Medical Journal of Australia最新文献

{"title":"Beyond the silver bullet: closing the equity gap for children within a generation","authors":"Sharon R Goldfeld, Elodie O'Connor, Cindy Pham, Sarah Gray, For the Changing Children's Chances Investigator Group","doi":"10.5694/mja2.52493","DOIUrl":"10.5694/mja2.52493","url":null,"abstract":"<p>Over the past decade, inequities in children's health, development and wellbeing have not improved despite great efforts globally.<span><sup>1</sup></span> Inequities are unfair and unjust differences caused by preventable social, economic or geographic factors. Inequities generally persist into adulthood, where they carry high costs for individuals and society,<span><sup>2</sup></span> generating substantial costs across health, education and welfare budgets.<span><sup>3</sup></span> This is an extraordinary system failure for any high income country, including Australia.<span><sup>3</sup></span> Addressing inequities would generate substantial savings across budgets and raise the productivity of society at large, delivering on greater human capital.<span><sup>2, 4</sup></span></p><p>For the first time in history, this generation will not live longer than the generation before it, worldwide.<span><sup>5</sup></span> The chronic disease epidemic is driving much of this trend, with impacts being disproportionately felt by those experiencing adversity.<span><sup>6</sup></span> Opportunities for thriving are becoming increasingly socially patterned. Evidence shows that strategic investments in early childhood are imperative for averting the onset of health challenges and mitigating their societal impacts.<span><sup>7</sup></span> Yet Australian children on a persistently disadvantaged trajectory over early childhood have a seven-fold increased risk of having poorer outcomes in multiple developmental domains by late childhood, compared with the most advantaged children.<span><sup>8</sup></span></p><p>Although it might seem an unachievable goal, with the right political will and resource commitments, Australia could close the child equity gap within a generation. Perhaps more than any other time in the past decade, current federal and state agendas align with this aspiration, with the latest intergenerational report underscoring the need for urgency.<span><sup>4</sup></span> Responding to current policy interests can inform priority areas and the intervention levers that could be considered. Some existing Australian policy interests include: Early Years Strategy,<span><sup>9</sup></span> National Framework for Protecting Australia's Children,<span><sup>10</sup></span> Entrenched Disadvantage Package,<span><sup>11</sup></span> National Children's Mental Health and Wellbeing Strategy,<span><sup>12</sup></span> and Early Childhood Education and Care agendas.<span><sup>13</sup></span></p><p>This article suggests a path forward that draws on the critical thinking of multidisciplinary leaders (across economics, health, education, social care, legislation and policy) and converges on key themes of “thinking and doing” that can and should inform the early years policy and research agenda for Australia. These collaborations are essential if Australian governments are prepared to deliver on closing the equity gap with the level of urgency required.</p><p>Rad","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 10","pages":"508-511"},"PeriodicalIF":6.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52493","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Young voices, healthy futures: the rationale for lowering the voting age to 16","authors":"Kevin Kapeke, Planning Saw, Edward Krutsch, Claudia Burgner, Hannah Pitt, Ravin Desai, Khalid Muse, Jennifer Rowan, Charlize Nalupta, Judith Bessant, Susan M Sawyer, Sara Wardak","doi":"10.5694/mja2.52496","DOIUrl":"10.5694/mja2.52496","url":null,"abstract":"<p>The saying “If you don't vote, you don't count” highlights the importance of exercising our democratic right to vote in Australia.<span><sup>1</sup></span> Voting is a fundamental mechanism through which citizens can articulate their concerns and advocate for responsive governance.<span><sup>1</sup></span> Children and young people are currently paying a high price, especially in terms of their health, because individuals aged under 18 years are not allowed to vote. The disenfranchisement of young people perpetuates political disillusionment and exacerbates health disparities.<span><sup>2</sup></span> Historically, marginalised groups have experienced similar patterns of exclusion, leading to systemic neglect of their needs.<span><sup>3</sup></span></p><p>In this 2024 <i>MJA</i> supplement article for the Future Healthy Countdown 2030,<span><sup>4</sup></span> we argue that lowering the voting age to 16 years would empower young people and the political system to address inequities and build an inclusive society that promotes wellbeing. By examining the association between political participation and health outcomes, this article positions voting not merely as a democratic right but as a strategic intervention to improve public health (Box). This argument is grounded in the World Health Organization's conceptualisation of social determinants of health, which acknowledges that participation in political processes is essential for individual and community wellbeing.<span><sup>5</sup></span></p><p>Political participation is a critical social determinant of health, fostering social inclusion, empowerment and equity, which are essential for mental and physical wellbeing.