Queensland Public Health Research Articles

Emergency examination authorities in Queensland, Australia.

In Queensland, where a person experiences a major disturbance in their mental capacity, and is at risk of serious harm to self and others, an emergency examination authority (EEA) authorises Queensland Police Service (QPS) and Queensland Ambulance Service (QAS) to detain and transport the person to an ED. In the ED, further detention for up to 12 h is authorised to allow the examination to be completed. Little published information describes these critical patient encounters. Queensland's Public Health Act (2005), amended in 2017, mandates the use of the approved EEA form. Data were extracted from a convenience sample of 942 EEAs including: (i) patient age, sex, address; (ii) free text descriptions by QPS and QAS officers of the person's behaviour and any serious risk of harm requiring urgent care; (iii) time examination period commenced; and (iv) outcome upon examination. Of 942 EEA forms, 640 (68%) were retrieved at three 'larger central' hospitals and 302 (32%) at two 'smaller regional' hospitals in non-metropolitan Queensland. QPS initiated 342 (36%) and QAS 600 (64%) EEAs for 486 (52%) males, 453 (48%) females and two intersexes (<1%), aged from 9 to 85 years (median29 years, 17% aged <18 years). EEAs commonly occurred on weekends (32%) and between 2300 and midnight (8%), characterised by 'drug and/or alcohol issues' (53%), 'self-harm' (40%), 'patient aggression' (25%) and multiple prior EEAs (23%). Although information was incomplete, most patients (78%, n =419/534) required no inpatient admission. EEAs furnish unique records for evaluating the impacts of Queensland's novel legislative reforms.

Evolving insights into the epidemiology of Moraxella species bloodstream infection from two decades of surveillance in Queensland, Australia.

The epidemiology of Moraxella species bloodstream infection (BSI) is poorly defined due to their rarity. We sought to determine the incidence, risk factors, and outcomes of Moraxella species BSI in a large Australian population. All Moraxella species BSIs in patients admitted to Queensland (population estimate 5 million) public health facilities between 2000 and 2019 and submitted to Queensland pathology laboratory-based surveillance were included. Clinical and hospitalisation data were matched with laboratory-based surveillance data. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were calculated. In total, 375 incident Moraxella species BSI occurred during 86 million person-years of surveillance, with an annualised age and sex standardised incidence of 4.3 per million residents. Isolates were most commonly identified as M. catarrhalis (n = 128; 34%) and community-associated (n = 225; 60%). Incidence was highest in infants, with increasing age associated with lower incidence rate. Males were at higher risk (incidence 2.9 vs. 2.0 per million, IRR1.4; 95% CI, 1.2-1.8), this was most pronounced at age extremes. Two-thirds of adults and 43% of children with Moraxella BSI had at least one comorbid illness. When compared to infections in adults, children were more likely to have community-associated disease, and a head and neck source focus of infection. The all-cause 30-day case-fatality rate was 4% (15/375) and this was significantly higher among adults (14/191; 7% vs 1/183; 1%; p < 0.001). Our findings demonstrate the low burden of Moraxella species BSI in a state-wide cohort, for which young children have the highest risk.

A case study of an academic-stakeholder partnership: Evaluation of the '10000 Lives' smoking cessation health promotion program.

In Australia, smoking prevalence is higher in regional areas than in metropolitan cities; Central Queensland, a central-east district of Queensland, has substantially higher smoking rates than the state average. In November 2017, Central Queensland Public Health Unit (CQPHU) launched the '10000 Lives' initiative to reduce the smoking prevalence in the region. The initiative partnered with local hospitals and community organisations to increase the uptake of interventions like Quitline in the region. Evaluating a program like '10000 Lives' is critical for evidence-based health promotion practice. CQPHU partnered with a large metropolitan Australian university to evaluate the '10000 Lives' through a scheme that provided a stipend for a Doctor of Philosophy (PhD) student. This narrative report describes the experience of evaluating '10000 Lives' in a collaborative partnership between CQPHU and the public health academia. A PhD student was recruited to join this collaboration, and both developed a program logic model and completed a process and impact evaluation. This evaluation provided an ideal 'living' case study to embed in the Master of Public Health curriculum and provided the PhD student with teaching experience delivering a demonstration of public health in practice. The collaboration project was highly successful, exemplifying research, learning and practical integration for all partners. SO WHAT?: The partnership demonstrated how universities can work with government health agencies to build practice-based evidence, and importantly give public health students authentic learning opportunities.

