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Background: Traditionally, general practitioners (GPs) have initiated the need for, and ordered, radiological tests. With the emergence of consumer-centred care, patients have started to request scans from doctors on their own initiative. Consumeristic health care has shifted the patient–doctor dyadic relationship, with GPs trending towards accommodating patients' requests. Methods: A mixed method analysis was conducted using a survey instrument with open ended questions and concurrent interviews to explore participants' responses from their requests for radiological studies from GPs. Themes emerging from both qualitative and quantitative methodologies were mapped onto the Andersen Newman Model (ANM). Results: Data were analysed for 'predisposing,' 'need' and 'enabling' elements of the ANM model and were correspondingly mapped to patient's requests for radiological referrals according to the elements of the ANM. Participants expressed anxiety about their health, were confident in the types of radiological scans they desired and typically indicated the need for evidence of good health. Their desire for such requested scans was often enabled through prior exposure to health information and the experience of specific symptoms. Requests came with the expectation of validation, and if these requests were denied, participants indicated that they would seek another doctor who would oblige. Conclusions: In our modest study of Australian patients, participants were well informed about their health. Exposure to information seems to create a sense of anxiousness prior to visiting the doctor. Individuals sought visual proof of wellness through imaging, and doctors in return often accommodated patient requests for radiological studies to appease patients' needs and to maintain workflow. With increased availability of online health information, individuals are more educated about managing their health care. Our study investigates patients requesting their own radiological scans rather than relying on their doctors' expertise. We explore participant responses to clinical encounters where they have initiated a radiological study from their general practitioner, and their self-reported responses and outcomes from such requests. [ABSTRACT FROM AUTHOR]

Aim: Globally, burns remain a significant public health issue that disproportionately affect young children. The current study examines the 10-year epidemiological profile of burn hospitalisations, hospital treatment cost and health outcomes by age group for children ≤16 years in Australia.Methods: National, population-based, linked hospital and mortality data from 1 July 2002 to 30 June 2012 were used to identify burn-related hospitalisations. Age-standardised hospitalisation rates and hospital treatment costs were estimated.Results: There were 25 098 children aged ≤16 years hospitalised after sustaining a burn. The age-standardised hospitalisation rate was 54.4 per 100 000 (95% confidence interval (CI): 53.7-55.1). Children aged 1-5 years had the highest burn hospitalisation rate (105.6 per 100 000; 95% CI: 103.8-107.3). The burn hospitalisation rate of infants <1 year declined by 3.1% per annum (95% CI: -4.84, -1.37, P < 0.001). Contact with heat and other substances, hot drinks, food, fats and cooking oils was the most common burn mechanism, and the home was the most common place of occurrence for children ≤10 years. Exposure to the ignition of highly flammable material was the most common burn mechanism for children aged 11-16 years. There were 7260 hospital readmissions within 28 days and 11 deaths within 30 days of the index burn hospitalisation. Total hospital treatment costs were estimated at $168 million.Conclusions: Childhood burns continue to account for a large proportion of hospitalised morbidity. To assist in reducing burn hospitalisations, the development, implementation and resourcing of national multi-sectorial childhood injury prevention is needed in Australia. [ABSTRACT FROM AUTHOR]

