Australian health review : a publication of the Australian Hospital Association最新文献

{"title":"Costs of 30-day potentially avoidable unplanned readmissions following discharge from general medicine wards: a South Australian retrospective cohort study.","authors":"Taylor-Jade Woods, Yogesh Sharma, Campbell Thompson, Arduino A Mangoni, Boloor Sudhir Rao, Isuru Kariyawasam, Richard Woodman, Chris Horwood, Billingsley Kaambwa","doi":"10.1071/AH25232","DOIUrl":"10.1071/AH25232","url":null,"abstract":"<p><strong>Objective: </strong>Directly influenced by hospital-related factors, potentially avoidable unplanned readmissions (PAURs) offer a more actionable indicator of care quality and safety than unplanned readmissions. Direct costs of PAURs are scarcely reported. This study estimates the direct costs of PAURs within 30 days of discharge and identifies factors associated with higher unplanned readmission costs.</p><p><strong>Methods: </strong>We retrospectively analysed hospitalisation data for all adult general medicine patients discharged alive from a South Australian hospital between 1 July and 30 September 2022 and readmitted to any state public hospital within 30 days. A panel of senior clinicians evaluated PAURs using pre-defined criteria. Costs were estimated using the National Hospital Cost Data Collection and inflated to 2024 Australian dollars. Predictors of cost were identified using a generalised linear model.</p><p><strong>Results: </strong>Of 375 readmitted patients, 78 readmissions were classified as PAURs. The total unadjusted unplanned readmission cost was $4,720,869, with PAURs accounting for $897,932 (19%). Mean costs were $11,512 (s.d. = $14,329) for PAURs and A$12,872 (s.d. = $19,089) for non-PAURs (P = 0.45). Readmission costs were higher among patients with congestive heart failure and chronic kidney disease (both P < 0.05). Adjusted mean cost per unplanned readmission (both PAURs and non-PAURs) was $13,703 (s.e. = $1112). PAURs were associated with a $3982 cost reduction (P = 0.037). Prior emergency department visits reduced costs (P = 0.017), whereas smoking (P = 0.043) and index admission length of stay (P < 0.05) increased costs.</p><p><strong>Conclusion: </strong>PAURs imposed substantial costs but were less expensive per admission than non-PAURs. Higher costs were observed among patients with congestive heart failure, chronic kidney disease, smoking, and longer index admissions. System-level transitional care strategies with targeted case management for high-risk, high-cost patients may enhance continuity of care, reduce readmission-related costs, and support more strategic resource allocation across the public healthcare system.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consumer involvement enhances allergy research: a National Allergy Centre of Excellence Consumer Engagement Framework.","authors":"Kylie Gwynne, Tanya O'Farrell, Angela Young, Thilanka Morawakage, Lisa Gamble, Kirsten Perrett","doi":"10.1071/AH25240","DOIUrl":"10.1071/AH25240","url":null,"abstract":"<p><p>Consumer involvement in research is essential for building public trust, accelerating translation, and ensuring relevance. The National Allergy Centre of Excellence exemplifies best practice through its Consumer Advisory Group and Consumer Engagement Register, embedding lived experience into every research stage to improve outcomes for Australians living with allergic disease.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"49 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical practice guidelines for Indigenous peoples with middle ear disease in Australia: a systematic scoping review.","authors":"Kai Nash, Rona Macniven, Carmen Parter, Margaret Apolima Fono, Yvonne Dimitropoulos, Catherine McMahon","doi":"10.1071/AH25092","DOIUrl":"10.1071/AH25092","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify practitioner awareness of and adherence to clinical practice guidelines for Indigenous peoples with otitis media in Australia.</p><p><strong>Methods: </strong>Database searches were conducted in Medline, Embase, APA PsychInfo, Scopus, Web of Science Core Collection, Academic Search Premier, and CINAHL. Studies were eligible for inclusion if they reported on practitioner awareness of or adherence to clinical practice guidelines for otitis media management for Indigenous peoples in Australia. Search terms included 'Indigenous peoples', 'otitis media', and 'guidelines'.</p><p><strong>Results: </strong>Four peer-reviewed studies published between 2007 and 2020 met eligibility for inclusion. This review identified three key concepts: (1) practitioner awareness rates for the Therapeutic Guidelines were significantly higher than for the 2001 OM Guidelines, (2) practitioners self-reported higher adherence to the Therapeutic Guidelines compared with the 2001 OM Guidelines, and (3) antibiotic prescriptions for Indigenous children varied, possibly due to use of different guidelines and adherence criteria, as well as variations in geographical areas and settings.