<span><sup>6</sup></span> Voting, as a direct form of political participation, empowers individuals with a sense of agency over decisions that affect their lives.<span><sup>3</sup></span></p><p>Historically, expanding voting rights has led to improved health outcomes. In the United States, for example, the enfranchisement of women and racial minorities reduced inequities, resulting in significant public health gains, including better education and income, and increased longevity.<span><sup>7, 8</sup></span> These precedents suggest that extending voting rights to young people could similarly drive positive health outcomes by ensuring their representation in policy making.</p><p>Young people face barriers to equitable access to health services, such as primary health care, and issues of trust and confidentiality, compounded by complex health issues such as sexual health, mental health, family violence and homelessness.<span><sup>9</sup></span> Since the coronavirus disease 2019 (COVID-19) pandemic, young people have been disproportionately affected by challenges such as the cost-of-living crisis, high education costs, lack of affordable housing, generational wealth inequities, and a highly casualised youth workforce.<span><sup>10</sup></span></p><p>Currently, major social and policy ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S10","pages":"S18-S22"},"PeriodicalIF":6.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52496","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental footprinting in health care: a primer","authors":"Jacob Fry, Angie Bone, Keiichiro Kanemoto, Carolynn L Smith, Nick Watts","doi":"10.5694/mja2.52481","DOIUrl":"10.5694/mja2.52481","url":null,"abstract":"<p>Health care systems are responsible for 4–5% of global greenhouse gas (GHG) emissions.<span><sup>1, 2</sup></span> There is increasing pressure to reduce the environmental effects of health care as more health professionals recognise its contribution to climate change.<span><sup>3, 4</sup></span> However, measuring environmental effects and assessing progress towards decarbonisation are not trivial processes because the mechanisms driving environmental burdens are often hidden. Although much of the early focus in health has been on decarbonisation of building and transport assets, most of health care's GHG emissions occur within the supply chains that provision the health care system before the final delivery of services.<span><sup>5</sup></span></p><p>This article is intended to serve as a beginner's introduction to the environmental footprinting techniques that can be applied to uncover health care's environmental impacts, including impacts occurring along supply chains. This article focuses on GHG emissions, but many other pollutants and environmental stressors can be assessed using these methods.</p><p>Environmental impacts can be separated into “direct” and “indirect” impacts. Direct impacts occur within an organisation's physical boundary, for example hospital grounds. Indirect impacts occur outside this immediate boundary, for example impacts from purchased products. Direct impacts are relatively easy to estimate using fossil fuel consumption and utility bills. In contrast, estimating indirect emissions is more challenging for health care organisations and requires detailed data on the quantity or cost of procured products and services and the application of environmental footprinting techniques. An organisation's indirect emissions form part of their suppliers’ direct emissions and likely occur in other regions and jurisdictions, rendering them more abstract and intangible.</p><p>Quantifying indirect environmental impacts requires consideration of the supply chains delivering goods and services to final consumption. Supply chains link production layers together, where at each stage numerous inputs and components are combined to make intermediate products. This can be depicted as a tree branching upwards and outwards from the consumer, with each node representing a production stage (Box 1). Here, “upstream” refers to layers occurring before the product reaches a consumer, and “downstream” refers to layers after final consumption, including disposal of the product.</p><p>Environmental effects can occur at each layer and accumulate along the supply chain as more layers are included.<span><sup>6</sup></span> Eventually, supply chains reach consumers as final products. Accounting for all upstream environmental impacts associated with a product or service is onerous because of the large number of production layers and the many inputs into each layer. An illustrative example of supply chain is “fossil fuel combustion > petrochemical refini","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"464-467"},"PeriodicalIF":6.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52481","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The national Cardiovascular Health Leadership Research Forum: a new data-driven model placing research at the centre of improving patient outcomes","authors":"Gemma A Figtree, Kerry Doyle, Lee Nedkoff, Dominique A Cadilhac, Jason Kovacic, For the Cardiovascular National Health Leaders Research Forum Writing Group","doi":"10.5694/mja2.52482","DOIUrl":"10.5694/mja2.52482","url":null,"abstract":"<p>The Australian health system is recognised as one of the best globally. However, the burden of chronic disease, including cardiovascular disease (CVD), remains high and the associated health care sector spend in Australia is rapidly expanding. In 2022–2023, Commonwealth expenditure was estimated at $132 billion, representing 16.8% of the total budget.