Health System In Australia Research Articles

Innovation bundles and platforms – a qualitative analysis of health system responses to the COVID-19 pandemic

BackgroundHealth systems underwent substantial changes to respond to COVID-19. Learning from the successes and failures of health system COVID-19 responses may help us understand how future health service responses can be designed to be both effective and sustainable. This study aims to identify the role that innovation played in crafting health service responses during the COVID-19 pandemic.MethodsSemi-structured interviews were conducted online, exploring 19 health professionals’ experiences in responding to COVID-19 in a large State health system in Australia. The data were collected from April to September 2022 and analysed utilising constant comparative analysis. The degree of innovation in health service responses was assessed by comparing them to pre-pandemic services using 5 categories adopted from the IMPISCO (Investigators, Methods, Population, Intervention, Setting, Comparators and Outcomes) framework, which classifies interventional fidelity as: 1/ Identical: No differences are found between health services; 2/ Substitution with alternatives that perform the same function, 3/ In-class replacement with elements that delivers roughly the same functionality, 4/ Augmentation with new functions, 5/ Creation of new elements. Services were decomposed into bundles and fidelity labels were assigned to individual bundle elements.ResultsNew services were typically created by reconfiguring existing ones rather than being created de novo. The presence of pre-existing infrastructure (foundational technologies) was seen as critical in mounting fast health service responses. Absence of infrastructure was associated with delays and impaired system responses.ConclusionsThe need to reconfigure rapidly and use infrastructure to support this suggests we reconceive health services as a platform (a general-purpose service upon which other elements can be added for specific functions), where a common core service (such as a primary care practice) can be extended by adding specialised functions using mediators which facilitate the connection (such as virtual service capabilities). Innovation can be costly and time consuming in crises, and during the COVID-19 pandemic, innovations were typically patched together from pre-existing services. The notion of platforms seems a promising way to prepare the health system for future shocks.

A qualitative analysis of health service problems and the strategies used to manage them in the COVID-19 pandemic: exploiting generic and context-specific approaches

BackgroundThe COVID-19 pandemic disrupted health systems around the globe. Lessons from health systems responses to these challenges may help design effective and sustainable health system responses for future challenges. This study aimed to 1/ identify the broad types of health system challenges faced during the pandemic and 2/ develop a typology of health system response to these challenges.MethodsSemi-structured one-on-one online interviews explored the experience of 19 health professionals during COVID-19 in a large state health system in Australia. Data were analysed using constant comparative analysis utilising a sociotechnical system lens.ResultsParticipants described four overarching challenges: 1/ System overload, 2/ Barriers to decision-making, 3/ Education or training gaps, and 4/ Limitations of existing services. The limited time often available to respond meant that specific and well-designed strategies were often not possible, and more generic strategies that relied on the workforce to modify solutions and repair unexpected gaps were common. For example, generic responses to system overload included working longer hours, whilst specific strategies utilised pre-existing technical resources (e.g. converting non-emergency wards into COVID-19 wards).ConclusionDuring the pandemic, it was often not possible to rely on mature strategies to frame responses, and more generic, emergent approaches were commonly required when urgent responses were needed. The degree to which specific strategies were ready-to-hand appeared to dictate how much a strategy relied on such generic approaches. The workforce played a pivotal role in enabling emergent responses that required dealing with uncertainties.

