{"title":"The Living Well, Living Longer program: an integrated care strategy to improve the health of people living with severe mental illness.","authors":"Andrew Simpson, Lisa Parcsi, Andrew McDonald","doi":"10.1071/AH24169","DOIUrl":"10.1071/AH24169","url":null,"abstract":"<p><p>Living Well, Living Longer (The Program) is an integrated care strategy to improve the physical health of people living with severe mental illness within a public mental health service. The significant life expectancy gap experienced by this cohort is largely attributed to higher rates of cardiovascular disease and modifiable risk factors. The Program addresses this by guiding people through the four stages of screening, detection, treatment initiation, and ongoing management of coexisting chronic health conditions. The Program adopted an integrated care approach to ensure the provision of appropriate and coordinated care across hospital and primary care services. Key care pathways include a cardiometabolic health assessment clinic, shared care with general practitioners, oral health services partnership and employment of peer support workers, dietitians, exercise physiologists, and smoking cessation to provide targeted community support and interventions. There has been strong engagement with the care pathways introduced since The Program's inception in 2013 and evaluation is currently underway to consider the impact on cardiometabolic health outcomes for participants. Critical to The Program's effectiveness has been engagement with lived experience expertise, multidisciplinary collaboration, and strong executive support. However, significant challenges persist amid an Australian public health crisis characterised by reducing rates of free primary healthcare access for people living with severe mental illness and enduring communication challenges between primary and secondary health services. With the implementation of MyMedicare and the imminent Single Digital Patient Record across NSW Health, we stand at a critical juncture. It is imperative to establish robust systems to enhance care for this vulnerable population.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"688-692"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482839","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}
Fiona Kent, Lynda Cardiff, Bronwyn Clark, Julie Gustavs, Brian Jolly, Josephine Maundu, Glenys Wilkinson, Sarah Meiklejohn
{"title":"Accreditation as a lever for change in the development of the collaborative practitioner in the Australian health system.","authors":"Fiona Kent, Lynda Cardiff, Bronwyn Clark, Julie Gustavs, Brian Jolly, Josephine Maundu, Glenys Wilkinson, Sarah Meiklejohn","doi":"10.1071/AH24165","DOIUrl":"10.1071/AH24165","url":null,"abstract":"<p><p>Objective Patient expectations in the Australian healthcare system are for coordinated, collaborative practice. There is a need for education institutions, health services, accreditation authorities, and consumers to work together to achieve this goal. As part of a larger body of work, we sought to understand how these stakeholders contribute to the development of collaborative healthcare practice. Method Nineteen focus groups were conducted in 2022 with 84 participants consisting of education providers (n =62), consumers (n =10), representatives from the Health Profession's Education Standing Group (n =8), and health service practitioners (n =4). Framework analysis was initially undertaken to understand facilitators of, and barriers to, collaborative practice and learning. In a secondary analysis, the themes were re-organised according to the Bolman and Deal domains of organisational practice, to make explicit the structural, human resource, political, and symbolic factors deemed useful for re-imaging a process for learning about and incentivising collaborative practice. Results There are multiple factors across healthcare settings that both facilitate and challenge the development of collaborative practice. Co-location of professions and participation in formal interprofessional processes such as team meetings and handovers facilitated learning collaborative practice, although traditional cultures which perpetuate siloed models of healthcare, power differentials between the professions, funding structures, and information sharing limited opportunities. The 'value' of collaborative practice was facilitated through both consistent curriculum messages throughout health professional courses and positive role modelling. Conclusions Education institutions, health service practitioners, accreditation authorities, and consumers can work together to facilitate the development of collaborative practice through attention to policy and processes, curriculum activities, student participation, health service activities and practice, and resource allocation.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"705-710"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121315","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":"Response to 'A collaborative approach to support people with a disability living in Australian group homes during the COVID-19 pandemic: a case study'.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1071/AH24264","DOIUrl":"10.1071/AH24264","url":null,"abstract":"","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"739-740"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482838","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}