Background: Australia and New Zealand have the highest incidence of colorectal cancer (CRC) in the world, presenting considerable health, economic, and societal burden. Over a third of the Australian population live in regional areas and research has shown they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. The extent to which geographical disparities exist in CRC management and outcomes has not been systematically explored. The present review aims to identify the nature of geographical disparities in CRC survival, clinical management, and psychosocial outcomes.Methods: The review followed PRISMA guidelines and searches were undertaken using seven databases covering articles between 1 January 1990 and 20 April 2016 in an Australian setting. Inclusion criteria stipulated studies had to be peer-reviewed, in English, reporting data from Australia on CRC patients and relevant to one of fourteen questions examining geographical variations in a) survival outcomes, b) patient and cancer characteristics, c) diagnostic and treatment characteristics and d) psychosocial and quality of life outcomes.Results: Thirty-eight quantitative, two qualitative, and three mixed-methods studies met review criteria. Twenty-seven studies were of high quality, sixteen studies were of moderate quality, and no studies were found to be low quality. Individuals with CRC living in regional, rural, and remote areas of Australia showed poorer survival and experienced less optimal clinical management. However, this effect is likely moderated by a range of other factors (e.g., SES, age, gender) and did appear to vary linearly with increasing distance from metropolitan centres. No studies examined differences in use of stoma, or support with stomas, by geographic location.Conclusions: Overall, despite evidence of disparity in CRC survival and clinical management across geographic locations, the evidence was limited and at times inconsistent. Further, access to treatment and services may not be the main driver of disparities, with individual patient characteristics and type of region also playing an important role. A better understanding of factors driving ongoing and significant geographical disparities in cancer related outcomes is required to inform the development of effective interventions to improve the health and welfare of regional Australians. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to describe post-discharge outcomes, and determine predictors of 3 and 6 months health status outcomes in a population of trauma patients at an inner city major trauma centre. Methods: This was a prospective cohort study of adult trauma patients admitted to this hospital with 3 and 6 months post-discharge outcomes assessment. Outcome measures were the Physical Component Scores (PCS) and Mental Component Scores (MCS) of the Short Form 12, EQ-5D, and return to work (in any capacity) if working prior to injury. Repeated measures mixed models and generalised estimating equation models were used to determine predictors of outcomes at 3 and 6 months. Results: One hundred and seventy-nine patients were followed up. Patients with lower limb injuries reported lower mean PCS scores between 3 and 6 months (coefficient −4.21, 95 % CI −7.58, −0.85) than those without lower limb injuries. Patients involved in pedestrian incidents or assaults and those with pre-existing mental health diagnoses reported lower mean MCS scores. In adjusted models upper limb injuries were associated with reduced odds of return to work at 3 and 6 months (OR 0.20, 95 % CI 0.07, 0.57) compared to those without upper limb injuries. Discussion: Predictors of poorer physical health status were lower limb injuries and predictors of mental health were related to the mechanism of injury and past mental health. Increasing injury severity score and upper limb injuries were the only predictors of reduced return to work. The results provide insights into the feasibility of routine post-discharge follow-up at a trauma service level. [ABSTRACT FROM AUTHOR]

Objective Little is known about whether rural-urban differences exist in patients after hip and knee joint replacement surgery. We compared patient characteristics, pain and functional outcomes of rural and urban patients undergoing joint replacement surgery in a single high-volume metropolitan centre. Design Prospective cohort study conducted in patients who underwent primary elective hip ( THJR) or knee replacement ( TKJR) between 1 January 2006 and 31 December 2009. Setting A university-affiliated tertiary referral centre situated in the central metropolitan region of Melbourne, Australia. Participants One thousand nine hundred fifty-five consecutive patients undergoing primary total joint replacement. Main outcome measure Pain and function were assessed preoperatively and 12 and 24 months postoperatively. The main independent variable was geographic location specifically comparing patients residing in rural/regional compared with urban communities. Results A total of 2193 primary joint replacements were performed (981 THJR and 1212 TKJR) in 1955 patients. Rural patients presented at a younger age and with earlier radiographic disease than their urban counterparts. There was a higher rate of rheumatoid arthritis among rural patients presenting for TKJR. There was no difference in pain and function scores between groups at 12 and 24 months post-surgery. Conclusion In our series of 1955 patients undergoing total hip and knee joint replacement surgery, rural patients presented at a younger age and an earlier stage of disease progression. At 24 months, rural patients had pain and functional outcomes as good as their urban counterparts. More research is required to determine which factors lead to the early presentation of rural patients. [ABSTRACT FROM AUTHOR]

Background Disease registries assist with clinical practice improvement. The Australian Stroke Clinical Registry aims to provide national, prospective, systematic data on processes and outcomes for stroke. We describe the methods of establishment and initial experience of operation. Methods Australian Stroke Clinical Registry conforms to new national operating principles and technical standards for clinical quality registers. Features include: online data capture from acute public and private hospital sites; opt-out consent; expert consensus agreed core minimum dataset with standard definitions; outcomes assessed at 3 months poststroke; formal governance oversight; and formative evaluations for improvements. Results Qualitative feedback from sites indicates that the web-tool is simple to use and the user manuals, data dictionary, and training are appropriate. However, sites desire automated data-entry methods for routine demography variables and the opt-out consent protocol has sometimes been problematic. Data from 204 patients (median age 71 years, 54% males, 60% Australian) were collected from four pilot hospitals from June to October 2009 (mean, 50 cases per month) including ischaemic stroke (in 72%), intracerebral haemorrhage (16%), transient ischaemic attack (9%), and undetermined (3%), with only one case opting out. Conclusion Australian Stroke Clinical Registry has been well established, but further refinements and broad roll-out are required before realising its potential of improving patient care through clinician feedback and allowance of local, national, and international comparative data. [ABSTRACT FROM AUTHOR]

