Health Care In Australia Research Articles

Is there a missing-middle in Australian mental health care?

The term 'missing-middle' has been prominent in discourse relating to provision of mental health care in Australia, particularly by proponents of non-governmental youth mental health services such as headspace and related adult services. We investigate whether there is an empirical basis for use of the 'missing-middle' term, founded on qualitative and quantitative research. Despite the widespread use of the term 'missing-middle' for advocacy in Australia, there is a lack of research characterising the epidemiological characteristics of the group. The validity of advocacy predicated on the basis of the 'missing-middle' care-gap should be reconsidered. Research, such as systematic service mapping and health needs assessment, is a necessary foundation for evidence-based mental healthcare policy, planning and implementation. Without such research, vital government funds may be deployed to 'missing-middle' programmes that may not improve Australian public health outcomes.

Too long to wait: South Asian migrants\u2019 experiences of accessing health care in Australia

BackgroundMigrants settling in a new country experience multiple complexities in navigating health care systems and adapting to a new way of life in the host country. In South Asia, migrating to another country for better life opportunities has been an ongoing trend and migration to Australia has significantly increased in recent years. Lower utilisation of health services and higher risks of chronic diseases among South Asian migrants poses a continuing challenge for the Australian health care system and little is known about why this demographic group does not access health services at the same rate. This study aimed to explore factors influencing access to health care by South Asian migrants in Australia.MethodsUsing a mixed-method design, we conducted 62 online survey and 14 in-depth interviews with participants from four South Asian countries: Nepal, India, Bhutan, and Sri Lanka. Participants were recruited using a purposive snowball sampling approach following a standard ethical approval process. Survey data were analysed descriptively in SPSS and interview data were recorded, transcribed, and analysed thematically.ResultsSouth Asian migrants experienced various complexities while accessing health services in Australia. The findings of this study highlighted a number of negative factors influencing their experiences of accessing health care: long waiting times for public health care, the expense of private health care, and communication problems due to socio-cultural differences. South Asian migrants also expressed their concern for a greater investment of resources into public health care to enable them to access quality and affordable care in these settings.ConclusionsGiven limited evidence available to help understand factors leading to the lower utilisation of health care and higher risks of chronic diseases among South Asian migrants, this study plays an important role in highlighting social, cultural, financial, and institutional factors that are critical to designing appropriate health-care strategies. This study recommends incorporating a collaborative and culturally competent model of care to increase access to health care and thereby help reduce existing disparities in health outcomes among South Asian migrant populations.

Climate change: A Wumpurrarni‐kari and Papulanyi‐kari shared problem

Climate change: A <i>Wumpurrarni‐kari</i> and <i>Papulanyi‐kari</i> shared problem

Australian dentists' knowledge, preparedness, and experiences during the COVID-19 pandemic.

BackgroundCOVID-19 is a global health crisis. Close contact with the mucous membranes and respiratory secretions of patients and aerosol-generating procedures renders dentists and other oral health professionals at high risk of exposure to SARS-CoV-2. We examined dentists’ knowledge, preparedness, and experiences of managing COVID-19 in Australia.MethodsA cross-sectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021.ResultsOf the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-to-date information. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n = 98/339) feeling more stressed than usual and having heavier workloads.ConclusionCOVID-19 had significant impact in oral healthcare in Australia. Dentistry has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines were fundamental for successful patient management during the COVID-19 outbreak.

Making ideas a reality: optimising healthtech innovation in Australia.

In Australia, there is a wealth of opportunity to accelerate innovation in healthtech. It is well known that Australia's healthcare system has the right ecosystem to support new ideas into reality. Surgeons together with academia play a significant role in democratising innovative solutions. However, we are learning it takes many actors and contributors to ensure the process is clearer into the future by addressing barriers, incentivising innovation and creating systemic frameworks.

Effect of COVID-19 Social Isolation Policies on Rehabilitation After Anterior Cruciate Ligament Reconstruction.

