Australian Health Ministers Research Articles

The need for improved Australian data on social determinants of health inequities

The need for improved Australian data on social determinants of health inequities

PCN223 Recommendations For The Collection Of Patient-Reported Outcomes (PRO) Data In The Post-Progression And Post-Treatment Setting Following Oncology Clinical Trials

Patient-reported outcomes (PROs) in the post-progression and post-treatment setting are important for continued understanding of the patient experience following oncology clinical trials. This research aims to summarize published literature and recommendations for the collection of PRO data post-progression and the use of this data in HTA decision-making. A targeted literature review was performed to identify publications from within the last 5 years. A search was performed on the Food and Drug Administration (FDA), European Medicines Agency (EMA) and various HTA agency websites for guidelines or recommendations. The literature review yielded 14 publications that were included in the analysis, with recommendations for protocol considerations, leveraging technology to facilitate data collection, prespecifying statistical analysis plans, and detailing causes of missing data. EMA advises that study duration should robustly support planned analysis and that PROs should be collected after progression to compare trends over time, where feasible. FDA advises that patients who fail to report due to dropout or treatment discontinuation should continue to provide PRO data, and the protocol should state how this data will be collected if withdrawal is unavoidable. The Australian Health Ministers’ Advisory Council highlights the need for further understanding of the transition between and after active treatment of cancer. The 8 HTA agencies reviewed did not provide specific recommendations for collection of this data. Continued collection of PRO data after disease progression and study treatment gives valuable insight into patients’ experiences, even as they experience changing health states. It also provides a comprehensive interpretation of disease and treatment-related impacts and is utilized by regulators and HTAs to differentiate treatments and contextualize study results, as well as patients and physicians to inform treatment selection. Current recommendations provide valuable insight, however, more guidance is needed to thoroughly inform PRO collection in this setting.

Aboriginal dental assistants can safely apply fluoride varnish in regional, rural and remote primary schools in New South Wales, Australia.

There are significant inequalities in oral health status between Aboriginal and non-Aboriginal children in Australia, particularly where the children have insufficient access to various forms of fluoride. There has been a growing interest in seeing fluoride varnish programs used more widely for Aboriginal children due to proven effectiveness. Despite this, there has been limited scale-up of these programs in Australia. This study investigates the feasibility of using Aboriginal dental assistants to provide regular fluoride varnish applications for Aboriginal children in the primary school setting. A mixed-methods approach including auditing the number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish, and collection and reporting of participant data on the each of the fluoride varnish days in the local patient management system. Six Aboriginal Community Controlled Health Services from regional NSW were invited to participate in the study. They also nominated a primary school and an Aboriginal dental assistant to participate in the study. Data were obtained from four 'fluoride varnish days' held at the schools over a 12-month period between December 2017 and December 2018. The number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish is also reported. In total, 8 Aboriginal dental assistants were trained to apply fluoride varnish during the study. Overall, students participating in the study received three or more fluoride varnish applications. Results showed that Aboriginal dental assistants are able to safely and effectively apply fluoride varnish in a school setting with remote supervision. This program can be scaled at the state level in NSW, and this could provide the basis for a nationally consistent program. Initial discussions have been held with several jurisdictions to lead this process via the Australian Health Ministers Advisory Council (AHMAC) based on the results of this study and the support of key stakeholders. The Poche Centre as part of its scale-up planning for the Fluoride Varnish Program is examining the feasibility of including the apply fluoride varnish skillset in its existing Aboriginal Dental Assistant Scholarship Program.

Transvaginal mesh, gender and the ethics of clinical innovation.

On 10 October 2018, Australian Health Minister Greg Hunt issued a national apology to the Australian women who experienced 'horrific outcomes' following surgery using transvaginal mesh-acknowledging the 'historic agony and pain that has come from mesh implantation'. This apology followed many decades of 'innovative' use of transvaginal mesh for the treatment of pelvic organ prolapse. We use the case of transvaginal mesh to explore how clinical innovation may not only harm patients, but also entrench vulnerability and exacerbate existing inequities-in this case, those relating to gender.

