Australian Health Review最新文献_第7页

Patterns of intensive care unit emergencies. 重症监护病房紧急情况的模式。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH22153

Alex Yartsev, Feibi Yang

{"title":"Patterns of intensive care unit emergencies.","authors":"Alex Yartsev, Feibi Yang","doi":"10.1071/AH22153","DOIUrl":"https://doi.org/10.1071/AH22153","url":null,"abstract":"Objective Little is known about the epidemiology of medical emergencies occurring in the intensive care unit (ICU). The aim of this study is to draw attention to the importance of auditing emergency events in the ICU. We hypothesised that emergency events occurring in the ICU would be clustered during periods of decreased medical and nursing attention and would occur in patients who had a higher illness severity and a greater risk of death. Methods A retrospective observational cohort study was carried out in a 36-bed tertiary intensive care unit. The data capture all intensive care patients admitted to the ICU from 1 January to 1 December 2020. The number of emergency events occurring during each clock hour was correlated with ICU shift staffing patterns. In-hospital mortality and illness severity scores for patients experiencing emergency events were compared with those for all other ICU patients. Results Serious medical emergencies were most frequent during the day, specifically during the morning ICU round (30% of all such events occurred between 08:00 and 12:00 hours), and there were peaks of incidence in the hour following each nursing and medical shift handover (following shift change times at 08:00, 15:00 and 21:00 hours). Agitation-related emergency events were least frequent during the periods of nursing day shift and afternoon shift overlap (07:00-08:00 hours and 13:00-15:00 hours). Patients who experienced serious medical emergency events in the ICU had a higher in-hospital mortality rate (28.3%) compared with the overall ICU mortality of 10.5% (OR = 4.89, 95% CI: 3.04-7.86). Conclusions Patients who deteriorate suddenly in the ICU have greater illness severity and a significantly increased risk of death. The incidence of serious emergency events correlates with patterns of ICU staffing and work routines. This has implications for rostering, clinical workflow and education program design.","PeriodicalId":55425,"journal":{"name":"Australian Health Review","volume":"47 2","pages":"234-238"},"PeriodicalIF":1.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9624951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Emergency clinician perceptions of patients who present frequently to the emergency department: a snapshot of current practice. 急诊临床医生对经常出现在急诊科的患者的看法:当前实践的快照。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH22160

Viola Korczak, Hueiming Liu, Kendall Bein, Thomas Lung, Stephen Jan, Michael Dinh

{"title":"Emergency clinician perceptions of patients who present frequently to the emergency department: a snapshot of current practice.","authors":"Viola Korczak, Hueiming Liu, Kendall Bein, Thomas Lung, Stephen Jan, Michael Dinh","doi":"10.1071/AH22160","DOIUrl":"https://doi.org/10.1071/AH22160","url":null,"abstract":"Objective This study aimed to assess emergency clinician perceptions of adult patients who present frequently to the emergency department (ED) in an Australian context and understand current practices. Methods ED clinicians including general practitioners, career medical officers and nurse unit managers working at New South Wales Australia level 3-6 hospitals were surveyed. Responses to open-ended questions were independently coded by two reviewers and the main themes were analysed. Results Almost all the 210 participants (99%) could identify a population of frequent ED presenters at their hospital. Participants suggested that 9-12 presentations per year was a useful benchmark to use to characterise frequent ED presentations. They also indicated the need to consider as criteria recurrent presentations, their complexity, disease category and timeframe. Participants believed that the cause for presentation, from a restricted list of clinical alternatives, was multifactorial but the single most common cause for presentation was thought to be mental health followed by drug and alcohol. A total of 73% of participants reported that their hospitals had interventions to address frequent ED presentations, most commonly case management, multidisciplinary meetings and staff specialist involvement. Lack of co-ordination between services and a lack of resources in ED were cited as barriers to improving outcomes for patients who frequently present. Conclusions ED clinicians surveyed offered suggestions on how to characterise frequent ED presentations beyond the number of visits to better identify this higher risk population. Additional services, as well as better coordination between patients, families, hospitals and outpatient services, appear needed in order to improve outcomes for this cohort of patients. Interventions should focus on increasing health outcomes, rather than a decrease in the number of presentations alone.","PeriodicalId":55425,"journal":{"name":"Australian Health Review","volume":"47 2","pages":"226-233"},"PeriodicalIF":1.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9308734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Health policy evaluation in rural and remote Australia: a qualitative exploration and lessons from the Northern Territory. 澳大利亚农村和偏远地区的卫生政策评价:质量探索和来自北领地的经验教训。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH22255