Paediatric post-grommets surgery review: Audiology-led clinic

BackgroundOtitis media (OM) has a high prevalence in childhood, and grommet insertion is the most common surgical treatment for OM. The public health system in Australia faces considerable strains, including high demand for Ear, Nose and Throat (ENT) specialists. Extending the scope of practice for audiologists to manage post-operative care for children receiving grommets has the potential to alleviate this burden. MethodsThis non-randomised, cross-sectional study investigated the efficacy and feasibility of an audiology-led clinic for managing paediatric patients after grommet insertion at a tertiary teaching hospital in Western Australia. Senior audiologists reviewed children at 6 weeks and 10 months post-operatively, escalating care to an ENT specialist if abnormalities were observed. Children with normal hearing and patent grommets were reviewed and discharged by the audiologist. ResultsA total of 93 children were included (mean age 5.18 ± 2.25 years, range 1.59–11.46 years). At the 6-week review, 72/93 (77 %) presented with in-situ grommets and normal hearing, while 21/93 (22 %) were escalated for immediate ENT care. At the 10-month review, 54/72 (75 %) were discharged without further ENT intervention, and 18/72 (25 %) required additional ENT investigation. ConclusionThis study demonstrated that an audiology-led follow-up clinic for post-grommet insertion is a viable option, providing efficient, high-quality care. Two-thirds of paediatric patients did not require ENT input or review post-operatively. The results support interdisciplinary models of care, which could help address challenges faced by overburdened ENT services.

OPCAT: How an international treaty regarding torture is relevant to the Australian mental health system.

The United Nations Subcommittee on the Prevention of Torture visits signatory nations to the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). Its role is to monitor and support signatory nations in implementing and complying with the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (CAT). In October 2022, the United Nations Subcommittee on the Prevention of Torture visited Australia but was barred from visiting mental health wards in Queensland and all detention facilities in New South Wales leading to the termination of its visit. This breach of Australia's obligations under the OPCAT presents a significant setback for the rights of people with mental illness and other involuntarily detained populations. This piece sets out to demonstrate the relevance of OPCAT to the mental health system in Australia. Individuals who are detained for compulsory treatment in locked facilities such as acute psychiatric inpatient wards and forensic mental health facilities are deprived of their liberty, often out of public view. Thus, it highlights the ethical and professional obligations of all mental health professionals, especially psychiatrists, to safeguard the human rights of individuals being detained in mental health facilities as enshrined in Australia's international legal obligations under the OPCAT. Adhering to these obligations diminishes the risk of future human rights violations of people with mental illness.

Understanding of seasonal influenza immunisation and its cardiovascular benefits among cardiology patients

Abstract Background Seasonal influenza immunisation reduces the risk of cardiovascular events. Patients with established cardiovascular disease (CVD) derive a greater benefit than those without yet up to 50% globally do not take up the immunisation. Purpose To describe the understanding and perceptions of seasonal influenza immuni2ation among patients CVD. Methods A cross sectional, voluntary and anonymous survey was administered to cardiology inpatients and outpatients attending a large health system in Australia during the 2022 influenza season, May 1st 2022 to August 31st 2022. Demographics, educational and employment status and prior immunisation behaviours were collected. Questions on perceptions and beliefs around seasonal influenza immunisation and influenza-related illness were presented with 5-point Likert scale (strongly disagree through to strongly agree). Results A total of 181 surveys were completed; median age was 64 (50.5% <65 years), 65.0% (115/177) of the population were inpatients, 82.2% (143/174) had completed high school or more; 35.0% (63/180) were female and 24.2% (43/178) spoke a language other than English at home. Over one third of respondents did not receive the seasonal influenza immunisation in the prior year (63/181, 34.5%). Only half (97/179, 54.2%) of patients agreed that their heart condition placed them at higher risk of complications and serious illness if they contracted influenza. While 73.3% (132/180) agreed that immunisation would help prevent risk of serious illness, only 26.8% (48/179) agreed that it would help to prevent myocardial infarction. Nearly a quarter of patients (24.0%, 43/179) were concerned about side effects while 1 in 10 (12.8%, 23/179) patients raised cost as a barrier despite being free-of-charge to all patients with CVD in Australia. If asked to receive the seasonal influenza immunisation, 86% (154/179) patients would agree if their cardiologist recommended it. Conclusions Despite guideline recommendations, most cardiology patients are uninformed of the cardiovascular benefits of seasonal influenza immunisation with many unaware they are at higher risk of influenza-related, preventable illness. The vast majority of patients would accept the immunisation if recommended by their cardiologist highlighting their important role in improving uptake among this high-risk group.