<span><sup>1</sup></span> Over $14 billion is spent on the direct health costs of CVD per annum.<span><sup>2</sup></span> Developing new models to harness immense research resources available to tackle our nation's key health challenges has the potential to accelerate implementation and drive new preventive and therapeutic strategies and foster a vibrant medical technology ecosystem, thereby, positively affecting patient and economic outcomes.</p><p>Until now, there has been no mechanism that allows for a fully integrated national conversation on CVD and stroke between the health system, clinicians, researchers, industry partners, state and federal governments, and data and health economics experts. The establishment of the Cardiovascular Health Leadership Research Forum (CV HLRF) in 2022<span><sup>3</sup></span> provides new opportunities relevant to the broad range of these health care stakeholders, connecting our health leaders from all jurisdictions to our world class researchers.</p><p>The CV HLRF was designed and is hosted by the Australian Cardiovascular Alliance (ACvA) — the nation's peak body for CVD researchers. The ACvA has established a coordinated and solution-focused model across its Flagships and Clinical Themes initiatives (Box). It is supported by senior leadership engagement from all Commonwealth, state and territory health jurisdictions, and a cash contribution from a number of jurisdictions. The total commitment to date is about $1.5 million to 2025–2026. This funding is supplemented by philanthropy and membership fees, as well as industry funding towards specific initiatives. It has engaged all relevant peak bodies across Australia, including the National Heart Foundation of Australia (NHFA), the Stroke Foundation, the National Cardiac Registry, the Australian Institute of Health and Welfare, and the Australian Commission on Safety and Quality in Health Care, who are committed to achieving unprecedented levels of collaboration towards the shared goal of optimal cardiovascular health and stroke care. It has also been endorsed by the national Health Chief Executives Forum.</p><p>There is already a wealth of information available for clinical quality improvement, but these data are often fragmented, lack robust metadata and are unable to be accessed in a systematic and timely manner. Visualisation of simplified and standardised outcomes and quality indicators will optimise its utility by health leaders, working with researchers and consumers to prioritise and solve health challenges. Disaggregated analysis of such a resource will allow for identification of inequities. This is pa","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"452-456"},"PeriodicalIF":6.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Melasma in the male: a less well recognised entity","authors":"Tim Aung,&nbsp;Rowland Noakes","doi":"10.5694/mja2.52478","DOIUrl":"10.5694/mja2.52478","url":null,"abstract":"<p>An otherwise healthy man of Southeast-Asian descent aged in his mid-30s presented with non-pruritic hyperpigmented patches involving the face for over 12 months (Figure). Clinically, the findings were consistent with melasma, characterised by brown or dark brown hyperpigmented patches with demarcated or ill-defined borders, involving the face (zygoma and cheeks) bilaterally. There was no history or clinical features suggestive of diagnoses such as post-inflammatory hyperpigmentation, drug-induced pigmentation or photosensitivity, or actinic lichen planus.</p><p>Melasma is a common acquired hyperpigmentary condition, described mostly in women of Asian, Middle Eastern or Latin American descent aged 30–50 years.<span>¹</span> Melasma in men is less well recognised,<span>²</span> with a reported sex ratio of 1:9 (male:female).<span>³</span> The precise aetiopathogenesis of melasma is incompletely understood. However, there are risk factors related to melasma development, such as sunlight exposure, genetic predisposition, hormonal exposure (contraceptive use and pregnancy), photosensitive medications and cosmetics use, and, rarely, thyroid disorder.<span>^2-5</span> Melasma can be diagnosed clinically based on distribution and characteristics of pigmentation and skin type or ethnicity; biopsy is rarely required.</p><p>Management includes sun protection with the use of a wide-brim hat and sunscreen (with a sun protection factor of 30 or over), and avoidance of risk factors such as phototoxic drugs, cosmetics, and hormonal contraception (in women). The triple combined topical therapy (hydroquinone 4–5% with tretinoin 0.05–0.1% and low potency corticosteroid), daily for three months, is usually the first line treatment of choice.<span>^1-3</span> Adjunct oral tranexamic acid may be considered for extensive lesions, dermal involvement, or for patients refractory to topical therapy, although there are no established studies in men.<span>²</span> There are also advanced treatment options, such as chemical peeling, microneedling, and light and laser-based therapies, with unpredictable or mixed results.<span>^{1, 3}</span></p><p>Open access publishing facilitated by the University of Queensland, as part of the Wiley – the University of Queensland agreement via the Council of Australian University Librarians.