Impact of the '10,000 lives' program on Quitline referrals, use and outcomes by demography and Indigenous status.

In November 2017, Central Queensland Public Health Unit launched the '10,000 Lives' initiative to reduce smoking prevalence in Central Queensland. The program partnered with local champions and other programs (e.g. 'Deadly Choices') to promote the use of smoking cessation services (e.g. Quitline) in Central Queensland. This study assesses the program's impact on Quitline use by participant demographics and Indigenous status. We compared the number of referred individuals who participated in and completed the Quitline program, and quit smoking during 26-months before (July 2015 to August 2017) and after (November 2017 to December 2019) the '10,000 Lives' launch. We conducted an interrupted time series analysis of monthly referrals to and use of Quitline for Aboriginal and Torres Strait Islander peoples. Overall, 3207 individuals were referred to Quitline during the 26-months-post-launch compared to 1594 during 26-months-pre-launch period of '10,000 Lives'. The number of referred individuals who completed Quitline program increased by 330.7% and quit smoking by 308.3% in post-launch period. The increase was substantially higher among aged 45+ years, females and Aboriginal and Torres Strait Islander peoples. The result for referrals and use of Quitline was validated by interrupted time series analysis for Aboriginal and Torres Strait Islander peoples. The '10,000 Lives' collaborative approach to partner with local champions and targeted smoking cessation programs was effective in increasing the use of Quitline and smoking cessation among all demographic groups, including Aboriginal and Torres Strait Islander peoples. This approach can be used in other regions to address higher smoking prevalence.

Building patient trust in health systems: A qualitative study of facework in the context of the Aboriginal and Torres Strait Islander Health Worker role in Queensland, Australia

Healthcare services in Australia are the primary responsibility of state and territory governments, which recruit and deploy health providers in hospital and primary-care services. Among the various health professional roles, that of Aboriginal and Torres Strait Islander Health Worker (A&TSIHW) is one of only two positions that must be occupied by an Aboriginal and/or Torres Strait Islander person, carrying unique responsibility for enacting cultural brokerage and promoting cultural safety at the facility-level. Implicit to these responsibilities is the assumption that A&TSIHW will use cultural capital to build clients' trust in themselves and ultimately the broader health system. Drawing on 82 in-depth interviews including 52 with A&TSIHWs, we applied Kroegar's Facework theory to explore the structures, processes and relationships that contribute to, or inhibit, A&TISHWs' capacity and willingness to build trust (beyond themselves) in government health services in Queensland, Australia. Analysis demonstrates that despite A&TSIHWs viewing and enacting interpersonal trust-building as central to their role, structural features of the health system inhibit the development of service-users' system-level trust. Findings re-establish that health systems are not ‘cultureless,’ but rather, shaped by a dominant culture that privileges certain actors, types of knowledge, and modes of communication and action, which in turn influence efforts to build trust. The study demonstrates a novel theory-driven approach to exploring the interactions between behavioural and structural factors that influence the production of systems-level trust. In the context of the Queensland public health service findings highlight a disconnect between the expectations of, and support provided to A&TISHWs to engage Aboriginal and Torres Strait Islander service-users.

Evaluation of a General Practitioner with Special Interest model: lessons learned from staff experiences.

The integration of general practitioners into specialist outpatient clinics is associated with improved access to care; however, little is understood about the organisation-level factors that affect successful implementation. We aimed to identify factors that were facilitators or barriers to the implementation of a General Practitioner with Special Interest (GPwSI) model of care across a range of specialties. Semi-structured, in-depth interviews were conducted with 25 stakeholders at 13 GPwSI clinics in operation within a Queensland public health service. A deductive content analysis was conducted using the Consolidated Framework for Implementation Research (CFIR). Stakeholders generally supported the GPwSI model and saw advantages to patients and specialist medical practitioners in terms of waiting lists, workload, and improving clinician self-efficacy and knowledge. A number of factors were identified as being crucial to the success of the program, such as adequate support and planning for the implementation, appropriate funding and advocacy. Our evaluation indicates that a GPwSI model can be a beneficial resource for improving care to patients and reducing wait lists, dependent upon adequate planning, training, and support.