Acting in the Public Interest: Learnings and Commentary on the Occupational Licensure Literature

There is increased interest in reforming the way occupations are licensed. However, most of the current dialogue focuses on the rapid growth in the number of people who need a license to pursue their chosen occupation. Consequently, significant questions are being raised as to the appropriateness of such requirements for groups that do not appear to present any tangible threat to public safety. Recent research has demonstrated that health professions have failed to articulate the need and value for licensure and how health regulators are addressing the many concerns being raised by the current debate. This study identifies dimensions or aspects of nurse licensure congruent with acting in the public interest and starts to curate (ie, to select, organize, and present) evidence related to each dimension, thereby identifying the current impact and highlighting opportunities for further research. This study utilizes a mixed-methods approach that combines documentary analysis, focus group discussion, and related literature associated with the various dimensions of acting in the public interest to highlight how nurse licensure addresses the current drivers for regulatory reform. A total of 99 documentary sources (ie, papers, articles, reports, and opinion editorials) were uploaded to NVivo 11 Plus for analysis. The analysis generated four overarching themes: (a) licensure reform, (b) impact of occupational associations, (c) occupational licensure issues, and (d) contemporary issues. Associated with these themes, 22 subthemes were also identified. The findings demonstrate there is clear evidence to support the fact that nurse regulators are acting in the public interest. However, further research is needed to provide definitive evidence to inform best practices in regulation and to offer direction for improved nurse regulatory reform. Furthermore, it is suggested that nurse regulators create and effectively maintain a global community capable of learning from one another and driving continuous improvement to better serve the public.

Learning from the past, looking to the future - Is there a place for injectable opioid treatment among Australia’s responses to opioid misuse?

In the 1990s, a trial of prescribing pharmaceutical heroin for people with opioid-dependence had support from Australian State Health Ministers. However, in 1997 the proposal was vetoed by the federal Prime Minister in face of a negative tabloid media campaign. The debate then shifted to abstinence-orientated treatments. Later on, reduced heroin availability took opioid-related harms away from public sight. In this commentary, we aimed to explore the current need and the options to implement such program, lately referred to as supervised injectable opioid treatment (SIOT), in Australia. We argue that with the aging populations of opioid-dependent people who have not benefited from existing treatment options, increased misuse of prescription opioids, rising overdose rates, and the risk of unfolding overdose crisis, it seems timely to pilot SIOT here. Since the 1990s, seven RCTs as summarised in two systematic literature reviews, demonstrated that SIOT is effective for treatment-resistant opioid dependence. A sustainable SIOT model should, however, respond to key concerns related to its delivery, such as the lack of a patient exit strategy and the high cost of indefinite treatment. Evidence from long-term studies seem to support the notion that SIOT could be provided as a medium duration treatment (as opposed to short-term or indefinite), with the clear aim to stabilise patients, gradually wean them off injectable medication and transfer to opioid assisted treatment (OAT). Also, SIOT could be integrated into the existing public OAT clinics in Australia. This would reduce costs, but also provide a more patient-centred response to opioid dependence and further improve the acceptability and efficiency of OAT. The controversy that developed in the past should be mitigated by advances in research since the first Australian enquiry, use of a registered medication (open-label hydromorphone) rather than pharmaceutical heroin, and setting up clear treatment aims.

Using Australia’s National Data Linkage Demonstration Project (NDLDP) to improve cardiac care: Towards a national, whole-of-population linked data resource for evidence-informed health policy

