantly less likely to develop disabilities. Participants who used one or more services were 55–77% less likely to be IADL disabled, and were 54–81% less likely to be ADL disabled, and were also 59–89% less likely to develop IADL and ADL disabilities as compared to those who used none. In the present study therefore, as the number of health services used increased the likelihood of developing a functional disability decreased. [Copyright &y& Elsevier]