Background:The coronavirus 2019 (COVID-19) pandemic has had a profound impact on health care in Australia. To contain the spread of the virus, strict physical distancing and social isolation policies were implemented from late March 2020. This presented a situation in which patients recovering from anterior cruciate ligament (ACL) reconstruction had limited access to face-to-face supervised rehabilitation and rehabilitation facilities.Purpose:To explore the impact of social distancing and isolation policies on postoperative rehabilitation in patients after ACL reconstruction.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients who had ACL reconstruction from October 2019 until the end of March 2020 (6 months before the implementation of COVID-19 restrictions) completed an online self-report questionnaire containing 5 sections: utilization of health care professionals for rehabilitation, frequency of rehabilitation, patient concerns and attitude, perceived impact on recovery, and changes to employment status. We compared the responses of patients who had surgery in 2019 with those who had surgery in 2020. Statistical analysis was performed using frequency statistics and central tendency measures.Results:A total of 185 patients (97 men, 88 women) completed the survey, for a 73% response rate. Patients had a mean age of 28 years (range, 13-57 years) and had undergone surgery a mean 4.5 months prior (range, 1.5-8 months). Most patients (80%) maintained face-to-face rehabilitation, predominantly with a physical therapist, regardless of whether their surgery took place in 2019 or 2020; rehabilitation with active, supervised exercises was most common. Almost all patients were performing strengthening exercises (164/185), and most were performing range-of-motion (139/185) and aerobic (123/185) activities at their homes. Patients were minimally concerned about access to supervised rehabilitation and knee reinjury, but they were concerned about access to equipment. Because of COVID-19, 30% were working from home; 17% were on reduced hours and 8% on increased hours; 15% were on leave or unemployed; and 30% reported no change in employment status.Conclusion:Patients who had undergone ACL reconstruction just before or during the first few months of the COVID-19 pandemic were able to maintain in-person contact with their health professionals during rehabilitation, and they had a positive outlook and managed well despite the restrictions.

Fathers\u2019 involvement in perinatal healthcare in Australia: experiences and reflections of Ethiopian-Australian men and women

BackgroundFamily-centred maternity care models include the expectation that fathers prepare for and attend the birth. In Australia over 20% of the population is from a culturally and linguistically diverse background. Public policies espouse culturally competent healthcare. Little is known about the experiences of perinatal health care of men from culturally and linguistically diverse (CALD) communities living in high income countries. The aim was to understand the experiences, attitudes and beliefs about father’s inclusion in perinatal healthcare, from the growing, and recently settled community of Ethiopian families living in Australia.MethodsA qualitative study using semi-structured individual interviews with Ethiopian-Australian men and women who had experienced Australian maternity care and were sampled for diversity of time since migration, and parity. Interviews were in English, audio-recorded, transcribed and then analysed thematically.ResultsParticipants were seven women and six men all born in Ethiopia, including two couples. Key themes included: the loss of extended family through migration, new roles for both parents and the need to establish ‘family-like’ relationships with friendship groups in Australia. There was a willingness to involve male partners in the Ethiopian community in Australia, although it was recognised as a cultural change. Experiences of male partner involvement were mixed among healthcare types, with men attending Maternal and Child Health (MCH) appointments less frequently than antenatal (ANC) appointments.ConclusionsResults suggests men may be missing out on the education provided during antenatal appointments and may benefit from an alternative. There were not universally high levels of cultural competency among healthcare professionals, with further training still required. Commitment to paid employment remains a barrier to men’s involvement, suggesting that flexible working conditions and increased paternity leave would support their involvement. Alternatively services could utilise flexible delivery methods such as phone and zoom to include fathers.

The development of National Safety and Quality Digital Mental Health Standards.

Digital mental health services offer innovative ways for individuals to access services but are not without risk. Our objective was to develop National Safety and Quality Digital Mental Health (NSQDMH) Standards that improve the quality of digital mental health service provision and protect service users from harm. The NSQDMH Standards were developed by adapting the National Safety and Quality Health Service (NSQHS) Standards and adding components highlighted through a national consultation process as critical to the safety and quality of services. Further public consultation and pilot testing assisted in refining the NSQDMH Standards. The NSQDMH Standards comprise three standards-Clinical and Technical Governance, Partnering with Consumers, and Model of Care-and were launched in November 2020. The NSQDMH Standards provide a quality assurance mechanism to improve digital mental health care in Australia.