IntroductionIn Australia, the Commonwealth, State and Territory governments are each responsible for specific aspects of health care. Historically, cross-jurisdictional health data have not been linked routinely, resulting in significant blind spots in our understanding of the interplay between hospital and primary care, a major impediment to evidence-informed health policy.
 Objectives and ApproachIn December 2016, the Australian Health Ministers’ Advisory Council approved the NDLDP, to establish the value of national linked data to inform health planning and policy. The Australian Institute of Health and Welfare (AIHW) linked five years of hospital, emergency department, pharmaceutical dispensing, medical services claims and mortality data for Australia’s two most populous states (New South Wales and Victoria). The Victorian Agency for Health Innovation (VAHI) is leading the ‘Delivering better cardiac outcomes: Primary, specialist and hospital care’ project to demonstrate the value of the collection in identifying evidence-practice gaps and driving change in cardiac care.
 ResultsThe NDLDP combined data for over 10 million individuals with over 7 billion records of health transactions, utilising a new strategy for confidentialising dates to protect patient privacy. The NDLDP is governed by a Steering Committee; the AIHW is the data custodian approving outputs from analyses within a secure host environment. VAHI established a Project Steering Committee to oversee roll-out, governance and capacity building of the approved cardiac project.
 The VAHI project was instigated by evidence that best-practice pharmacological treatments for cardiac care are underutilised in Australia, but with no quantification of the population-level extent of this gap. The project quantified significant variations and underuse of post-discharge pharmacological care for patients admitted to hospital with key cardiac conditions, including atrial fibrillation and acute myocardial infarction.
 Conclusion/ImplicationsThis collaboration between government, clinical networks and academic researchers demonstrated this novel data linkage can enable evaluation of patient care pathways across both hospital and community-based services. These linked data resources provide essential information to investigate variation in care in Australia and improve care integration in cardiac care and beyond.

Neoliberal Mental Health Policy Reform in Australia

This paper examines the process of Australian mental health policy reform and explores the extent to which they reflect neoliberal ideals. The mental health policy reform has begun with the National Mental Health Strategy was agreed by Australian Health Ministers following the establishment of the National Mental Health policy in 1992. The National Mental Health Strategy has provided the overarching policy framework that has guided and extensive process of mental health reform in Australia for the last 25 years. The National Mental Health Strategy has been in place including the National Mental Health Policy(1992), the National Mental Health Plan(1993~2020), COAG National Action Plan on Mental Health(2006~2011), the Roadmap for National Mental Health Reform 2012~2022. It argues, through the process of Australian mental health reform, that the families of people with mental health problems have been reconstructed as a fundamental source of informal care. The development of community care and informal care in Australian mental health policy reform reflect a neoliberal understanding of the individual and their family, one that views the family as an autonomous unit responsible for its own maintenance.

The national health genomics policy framework

Genomic technology holds promise for faster and more accurate diagnosis of disease, better disease prevention and targeted medical care for Australians, but its integration into Australia's health system is not without challenges. To address this, at the Council of Australian Governments Health Council (CHC) meeting of November 2017, Australian Health Ministers agreed on Australia’s first National Health Genomics Policy Framework (the Framework). The Framework will capitalise on emerging genomic knowledge by better integrating genomics into the Australian health system. The Framework is focused on a whole-of-governments and system-focused approach with the public at its core. Australian Governments are dedicated to implementing the Framework and to guiding the integration of genomics into healthcare so that its benefits may be delivered in an ethical, sustainable and equitable way. As such, the Health Ministers also agreed to the development of an Implementation Plan for their Framework for CHC consideration in the first half of 2018.