Ben P White, Amanda Ward, Rachel Feeney, Laura Ley Greaves, Lindy Willmott
{"title":"Models of care for voluntary assisted dying: a qualitative study of Queensland's approach in its first year of operation.","authors":"Ben P White, Amanda Ward, Rachel Feeney, Laura Ley Greaves, Lindy Willmott","doi":"10.1071/AH24199","DOIUrl":"10.1071/AH24199","url":null,"abstract":"<p><p>Objective Voluntary assisted dying (VAD) began in Queensland in January 2023 but little is known about its practical operation. This research examined models of care for providing VAD in Queensland. Methods Semi-structured interviews were conducted with 24 participants involved with VAD delivery across Queensland's 16 Health and Hospital Services (HHSs). Participants included HHS VAD Coordinators, nurse practitioners and nurses who acted as administering practitioners, and Queensland VAD Support and Pharmacy Service (QVAD SPS) staff. Results Five themes about Queensland VAD models of care were developed: VAD is accessed almost exclusively through the public sector via HHSs, influenced by a Health Service Directive; local models of care vary; nurses play significant roles facilitating access to and providing VAD; QVAD SPS has been instrumental supporting HHSs and ensuring statewide access as back-up VAD provider; and VAD services need more resourcing. Conclusions The Queensland approach to providing VAD has been largely successful in ensuring patient access across the state. However, it differs from previous Australian VAD models with access predominantly through the public sector, greater roles played by nurse practitioners/nurses, and VAD being provided by QVAD SPS. Under-resourcing and consistency in provision of VAD services remain challenges.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"693-699"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382732","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}
Geetanjali Tanji Lamba, Camille LaBrooy, Sophie Lewis, Ian Olver, Alexander Holmes, Cameron Stewart, Paul Komesaroff
{"title":"Voluntary assisted dying: impacts on health professionals.","authors":"Geetanjali Tanji Lamba, Camille LaBrooy, Sophie Lewis, Ian Olver, Alexander Holmes, Cameron Stewart, Paul Komesaroff","doi":"10.1071/AH24142","DOIUrl":"10.1071/AH24142","url":null,"abstract":"<p><p>Objective The introduction and implementation of voluntary assisted dying (VAD) legislation represents a major shift in Australian health policy. Given potential repercussions for health professionals, understanding how they are being affected by this legislation is important to guide future policy and legislative changes. This study aims to explore the perspectives and experiences of Australian health professionals on VAD and compare impacts on those working under different state legislation in Victoria and WA. Methods Data were collected using a cross-sectional survey design, targeting health professionals nationally, primarily doctors and nurses. The survey had closed and open-ended response options, was informed by previous publications and was piloted prior to further roll-out. Recruitment was via professional networks and social media. Quantitative data were descriptively analysed and qualitative data were coded using NVivo and thematically analysed. Results There was a final sample size of 223. Impacts on clinicians identified include inadequate remuneration, a need for ongoing support and the recognition of barriers to mandatory training. Conclusions Impacts on health practitioners, if not addressed, have future implications for workforce sustainability. Increasing numbers of trained VAD practitioners may enable distribution of clinical load and prevent burnout. VAD practitioners are not being appropriately remunerated, which could be addressed by introducing dedicated Medicare Benefits Schedule items for VAD. Attention should also be given to incentivising training, including continuing professional development accreditation and appropriate funding. Strategies to support staff could include debriefing, mentoring, peer support and psychological consultations.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"720-728"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482841","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}
Andy Wong, Rob Eley, Paul Corry, Brendan Hoad, Prasad Yarlagadda