Sexual and reproductive health education: Midwives’ confidence and practices

ProblemThere is limited evidence regarding midwives’ confidence and practices in providing sexual and reproductive health care in Australia. BackgroundMidwives provide important public health education to women regarding sexual and reproductive health care. AimThe aim of this study was to explore midwives’ confidence and practices around providing education to women on three key areas of sexual and reproductive health: contraception and family planning; sexual activity; and sexual health. MethodsA cross-sectional exploratory study was conducted with responses from n = 164 midwives (43.1% response rate) working in a public tertiary maternity hospital in Western Australia. The survey included items measuring confidence; method and frequency of practice. Open-ended questions captured qualitative data. Data analysis was conducted using descriptive statistics for quantitative data and content analysis for qualitative data. FindingsThere was a significant association between age, years of clinical experience (p = 0.001) and work setting (p = 0.032) on the confidence to provide education on sexual activity. Most (92.1%) midwives indicated that they wanted further education. Lack of time, knowledge and language barriers were key factors preventing education. DiscussionMidwives’ provision of education to women is essential for improving health literacy and health outcomes. Results reveal the necessity to include sexual and reproductive health education in entry to registration courses and the importance of continuing professional development. ConclusionEvidence of midwives’ confidence and current practices in the provision of sexual and reproductive health care offers utility for leaders and educators in midwifery to prepare and equip midwives to fulfil this important public health role.

Estimated Financial Impacts of Inaccurate Obese Patient Data Recorded by the Western Australian Country Health Service.

PurposePressure on Australia’s healthcare system is increasing annually due to corresponding increases in chronic diseases such as obesity and rapidly ageing population growth across Australia, resulting in requirements for increased funding. This study investigates the financial impact to hospitals due to inaccurate obese patient recording and coding.BackgroundAustralian healthcare organisations receive Activity-Based Funding (ABF) which provides reimbursement of costs relating to the type of patient care delivered and the resources required for the patient treatment. Accurate healthcare data are essential to ensure accuracy of ABF and appropriate reimbursement of costs incurred by hospitals that manage obese patients. Managing obese patients results in operational funding requirements such as increased staffing and purchasing of equipment such as hoists, bariatric wheelchairs and bariatric beds, and hospitals must ensure that these clinical requirements are documented accurately in order to be reimbursed of these costs by way of ABF.MethodsThis study identifies the financial implications of inaccurate obesity data within the Western Australian Country Health Service (WACHS) and examines factors that may affect obesity data recording accuracy. The study involves 85 cases of identified obesity data recording inaccuracy that were adjusted by entering corrected obesity codes, which then adjusted Diagnosis-related Groups, National Weighted Activity Units and Activity-Based Funding results.ResultsThe study demonstrated estimated annual lost funding opportunities of $2.23 million due to obesity coding inaccuracy. An annual average of 616 cases of obesity data inaccuracy was calculated with an average lost funding opportunity of $3625 per case.ConclusionImprovements are required in the clinical recording and coding of patient obesity, such as mandatory recording of patient weight and height data and automated BMI calculations within electronic patient records. Enhanced obesity recording and coding accuracy will result in increased funding opportunities and reduced cost burdens that hospitals currently experience when required to fund obesity-related clinical and safety requirements within operational budgets.

Inequality in out of pocket fees, government funding and utilisation of maternal health services in Australia

This study aimed to assess the distribution of service utilisation, out-of-pocket fees and government funding for maternal health care in Australia by socioeconomic group. A large linked administrative dataset was utilised. Women were grouped into socioeconomic quintiles using an area-based measure of socioeconomic status. Descriptive statistics were used to quantify the distribution of number of services, out of pocket fees, and government funding by socioeconomic quintile. Needs-adjusted concentration indices (CINA) were utilised to quantify inequity.The mean out of pocket fees for women of least socioeconomic advantage was $1,026 and for women of most socioeconomic advantage the mean was $2,432 (CINA 0.093, 95% CI: 0.088 – 0.098). However, use of many services were higher for women of most socioeconomic advantage: private obstetrician (CINA: 0.035, 95% CI: 0.032 – 0.038), other specialist services (CINA: 0.089, 95%CI: 0.083 – 0.094), and diagnostic and pathology tests (CINA: 0.027, 95%CI: 0.025 – 0.030). Federal government funding through Medicare was distributed towards women of most socioeconomic advantage (CINA: 0.036, 95%CI: 0.033 – 0.039); whereas government public hospital funding was skewed towards women of least socioeconomic advantage (CINA: -0.05, 95%CI: -0.057 - -0.046). Future policy changes in Australia's healthcare system need to ensure that women of least socioeconomic advantage have adequate access to maternity and early childhood care, and out of pocket fees are not an access barrier.