The impact of a regional smoking cessation program on referrals and use of Quitline services in Queensland, Australia: a controlled interrupted time series analysis

BackgroundThe prevalence of smoking in Central Queensland (CQ), Australia was higher than the state and national averages. A regional smoking cessation initiative (“10,000 Lives”) was launched to promote available interventions (e.g., Quitline). We investigated the impact of “10,000 Lives” on referral to and use of Quitline services. MethodsWe conducted an interrupted time series analysis using a segmented Poisson regression model to measure the impact of “10,000 Lives” on monthly referrals to, and use of Quitline services (counselling sessions and nicotine replacement therapy (NRT) dispatched by Quitline), in CQ compared to other areas in the state (control population). The control population included all regional areas in Queensland with a comparable smoking prevalence to CQ and similar access to Quitline's Intensive Quit Support Program. We calculated the changes in level and trend of outcomes in CQ relative to the change in the control area during the post-launch period of “10,000 Lives”. The models were checked for autocorrelation and seasonality and adjusted accordingly. FindingsAfter the introduction of “10,000 Lives”, the mean monthly rate per 1,000 smoking population increased in the intervention area for each outcome; e.g., from 3.3 to 10.8 for referrals to Quitline, from 1.6 to 4.4 for initial counselling session completed. These results were validated by the controlled interrupted time series analysis which showed relative increases for each of these outcomes (238•5% for monthly rate of referral to Quitline per 1,000 smoking population and 248•6% for monthly rate of initial counselling sessions completed per 1,000 smoking population). InterpretationOur study demonstrates a locally coordinated health promotion initiative can promote and boost the referral to, and use of Quitline smoking cessation services. FundingThe research is funded by a collaborative research grant between School of Public Health at University of Queensland and Central Queensland Public Health Unit which is awarded by the Central Queensland Hospital and Health Service (CQHHS93907). The lead author (AK) is supported by a University of Queensland Research Training Scholarship and a Research Higher Degree Top-up Scholarship.

The Impact of a Regional Smoking Cessation Program on Referrals and Use of Quitline Services in Queensland, Australia: A Controlled Interrupted Time Series Analysis

Background: Prevalence of smoking in Central Queensland (CQ), Australia was higher than state and national averages. A regional smoking cessation initiative (“10,000 Lives”) was launched to promote available interventions (e.g. Quitline). We investigated the impact of “10,000 Lives” on referral to and use of Quitline services. Methods: We conducted interrupted time series analysis using a segmented Poisson regression model to measure the impact of “10,000 Lives” on monthly referrals to and use of Quitline services (program participation, Quitline calls and nicotine replacement therapies dispatched by Quitline), in CQ compared to other areas in the state (control population). The control population was regional areas in Queensland with a comparable smoking prevalence and similar access to Quitline’s Intensive Quit Support Program. We calculated the level and trend changes of outcomes in CQ relative to control after “10,000 Lives” commenced. The models were checked for autocorrelation and seasonality and adjusted accordingly. Findings: Mean monthly numbers of referral to, participation in, and interaction with Quitline, and NRT gum, lozenge and patch dispatches from Quitline in CQ increased by 277·2%, 154·9% and 242·7% and, 573·9%, 1170·6% and 740·9% respectively after “10,000 Lives” introduction. The result was validated by the controlled interrupted time series analysis which showed 238·5%, 248·6% and 251·6% and, 93·6%, 141·4% and 121.6% relative increase in CQ compared to control for the monthly rates of these outcomes. Interpretation: Our study demonstrates a low-cost health promotion initiative can promote and boost the referral to and use of Quitline smoking cessation services. Funding Statement: The research is funded by the collaborative research grant between School of Public Health at University of Queensland and Central Queensland Public Health Unit which is awarded by the Central Queensland Hospital and Health Service (CQHHS93907). Declaration of Interests: Lead author (AK) is supported by a University of Queensland Research Training Scholarship and a Research Higher Degree Top-up Scholarship; Dr. Gartner reports grants from Central Queensland Hospital and Health Service, during the conduct of the study; Dr. Green reports grants from Central Queensland Hospital and Health Service, during the conduct of the study; Dr. Lawler reports a collaborative research grant between School of Public Health at University of Queensland and Central Queensland Public Health Unit which is awarded by the Central Queensland Hospital and Health Service (CQHHS93907), Australia, for the conduct of the study; r. Khandaker reports grants from Central Queensland Hospital and Health Service, during the conduct of the study. Ethics Approval Statement: The study was approved by the CQHHS Human Research Ethics Committee (HREC) approved (HREC/2019/QCQ/50602) which was subsequently ratified by the HREC of the University of Queensland (Clearance Number: 2019001760).