</p><p><strong>Conclusions: </strong>Practitioner adherence to clinical practice guidelines specific for Indigenous peoples with otitis media is critical to ensuring a consistent impact and, by extension, closing the gap in related life outcomes for Indigenous peoples in Australia. It is important to evaluate guideline impact through establishing current practitioner adherence rates. Furthermore, increasing awareness of culturally appropriate research approaches and availability of evaluation tools, such as the Aboriginal and Torres Strait Islander Quality Appraisal Tool, should improve the conduct of future Indigenous research.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"49 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating cybersecurity into healthcare quality governance: a policy perspective on artificial intelligence risks in Australia.","authors":"Dieu Phuong Lan Luc, Mai Phuong Nguyen","doi":"10.1071/AH25195","DOIUrl":"10.1071/AH25195","url":null,"abstract":"<p><p>The integration of artificial intelligence (AI) into Australian healthcare promises to improve diagnostic accuracy, workflow efficiency, and personalised care, yet it also introduces critical cybersecurity vulnerabilities that threaten not only data privacy but also patient safety and health system trust. This perspective argues that cybersecurity must be recognised as a core dimension of healthcare quality and formally embedded in Australia's safety governance frameworks. Drawing on recent national incidents, regulatory gaps, and international comparisons, we propose five policy actions to align AI-enabled innovation with secure, ethical, and resilient healthcare delivery. Embedding cybersecurity within clinical governance and system reform agendas is vital to ensure sustainable digital transformation.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"49 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'I love my job, but it's time to go': wellbeing triggers for retirement in Australian female general practitioners.","authors":"Louise Stone, Karen Price, Michelle Barrett, Megan Cahill, Erin Walsh","doi":"10.1071/AH25170","DOIUrl":"10.1071/AH25170","url":null,"abstract":"<p><strong>Objective: </strong>Australia has a critical shortage of general practitioners (GPs). A third of the profession are expected to leave within the next 5 years, and recruitment initiatives have been insufficient to address the gap. Female GPs practice differently to their male colleagues and seem to be reducing their clinical work at higher rates. The aim of this study was to explore the reasons why they are leaving, so that Australian communities are better able to attract and retain their expertise and capacity.</p><p><strong>Methods: </strong>The study used a narrative methodology with an online survey method. We recruited female GPs who were retiring or reducing their clinical workload by at least 50% and used descriptive, comparative and open-ended questions. The survey explored the way physical, emotional, social, financial and occupational wellbeing influenced their decisions to: become GPs, remain in general practice, choose to leave and consider returning.</p><p><strong>Results: </strong>There was rapid uptake with 770 eligible participants completing the survey within a month. The cohort was broadly representative of the female GP population, in age, experience and geographical distribution. Female GPs expressed a deep commitment to their patients and communities, but described financial, social and occupational barriers to care that were physically, mentally and morally harmful. GPs felt 'targeted' by politicians and policy makers who treated them with 'malignant disregard'.</p><p><strong>Conclusions: </strong>Female GPs describe unsustainable working conditions that prevent them from working in a profession they love. Rebuilding trust will be a core task if this critical workforce is to be retained.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in size and co-location of health services for Australian general practice, 2000-2016.","authors":"Preet Kalkat, Shaun Larkin, Jennifer Lacy-Nichols, Adam Elshaug, Christopher Harrison","doi":"10.1071/AH25105","DOIUrl":"10.1071/AH25105","url":null,"abstract":"<p><strong>Objective: </strong>The study analysed how the proportion of general practitioners (GPs) working in different practice sizes and how co-located health services changed over time in Australia, including the differences in these variables across different geographic and socioeconomic areas.