Australian health review: a publication of the Australian Hospital Association Journal Impact Factor & Information

Publisher: Australian Hospital Association, CSIRO Publishing

Journal description

Current impact factor: 1.00

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1
2012 Impact Factor 0.698
2011 Impact Factor 0.545
2010 Impact Factor 0.803
2009 Impact Factor 0.584

Impact factor over time

Impact factor
Year

Additional details

5-year impact 0.92
Cited half-life 5.60
Immediacy index 0.10
Eigenfactor 0.00
Article influence 0.26
Website Australian Health Review website
Other titles Australian health review (Online)
ISSN 0156-5788
OCLC 60624483
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

CSIRO Publishing

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • On author's personal repository or institutional repository
    • Must link to publisher version
    • Published source must be acknowledged
    • Publisher's version/PDF cannot be used
  • Classification
    ​ green

Publications in this journal

  • Alison Mudge, Katherine Radnedge, Karen Kasper, Robert Mullins, Julie Adsett, Serena Rofail, Sophie Lloyd, Michael Barras
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    ABSTRACT: Objective Multimorbidity and associated polypharmacy are risk factors for hospital re-admission. The Targeting Hospitalization Risks in Vulnerable Elders (THRIVE) clinic is a novel multidisciplinary out-patient clinic to improve transitions of care and decrease re-admission risk for older medical patients with frequent hospital admissions. This pilot study examined the effect of the THRIVE model on medication count, tablet load and potentially inappropriate medicines (PIMs).Methods Participants with frequent medical admissions were referred within 2 weeks of discharge from hospital and assessed at baseline and then at 4 and 12 weeks by the THRIVE team. A thorough reconciliation of all medications was performed collaboratively by a clinical pharmacist and a physician. Optimising medications, including deprescribing, was in collaboration with the participants' general practitioner. The complete medication history of each patient was compared retrospectively by an independent assessor at baseline and after the 12-week clinic, comparing total number of regular medications, tablet load and PIMs (measured using the Screening Tool of Older Persons Prescriptions (STOPP) tool).Results All 17 participants attending the pilot THRIVE clinic were included in the study. At 12 weeks, there was a significant reduction in mean medication count (from 14.3 to 11.2 medications; P < 0.001) and mean tablet load (from 20.5 to 16.9 tablets; P < 0.01). There was an absolute reduction in the total number of PIMs from 38 to 14. Common medications deprescribed included opioids, tricyclic antidepressants, benzodiazepines and diuretics.Conclusions Patients who attended the THRIVE clinic had a significant reduction in medication count and tablet load. The pilot study demonstrates the potential benefits of a multidisciplinary out-patient clinic to improve prescribing and reduce unwarranted medications in an elderly population. An adequately powered comparative study would allow assessment of clinical outcomes and costs.What is known about the topic? Elderly patients are prone to polypharmacy. The identification and deprescribing of potentially inappropriate medications is effective in reducing adverse drug events in this population. However, acute hospitalisation is not always the ideal setting to initiate deprescribing.What does the paper add? Intensive multidisciplinary out-patient care for frequently re-admitted patients optimises their medication management plan and helps reduce the use of unwarranted medications.What are the implications for practitioners? Effective deprescribing in elderly patients can be achieved after hospital discharge using a multidisciplinary collaborative model, but costs and clinical benefits require further investigation.
    Australian health review: a publication of the Australian Hospital Association 07/2015; DOI:10.1071/AH14219
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    ABSTRACT: Objectives The aim of the present study was to determine cardiovascular disease (CVD) risk factors and compare presentation and severity of ischaemic heart disease (IHD) among South Asians (SAs) and Anglo Australians (AAs).Methods A retrospective clinical case audit was conducted at a public tertiary hospital. The study population included SA and AA patients hospitalised for IHD. Baseline characteristics, evidence of diabetes and other CVD risk factors were recorded. Angiography data were also included to determine severity, and these were assessed using a modified Gensini score.Results SAs had lower mean (± s.d.) age of IHD presentation that AAs (52 ± 9 vs 55 ± 9 years, respectively; P = 0.02), as well as a lower average body mass index (BMI; 26 ± 4 vs 29 ± 6 kg/m2, respectively; P = 0.005), but a higher prevalence of type 2 diabetes (57% vs 31%, respectively; P = 0.001). No significant differences were found in coronary angiography parameters. There were no significant differences in the median (interquartile range) Gensini score between SAs and AAs (43.5 (27-75) vs 44 (26.5-68.5), respectively), median vessel score (1 (1-2) vs 2 (1-3), respectively) or multivessel score (37% (33/89) vs 54% (22/41), respectively).Conclusions The findings show that in those with established IHD, cardiovascular risk factors, such as age at onset and BMI, differ between SAs