Search

Background: Providing cultural education to health professionals is essential in improving the quality of care and outcomes for Aboriginal and Torres Strait Islander patients. This study reports the evaluation of a novel training workshop used as an intervention to improve communication with Aboriginal and Torres Strait Islander patients of persistent pain services. Methods: In this single-arm intervention study, health professionals undertook a one-day workshop, which included cultural capability and communication skills training based on a clinical yarning framework. The workshop was delivered across three adult persistent pain clinics in Queensland. At the end of the training, participants completed a retrospective pre/post evaluation questionnaire (5 points Likert scale, 1 = very low to 5 = very high), to rate their perceived importance of communication training, their knowledge, ability and confidence to communicate effectively. Participants also rated their satisfaction with the training and suggested improvements for future trainings. Results: Fifty-seven health professionals were trained (N = 57/111; 51% participation rate), 51 completed an evaluation questionnaire (n = 51/57; 90% response rate). Significant improvements in the perceived importance of communication training, knowledge, ability and confidence to effectively communicate with Aboriginal and Torres Strait Islander patients were identified (p < 0.001). The greatest increase was in the perceived confidence pre-training mean of 2.96 (SE = 0.11) to the post-training mean of 4.02 (SE = 0.09). Conclusion: This patient-centred communication training, delivered through a novel model that combines cultural capability and the clinical yarning framework applied to the pain management setting, was highly acceptable and significantly improved participants' perceived competence. This method is transferrable to other health system sectors seeking to train their clinical workforce with culturally sensitive communication skills. [ABSTRACT FROM AUTHOR]

Background and purpose: The sustainability of physiotherapy clinical placements is an ongoing challenge, yet there is potential to increase placement capacity within the private practice sector. Barriers to hosting students, including perceived impacts on patient care, reportedly limit the uptake of hosting students within this setting. This study aimed to evaluate the effect of physiotherapy student involvement on patient‐reported Global Rating of Change (GRoC) in Australian physiotherapy private practice care. Methods: A cross‐sectional, patient survey study was conducted in three private physiotherapy practices over two 5‐week periods. At their completion of care, participants completed the survey seeking demographic information, GRoC and aspects of care including number of consultations involving students, proportion of physiotherapy time involving students and frequency of student involvement in treatment delivery. After accounting for clinic‐level differences, ordinal logistic regression analyses were performed to explore the impact of supervised student care on GRoC. Results: 119 participants across three practices completed the survey. There were no significant associations between patient‐reported GRoC and: (1) student involvement in patient care; (2) number of consultations involving students; (3) proportion of physiotherapy time involving students; or (4) frequency of student involvement in treatment delivery (p > 0.05). Conclusions: Supervised student care in private physiotherapy practice does not appear to have a detrimental impact on patient‐reported outcomes. These findings may address concerns relating to student involvement in patient care within this setting. Future research should address economic and service delivery impacts of supervised student care on private practices. [ABSTRACT FROM AUTHOR]

Objective. Identifying and quantifying the health needs of a population are the basis of evidence-based health policy and workforce planning. The motivation for undertaking the present study was to evaluate whether the current level of medication review services corresponds to population need, as proxied by the rate of polypharmacy, and to undertake a preliminary analysis of the sufficiency of the current workforce. This paper: (1) estimates the age- and sex-standardised rates of polypharmacy as a proxy for population need for home medicines review; (2) compares the rate of polypharmacy with current service provision of home medicines reviews; and (3) links the estimated need for services with the current number and location of pharmacist providers. Methods. Age- and sex-adjusted polypharmacy rates, by state, were estimated from the National Health Survey of Australia (2017-18), service levels were estimated from national-level administrative claims data (2017-18) and the current workforce was estimated from the Australian Association of Consultant Pharmacists (2018). The current level of service provision was compared to the estimated population need for services, alongside the size of the pharmacy workforce required if need was met. Results. The adjusted rate of polypharmacy in Australia, using the strictest definition of 10 medications and 3 current chronic illnesses, was 1389 per 100 000 population. The illustrative needs-based analysis suggests that there may be a disconnect between the current level of service provision and population health needs. Conclusion. Given that polypharmacy is a risk factor for medication-related problems, and that medication review is one of the few targeted strategies currently available to address medication-related problems in the population, service provision may be inadequate. Policy options to improve service provision could include interventions to increase workforce productivity and relaxing the current eligibility criteria for review, especially in rural and remote areas. [ABSTRACT FROM AUTHOR]

The article offers information on the inter-rater agreement in Traditional Chinese Medicine (TCM). Topics discussed include role the symptoms of the patient play in deciding the pattern of diagnosis, arguments for not using the Fleiss Kappa statistic as a test of agreement in TCM, and details of the instrument Popplewell developed to address the problem of low diagnostic agreement in TCM studies.