</p><p><strong>Methods: </strong>A secondary analysis of University of Sydney's Bettering the Evaluation and Care of Health dataset, a continuous cross-sectional study of GP activity in Australia, was performed. We analysed changes in practice size; changes in co-location of GP practices with other health services (e.g. physiotherapy, psychology, pathology, imaging); changes in practice nurses employed within GP practices; and changes in GP and practice characteristics (including GP sex, GP age, GP hours worked, and practice after-hours arrangements) from April 2000 to March 2016.</p><p><strong>Results: </strong>The average practice size increased from 4.6 (95% confidence interval (CI) 4.4-4.9) GPs in 2000-2001 to 7.5 (95% CI 7.2-7.8) GPs in 2015-2016. The proportion of GPs working at practices with co-located health services increased from 66.3% (95% CI 63.4-69.2) in 2008-2009 to 94.0% (95% CI 92.5-95.5) in 2015-2016. The proportion of GPs at practices with practice nurses significantly increased from 60.1% (95% CI 56.9-63.2) in 2004-2005 to 84.7% (95% CI 82.4-87.0) in 2015-2016. There were no significant differences across these variables in different geographic and socioeconomic areas, except for practice nurses.</p><p><strong>Conclusion: </strong>This research confirms that GP practice size, co-location of health services, and the number of nurses employed within general practices have increased significantly from 2000 to 2016. We suggest that further data sources are required to explore the implications of these findings and to inform policy.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"49 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and strategies for international medical graduates in registration and integration into the Australian healthcare system: a systematic scoping review.","authors":"Wen Li, Mehwish Nisar, Robyn M Gillies, Matthew McGrail, Asaduzzaman Khan","doi":"10.1071/AH25210","DOIUrl":"10.1071/AH25210","url":null,"abstract":"<p><strong>Objective: </strong>International medical graduates (IMGs) are vital for addressing Australia's healthcare shortages but face significant barriers. This review aims to update evidence on their challenges, assess progress since the 2012 Lost in the Labyrinth report, and propose new actions.</p><p><strong>Methods: </strong>This systematic scoping review focuses on literature from 2001 to 2025 in the databases of PubMed, Embase, Scopus, Web of Science, and Cochrane, including articles that reported quantitative or qualitative research or data analyses, opinion papers, and editorials. The study adapts the Health Systems Strengthening Framework to synthesise findings, with an emphasis on the Lost in the Labyrinth's recommendations.</p><p><strong>Results: </strong>Fifty-four studies revealed persistent challenges, including supervision gaps, governance issues, financial burdens, visa inequities, and accreditation barriers. Emerging issues involved regulatory inefficiencies, insufficient support, and inequitable job access. Continuing strategies focus on supervision and workplace-based assessments (WBAs), and new recommendations propose shadowing programs, policy buffers, leadership reforms, mental health support, and equitable benefits. Despite progress, challenges persist in service delivery and equity. Six new recommendations emphasise government leadership, scalable assessments, and targeted support for an inclusive healthcare system.</p><p><strong>Conclusions: </strong>Significant challenges remain in IMGs' registration and integration, particularly in service delivery and workforce equity. Six new recommendations complement the Lost in the Labyrinth recommendations, underscoring the need for consistent government leadership, scalable WBA, and targeted support for an inclusive, sustainable healthcare system.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"49 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voices of the future: an exploration of the Australian Capital Territory speech pathology workforce.","authors":"Lilian Anderson, My Tran, Jinhu Li, Mark Cormack","doi":"10.1071/AH25203","DOIUrl":"10.1071/AH25203","url":null,"abstract":"<p><strong>Objective: </strong>To establish a dataset of the speech pathology workforce in the Australian Capital Territory, addressing gaps in workforce data caused by the absence of National Registration and Accreditation Scheme regulation.</p><p><strong>Methods: </strong>A 21-question online survey was adapted and distributed by subject matter and health workforce experts, based on existing workforce survey data for National Registration and Accreditation Scheme regulated allied health professionals, and previous allied health and speech pathology workforce surveys in other Australian health jurisdictions. Descriptive statistics and regression analysis were performed to examine the relationship between demographic and employment characteristics.