Embedded Research: Possibilities for Learning Health Systems Comment on "'We're Not Providing the Best Care if We are Not on the Cutting Edge of Research': A Research Impact Evaluation at a Regional Australian Hospital and Health Service".

Brown et al show that research investments in an organization with a research and translation mandate can make important gains for research impact across domains, including quality of care and patient outcomes. Their multi-stage mixed methods evaluation provides insight into research capacity development in rural health systems in Australia and draws attention towards persistent geographic inequities. In extension of this important contribution, here, a focus on the "what and the why" of embedded research is offered. Specific attention is paid to the sustainability potentials of systematized data capture systems, funding-operational mandate alignments, researcher-scientist career pathways, and networked approaches to mentorship.

Stemming the tide of mental health problems in young people: Challenges and potential solutions.

One in five people experience clinically relevant mental health problems before the age of 25 years. Furthermore, in Australia, one in seven children are reported to experience a mental health disorder. Consequently, there has been a steady increase in demand for mental health services for children and young people, and this has been compounded by the COVID-19 pandemic. Unfortunately, currently many children and young people with mental health difficulties are not accessing appropriate and/or timely care, with individuals and families finding it increasingly difficult to access and navigate suitable services. In part, this is related to the fragmented and isolated manner in which child mental health services are operating. To address the current issues in access to appropriate child and adolescent mental health care in Australia, a novel Integrated Continuum of Connect and Care model is proposed to integrate relevant services along a tiered care pathway. The aim of this model is to facilitate timely access to mental health services that meet the specific needs of each child/young person and their family. This model will function within co-located service hubs that integrate health care through a comprehensive assessment followed by a link up to relevant services. The Integrated Continuum of Connect and Care has the potential to pave the way for unifying the fragmented child and youth mental health system in Australia.

Barriers and facilitators to treatment seeking and engagement amongst women with complex trauma histories.

Complex traumatic experiences, such as childhood sexual and physical abuse, occur in approximately 13% of the Australian population and are more common in women. Despite the prevalence of complex trauma and the need for evidence-based services for survivors, no studies have explored treatment-related experiences of women with complex trauma in Australia. The aim of the current study was to identify barriers and facilitators to treatment seeking and engagement amongst women who have experienced complex trauma in Australia. Semi-structured interviews were conducted with 11 women with complex trauma histories who presented to a university outpatient psychology clinic. Content analysis was used to identify common barriers and facilitators to mental health treatment seeking and engagement amongst these women. Participants faced three key barriers when seeking treatment and engaging in mental health services: systemic issues, dissatisfaction with treatment and intrapersonal barriers (e.g. fear of the healthcare system). Appropriate support from supportive, committed health care workers was a facilitator to engagement and access. Findings from this study suggest that the mental health system in Australia may not be meeting the needs of women with complex trauma histories. Increasing access to affordable, trauma-informed care and bolstering providers' knowledge of complex trauma, may enable some of the barriers identified by participants to be overcome.

Are We There Yet? Exploring the Use of Single-Pill Combination Therapy in the Management of Raised Blood Pressure in Australia