</p><p>No relevant disclosures.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"468"},"PeriodicalIF":6.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic testing in cardiovascular disease","authors":"Andrew C Martin,&nbsp;Ari E Horton,&nbsp;Shubha Srinivasan","doi":"10.5694/mja2.52479","DOIUrl":"10.5694/mja2.52479","url":null,"abstract":"<p><span>To the Editor:</span> We read with interest the review by Gray and colleagues on genetic testing in cardiovascular disease, in particular familial hypercholesterolaemia.<span>¹</span> As they highlight, familial hypercholesterolaemia is common and when undetected and untreated, leads to premature coronary artery disease (CAD). There are more than 100 000 individuals with familial hypercholesterolaemia in Australia, with 20 000 of them children under 16 years, with an additional three children born with familial hypercholesterolaemia every day.<span>²</span> Similar to other countries, more than 95% of children with familial hypercholesterolaemia across Australia are currently undiagnosed, and on a trajectory to develop premature CAD.<span>³</span></p><p>Genetic testing should be offered to confirm the diagnosis in children with probable familial hypercholesterolaemia.</p><p>Currently, the diagnosis of familial hypercholesterolaemia in childhood usually follows cascade screening after detection of a parent with familial hypercholesterolaemia. However, several opportunities to detect familial hypercholesterolaemia in childhood have been proposed, including child–parent screening at the time of an immunisation.<span>⁵</span> Universal screening of children and genomic newborn screening, combined with reverse cascade screening of parents, have great potential for improving outcomes of both children and adults with familial hypercholesterolaemia.</p><p>Once the diagnosis of familial hypercholesterolaemia has been made in a child, the management is relatively straightforward, with education on a healthy lifestyle and the initiation of lipid lowering therapy by the age of 8 to 10 years in heterozygous familial hypercholesterolaemia, to achieve an LDL-cholesterol level less than 3.5 mmol/L (95th percentile) or a 40–50% reduction. Treatment in homozygous familial hypercholesterolaemia should ideally be started by the age of 2 to 5 years.</p><p>“Prevention is better than cure”. It is time that we redefine familial hypercholesterolaemia as a treatable paediatric disorder, transforming the perspectives of our adult colleagues so that together we can change the natural history of this condition from childhood, thus avoiding the development of CAD and improving cardiovascular outcomes at a national level.</p><p>No relevant disclosures.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"501"},"PeriodicalIF":6.7,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52479","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic testing in cardiovascular disease","authors":"Michael P Gray,&nbsp;Gemma A Figtree","doi":"10.5694/mja2.52480","DOIUrl":"10.5694/mja2.52480","url":null,"abstract":"&lt;p&gt;&lt;b&gt;&lt;i&gt;&lt;span&gt;In reply&lt;/span&gt;&lt;/i&gt;&lt;/b&gt;: We thank Martin and colleagues&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; for their critical appraisal of our review on genetic testing in cardiovascular disease, published in the &lt;i&gt;MJA&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; We agree that the utility of genetic testing needs to consider the burden of disease, the age of onset, and treatment options available to individuals identified with the causal genetic variant. We also concur with Martin and colleagues regarding the value of early detection and treatment of familial hypercholesterolaemia.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; We particularly appreciate the emphasis of familial hypercholesterolaemia being a disorder frequently identified in paediatric patients, and the proposed clinical pathway for prevention of atherosclerosis and myocardial infarction, with consideration of lipid-lowering treatment after maximal lifestyle interventions from age six for those with homozygosity.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In the general population, current expert consensus guidelines continue to recommend genetic testing as a confirmatory tool following identification using clinical tools such as Simon Broome Diagnostic Criteria or the Dutch Lipid Clinic Network Score.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; However, identification of a familial hypercholesterolaemia-associated variant in an individual justifies further cascade variant testing in first-, second-, and even third-degree biological relatives for earlier diagnosis and intervention.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;As with many conditions highlighted in our article, the role of genetic testing in the identification of familial hypercholesterolaemia continues to evolve with improved understanding of the disease genetic architecture, clinical experience incorporating genomic testing, and access to sequencing technologies. Health economics, guideline development, and policy changes will be key to maximising the value of all genetic tests in the cardiovascular disease space.