Integration of Health and Education: The past, present and future of school-based health care in Australia

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Integrating Oral and General Health Care in Australia: Utilising Aged Care to demonstrate essential elements of this global issue.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Dental Restrictions to Clinical Practice during the COVID-19 Pandemic: An Australian Perspective.

The reportedly low COVID-19 transmission occurring in dental settings highlight achievements made by the dental profession. There are valid reasons to reconsider risk-based essential oral healthcare during the COVID-19 pandemic.

The problematic place of private payment for healthcare in Australia

Private funding and private hospital provision play a key role in Australian healthcare. However, this role is inherently inequitable, creating a 2-speed health system. Canada should avoid expanding private involvement in paying for healthcare.

A digital approach in the rapid response to COVID-19 – Experience of a paediatric institution

IntroductionCOVID-19 has radically changed the delivery of healthcare in Australia. Central to a tertiary paediatric institution’s (The Royal Children’s Hospital Melbourne (RCH) response was a digital health approach comprising a broad suite of informatics and technology solutions including optimising a fully integrated electronic medical record (EMR). MethodsThis comprehensive approach spanned all patient care areas and encompassed a broad range of hospital operations. They included patient triage, registration, COVID-19 screening clinic operations, electronic ordering, prescribing and documentation, telehealth, reporting and analytics and research. DiscussionThis paper outlines key aspects of our COVID-19 digital health strategy, highlighting the rapid transition to telehealth and the development of a remote “virtual telehealth” strategy for clinicians which proved popular and allowed true “working from home”. ConclusionCOVID-19 has inadvertently focussed the spotlight on the utility of digital health for clinical care. The speed and uptake of digital health within this pandemic has been remarkable and unprecedented in both an Australian and global setting. Whilst many of these changes have been beneficial, some may have been rushed or forced with minimal consideration of ongoing governance. Key stakeholders and enablers should be identified for post-pandemic consideration in future digital health implementation and adoption strategies.

Paying for value: options for value-based payment reform in Australia.

Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of 'low-value' interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical for success: attributing financial risk fairly and organisational structures. What is known about the topic? 'Fee for service' is the dominant payment method in Australia and creates incentives to increase service volume, rewarding inputs rather than improvements in longer-term health outcomes. There is increasing recognition that payment reform is needed to support the shift to value-based health care in Australia. What does this paper add? This paper describes the three main options for value-based payment reform: episode-based bundled payments chronic condition bundled payments and comprehensive capitation payments. Each involves some degree of funds pooling, and the shifting of risk from the funder to provider to stimulate the more efficient use of resources. What are the implications for practitioners? We conclude that local hospital authorities in the states, private health insurers and primary health networks could implement reform as payment holders, but that capacity development in coordination and risk adjustment will be required. Successful implementation of payment reform will also require investment in data collection and information technology to track patients' care and measure outcomes and costs.

Prioritising models of healthcare service delivery for a more sustainable health system: a Delphi study of Australian health policy, clinical practice and management, academic and consumer stakeholders.