OP65 Genomics: From Horizon Scanning To National Health Policy

Introduction:Technology advances have resulted in cheaper and quicker genomic sequencing (panels, exomes, whole genomes). Uptake into clinical practice has been rapid despite limited consideration of workforce, patient safety, consent, practice standards, guidelines and cost benefit. AUD 150M (USD 113M) has been independently allocated to genomic initiatives by Australian state and federal governments that don't reflect a national approach to genomics.Methods:Modified horizon scanning (HS) methodology identified issues around genomic sequencing to be considered by governments regarding their support, or otherwise, before appropriate implementation and diffusion into local healthcare systems. A national jurisdictional advisory group was subsequently established that undertook extensive stakeholder consultation across Australia, including written submissions, over a four-month period.Results:HS identified that genomic sequencing is diffusing rapidly through the health system and flagged issues of pressing concern, including: workforce requirements; education, training and literacy for the medical workforce and community; infrastructure; data; and ethical, legal and social implications (ELSI). HealthPACT recommended a national coordinated approach to policy development across jurisdictional boundaries to ensure appropriate adoption of genomics. Stakeholder consultation confirmed overwhelming support for greater national coordination of the application of genomic knowledge in healthcare. Five strategic priorities were developed to support appropriate integration of genomics into health care for Australians: person-centered approach; workforce; financing; services; and, data. Three principles underpin strategic priorities: i) application of genomic knowledge is ethically, legally and socially responsible and community trust is promoted; ii) access and equity are promoted for vulnerable populations; and, iii) application of genomic knowledge to health care is supported and informed by evidence and research.Conclusions:HS identified significant policy, workforce, funding and sustainability issues already facing state and territory governments that would, in time, face the federal government. The National Health Genomics Policy Framework outlines an agreed high-level national approach to policy, regulatory and investment decision-making for genomics and was approved by all Australian health Ministers in November 2017.

Mutual Learning about Health System Performance in Australia's Intergovernmental Health Committee System?

Since the early 1990s Australia, through the Australian Health Minister’s Advisory Council, began the process of developing a national health system performance framework. This includes service delivery measures for hospitals and has been used as a template for national data collections in mental health services. National performance frameworks have since become part of promoting greater integration of policy making and service delivery across Commonwealth and State jurisdictional health functions. The key focus of this paper is upon inter-governmental processes and routines to develop Australian national performance regimes in the realms of health and mental health care services. It presents initial findings from 26 elite interviews working across the inter-governmental interface, including some data about experiences of service managers. The report provides two contributions to the existing literature on Australia’s federal health system and more specifically health governance. Firstly, it presents a literature review of studies and theoretical concepts that have been deployed to examine cross jurisdictional processes of decision making. There is particular attention for the European literature on inter-governmental committee systems. Secondly, the paper presents initial findings from an explorative study of Australia’s inter-governmental machinery in the realms of health and mental health care services. This explorative study was based upon an initial 26 elite interviews from respondents working (or having worked in) Australia’s inter-governmental machinery, including some respondents from representatives of relevant Commonwealth semi-autonomous bodies. The researcher also observed two inter-governmental committee proceedings although reported data here draws only from interviews. These findings provide a first insight into the inner workings of Australia’s inter-governmental health machinery. It is argued that there has been evidence of mutual learning from Australia’s National Health Performance initiatives, and, exchanges and recommendations for future research to further investigate and pinpoint the causal processes through which mutual learning occurs are provided.

The Master's Apprentice: How do Australian medical interns learn?

Introduction: The 2015 Review of Medical Intern Training Discussion Paper (Australian Health Ministers' Advisory Council, 2015) questions the purpose and effectiveness of the current model of internship. However, there is limited literature describing how the medical internship functioned when first established in Australia, or how the educational model has changed over the years. Methods: A study with the aim of determining how interns currently learn and the degree to which learning still follows an apprenticeship model was conducted over a 2-year period in a large Australian regional hospital. Sixty interns entered learning reflections into a 4-step online survey. A descriptive analysis was undertaken on the extracted data using Microsoft Excel. Results: Results of the study indicate that interns still learn via the apprenticeship relationship they have with their supervisors (registrars and/or consultants) more than they do via self-directed means. Findings from this study suggest that learning in medicine is an iterative process; interns will learn via modelling from their supervisors, on the one hand, but will use self-directed learning when and where necessary. Interns indicated learning more content than they do tasks related to administration or professional identity. There are varying emphases of learning in each of the core terms of medicine, surgery and emergency medicine, which suggests that it is important for interns to continue to have learning opportunities in a variety of settings and disciplines. Conclusions: This study provides some insights into how and what interns learn, which should be considered when decisions are made about future models of medical intern training.