Real-time suicide mortality data from police reports in Queensland, Australia, during the COVID-19 pandemic: an interrupted time-series analysis

BackgroundDeaths by suicide can increase during infectious disease outbreaks. This study analysed suspected suicide rates in 2020 relative to 2015–19 to assess any early effects of the COVID-19 pandemic in Queensland, Australia.MethodsWe analysed data from the interim Queensland Suicide Register (iQSR), a state-wide real-time suicide surveillance system, using an interrupted time-series design. The data source for the iQSR is the Form 1 police report of a death to a coroner. Two QSR staff independently classed the probability of a death by suicide as possible, probable, or beyond reasonable doubt. The analysis included the probable or beyond reasonable doubt categories as suspected suicides. The primary outcome was the monthly suspected suicide rate. We applied Poisson and negative binomial regressions to assess whether Queensland's Public Health Emergency Declaration on Jan 29, 2020, affected suspected suicides from Feb 1 to Aug 31, 2020. Secondary outcomes included absolute or relative changes in police-reported motives of recent unemployment, financial problems, domestic violence, and relationship breakdown.Findings3793 suspected suicides were recorded with an unadjusted monthly rate of 14·85 deaths per 100 000 people (from Jan 1, 2015, to Jan 31, 2020) before the declaration, and 443 suspected suicides were recorded with an unadjusted monthly rate of 14·07 deaths per 100 000 people (Feb 1, 2020, onwards) after the declaration. An interrupted time-series Poisson regression model unadjusted (rate ratio [RR] 0·94, 95% CI 0·82–1·06) and adjusted for overdispersion, seasonality, and pre-exposure trends (RR 1·02, 95% CI 0·83–1·25) indicated no evidence of a change in suspected suicide rates. We found no absolute or relative increases in the motives for suspected suicides, including recent unemployment, financial problems, relationship breakdown, or domestic violence from February to August, 2020, compared with the pre-exposure period.InterpretationThere does not yet appear to be an overall change in the suspected suicide rate in the 7 months since Queensland declared a public health emergency. Despite this, COVID-19 has contributed to some suspected suicides in Queensland. Ongoing community spread and increasing death rates of COVID-19, and its impact on national economies and mental health, reinforces the need for governments to maintain the monitoring and reporting of suicide mortality in real time.FundingNone.

Analysis of health administration data to inform health service planning for paediatric palliative care

BackgroundHealth service planning in paediatric palliative care is complex, with the diverse geographical and demographic characteristics adding to the challenge of developing services across different nations. Accurate and reliable data...

The improving state of Q fever surveillance. A review of Queensland notifications, 2003-2017.

Q fever is a notifiable zoonotic disease in Australia, caused by infection with Coxiella burnetii. This study has reviewed 2,838 Q fever notifications reported in Queensland between 2003 and 2017 presenting descriptive analyses, with counts, rates, and proportions. For this study period, Queensland accounted for 43% of the Australian national Q fever notifications. Enhanced surveillance follow-up of Q fever cases through Queensland Public Health Units was implemented in 2012, which improved the data collected for occupational risk exposures and animal contacts. For 2013-2017, forty-nine percent (377/774) of cases with an identifiable occupational group would be considered high risk for Q fever. The most common identifiable occupational group was agricultural/farming (31%). For the same period, at-risk environmental exposures were identified in 82% (961/1,170) of notifications; at-risk animal-related exposures were identified in 52% (612/1,170) of notifications; abattoir exposure was identified in 7% of notifications. This study has shown that the improved follow-up of Q fever cases since 2012 has been effective in the identification of possible exposure pathways for Q fever transmission. This improved surveillance has highlighted the need for further education and heightened awareness of Q fever risk for all people living in Queensland, not just those in previously-considered high risk occupations.