Objectives Healthcare expenditure is growing at an unsustainable rate in developed countries. A recent scoping review identified several alternative healthcare delivery models with the potential to improve health system sustainability. Our objective was to obtain input and consensus from an expert Delphi panel about which alternative models they considered most promising for increasing value in healthcare delivery in Australia and to contribute to shaping a research agenda in the field. Methods The panel first reviewed a list of 84 models obtained through the preceding scoping review and contributed additional ideas in an open round. In a subsequent scoring round, the panel rated the priority of each model in terms of its potential to improve health care sustainability in Australia. Consensus was assumed when ≥50% of the panel rated a model as (very) high priority (consensus on high priority) or as not a priority or low priority (consensus on low priority). Results Eighty-two of 149 invited participants (55%) representing all Australian states/territories and wide expertise completed round one; 71 completed round two. Consensus on high priority was achieved for 59 alternative models; 14 were rated as (very) high priority by ≥70% of the panel. Top priorities included improving medical service provision in aged care facilities, providing single-point-access multidisciplinary care for people with chronic conditions and providing tailored early discharge and hospital at home instead of in-patient care. No consensus was reached on 47 models, but no model was deemed low priority. Conclusions Input from an expert stakeholder panel identified healthcare delivery models not previously synthesised in systematic reviews that are a priority to investigate. Strong consensus exists among stakeholders regarding which models require the most urgent attention in terms of (cost-)effectiveness research. These findings contribute to shaping a research agenda on healthcare delivery models and where stakeholder engagement in Australia is likely to be high. What is known about the topic? Healthcare expenditure is growing at an unsustainable rate in high-income countries worldwide. A recent scoping review of systematic reviews identified a substantial body of evidence about the effects of a wide range of models of healthcare service delivery that can inform health system improvements. Given the large number of systematic reviews available on numerous models of care, a method for gaining consensus on the models of highest priority for implementation (where evidence demonstrates this will lead to beneficial effects and resource savings) or for further research (where evidence about effects is uncertain) in the Australian context is warranted. What does this paper add? This paper describes a method for reaching consensus on high-priority alternative models of service delivery in Australia. Stakeholders with leadership roles in health policy and government organisations, hospital and primary care networks, academic institutions and consumer advocacy organisations were asked to identify and rate alternative models based on their knowledge of the healthcare system. We reached consensus among ≥70% of stakeholders that improving medical care in residential aged care facilities, providing single-point-access multidisciplinary care for patients with a range of chronic conditions and providing early discharge and hospital at home instead of in-patient stay for people with a range of conditions are of highest priority for further investigation. What are the implications for practitioners? Decision makers seeking to optimise the efficiency and sustainability of healthcare service delivery in Australia could consider the alternative models rated as high priority by the expert stakeholder panel in this Delphi study. These models reflect the most promising alternatives for increasing value in the delivery of health care in Australia based on stakeholders' knowledge of the health system. Although they indicate areas where stakeholder engagement is likely to be high, further research is needed to demonstrate the effectiveness and cost-effectiveness of some of these models.

Principles guiding ethical research in a collaboration to strengthen Indigenous primary healthcare in Australia: learning from experience

IntroductionIndigenous communities worldwide are leading calls for all research involving Indigenous people to be underpinned by values and principles articulated by them. Many researchers are explicitly adopting these principles to...

Transition to practice: Supporting first year nurses within a collaborative faith based graduate program

Objective: Faith-based organisations play a major role in health care in Australia providing a unique service supported by compassionate and concerned staff. In response to the changing Australian health care landscape the increasing demands placed on first year registered nurses, a graduate program provided in partnership with a Catholic University, engages students in academic and clinical learning. The study aimed to determine if the provision of nursing care in the context of catholic faith and values provides first year nurses with a supportive learning environment.Methods: This study used a mixed method explanatory sequential design in two phases: (1) quantitative online surveys sent to graduate nurses (n = 60) to report on their perceptions of work integrated learning prior to and during their first year of nursing at the private catholic hospital; and (2) focus groups were conducted to explore key themes in further detail. The evaluation occurred at both the halfway and the end point of the 12-month Graduate Program. Data was analysed using descriptive statistics and theming of the text data to identify emergent ideas.Results: The findings suggest that the graduate nurses felt engaged with the programs academic and clinical learning outcomes. This was achieved in a supportive pastoral care environment underpinned by catholic faith and values.Conclusions: The Graduate Program in collaboration with a Catholic University School of Nursing and Midwifery has provided a positive learning experience and support structure for its first year registered nurses with the achievement of a formally recognised qualification.