Single-pill combination (SPC) therapy is recommended as first-line therapy for most patients in global hypertension guidelines due to benefits of improved adherence and blood pressure (BP) control. We aimed to understand factors affecting SPC use in the management of raised BP in Australia. A mixed-method study comprising of qualitative (policy review and interviews) and quantitative (Pharmaceutical Benefits Scheme [PBS] data) approaches. Australian and international hypertension guideline recommendations regarding SPC use; the Australian registration and subsidy approval processes of SPCs; use of SPCs on the PBS; cost-analysis of PBS-listed SPCs compared to free-drug combinations; perceptions of healthcare providers towards SPCs. The 2016 Australian Heart Foundation's "Guideline for the diagnosis and management of hypertension in adults" does not recommend combination therapy (including SPCs) as first-line treatment. Additional challenges in the uptake of SPCs include: (1) the additional PBS requirements and barriers imposed for the listing of SPCs. (2) Script volumes for SPCs have not matched the rise in the number of SPCs listed for subsidy, have plateaued since 2016 and remained significantly lower than single constituent scripts. (3) SPCs are not subsidised by the PBS for initial treatment. Most SPCs provided substantial cost savings for individual patients compared to free-drug combinations. Health care providers were positive about the cost-saving and convenience of SPCs, however perceived negatives included inflexibility of SPCs during dose titration, medicine shortages, and potential adverse effects when initiating treatment with multiple drugs. The safety, efficacy and cost-saving potential of SPCs have been established in the literature but several roadblocks in the existing health system in Australia impede uptake. Interventions addressing these barriers may facilitate improved uptake, which may in turn improve blood pressure control in Australia.

Achieving change readiness for health service innovations.

Continual innovation to address emerging population needs necessitates health service ongoing redesign and transformation worldwide. Recent examples include service transformations in response to Covid‐19, many of which were led and managed by nurses. Ensuring change readiness is central to delivering these transformative changes yet has been identified as a central challenge impacting nurse leaders and managers. Recent evidence indicates that affective commitment to change among healthcare staff may be an important contributor to gaining support for change implementation but understudied in healthcare. A cross‐sectional survey study was used to examine the association between affective commitment to change and change readiness among 30 healthcare staff across four projects in one state‐wide health system in Australia. Our findings indicate that affective commitment to change; healthcare worker's emotional and personal perception of the value of the proposed change is independently associated with individual and collective change readiness. Given that achieving change readiness is a central goal of change management strategies, this pilot work provides valuable insight to inform the change management practices of nurse leaders and managers.

Restoration to practice of health practitioners removed for serious sexual misconduct: evaluating public confidence and assessing risk

ABSTRACT This article examines how the health system in Australia ensures public protection and confidence when making determinations about the reinstatement of health practitioners who have previously been deregistered for sexual misconduct. Three main issues are addressed: first, the lack of public process and accessible reasons concerning the majority of reinstatement decisions, with consequent omissions in the public record and impact upon public confidence. Second, a detailed analysis is undertaken of the limited available reinstatement decisions, to understand how legislative and jurisprudential criteria of public protection (including protecting patient safety, promoting professional standards and maintaining public confidence) are weighed against the ‘rehabilitative’ impetus within a context strongly influenced by health evidence and therapeutic considerations. Third, a call is made to develop a responsive, modern and transparent framework for understanding and assessing the impact on public confidence of disciplinary decisions concerning the reinstatement of health practitioners.

Government-subsidised mental health services are underused in Australian residential aged care facilities

Objective To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access.

Changes in US hearing aid regulations: possible benefits and risks to Australia.

Hearing aids are costly for many Australians with hearing loss who are not eligible for public funding, and are not widely used. The purpose of this article is to describe a recent policy shift from the United States (US) that might improve access to hearing devices and services in Australia. Type of program or service: In 2017, the US legislated the Over-the-Counter Hearing Aid Act of 2017, directing the Food and Drug Administration (FDA) to develop regulations for over-the-counter sale of hearing aids for mild to moderate hearing loss. Changes in the development of hearing devices and changes to service delivery were well underway in the US prior to anticipated release of new FDA regulations, with new technology entrants in the 'hearables' market. For Australians with hearing loss not eligible for public funding, the current hearing health system is expensive and device-centred. If Australia follows suit with regulatory changes for a class of over-the-counter hearing aids, consumers are likely to benefit from access to safe and affordable devices. Additional policies to support access to hearing services are also likely to be needed. The hearing health system in Australia will undergo tremendous change in the coming years because of the introduction of over-the-counter hearing aids in the US. For Australians to benefit, changes to regulations of devices, as well as hearing services and device provision, will be required.

Why Community Health Systems Have Not Flourished in High Income Countries: What the Australian Experience Tells Us.