Kate Raymond, Sally Nathan, Reema Harrison, Lois Meyer

引用次数: 0

Demographic changes in Australia's regulated health professions: 6-year trends. 澳大利亚受监管卫生专业的人口变化:6年趋势。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH23004

Sarah Anderson, Eva Saar, Jacinta Evans, Michael Rasmussen, Sunita Bapuji Bayyavarapu, Penelope Ann Elizabeth Main, Samantha Stark, Helen Townley

{"title":"Demographic changes in Australia's regulated health professions: 6-year trends.","authors":"Sarah Anderson, Eva Saar, Jacinta Evans, Michael Rasmussen, Sunita Bapuji Bayyavarapu, Penelope Ann Elizabeth Main, Samantha Stark, Helen Townley","doi":"10.1071/AH23004","DOIUrl":"https://doi.org/10.1071/AH23004","url":null,"abstract":"Objective Studies of Australian health workforce demographics tend to be limited to single professions, a set geographic area, or based on incomplete data. This study aims to comprehensively describe changes to the demographic characteristics of Australia's regulated health professions over 6 years. Methods Data were sourced from the Australian Health Practitioner Regulation Agency (Ahpra) registration database, and a retrospective analysis of 15 of the 16 regulated health professions between 1 July 2015 and 30 June 2021 was conducted. Variables including profession, age, gender and state/territory locations for the practitioners' principal places of practice were analysed descriptively and via appropriate statistical tests. Results Changes in age, gender representation, and place of practice varied significantly and in different ways across the 15 professions. The total number of registered health practitioners increased by 141 161 (22%) from 2016 to 2021. The number of registered health practitioners per 100 000 population increased by 14% from 2016, with considerable variation across the professions. In 2021, women accounted for 76.3% of health practitioners across the 15 health professions, a significant increase of 0.5% points since 2016. Conclusions Changes to demographics, especially in ageing workforces and feminising professions, can have implications for workforce planning and sustainability. Future research could build on this demographic trend data by investigating causes or undertaking workforce supply or demand modelling.","PeriodicalId":55425,"journal":{"name":"Australian Health Review","volume":"47 2","pages":"246-253"},"PeriodicalIF":1.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9256140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hepatitis B immune status of staff in smaller acute healthcare facilities. 小型急症医疗机构工作人员乙型肝炎免疫状况。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH22219

Alex Hoskins, Leon James Worth, Michael James Malloy, Katherine Walker, Ann Bull, Noleen Bennett

{"title":"Hepatitis B immune status of staff in smaller acute healthcare facilities.","authors":"Alex Hoskins, Leon James Worth, Michael James Malloy, Katherine Walker, Ann Bull, Noleen Bennett","doi":"10.1071/AH22219","DOIUrl":"https://doi.org/10.1071/AH22219","url":null,"abstract":"Objective To determine the proportion of staff employed in smaller Victorian public acute healthcare facilities with evidence of immunity to hepatitis B. Methods For optimal long-term immunity, a completed hepatitis B vaccination course and post vaccination hepatitis B surface antibody (anti-HBs) level ≥10 mIU/mL is desirable for all high-risk staff employed in healthcare facilities. For the financial years 2016/17-2019/20, a standardised surveillance module developed by the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre was completed by the smaller Victorian public acute healthcare facilities (individual hospitals with Results A total of 88 healthcare facilities reported hepatitis B immunity status of high-risk (Category A) staff (n = 29 920) at least once over 5 years; 55 healthcare facilities reported more than once. The aggregate proportion with evidence of optimal immunity was 66.3%. Healthcare facilities with 100-199 Category A staff employed reported the lowest evidence of optimal immunity (59.6%). Of all Category A staff with no evidence of optimal immunity, the majority had 'unknown' status (19.8%), with only 0.6% overall who declined vaccination. Conclusions Our study found evidence of optimal staff hepatitis B immunity in only two-thirds of Category A staff working in surveyed healthcare facilities.","PeriodicalId":55425,"journal":{"name":"Australian Health Review","volume":"47 2","pages":"254-257"},"PeriodicalIF":1.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9262158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Change in costs to funders of maternity care over time: an analysis of Queensland births. 随着时间的推移，产妇护理资助者的成本变化:对昆士兰州出生的分析。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH22108