The improving state of Q fever surveillance. A review of Queensland notifications, 2003–2017

Q fever is a notifiable zoonotic disease in Australia, caused by infection with Coxiella burnetii. This study has reviewed 2,838 Q fever notifications reported in Queensland between 2003 and 2017 presenting descriptive analyses, with counts, rates, and proportions. For this study period, Queensland accounted for 43% of the Australian national Q fever notifications. Enhanced surveillance follow-up of Q fever cases through Queensland Public Health Units was implemented in 2012, which improved the data collected for occupational risk exposures and animal contacts. For 2013–2017, forty-nine percent (377/774) of cases with an identifiable occupational group would be considered high risk for Q fever. The most common identifiable occupational group was agricultural/farming (31%). For the same period, at-risk environmental exposures were identified in 82% (961/1,170) of notifications; at-risk animal-related exposures were identified in 52% (612/1,170) of notifications; abattoir exposure was identified in 7% of notifications. This study has shown that the improved follow-up of Q fever cases since 2012 has been effective in the identification of possible exposure pathways for Q fever transmission. This improved surveillance has highlighted the need for further education and heightened awareness of Q fever risk for all people living in Queensland, not just those in previously-considered high risk occupations.

Queensland smoking care in adult acute mental health inpatient units: Supporting practice change.

To review a clinical practice improvement approach to statewide implementation of smoking care in adult acute mental health inpatient units across public mental health services in Queensland. Queensland public mental health services, with adult acute inpatient units, joined a statewide collaborative to work together to increase the routine screening of smoking and delivery of a Smoking Cessation Clinical Pathway brief intervention to identified smokers. Over a 2-year period, statewide improvements were demonstrated in the recording of smoking status (88-97%) and in the provision of a brief smoking cessation intervention to smokers (38-73%). In addition, all individual mental health services increased the delivery of a brief intervention to identified smokers and the recording of smoking status either improved or remained at high levels. Smoking remains an ongoing challenge for mental health services and one of the most important physical health issues for people living with a mental illness. The ability to implement statewide smoking care in public mental health services is an important step in shifting poor health outcomes. The clinical practice change approach adopted in Queensland has demonstrated encouraging outcomes in improving the delivery of smoking care that has been sustained over a 2-year period.

The Epidemiology of Extrapulmonary Non-tuberculous Mycobacterial Infection in a Pediatric Population.

Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and a well-known cause of lymphadenitis, skin and soft tissue infections. The aim of this study was to evaluate the epidemiology of extrapulmonary pediatric NTM infections occurring from 2000 to 2017 in Queensland, Australia. All cases of NTM and TB are notifiable under the Queensland Public Health Act (2005) and associated regulations (2005). Data from 2000 to 2017 inclusive was collected from the Notifiable Conditions Database, a laboratory based notification system that covers private and public laboratory systems. Pediatric population demographic data were obtained from the Australian Bureau of Statistics by researching the number of children 0-14 years of age in Queensland from 2000 to 2017; both annual and averaged population was determined. The statistical software SPSS and Tableau was used for analysis. The mean age of diagnosis was 2.5 years with a majority of the cohort being women. Mycobacterium avium was the most commonly diagnosed pathogen. Geographic regions with the highest numbers of cases were predominantly tropical and coastal areas. M. haemophilum emerged as a more common pathogen from 2011 following a period of major flooding. Characteristics of the cohort of children susceptible to NTM disease appears consistent with previous reports. However, changes in the epidemiology of NTM infection (such as incidence, species, and geographic distribution) in children may be linked to environmental and weather factors.