and AAs and these differences should be considered in the prevention and management of IHD.What is known about the topic? There is much evidence on CVD and SAs, it being a leading cause of mortality and morbidity for this population both in their home countries and in countries they have migrated to. Studies conducted in Western nations other than Australia have suggested a difference in the risk profiles and presentations of CVD among SA migrants compared with the host populations in developed countries. Although this pattern of cardiovascular risk factors among SAs has been well documented, there is insufficient knowledge about this population, currently the largest population of incoming migrants, and CVD in the Australian setting.What does this paper add? This paper confirms that a similar pattern of CVD exists in Australia among SAs as does in other Western nations they have migrated to. The CVD pattern found in this population is that of an earlier age of onset at lower BMI compared with the host AA population, as well as a differing cardiovascular risk profile, with higher rates of type 2 diabetes and lower smoking rates. In addition, this study finds similar angiographic results for both the SAs and AAs; however, the SAs exhibit these similar angiographic patterns at younger ages.What are the implications for practitioners? SAs in Australia represent a high cardiovascular risk group and should be targeted for more aggressive screening at younger ages. Appropriate preventative strategies should also be considered bearing in mind the differing risk factors for this population, namely low BMI and high rates of type 2 diabetes. More intensive treatment strategies should also be regarded by practitioners. Importantly, both policy makers and health professionals must consider that all these strategies should be culturally targeted and tailored to this population and not assume a 'one-size fits all' approach.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH14254
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    ABSTRACT: The growing demands on the health system to adapt to constant change has led to investment in health workforce planning agencies and approaches. Health workforce planning approaches focusing on identifying, predicting and modelling workforce supply and demand are criticised as being simplistic and not contributing to system-level resiliency. Alternative evidence- and needs-based health workforce planning approaches are being suggested. However, to contribute to system-level resiliency, workforce planning approaches need to also adopt system-based approaches. The increased complexity and fragmentation of the healthcare system, especially for patients with complex and chronic conditions, has also led to a focus on health literacy not simply as an individual trait, but also as a dynamic product of the interaction between individual (patients, workforce)-, organisational- and system-level health literacy. Although it is absolutely essential that patients have a level of health literacy that enables them to navigate and make decisions, so too the health workforce, organisations and indeed the system also needs to be health literate. Herein we explore whether health workforce planning is recognising the dynamic interplay between health literacy at an individual, organisation and system level, and the potential for strengthening resiliency across all those levels.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH14192
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    ABSTRACT: Objective Intravenous thrombolysis with tissue plasminogen activator (tPA) improves patient outcomes in acute ischaemic stroke. Because its benefit is time-dependant, treatment delays must be minimised. The aim of the present study was to review patient characteristics, timeliness of tPA delivery and clinical outcome in patients receiving t-PA in a tertiary hospital stroke unit in Queensland, and to compare the findings with those of other Australian studies.Methods The present study was a retrospective study conducted between 1 January 2010 and 31 December 2012. Information was collected regarding demographics, stroke characteristics, timeliness of tPA delivery, clinical outcome, safety outcome and protocol deviation.Results Of 490 patients admitted with ischaemic stroke, 57 (11.6%) received tPA. Compared with other studies, the patients in the present study had more severe stroke (median National Institutes of Health Stroke Scale (NIHSS) score), more cardioembolic strokes and more patients receiving tPA between 3 and 4.5 h of symptoms onset. Median symptom onset to treatment time was 175 min and median door to needle time was 97 min. At 3 months, 21.1% of patients had died and 41.5% had a favourable outcome (modified Rankin scale ≤2). Symptomatic intracerebral haemorrhage occurred in 5.3% of patients and protocol deviations occurred in 21.1%. Overall, delivery and outcomes of tPA at the Princess Alexandra Hospital were comparable to those reported in other Australian studies of usual care. Several challenges and strategies for optimal thrombolysis were identified, with supporting evidence from selected Australian sites.Conclusion The proportion of eligible stroke patients who receive tPA in a timely manner remains less than ideal at our centre. More accurate patient selection and reductions in treatment delays serve as targets for quality improvement efforts that have broad applicability.What is known about the topic? Stroke unit care and tPA thrombolysis