&lt;/p&gt;&lt;p&gt;MPG reports no relevant financial conflicts of interest. GAF reports grants from the National Health and Medical Research Council (Australia), grants from Abbott Diagnostic, Sanofi, Janssen Pharmaceuticals, and NSW Health. GAF reports honorarium from CSL, CPC Clinical Research, Sanofi, Boehringer-Ingelheim, Heart Foundation, and Abbott Diagnostic. GAF serves as board director for the Australian Cardiovascular Alliance (past president), executive committee member for CPC Clinical Research, founding director and CMO for Prokardia and Kardiomics, and executive committee member for the CAD Frontiers A2D2 Consortium. In addition, GAF serves as CMO for the non-profit, CAD Frontiers, with industry partners including Novartis, Amgen, Siemens Healthineers, ELUCID, Foresite Labs LLC, HeartFlow, Canon, Cleerly, Caristo, Genetech, Artyra, and Bitterroot Bio and Allelica. In addition, GAF has the following patents: “Patent Biomarkers and Oxidative Stress” awarded USA May 2017 (US9638699B2) iss","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"501-502"},"PeriodicalIF":6.7,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redrawing Australia's next National Health Reform Agreement: confronting the wickedest of wicked problems","authors":"Claire L Jackson","doi":"10.5694/mja2.52476","DOIUrl":"10.5694/mja2.52476","url":null,"abstract":"&lt;p&gt;Source: Mid-term review of the National Health Reform Agreement Addendum 2020-2025 final report.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; &lt;b&gt;1. Whole of system agreement.&lt;/b&gt; Establishing the National Health Reform Agreement (NHRA) as a strategic reform agreement, with the remit and governance to take a whole of health system view. &lt;b&gt;2. Intersectoral collaboration.&lt;/b&gt; Delivering integrated, coordinated and responsive patient-centred care that reduces fragmented patient care pathways, suboptimal patient experiences and outcomes, and bottlenecks in hospital flows. &lt;b&gt;3. Optimal blended models of care.&lt;/b&gt; Providing sustainable, innovative and scalable public hospital funding and holistic, blended models of care that can deliver the right care in the right place at the right time. &lt;b&gt;4. Financing reform.&lt;/b&gt; Ensuring a transparent and accountable funding model that generates the right incentives and is fit for purpose for future challenges. &lt;b&gt;5. Long term health reforms.&lt;/b&gt; Building innovation and options for future reform and associated governance. &lt;b&gt;6. Rural and remote service delivery.&lt;/b&gt; Ensuring equitable access to health care that meets rural and remote community needs and service delivery. &lt;b&gt;7. First Nations people.&lt;/b&gt; Strengthening and addressing culturally responsive support, access and equity of services provided to First Nations people within the health system. &lt;b&gt;8. Workforce and digital health.&lt;/b&gt; Enabling and incentivising a sufficient and skilled health professional workforce providing digital health services, and accessing comprehensive health information about patients across the health sector at the point of care. &lt;b&gt;9. Measuring success.&lt;/b&gt; Embedding a performance framework as a proactive monitoring and planning tool to measure the performance of the health system, understand future pressures, and the capacity of the system to respond to these pressures. &lt;b&gt;10. Coronavirus disease 2019 (COVID-19).&lt;/b&gt; Providing flexibility in the agreement to respond to large external shocks and major disruptions to the system, such as COVID-19.&lt;/p&gt;&lt;p&gt;Next year will conclude the current (2020–25) National Health Reform Agreement (NHRA) and work is progressing rapidly to develop the next addendum. Established in 2011, the NHRA is an enduring agreement, describing how the Commonwealth, states and territories will “cooperate to achieve a sustainable, connected, and equitable health system that delivers the best outcomes for Australians”.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The agreement represents the ultimate accord — binding all jurisdictions to cooperate on providing and expending $60 billion per year in health funding to the nation's best advantage.&lt;/p&gt;&lt;p&gt;As the historical focus has been primarily on hospital resourcing, recent addenda have struggled to deliver the broad reform and improved intergovernmental efficiency initially sought. In an environment of national public outcry around health delivery shortcomings,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; a mid-term review w","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 9","pages":"460-463"},"PeriodicalIF":6.7,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recruitment and retention of new doctors in remote and Aboriginal medical services through the Remote Vocational Training Scheme's Targeted Recruitment Strategy: a focus group study","authors":"Belinda G O'Sullivan,&nbsp;Veeraja Uppal,&nbsp;Ronda Gurney,&nbsp;Patrick Giddings","doi":"10.5694/mja2.52428","DOIUrl":"10.5694/mja2.52428","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the results of a targeted recruitment strategy designed to attract and retain new doctors in remote and Aboriginal medical services where they can access Remote Vocational Training Scheme (RVTS) training and support to qualify as general practitioners.