The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase. [ABSTRACT FROM PUBLISHER]

The article points out some of the lessons that can be learned by Canadian policy makers on the financial support and delivery of oral health care provided by Australia, Great Britain, New Zealand, and the U.S. According to the authors, government expenditures per capita on oral health care in Canada are high compared with the four countries. They add that countries in North America support publicly funded oral health programs for children.

Objectives: Choosing between reusable instruments (RIs) and disposable instruments (DIs) for dental care provision requires a careful consideration of costs and their contributing factors, alongside other choice criteria. This study aimed to assess the current use of instruments in the West Moreton Oral Health Service (WMOHS) in Queensland, Australia, with a broader goal of informing future practice in this and comparable organizations., Methods: A cost model was developed reflecting costs arising from procurement, reprocessing and disposal, depending on the RI and DI composition of instrumentation. The current practice in WMOHS was compared to modular (RI-only and DI-only) strategies by considering four standard instrument sets (examination, simple extraction, surgical extraction, restoration) and the annual use of instruments in the organization at large. The use of resources (water, electricity) and emissions (waste) were quantified for each strategy. The robustness of findings was explored across a range of scenarios that involved varying instrument prices, lifespans, factors impacting on the cost of reprocessing (labour, water, energy), the cost of waste disposal and couriering., Results: At the organization level, the current mix of instruments (A$1.28 m per year) was 4% more costly than the lower cost, RI-only alternative (A$1.23 m). However, with lower DI prices or higher labour costs current practice would become the lowest cost option. Results for specific instrument sets varied by service type. DI-only offered the lowest cost option for oral examinations (A$6.29), and the current practice of mixed instrumentation for simple extractions (A$16.56). RI-only sets were less costly in more resource intensive procedures such as surgical extractions (A$40.19) and restorations (A$43.83). In terms of environmental impacts, the use of instruments based on current practice required 37% of water and energy use of an RI-only alternative and generated 36% waste of the DI-only alternative., Conclusions: Reusable instruments are generally less costly than DIs, but for specific instrument sets the outcome depends on the type of procedure. In some circumstances, mixed instrumentation can provide the lowest cost alternative. While the WMOHS instrument mix used in current practice does not minimize cost for the provider, it may be justified in light of operational risks, logistics and uncertainty regarding cost factors., (© 2022 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Background: In the face of rapidly ageing populations and increasing costs of health care provision, questions continue to be raised about the long-term sustainability of publicly funded health care programmes around the world. But despite increasing evidence of dynamic changes in epidemiology, most official health service planning models continue to rely on the implicit assumption that age-specific requirements for services (and by implication age-specific needs for care) will remain constant across future years ('constant-use models')., Objectives: In this paper, we discuss the advantage of dynamic 'changing needs' planning models, compared to 'constant-use' planning models, and consider a framework that integrates population needs directly into health service planning. Using Australian survey data, we empirically illustrate the difference between static health service planning approaches to dynamic needs-driven planning models., Methods: We use data from the Household, Income and Labour Dynamics Survey in Australia (HILDA) to explore trends in health needs from 2001 to 2020. We subsequently simulate a 'changing-needs' planning model where changes in health needs by birth-cohorts are incorporated into official government estimates from the Australian Intergenerational Reports (IGR) to understand the potential impact on future health care requirements., Results: Our results show that healthy ageing trends are being observed for successive birth-cohorts with these trends greatest in older age groups, the age groups for which health care expenditures are largest. Adjusting for these changes in needs using Australian data leads to reductions in the expenditures required for future years ranging from 1.5 (2.50%) to 3 billion (5.25%) 2019 AUD., Conclusion: We conclude that 'constant-use' planning models based on the expected future numbers of people in different age groups applied to current levels of service use by age groups without any consideration given to changing age-specific needs for health care lead to inefficient resource planning., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Despite considerable academic and policy interest in the taxation of sugar-sweetened beverages (SSBs), its extra-health implications remain largely unexplored. We investigated the impact of an SSB tax on school absenteeism due to improved dental health, in a framework that accounted for the distribution of the benefit. We designed a quantitative, decision-analytic model that synthesised existing evidence in the areas of dental epidemiology, public health and economics, and simulated causal mechanisms that lead to changes in school attendance in Australian children and adolescents aged 6-17, in a tax vs no tax scenarios. Introducing a 20% sales tax on SSBs would result in a 0.73% (95% confidence interval: 0.38; 1.10), or 4684 (2412; 7071) days per year nationwide, reduction in school absences attributable to dental health reasons. While positive impacts would be seen across the board, the distribution of benefit was favourable towards boys, older teens and those from lower socio-economic status. Our study highlights the need for, and the viability of, quantifying distributions of direct and indirect consequences of public health policy. Despite modest effect size, the equity profile of SSB tax, the long-lasting benefits of educational gains, and potential synergies with other interventions, make it an attractive option for policymakers to consider.