are two proven strategies to improve outcome in patients with ischaemic stroke. Although the stroke unit is gaining momentum of growth in Australia (especially in Queensland), little improvement has been achieved in thrombolysis rate and timeliness of treatment delivery, and little is known about the service delivery in Queensland because there are no published data.What does this paper add? This paper provides an extensive review of thrombolysis treatment in a tertiary Queensland hospital, adding to the understanding of treatment implementation. It also provides a complete and comprehensive review of treatment delay (including emergency department referral time and computed tomography to needle time, which have not been reported in other Australian studies), and a template for data collection to review treatment delay and outcome measurement in detail. It also compares findings with peer Australian studies (this has not been reported previously) and summarises potential strategies that could be adopted systemically.What are the implications for practitioners? Delivery of thrombolysis treatment in a timely manner remains a significant challenge to stroke physicians. All stroke units are encouraged to prospectively collect thrombolysis data in the format adopted in the present study for purposes of peer comparisons and shared learning.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH14167
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    ABSTRACT: Objective To establish prevalence and associations of general practice nurses' (GPNs) involvement in general practitioner (GP) registrars' consultations.Methods A cross-sectional analysis from an ongoing cohort study of registrars' clinical consultations in five Australian states. Registrars recorded detailed data from 60 consecutive consultations per 6-month training term. Problems and diagnoses encountered, including chronic disease classification, were coded using the International Classification of Primary Care, second edition duplication system (ICPC-2plus) classification system. The outcome factor in our analysis was GPN involvement in management of individual problems and diagnoses. Independent variables were a range of patient, registrar, practice, consultation and educational factors.Results We analysed 108759 consultations of 856 registrars including 169307 problems or diagnoses. Of the problems/diagnoses, 5.1% (95% confidence interval (CI) 5.0-5.2) involved a GPN. Follow-up with a GPN was organised for 1.5% (95% CI 1.4-1.5) of all problems/diagnoses. Significant associations of GPN involvement included patient age, male sex, Aboriginal or Torres Strait Islander status, non-English-speaking background (NESB) and the patient being new to the practice. Larger practice size, the particular training organisation, and the problem/diagnosis being new and not a chronic disease were other associations.Conclusions Associations with Aboriginal or Torres Strait Islander status and NESB status suggest GPNs are addressing healthcare needs of these under-serviced groups. But GPNs may be underutilised in chronic disease care.What is known about this topic? GPNs are increasingly involved in team-based care in Australian general practice. The potential positive contribution of GPNs to general practice teams is acknowledged, but the role of the GPN is still being refined.What does this paper add? GPNs contribute to the care of a modest proportion of patients seen by GP registrars. Aboriginal or Torres Strait Islander status and NESB of patients are positively associated with being seen by a GPN; chronic disease is negatively associated with being seen by a GPN. There is geographic variability in prevalence of GPN consultations, not explained by other factors.What are the implications for practitioners? Given the match of GPN skills and attributes to the needs of patients with chronic diseases, GPNs currently may be underutilised in chronic disease care in Australian general practice. The marked geographic variation in uptake of GPNs also suggests scope for greater utilisation of GPNs Australia-wide.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH15010
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    ABSTRACT: Objective The Wagga Wagga Ambulatory Rehabilitation Service (WWARS) clinicians felt the Australian Modified Lawton's Instrumental Activities of Daily Living Scale (Lawton Scale) was unresponsive to changes detected in many patients following their individualised programs. This study examined the performance of the Goal Attainment Scaling (GAS) concomitantly with the Lawton Scale in ambulatory rehabilitation patients.Methods Consecutive patients (n = 83) of WWARS were evaluated pre and post treatment with the Lawton Scale and GAS. The statistical properties, particularly responsiveness, of the scales were compared.Results Statistically significant change (P < 0.001) was observed following treatment on both the Lawton Scale and GAS. Mean GAS scores changed by 38.7% compared with 8.3% for the Lawton Scale. GAS demonstrated a greater effect size (Cliff's δ) of 1.67 (95% confidence interval 1.51-1.91) than the Lawton Scale 0.83 (95% confidence interval 0.57-0.94). In 33.7% of patients, the Lawton Scale was invariant but improved with GAS.Conclusions GAS was a more responsive measure than the Lawton Scale in rural ambulatory rehabilitation patients. Consequently, GAS is recommended as a performance outcome measure in the evaluation of ambulatory rehabilitation services to supplement standardised outcome