VP14 Screening Recommendations For Socioeconomic Disadvantages In Pregnancy

INTRODUCTION:In 2015, 18.3 percent of the Austrian population were at risk of poverty and social exclusion - about 211,000 (20 percent) women aged 20–39 years were affected. International studies report that poverty may lead to an increased risk of complications and pathologies during pregnancy. Further, children who grow up in poverty often have poorer long-term health outcomes.METHODS:In order to identify recent guidelines (2011-2016) a comprehensive handsearch was conducted in the guideline databases National Guideline Clearinghouse (NGC) and Guidelines International Network (GIN). Moreover, a handsearch for systematic reviews and primary studies was conducted in PubMed.RESULTS:Two guidelines, the British National Institute for Health and Clinical Excellence (NICE) Guideline “Pregnancy and Complex Social Factors”, as well as the Australian Health Ministers' Advisory Council (AHMAC) Guideline “Antenatal Care”, address socioeconomic disadvantages of women during antenatal care. The recommendation of the AHMAC is that pregnancy care should be offered to all pregnant women. In addition, an individual approach will help to pay particular attention to socioeconomic factors and to incorporate them in routine examinations. NICE recommends in its guideline, affected women should be supported in order to ensure adequate prenatal care. NICE also defines criteria which are used to identify pregnant women who are in greater need of support. The only identified study developed and tested a tool for the identification of patients affected by poverty. The authors of this Canadian pilot study concluded that the defined questions helped to identify socioeconomically disadvantaged persons during anamnesis without stigmatizing.CONCLUSIONS:Due to the proven link between poverty and health risks, special attention must be paid to socioeconomically disadvantaged pregnant women. Research on non-stigmatizing instruments, which can identify vulnerable women, is of great importance. In addition to social policy measures, it is necessary to ensure that low-threshold services are available for socioeconomic disadvantaged women and their children.

Newborn bloodspot screening policy framework for Australia.

The aim of newborn bloodspot screening (NBS) is to identify rare genetic and non-genetic conditions in children soon after birth in order to commence therapies that prevent the development of progressive, serious, and irreversible disabilities. Universal NBS programmes have been implemented in most countries, with minor adaptations to target conditions most relevant to the local healthcare environment. In this article, we describe the initiatives of international and Australian governments to develop policies to address the expansion of NBS in their healthcare systems. We have reviewed published public policies and literature to formulate recommendations based on clinical, social, legal, and ethical principles to inform a national governance and policy framework for Australia. Australian policy makers have been slow to develop a coordinated plan. While the experience from other governments can guide our national policy, there are specific areas that require further consideration by Australian health experts. Key reforms involve the separation of policy and operational activities, multidisciplinary decision-making and oversight by the Australian Health Ministers' Advisory Council for policy direction. A formal national policy framework will guide the coordination of NBS services that can adapt to the needs of Australian children and families.

The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

Review question/objective The objective of this systematic review is to synthesize the eligible evidence of patients’ experience of engaging and interacting with nurses, in the medical-surgical ward setting. This review will consider the following questions: What are the expressed experiences of patients engaging and interacting in patient-centred communication with nurses? What are the beliefs, opinions and desires of patients, when engaging and interacting with nursing staff in terms of communicating in ways that meet the patients’ needs and wants? What factors do patients perceive influence (facilitate or prevent) patient-centred communication and their engagement and interaction with nursing staff? What are the experiences of patients of nurses listening to and responding to them within patient-centred communication with respect to their safety and experience of care? Inclusion criteria Types of participants The review will consider studies that include adult patients who are 18 years of age and older who have been admitted as inpatients to a medical-surgical ward. Studies and texts presenting adult inpatients to all other hospital wards settings will be excluded. Maternity, emergency department, operating room, palliative and psychiatric ward settings will be excluded. Emergency department settings are excluded as they may not include patients that are admitted to hospital. Operating room settings are excluded because of the variations in the level of consciousness that may occur to patients. Maternity, palliative care and psychiatric patients because of unique needs of care required by these patients. Studies that include patients with cognitive disorders will also be excluded. Phenomena of interest This review will consider studies that investigate patient experience of engaging and interacting with nurses at the bedside in the hospital setting and the meaningfulness of that experience.