Background: Despite the value of community health systems, they have not flourished in high income countries and there are no system-wide examples in high income countries where community health is regarded as the mainstream model. Those that do exist in Australia, Canada, the United States and the United Kingdom provide examples of comprehensive primary healthcare (PHC) but are marginal to bio-medical primary medical care. The aim of this paper is to examine the factors that account for the absence of strong community health systems in high income countries, using Australia as an example. Methods: Data are drawn from two Australian PHC studies led by the authors. One examined seven case studies of community health services over a five-year period which saw considerable health system change. The second examined regional PHC organisations. We conducted new analysis using the ‘three I’s’ framework (interests, institutions, ideas) to examine why community health systems have not flourished in high-income countries. Results: The elements of the community health services that provide insights on how they could become the basis of an effective community health system are: a focus on equity and accessibility, effective community participation/control; multidisciplinary teamwork; and strategies from care to health promotion. Key barriers identified were: when general practitioners (GPs) were seen to lead rather than be part of a team; funding models that encourage curative services rather than disease prevention and health promotion; and professional and medical dominance so that community voices are drowned out. Conclusion: Our study of the community health system in Australia indicates that instituting such a system in high income countries will require systematic ideological, political and institutional change to shift the overarching government policy environment, and health sector policies and practices towards a social model of health which allows community control, and multidisciplinary service provision.

Environmental impacts of Australia's largest health system

Climate change is causing a range of impacts on communities such as more frequent extreme weather, air pollution, changing distribution of infectious diseases, mental health impacts and others. The 2018 report of the Lancet Countdown on health and climate change concluded that “…climate change is the biggest global health threat of the 21st century” (Watts et al. 2018). This study aims to provide a quantitative supply-chain assessment of the environmental impacts of the health system in Australia's largest state, New South Wales (NSW). We integrate a range of environmental indicators, such as greenhouse gas emissions (GHGEs), water use and waste into a cloud-computing platform for constructing a custom-built sub-national multi-regional input-output (MRIO) table for Australia. We then use specific health system data to construct a hybrid life-cycle assessment model featuring detail on the health system, and quantify the environmental impact of interactions of the health system with the rest of the NSW and Australian economy. Our findings show that the health system in Australia's largest state was responsible for 6.6% of the total estimated GHGEs in 2017, 4% of water use, and 8% of waste produced in the NSW economy. The results highlight the need for implementation of targeted policies to reduce not only the direct environmental impacts generated by health systems but also those from its supply chains that connect with many other economic sectors.

How nursing leaders promote evidence-based practice implementation at point-of-care: A four-country exploratory study.

To describe strategies nursing leaders use to promote evidence-based practice implementation at point-of-care using data from health systems in Australia, Canada, England and Sweden. A descriptive, exploratory case-study design based on individual interviews using deductive and inductive thematic analysis and interpretation. Fifty-five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016. Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence-based practice implementation. Nursing leaders actively promote evidence-based practice implementation, work to influence evidence-based practice implementation processes and integrate evidence-based practice implementation into everyday policy and practices. The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence-based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence-based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship-focused approaches nursing leaders take towards promoting evidence-based practice implementation. This study explored how nursing leaders promote evidence-based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence-based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness.

Using the National Mental Health Service Planning Framework to support an integrated approach to regional mental health planning in Queensland, Australia.

Regional integrated service planning has been identified as a key priority for improving the mental health system in Australia. The National Mental Health Service Planning Framework (NMHSPF) is an integrated planning tool that estimates the resources required to deliver the optimal mix of mental health services to a population. In 2016, Queensland Health commissioned a trial application of the NMHSPF for joint mental health planning between a Primary Health Network (PHN) and the corresponding state Hospital and Health Services (HHSs) in a regional area. The aim of this work was to collaborate with stakeholders from each organisation to collect available data on the delivery and resources of existing mental health services in the region and compare these to NMHSPF estimates to identify potential priority areas for planning. This paper provides mental health planners with an exemplar model for using the NMHSPF to support integrated planning at the regional level and describes the barriers, facilitators and key outcomes of this work.