Bonnie Eklom, Sally Tracy, Emily Callander

{"title":"Change in costs to funders of maternity care over time: an analysis of Queensland births.","authors":"Bonnie Eklom, Sally Tracy, Emily Callander","doi":"10.1071/AH22108","DOIUrl":"https://doi.org/10.1071/AH22108","url":null,"abstract":"Objective To describe change in costs to different funders over time for women giving birth in Queensland between 2012 and 2018. Methods A whole-of-population linked administrative dataset was used that contained all health service use in Queensland for women who gave birth between 1 July 2012 and 30 June 2018 and their babies. Aggregated costs for mother and baby from pregnancy to 12 months postpartum were used to compare the change in costs to funders over time. Results There was an increase in mean total cost to all funders per birth in the public system and private system from 2012 to 2018. North West Hospital and Health Service (HHS) had the highest mean total cost (in Australian dollars) in 2018 (A$42 353), while home births had the lowest (A$6105). For the majority of HHSs the proportion of births with a positive birth outcome (as defined by a composite outcome measure) has remained largely static or declined during this time period. Cairns and Hinterland HHS and Townsville HHS had the largest declines of 15% and 16% respectively, while mean total cost to all funders rose 36.39% and 46.41%, respectively. Conclusions There has been an increase over time across Queensland in the cost of childbirth in public hospitals and in the private system, while the cost of home birth has remained static. For most HHSs this increase in cost is also associated with little change or a decline in the percentage of births with a positive outcome. Increases in cost are therefore not being translated into better outcomes for women and their babies. Routine performance monitoring of cost, quality and safety should be adopted to ensure the provision of high value maternity care in Australia.","PeriodicalId":55425,"journal":{"name":"Australian Health Review","volume":"47 2","pages":"148-158"},"PeriodicalIF":1.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9255165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medicare reimbursed telehealth exercise physiology services were underutilised through the coronavirus (COVID-19) pandemic: an ecological study. 在冠状病毒(COVID-19)大流行期间，医疗保险报销的远程医疗运动生理学服务未得到充分利用:一项生态学研究。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH22220

Riley C C Brown, Jeff S Coombes, Centaine L Snoswell, Jaimon T Kelly, Shelley E Keating

{"title":"Medicare reimbursed telehealth exercise physiology services were underutilised through the coronavirus (COVID-19) pandemic: an ecological study.","authors":"Riley C C Brown, Jeff S Coombes, Centaine L Snoswell, Jaimon T Kelly, Shelley E Keating","doi":"10.1071/AH22220","DOIUrl":"https://doi.org/10.1071/AH22220","url":null,"abstract":"Objectives To describe the quantity and cost of in-person and telehealth exercise physiology (EP) reimbursed under the Medicare Benefits Schedule (MBS) in Australia before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods This study uses publicly available MBS data to describe EP services (in-person and telehealth) reimbursed by Medicare between January 2020 and December 2021. Data were extracted at state and national levels. Results Despite a reduction in quantity and cost in quartile (Q) 2 2020 (41% reduction), MBS-reimbursed EP services have remained relatively constant at a national level through the 2-year observation period. Service claims averaged 88 555 per quarter in 2020 and 95 015 in 2021. The proportion of telehealth consultations relative to total quarterly claims for EP was <1% in Q1 2020, 6.0% in Q2 2020, 2.4% in Q3 2020 and 1.7% in Q4 2020. This dropped to an average of 1.4% across 2021 (Q1-Q4). States undergoing lockdown periods reported decreased service rates relative to February 2020 (i.e. pre-lockdown). EP services were associated with a Medicare expenditure of AUD17.9M in 2020 (telehealth = 2.4% of total) and AUD19.7M (telehealth = 1.5% of total) in 2021. Conclusions Quantity and cost of MBS-reimbursed EP services remained relatively constant throughout the height of service disruption due to COVID-19 (2020/21). Telehealth uptake during this time has been minimal for EP.","PeriodicalId":55425,"journal":{"name":"Australian Health Review","volume":"47 2","pages":"175-181"},"PeriodicalIF":1.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9247779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Investing in health system resilience. 投资于卫生系统复原力。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH23051

Jane Hall, Philip Haywood

引用次数: 0

Opioid dispensing 2008-18: a Queensland perspective. 阿片类药物配药2008-18:昆士兰州的观点。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH22247