Background: Despite perceived economic barriers to hosting physiotherapy students in private practice settings, no research to date has investigated the effect of hosting students on service delivery and income during clinical placements., Objectives: The aim of this study was to determine the effect of student placement provision on service delivery and income in private practice settings., Methods: A retrospective economic analysis using a temporal synthetic control period was undertaken. Physiotherapy private practices who had hosted at least one pre-registration physiotherapy student with a matched control period in the subsequent or previous year were invited to participate. Direct service and economic comparisons were conducted across five-week periods and individual placement weeks., Results: No significant differences in occasions of service and income were found when students were hosted and not hosted, and this remained non-significant after controlling for practice-specific characteristics. The overall mean income per practice was higher for week one of the student placement (95% CI: 657.35 to 1240.95) as compared to week one of the control period, but this finding was not significant. Overall mean income per practice was significantly higher in weeks two to five of the student placement (95% CI: 29.03 to 1732.19) when compared to weeks two to five of the control period., Conclusion: Hosting pre-registration physiotherapy students within private practice settings is not associated with a reduction in service and economic outcomes. Hosting physiotherapy students has a positive economic effect following their initial placement week., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Toyohari meridian therapy (TMT) is a Japanese system of acupuncture. Acupoint selection follows diagnosis of the primary and secondary patterns of disharmony (sho) and disturbances in the yang channels. Pulse diagnosis and abdominal palpation diagnosis are the two main diagnostic methods used. Little is known about the reliability of pulse, abdominal, and pattern diagnosis in TMT. This is important since diagnosis of the sho determines acupoint treatment. If diagnosis is unreliable, there can be less confidence that the patient will receive optimal treatment., Objective: The objective of this study is to assess the level of agreement between two TMT practitioners on pulse diagnosis, abdominal diagnosis, and diagnosis of the primary and secondary sho., Methods: An inter-rater reliability study was conducted. Two (2) TMT practitioners separately conducted a TMT examination and completed an assessment form, choosing from a range of possible responses relating to pulse characteristics, abdominal diagnosis, and diagnosis of primary sho and secondary sho. The kappa coefficient was used as a measure of inter-rater reliability of the outcome variables., Results: Sixty-two (62) Australians (22 males, 40 females) aged 20-65 years participated (mean age 49.2 +/- 12.2 years). Level of agreement for pulse diagnosis was 57%, 61%, and 77% for pulse depth, speed, and strength, respectively. For abdominal diagnosis, the level of agreement for involvement of the Lung, Kidney, Spleen, and Liver abdominal regions was 58%, 53%, 35%, and 10%, respectively. The overall level of agreement on primary sho diagnosis was 48% and for secondary sho diagnosis, 44%., Conclusions: Overall, there was a reasonable level of agreement on basic pulse characteristics and on abdominal diagnosis for two of the abdominal regions. Level of agreement on primary and secondary sho diagnosis suggests room for improvement. Further studies are required in order to gain a greater understanding of the reliability of diagnosis in TMT.