Objectives: To assess health outcomes of home follow-up visits after postpartum discharge and assess relationships between the number of home visits and selected outcomes among women who gave birth at two Queensland, Australia, regional hospitals. Design: A cross sectional study. Services provided during the home visits were responsive to a woman's need rather than having a structured protocol of services. Main Outcome Measures: The four measured health outcomes were: 1) postpartum depression; 2) confidence to undertake maternal roles; 3) breastfeeding; and, 4) satisfaction with postpartum care. Results: Of 210 women who were invited to participate in the study, 143 (68.1%) provided information. Women who received a higher number of home visits had significantly lower confidence to undertake maternal roles than those who received fewer home visits. There was a positive correlation between the number of home follow-up visits and postpartum depression among women who gave birth at one hospital (Hospital B), but not at the other (Hospital A). No relationship was found between the home postpartum visits and the other outcomes. Conclusion: These results could be explained in that home follow-up visits were offered to all women at Hospital A while Hospital B only provided home visits to women who had a health risk due to their social, physical and psychological characteristics. The lack of protocol home visits and the characteristics of women receiving the visits were probably the major factors which influenced these limited beneficial outcomes. [ABSTRACT FROM AUTHOR]

Understanding barriers to healthcare access is a multifaceted challenge, which is often highly diverse depending on location and the prevalent surroundings. The barriers can range from transport accessibility to socio-economic conditions, ethnicity and various patient characteristics. Australia has one of the best healthcare systems in the world; however, there are several concerns surrounding its accessibility, primarily due to the vast geographical area it encompasses. This review study is an attempt to understand the various modeling approaches used by researchers to analyze diverse barriers related to specific disease types and the various areal distributions in the country. In terms of barriers, the most affected people are those living in rural and remote parts, and the situation is even worse for indigenous people. These models have mostly focused on the use of statistical models and spatial modeling. The review reveals that most of the focus has been on cancer-related studies and understanding accessibility among the rural and urban population. Future work should focus on further categorizing the population based on indigeneity, migration status and the use of advanced computational models. This article should not be considered an exhaustive review of every aspect as each section deserves a separate review of its own. However, it highlights all the key points, covered under several facets which can be used by researchers and policymakers to understand the current limitations and the steps that need to be taken to improve health accessibility.

Context: Many people with Whiplash Associated Disorder (WAD) seek treatment though a compensation system where factors such as legal involvement have been reported as having a negative impact on recovery outcomes., Objective: To compare those with and without legal involvement in their compensation claim, and identify associations with legal involvement at 12 months post injury; and longer term disability., Study Design: Inception cohort study., Participants: 246 people with WAD compensation claim., Outcome Measures: Legal involvement and Functional Rating Index at 12 months post injury., Methods: Participants were recruited from an insurance database. Baseline health (Functional Rating Index, Pain Catastrophising Scale and SF-36), socio-economic, work capacity, and claims data were collected within three months of injury and 12 months. Logistic regression models were used to identify associations with legal involvement at 12 months; and disability (FRI) at 12 months., Results: At baseline 246 participants were enrolled into the study in a median 72 days post injury. At 12 months post injury 52 (25%) had engaged a lawyer. The significant independent associations with legal involvement at 12 months were higher levels of initial disability, work disability, speaking a language other than English at home and lower levels of mental health. Specifically, the odds of lawyer involvement at 12 months post injury was 4.9 times greater for those with work disability; 2.3 times greater for those who spoke a language other than English at home. In terms of health, they had poorer mental health and for every 10 unit increase in the baseline FRI score the odds of having lawyer involvement increased by 38%. DISABILITY: at 12 months (FRI) was significantly independently associated with, PCS-helplessness (p<0.001), age (p<0.001) and prior claim (p=0.001)., Conclusion: This study suggests the people with lawyer involvement in their claim 12 months after injury have socio-economic disadvantage, have had a prior claim and a worse baseline health profile compared to those without a lawyer. Understanding this profile could allow for improved claims processes and targeted interventions to assist this group through any perceived complexities in the system and address the underlying reasons for lawyer participation within compensation schemes., (Copyright © 2015 Elsevier Ltd. All rights reserved.)