Rural competencies in emerging medical practitioners: Beyond clinical skills.

Recruitment and retention of rural doctors remains a challenge in Australia. The Queensland Rural Generalist Program was developed to address this challenge and provides a range of tailored professional development opportunities to support rural medical training, recruitment and retention. The Rural Generalist Vocational Preparation Workshop was developed to maintain connection with trainees during a known attrition risk period and address a gap in training that focused on competencies required for rural practice. The Rural Generalist Vocational Preparation Workshop, designed using adult learning principles, includes an optimal balance between theory, scenario-based learning and facilitated group discussions. A cross-sectional survey design was employed to evaluate the workshops delivered between 2015 and 2017. The workshops were attended by Queensland Rural Generalist Program trainees in the year prior to undertaking a vocational training position in a rural hospital or general practice. Participants were from 10 Hospital and Health Services in the Queensland public health sector at the time of attendance. An evaluation survey captured participant feedback about the workshop, its value, impact and their intention to implement changes in practice. Fifty-one trainees attended the workshops across four locations. Eight-eight per cent of participants reported intentions to implement changes to practice in: pursuit of career options and enhanced team work, leadership skills and networking. Evaluation results indicated that Rural Generalist Vocational Preparation Workshop was a highly valued opportunity. It provided future rural medical practitioners with professional support and networking opportunities, promoted identity formation and stimulated rural career planning.

Implementation and strength of root cause analysis recommendations following serious adverse events involving paediatric patients in the Queensland public health system between 2012 and 2014.

This study evaluates the implementation rate and strength of the recommendations developed in all root cause analyses (RCAs) performed following serious clinical incidents involving children that have resulted in permanent harm or death in Queensland public hospitals over a 3-year period. Severity assessment classification 1 events were identified from a Queensland Paediatric Quality Council database of paediatric clinical incidents that occurred in Queensland between 1 January 2012 and 31 December 2014. There were 150 recommendations extracted from RCAs pertaining to the 42 serious adverse events involving paediatric patients. Of the recommendations, 82% were implemented; 33% of recommendations were classified as stronger, 33% as intermediate and 34% weaker in terms of their potential to improve patient safety. This study describes the implementation of recommendations and classifies them in terms of potential to prevent patient harm and save lives. Future research is needed to determine if the RCA process does indeed prevent harm.

Challenging the Status Quo ... Co-designing the future of child and youth mental health services with young people

Introduction : The commitment to partnering with consumers and carers remains a stable priority for mental health services. This is evidenced by an emerging lived experience workforce. Research demonstrates that when people share their lived experience they can have a positive impact on the recovery journeys of others. Less clear is the role of young people in peer support roles, especially within child and youth mental health settings. There is no known dedicated child and youth mental health peer workforce operating within Queensland public mental health services. This paper will challenge the status quo and pose the question “why not”. Furthermore, this paper will examine how a large child and youth mental health service has developed and sustained a model of meaningful consumer and carer participation for more than ten years. It will analyse the key success factors such as organisation readiness, mutuality and co-design practice. This paper will explore the trajectory of consumer and carer participation to the current work occurring to implement a dedicated youth mental health peer workforce. Practice Change Implemented : The experiences of consumers, carers, clinicians and managers over the past decade have driven many practice changes, including defining and refining meaningful consumer and carer particiaption and engagement, governance mechanisms, as well as policies and procedures. The paper will share the lived experience of a young person (co-author) who has transitioned from service user to valued mental health worker and will explore the key ingredients that have led to the organisational readiness to co-design, develop, implement and evaluate an innovative youth peer support worker model, using a participatory action research approach. Aims : The paper aims to showcase integrated practice and present the voice of lived experience, to shift perceptions about the value of consumers and carers working in partnership with health professionals and improve integrated mental health services for young people and families. Highlights : The paper will showcase lessons learned and common threads gleaned from young people, parents and carers as well as from clinicians and managers including: Value your experiences Listen to young people and what they want Do not reinvent the wheel - learn from others Perseverance is the key ingredient to change, closely followed by commitment and action Co-designing services for young people with young people is hugely rewarding and improves service delivery and consumer outcomes and experiences Furthermore, it will identify the success factors and limitations and barriers to working alongside young people and present the collaborative partnership between Children’s Health Queensland Hospital and Health Service and Health Consumers Queensland as we embark on co-designing the youth peer support workforce with young people. Discussion and conclusions : Creating a valued youth peer workforce is more than merely transplanting a model into an organisation, you need to nurture and build the machinery that supports meaningful integration of the lived experience. It is believed that CYMHS has created this foundation and the establishment of a youth peer workforce is a much-desired outcome of years of preparatory work.