{"title":"Predicting hospital bed utilisation for post-surgical care by means of the Monte Carlo method with historical data.","authors":"Andy Wong, Rob Eley, Paul Corry, Brendan Hoad, Prasad Yarlagadda","doi":"10.1071/AH24160","DOIUrl":"10.1071/AH24160","url":null,"abstract":"<p><p>Objective This study aim was to develop a predictive model of bed utilisation to support the decision process of elective surgery planning and bed management to improve post-surgical care. Methods This study undertook a retrospective analysis of de-identified data from a tertiary metropolitan hospital in Southeast Queensland, Australia. With a reference sample from 2years of historical data, a model based on the Monte Carlo method has been developed to predict hospital bed utilisation for post-surgical care of patients who have undergone surgical procedures. A separate test sample from comparable data of 8weeks of actual utilisation was employed to assess the performance of the prediction model. Results Applying the developed prediction model to an 8-week period test sample, the mean percentage error of the prediction was 1.5% and the mean absolute percentage error 5.4%. Conclusions The predictive model developed in this study may assist in bed management and the planning process of elective surgeries, and in so doing also reduce the likelihood of Emergency Department access block.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"642-647"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309352","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}
Anna Janssen, Melissa Baysari, Christina Igasto, Kate Quirke, Petra Milnes, Tim Shaw, Adam Dunn
{"title":"A digitally enabled health workforce for Australia.","authors":"Anna Janssen, Melissa Baysari, Christina Igasto, Kate Quirke, Petra Milnes, Tim Shaw, Adam Dunn","doi":"10.1071/AH24286","DOIUrl":"10.1071/AH24286","url":null,"abstract":"<p><p>Australia has world-class education for healthcare professionals and is recognised for its strength in digital health research but is yet to fill some important gaps in training healthcare professionals in the safe implementation and use of digital technologies. In this case study, we bring together the perspectives of clinicians, health system leaders, and academics to guide efforts in establishing a digitally enabled workforce in Australia. Building on published evidence, our recommendations include leveraging on recent momentum, building strong partnerships with healthcare organisations, academia, and the digital health industry, and ultimately an expansion of a digitally enabled clinical informatics and digital health workforce.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"700-704"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649966","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":"Utility of a digital app to enhance patient-nurse communications and patient involvement in bedside handover: patient and nurse perceptions.","authors":"Penelope Casey, Eva Yuen, Raj Liskaser, Philippa Blencowe, Leanne Boyd, Mohamed Abdelrazek, Zoe Wang, Julie Considine","doi":"10.1071/AH23270","DOIUrl":"10.1071/AH23270","url":null,"abstract":"<p><p>Objective This study aimed to explore patient and nurse perceptions of using a prototype co-designed app to support patient-nurse communication and patient engagement in bedside handover. Methods This qualitative descriptive study evaluated usability of the app with a convenience sample of patient-nurse dyads in a 22-bed medical/oncology ward, during morning shifts. Participants were nurses, and patients proficient in English but without cognitive impairment or physical or mental distress. Patients entered healthcare questions and preferences into the app, nurses acknowledged the information in the app and responded during their usual workflow. Patient comfort level with app use was surveyed. Handovers were observed, and patient involvement rated. After handover, semi-structured interviews and feedback surveys on app usability were conducted. Interviews were recorded, transcribed, and then analysed thematically. Survey data were analysed using descriptive statistics. Results Patient-nurse dyads (n =18) used the app between March and May 2023. Patients were mostly older (median 69.5years; IQR 52.3, 75), female, and frequent users of smartphones. Nurses were mostly younger (median 23years; IQR 21, 40) and female. Five themes were identified, which indicated that using the app empowered patients to engage in healthcare communications, facilitated opportunities for patient-centred information sharing, and refocused nurses' attention onto patient-centred care. Views differed on the app's influence on patient involvement in handover. Surveys (n =36, 100%) indicated that the interface was easy to navigate, features were useful, and only minor amendments were suggested. Conclusion This prototype app shows potential to facilitate patient-centred communication and patient engagement with health care, including bedside handover. With further refinement and testing, this app could enhance experiences of care and reduce harm from miscommunication.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"673-681"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303280","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}