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Two 2-hour purposeful online focus groups on the RVTS’ Targeted Recruitment Strategy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and participants</h3>\u0000 \u0000 <p>Five participants and nine stakeholders with knowledge and experience of the strategy. Data were transcribed and deductively and inductively coded for themes including insights from separate project reference and stakeholder advisory groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcomes measures</h3>\u0000 \u0000 <p>Perspectives of the strategy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overarching theme was that the strategy is useful for attracting and retaining new general practitioners in areas of high need and is potentially scalable. Since 2018, 20 new doctors were recruited via the Targeted Recruitment Strategy and six of them completed the RVTS program. The strategy could better differentiate target locations because increasing communities are experiencing major general practice workforce shortages. The package of employment and training could also be more clearly defined for participants, nationally marketed and collaboratively implemented. Further, more site accreditation and ongoing risk and quality review is needed, along with intense early supports for participants who are new to both the community and general practice work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Targeted Recruitment Strategy is still maturing but the early results suggest it is a unique and proactive model for attracting and improving access to general practitioners in places with high needs. It could be strengthened through formal agreements between communities and agencies, ensuring coordinated implementation, clarifying roles and responsibilities, and developing clear pathways for risk and quality management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S7","pages":"S23-S28"},"PeriodicalIF":6.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Australia's Remote Vocational Training Scheme: training and supporting general practitioners in rural, remote and First Nations communities","authors":"Patrick Giddings,&nbsp;Belinda G O'Sullivan,&nbsp;Matthew R McGrail,&nbsp;Marlene Drysdale,&nbsp;Tony T Trevaskis,&nbsp;Jacki Mein","doi":"10.5694/mja2.52449","DOIUrl":"10.5694/mja2.52449","url":null,"abstract":"&lt;p&gt;The Remote Vocational Training Scheme (RVTS) is an independent rural general practice workforce and training program fully funded by the Department of Health and Aged Care since 2000. It is operationally delivered by the Remote Vocational Training Scheme Ltd (a national training provider). This perspective article describes the RVTS and its development over time to lay the foundations for this supplement on &lt;i&gt;Growing and sustaining doctors in rural, remote and First Nations communities&lt;/i&gt;, which shows the outcomes of the RVTS program.&lt;/p&gt;&lt;p&gt;The RVTS supports the delivery of vocational general practice and rural generalist training for the Royal Australian College of General Practitioners (RACGP) and/or the Australian College of Rural and Remote Medicine (ACRRM). In doing so, the RVTS regularly liaises with both general practice colleges to manage accreditation, training requirements, and examinations among other issues. However, the RVTS has a nuanced focus compared with other rural general practice vocational training pathways (Box 1).&lt;/p&gt;&lt;p&gt;First, the RVTS specifically aims to support vocational training in more remote locations classified as Modified Monash Model (MMM) 4–7 and rural Aboriginal Medical Services (AMS) (MMM2–7) through a Remote and an AMS Stream respectively.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Second, although the ACRRM and the RACGP apply remote supervision selectively when they hope to expand the training in rural locations with limited supervisors,&lt;span&gt;&lt;sup&gt;2, 5&lt;/sup&gt;&lt;/span&gt; the RVTS fully uses remote supervision (ie, online and intermittent face-to-face) because of its context of supporting more isolated and remote doctors.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Many RVTS registrars are in areas with major general practice workforce shortages and a high clinical workload, which function as barriers to sourcing local supervision.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Third, the RVTS only enrols doctors who are already working in eligible rural and remote general practices or AMS as prevocational doctors with minimum level 3 or 4 supervision under the Australian Medical Council (ie, deemed able to work independently with remote supervision).&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; This differs from wider rural general practice training models where doctors commonly move to a rural training practice to commence training, relative to the eligibility and accreditation requirements of various rural general practice training pathways.&lt;/p&gt;&lt;p&gt;Fourth, the RVTS has a specific requirement for the participating doctors to continue to work in the same practice (in the eligible location from where they applied for the RVTS) while completing the RVTS’ three-to-four years of practice-based general practice training.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; If the doctors choose to move locations, they typically need to withdraw and re-apply in subsequent rounds (note the RVTS has two intakes per year since 2022). This focus on continuity of work/retention in the same practice is unique among ge","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S7","pages":"S3-S8"},"PeriodicalIF":6.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52449","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}