Nurse-led services in Queensland: A scoping study

BackgroundNurse-led services are expanding in Australia, yet current information about the scope and nature of these services is lacking. The need for more coordinated service planning and systematic evaluation prompted a scoping study to inform future development. AimTo provide a comprehensive profile of nurse-led services in the Queensland public health system. MethodsA scoping study of 257 nurse-led services was conducted using an online survey distributed through each Hospital and Health Service in Queensland. Service level data were collected on structure, process and outcome evaluation, as well as enablers and barriers to sustainability of care delivery models. FindingsThere is a diverse and growing range of nurse-led services across the state that have evolved to meet the dynamic needs of their communities. Increasingly, registered nurses are rising to the challenge of providing equitable and accessible healthcare in ways that transcend traditional professional or care setting boundaries. The major challenges for sustainability were funding and resource limitations, particularly for developing service capacity to meet growing demands. There were also tensions around the need for ongoing negotiation and review of nurse-led services with medical and administrative stakeholders. DiscussionFindings underscore the need for a modernised regulatory and policy framework to support sustainable nurse-led services and allow nurses to work to their full potential to optimise outcomes for the community. ConclusionNurse-led services are the sleeping giant of healthcare reform in Australia. Now is the time for policy and practice changes that will realise the transformative potential of nurse-led care.

Characterisation of invasive clinical Haemophilus influenzae isolates in Queensland, Australia using whole-genome sequencing.

Haemophilus influenzae is an important aetiological organism of both adult and child respiratory disease. The number of non-typeable (NTHi) invasive H. influenzae isolates referred to the Queensland (QLD) Public Health Microbiology laboratory has increased notably year-by-year. In this study we used whole-genome sequencing to molecularly characterise 100 referred invasive H. influenzae, including 74 NTHi isolates over a 15-year period, observing the carriage of capsular and putative virulence genes, including the major adhesins, antimicrobial resistance genes and population diversity. Encapsulated isolates were largely clonal, however NTHi isolates displayed high genetic variability by MLST and single nucleotide polymorphism typing with no dominant clone observed. The only mechanism for β-lactam resistance identified in the QLD isolates was β-lactamase production. No single set of virulence determinants was conclusively associated with invasive QLD NTHi isolates.

Notification of Nontuberculous Mycobacteria: An Australian Perspective.

In Queensland, Australia, all cases of mycobacterial infection (tuberculosis [TB] and nontuberculous mycobacteria [NTM]) are notifiable under the Queensland Public Health Act (2005). This process originally emerged to avoid NTM confounding with notification of cases of TB, but has facilitated awareness of the increasing incidence and changing epidemiology of NTM. Although initially not a public health priority, the notification process has facilitated research that has led to an appreciation of both public health and environmental health issues associated with these pathogens. When reports of NTM infections were low in frequency, reporting was managed largely by clinicians specializing in TB. However, as reports of NTM isolates surpassed those for TB, the workload associated with clinical reporting exceeded resources. The Communicable Diseases Branch transitioned to digital reporting of laboratory isolates of mycobacteria, thereby enabling weekly and quarterly reporting of data, and generation of more detailed annual reports. The reports now include species and geographic distributions by health service district, allowing identification of clusters requiring further investigation and systematic reviews of different species. With ecological and climate change, the distribution and virulence of these emerging pathogens are evolving. Evidence of transmission of highly virulent and antibiotic-resistant clones of Mycobacterium abscessus among patients with cystic fibrosis internationally heightens the need for timely reporting to public health authorities. Ongoing systematic monitoring by public health authorities will be crucial to our understanding of NTM diseases.