Martin Chadwick, Jennifer R Hemler, Benjamin F Crabtree
{"title":"Leading innovation in transdisciplinary care.","authors":"Martin Chadwick, Jennifer R Hemler, Benjamin F Crabtree","doi":"10.1071/AH24089","DOIUrl":"10.1071/AH24089","url":null,"abstract":"<p><p>Background Benefits of effective team-based working in healthcare settings are well established, with the ultimate form being transdisciplinary teams. Achieving transdisciplinary teams at the large organisation or system level has not been extensively studied. Purpose To examine and describe exemplar organisations where transdisciplinary working was enabled and that can be reproduced in other organisations. Methods An expert panel reached consensus on three healthcare organisations in the USA that exemplified transdisciplinary working. Available public information about each organisation was reviewed and site visits with direct observation and interviews were conducted with two of the three exemplar sites (the third completed remotely due to the onset of COVID-19). The process of immersion-crystallisation was used to review the collated material and to identify key themes that were then repeatedly checked with the expert panel. Results Consistent themes were identified across all three organisations, although they each arrived at these commonalities via distinctly different routes. All had a clear and shared creation story as to how they came about as an entity, which was supported by consistent longitudinal leadership. This enabled an environment whereby each organisation created its own language that reflected their culture as an organisation, thus continually reinforcing the uniqueness of their organisation. Conclusions Large healthcare organisations can achieve the concepts of transdisciplinary practice. While no single achievement pathway was identified, common themes noted were a clear creation story, consistent leadership, and building a language that reflected the organisation.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"682-687"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482835","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}
Yogesh Sharma, Arduino A Mangoni, Chris Horwood, Campbell Thompson
{"title":"External validation and comparative analysis of the HOSPITAL score and LACE index for predicting readmissions among patients hospitalised with community-acquired pneumonia in Australia.","authors":"Yogesh Sharma, Arduino A Mangoni, Chris Horwood, Campbell Thompson","doi":"10.1071/AH24204","DOIUrl":"10.1071/AH24204","url":null,"abstract":"<p><p>Objective Community-acquired pneumonia (CAP) is a leading cause of emergency hospitalisations globally and is associated with high readmission rates. Specific score systems developed for all medical conditions such as the HOSPITAL score and the LACE index can also usefully predict CAP readmissions. However, there is limited evidence regarding their performance in the Australian healthcare settings. Methods This multicentre retrospective study analysed adult CAP discharges from two metropolitan hospitals in South Australia between 1 January 2018 and 31 December 2023. Data for determining the HOSPITAL score and the LACE index were derived from electronic medical records. Demographic characteristics of patients readmitted within 30 days were compared with those who were not readmitted. The scores were evaluated for overall performance, discriminatory power and calibration, with discriminatory power assessed using the concordance statistic (C-statistic). Results Over 6years, 7245 CAP discharges were recorded, with 1329 (18.3%) readmissions within 30days. The mean (s.d.) age of the cohort was 74.4 (17.8) years. Readmitted patients were more likely to have multiple morbidities and frailty than those not readmitted (P <0.05). They also had a higher mean number of emergency department presentations and hospital admissions in the previous year and a longer initial hospital stay (P <0.05). Overall, the mean (s.d.) HOSPITAL score and LACE index were 3.4 (2.1) and 9.3 (3.6), respectively. Among readmissions, 28.4% occurred in patients with a HOSPITAL score >4 (intermediate and high-risk group), while 25.8% occurred in patients in the high-risk LACE category (LACE index>10). The C-statistic for the HOSPITAL score and LACE index was 0.62 (95% CI 0.61-0.64) and 0.63 (95% CI 0.61-0.65), respectively, with no significant difference in the area under the receiver operating characteristic curves (P >0.05). Conclusions The predictive abilities of the HOSPITAL score and the LACE index for CAP readmissions are modest and comparable in an Australian setting.</p>","PeriodicalId":93891,"journal":{"name":"Australian health review : a publication of the Australian Hospital Association","volume":" ","pages":"656-663"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115892","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}