</p><p><strong>Results: </strong>The survey revealed an emerging speech pathology workforce requiring structured supervision and support, that is inequitably distributed across the Australia Capital Territory. The collected demographic and basic employment characteristics of speech pathologists in the Australian Capital Territory were largely consistent with 2021 Census data and Speech Pathology Australia estimates. The survey provided greater granularity of speech pathology workforce data that aligns more closely with datasets used for other AH professions under the National Registration and Accreditation Scheme.</p><p><strong>Conclusions: </strong>This research has established a purpose-built dataset of the speech pathology workforce in the Australian Capital Territory. The granularity of this data can better inform workforce planning for speech pathology and other allied health professions not covered by the National Registration and Accreditation Scheme. A public online register based on this framework for speech pathologists and allied health professions would enhance the understanding of critical workforce dynamics over time and allow more robust planning of the allied health workforce.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corporatisation without clarity: empirical gaps in Australian general practice data.","authors":"Preet Kalkat, Shaun Larkin, Adam G Elshaug, Christopher Harrison, Jennifer Lacy-Nichols","doi":"10.1071/AH25233","DOIUrl":"10.1071/AH25233","url":null,"abstract":"<p><p>The increase in corporatisation in the healthcare sector is commonly discussed in international literature. However, in Australia, attempts to measure the extent of general practice corporatisation and its impacts have been hindered by poor data availability. We compare the availability of data about general practice corporatisation in the Australian context with international examples, providing evidence of the shortcomings in Australian data. We recommend improved data disclosure in Australia to allow regulators, policy makers, clinicians, and the public to make informed decisions and understand the impacts that corporatisation has on the quality, access, and affordability of health care.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":"49 6","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The process of adapting an innovative program for the self-management of type 2 diabetes in Aboriginal peoples: guided self-determination in healthcare settings.","authors":"Tanya Druce, Sharon Atkinson-Briggs, Debra Kerr, Catharine McNamara, Bodil Rasmussen","doi":"10.1071/AH25168","DOIUrl":"10.1071/AH25168","url":null,"abstract":"<p><strong>Objectives: </strong>The Guided Self-Determination (GSD) method is an evidence-based life-skill intervention program that involves self-directed and shared decision-making between people with an ongoing health issue and GSD-trained healthcare practitioners. Type 2 diabetes (T2D) is a significant contributor to disease burden for Aboriginal and Torres Strait Islander peoples. This paper describes the process of developing a co-designed, culturally tailored GSD program to improve diabetes self-management and wellbeing for Aboriginal and Torres Strait Islander peoples.</p><p><strong>Methods: </strong>Two co-design workshops were held with Aboriginal peoples with lived experience of T2D, in conjunction with healthcare practitioners.</p><p><strong>Results: </strong>The participants' feedback highlighted the need for plain language and pictorials; using respectful Indigenous language terms; the importance of emphasising successful diabetes management; the inclusion of mind mapping; and the use of strengths-based yarning as the foundation of the program.</p><p><strong>Conclusions: </strong>The importance of tailoring communication methods to fit the cultural and linguistic context for Aboriginal people was integral to participants. Using less medical and technical language and including diagrams, drawings or symbols ensured that the information was accessible. By aligning language and communication styles with that of Aboriginal people, healthcare practitioners can help ensure that their messages are valued and understood. In the next phase of the project, the effectiveness of the co-designed GSD program will be evaluated using diabetes self-management and quality of life measures. In addition, the feasibility and acceptability of the GSD program will be explored.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}