Evidence requirements for the development of the National Australian Arts and Health Framework

Abstract This article outlines the work undertaken to provide evidence required to support the development of the National Arts and Health Framework endorsed by the Australian health ministers in November 2013. The Institute For Creative Health was charged with being the sector’s reference organization and supplied the evidence required throughout the Framework’s development, as well as moderating the sector’s response to draft proposals. A two-phase process of assembling the evidence required to support government action was identified. With Finland, Australia leads the world in having the health jurisdictions create a National Arts and Health Framework, and appropriate evidence was critical at all stages of its development.

The double misfortune: time to improve off‐label immune intervention

The double misfortune: time to improve off‐label immune intervention

Towards best practice in national health workforce planning.

Health Workforce Australia (HWA) was established by the Council of Australian Governments through its 2008 National Partnership Agreement on Hospital and Health Workforce Reform, as the national agency to progress health workforce reform and address the challenges of providing a skilled, innovative and flexible health workforce in Australia. The Australian Health Ministers' Conference commissioned HWA to undertake a workforce planning exercise for doctors, nurses and midwives over a planning horizon to 2025. Health Workforce 2025 (HW 2025) was conducted in two phases: developing projections for the size and type of the health workforce (doctors, nurses and midwives) needed to meet future service requirements from 2012 to 2025; and modelling the training pipeline necessary to meet the size and type of this health workforce. HWA has used a number of key principles in developing HW 2025 to ensure the projections are robust and able to be applied nationally. HW 2025 is not a one-off project. Projections will be updated as new data become available, and methodology and assumptions underpinning the projections will be periodically reviewed. To also ensure the continued improvement of national health workforce planning, HWA is pursuing other areas for improvement, including better national data collections and improved estimation methodology for demand. Results of HW 2025 were presented to the Australian Health Ministers (through the Standing Council on Health) in April 2012.

“Never mind the logic, give me the numbers”: Former Australian health ministers' perspectives on the social determinants of health

The articulation of strong evidence and moral arguments about the importance of social determinants of health (SDH) and health equity has not led to commensurate action to address them. Policy windows open when, simultaneously, an issue is recognised as a problem, policy formulation and refinement happens and the political will for action is present. We report on qualitative interviews with 20 former Australian Federal, State or Territory health ministers conducted between September 2011 and January 2012 concerning their views about how and why the windows of policy opportunity on the SDH did or did not open during their tenure.Almost all ex-health ministers were aware of the existence of health inequalities and SDH but their complexity meant that this awareness rarely crystalised into a clear problem other than as a focus on high needs groups, especially Aboriginal people. Formulation of policies about SDH was assisted by cross-portfolio structures, policy entrepreneurs, and evidence from reviews and reports. It was hindered by the complexity of SDH policy, the dominance of medical power and paradigms and the weakness of the policy community advocating for SDH. The political stream was enabling when the general ideological climate was supportive of redistributive policies, the health care sector was not perceived to be in crisis, there was support for action from the head of government and cabinet colleagues, and no opposition from powerful lobby groups. There have been instances of Australian health policy which addressed the SDH over the past twenty five years but they are rare and the windows of opportunity that made them possible did not stay open for long.

The critical role of nurses to the successful implementation of the National Safety and Quality Health Service Standards

The National Safety and Quality Health Service Standards requires health service compliance by 2013 and covers several areas including governance arrangements, partnerships with consumers and eight key clinical processes. Nurses in Australia comprise 62% of the hospital workforce, are the largest component and hence play a critical role in meeting these standards and improving the quality of patient care. Several of the standards are influenced by nursing interventions, which incorporate any direct-care treatment that the nurse performs for a patient that may be nurse or physician initiated. The ability for nurses to undertake these interventions is influenced by the hours of care available, the skill mix of the nursing workforce and the environment in which they practice. Taking into consideration the predicted nursing shortages, the challenge to successfully implement the National Safety and Quality Health Service Standards will be great. This paper examines the role of nursing in the delivery of the National Standards, analyses the evidence with regard to nursing-sensitive outcomes and discusses the implications for health service decision makers and policy.