What Can Twitter Tell Us about Skin Cancer Communication and Prevention on Social Media?

Background: Skin cancer places a substantial burden on the health system in Australia. The modernisation of skin cancer prevention interventions by using social media may enhance their contemporary reach and relevance, especially among the youth. This study aimed to analyse Twitter posts in Australia to establish a baseline of skin cancer and sun-related communication trends. Methods: Tweets posted over the summer of 2018/2019 relating to relevant keywords and hashtags such as “slipslopslap” and “sunscreen” were analysed using quantitative and qualitative methods. The number of tweets, related communication patterns, and possible factors for sudden changes in tweet volume were studied. Results: Results showed that Australians are using Twitter to communicate about their sun-related and skin cancer experiences and to share advice and information on this matter. Overall, Australians use Twitter more frequently to talk about sunscreen (number of tweets between December 2018 and February 2019 = 5,842) and/or skin cancer (n = 3,936), but not so often to communicate about other sun-protective behaviours (n = 1,972) or skin cancer prevention campaigns (n = 108). The number of tweets is greatly affected by the increase in temperature. Celebrities, non-health-related organisations with a high number of followers, and individuals sharing their own skin cancer experiences achieve a substantial number of likes and retweets and thus influence on Twitter regarding skin cancer-related communication. Conclusions: The results allow deeper understanding of important determinants for effective social media use for health promotion and public health messaging in the future. Linking tweets with temperature, sharing by celebrities or non-health-related organisations and individuals with a high following can all contribute to greater spread of skin cancer and sun-related messages.

The Rohingya Little Local: exploring innovative models of refugee engagement in Sydney, Australia

The Rohingya community living in the City of Canterbury-Bankstown in Sydney have been identified as a priority population with complex health needs. As part of ongoing work, AU$10000 was provided to the community to address important, self-determined, health priorities through the Can Get Health in Canterbury program. Program staff worked with community members to support the planning and implementation of two community-led events: a soccer (football) tournament and a picnic day. This paper explores the potential for this funding model and the effect of the project on both the community and health services. Data were qualitatively analysed using a range of data sources within the project. These included, attendance sheets, meeting minutes, qualitative field notes, staff reflections and transcripts of focus group and individual discussions. This analysis identified that the project: (1) enabled community empowerment and collective control over funding decisions relating to their health; (2) supported social connection among the Australian Rohingya community; (3) built capacity in the community welfare organisation -Burmese Rohingya Community Australia; and (4) enabled reflective practice and learnings. This paper presents an innovative model for engaging with refugee communities. Although this project was a pilot in the Canterbury community, it provides knowledge and learnings on the engagement of refugee communities with the health system in Australia.

The Importance of Wildlife Disease Monitoring as Part of Global Surveillance for Zoonotic Diseases: The Role of Australia.

Australia has a comprehensive system of capabilities and functions to prepare, detect and respond to health security threats. Strong cooperative links and coordination mechanisms exist between the human (public health) and animal arms of the health system in Australia. Wildlife is included in this system. Recent reviews of both the animal and human health sectors have highlighted Australia’s relative strengths in the detection and management of emerging zoonotic diseases. However, the risks to Australia posed by diseases with wildlife as part of their epidemiology will almost certainly become greater with changing land use and climate change and as societal attitudes bring wildlife, livestock and people into closer contact. These risks are not isolated to Australia but are global. A greater emphasis on wildlife disease surveillance to assist in the detection of emerging infectious diseases and integration of wildlife health into One Health policy will be critical in better preparing Australia and other countries in their efforts to recognize and manage the adverse impacts of zoonotic diseases on human health. Animal and human health practitioners are encouraged to consider wildlife in their day to day activities and to learn more about Australia’s system and how they can become more involved by visiting www.wildlifeheathaustralia.com.au.