Benita Suckling, Champika Pattullo, Peter Donovan, Marcus Gallagher, Asad Patanwala, Jonathan Penm

{"title":"Opioid dispensing 2008-18: a Queensland perspective.","authors":"Benita Suckling, Champika Pattullo, Peter Donovan, Marcus Gallagher, Asad Patanwala, Jonathan Penm","doi":"10.1071/AH22247","DOIUrl":"https://doi.org/10.1071/AH22247","url":null,"abstract":"Objective This study provides an overview of opioid dispensing in Queensland from 2008 to 2018 by recipient age, drug, oral morphine equivalent and remoteness. Methods Data were obtained from the Queensland Monitoring of Drugs of Dependence System database for 2008-18 and analysed using data from the Australian Bureau of Statistics to account for population growth. Opioid dispensing by age, drug, oral morphine equivalent and remoteness were assessed. Results The number of prescriptions for Schedule 8 opioid medicines dispensed in Queensland increased from 190 to 430 per 1000 population over the study period (2.3-fold increase). Oxycodone had the largest increase in dispensing over the study period of 3.1-fold, with tapentadol increasing rapidly since initial Pharmaceutical Benefits Scheme listing in 2013 to the third most dispensed opioid by 2018. By 2018, opioid dispensing among the oldest Queenslanders, those aged 85+ years, occurred at triple the rate for those aged 65-84 years. When adjusted to report oral morphine equivalents (OME) in milligrams (mg), there has been an increase of approximately 1.9-fold over the study period. Results were also presented by geographical area, including a heatmap and analysis by remoteness. Prescriptions dispensed per 1000 population were 416 for major cities, 551 for inner regional and 445 for outer regional, and highlight that inner and outer regional areas have higher rates of prescriptions when compared to major cities (32 and 7% higher, respectively). Conclusion This study highlights changes in opioid prescription dispensing by drug and OME, as well as the variation in dispensing rates when accounting for remoteness. Further studies to link statewide databases, and to better understand drivers for differences in dispensing by location, will provide valuable insights to further inform policy and service provision.","PeriodicalId":55425,"journal":{"name":"Australian Health Review","volume":"47 2","pages":"217-225"},"PeriodicalIF":1.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9308769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Exploring the delivery of phase II cardiac rehabilitation services in rural and remote Australia: a scoping review. 探索在澳大利亚农村和偏远地区提供II期心脏康复服务:范围审查。

IF 1.8 4区医学

Australian Health Review Pub Date : 2023-04-01 DOI: 10.1071/AH22204

Katina Corones-Watkins, Marie Cooke, Michelle Butland, Amanda McGuire

{"title":"Exploring the delivery of phase II cardiac rehabilitation services in rural and remote Australia: a scoping review.","authors":"Katina Corones-Watkins, Marie Cooke, Michelle Butland, Amanda McGuire","doi":"10.1071/AH22204","DOIUrl":"https://doi.org/10.1071/AH22204","url":null,"abstract":"Objective Phase II cardiac rehabilitation (CR) reduces cardiovascular risk factors, morbidity and mortality after a cardiac event. Traditional Australian CR programs are located in metropolitan areas and delivered by an expert, multidisciplinary team. Referral and uptake barriers for people living in rural and remote locations are significantly affected by geographical isolation. This scoping review aimed to explore how phase II CR services in rural and remote Australia are being delivered. Methods A scoping review was conducted to obtain all published literature relating to CR service delivery for people living in rural and remote Australia. A literature search of the following databases was performed in December 2021: Cumulative Index to Nursing and Allied Health Literature, Embase, the Physiotherapy Evidence Database, and PubMed. Results Six articles met the inclusion criteria. Study designs varied and included mixed methods, cross-sectional design and narrative review. Overall, literature relating to CR programs in rural and remote Australia was limited. Three themes were apparent: (1) barriers to the delivery of phase II CR in rural and remote Australia remain; (2) community centre-based programs do not reach all people in rural and remote Australia; and (3) alternative models of CR are underutilised. Conclusions Phase II CR programs in rural and remote Australia do not align with current recommendations for service delivery. The use of technology as a primary or adjunct model of delivery to support people living in rural and remote Australia needs to be further developed and implemented. Further research exploring barriers to the uptake of alternative models of CR delivery is recommended.","PeriodicalId":55425,"journal":{"name":"Australian Health Review","volume":"47 2","pages":"239-245"},"PeriodicalIF":1.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9308771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0