measures such as the Lawton Scale.What is known about the topic? GAS has been shown to be more responsive in detecting changes in patient outcomes than the original Lawton's Instrumental Activities of Daily Living Scale when assessing the requirements of the elderly for geriatric services and for people with acquired brain injury undergoing cognitive rehabilitation. Its responsiveness in patients with greater casemix diversity, such as those found in rural ambulatory rehabilitation services, remains uncertain.What does this paper add? This study demonstrates GAS is more responsive than the Lawton Scale for detecting clinically meaningful change in a rural Australian ambulatory rehabilitation service delivering programs to people with heterogeneous goals.What are the implications for practitioners? GAS facilitates the delivery of patient-centred care, accommodates the heterogeneity of patient-centred goals for evaluation, and better measures goal-achievement. Global standardised measures such as the Lawton Scale may be useful for the comparison of differing patient populations, but a weakness is they may not capture the individualised goals valued by each patient seen in rehabilitation. Consequently, GAS should be considered as an additional outcome measure in the evaluation of ambulatory rehabilitation services in assessing program effectiveness and possibly for service comparison. Furthermore, ongoing training and support in GAS application should be provided to ensure the maintenance of accurate goal setting and scaling.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH14218
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    ABSTRACT: Objective To investigate retirements over a 4-year period among Australian general practitioners (GPs) and specialists aged 65 years and over, and factors influencing retirement.Methods Data from Medicine in Australia: Balancing Employment and Life (MABEL) for the years 2009-12 were analysed for 435 GPs and 643 specialists aged 65 years and over at the time of entry to the MABEL survey. Discrete time survival analysis was used.Results The retirement rates were 4.1% (2009), 5.1% (2010), 4.2% (2011) and 10.4% (2012). Retirement was associated with: (1) the intention to leave medical work in 2009 and 2010; (2) working fewer hours in private consulting rooms in 2010 and 2012; (3) having lower job satisfaction in 2009 and 2011; (4) being older in 2009; (5) working fewer hours in a public hospital in 2012; and (6) working fewer hours in a private hospital in 2010. Doctors who intended to reduce their working hours were less likely to retire in 2009.Conclusions Strategies to support doctors at the late career stage to provide their valued contributions to the medical workforce for as long as possible may include increasing job satisfaction and addressing barriers to reducing work hours.What is known about the topic? Much of the available literature provides measures of retirement intentions.What does this paper add? The present study examined actual retirements and the factors associated with them.What are the implications for practitioners? Consideration should be given by policy makers to ensure that doctors are retained for as long as possible as active contributors to the medical workforce in a safe, appropriate manner.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH14176
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    ABSTRACT: Objective The Royal Melbourne Hospital established a mobile X-ray service (MXS) in 2013. The goal of the MXS is to address the radiology needs of frail, elderly or demented residents of residential aged care facilities (RACFs) who would otherwise require transportation to attend for X-ray. The present study describes the activity of the MXS, and the impact of the MXS on emergency department (ED) attendances by residents of RACFs.Methods The study is a descriptive study and uses a before-and-after cohort approach. Activity for the first year of operation was collected and described. At the end of the first year of operation, the top 30 RACF users of the MXS were identified. The hospital Department of Radiology database was examined to find all plain X-rays performed on any patient presenting from the same 30 RACFs for the 1 year before commencement of the MXS (1 July 2012-30 June 2013) and for the 1 year period after the commencement of the MXS (1 July 2013-30 June 2014). Attendances were compared.Results The MXS delivered 1532 service attendances to 109 different RACFs. The mean age of patients receiving MXS services was 86 years (range 16-107 years). In all, 1124 services (73.4%) were delivered to patients in high-care RACFs. Most patients (n = 634; 41.4%) were bed or wheelchair bound, followed by those who required assistance to ambulate (n = 457; 29.8%). The most common X-ray examinations performed were chest, hip and pelvis, spine and abdomen. There were 919 service attendances to the top 30 RACFs using the MXS (60.0% of all attendances). There was an 11.5% reduction in ED presentations requiring plain X-ray in the year following the commencement of the MXS (95% confidence interval 0.62-3.98; P = 0.019).Conclusion The present study suggests a reduction in hospital ED attendances for high users of the MXS. This has benefits for hospitals, patients and nursing homes. It also allows the extension of other programs designed to treat patients in their RACFs. Special rebates for home-based radiology service provision should be considered.What is already known about this subject? Digital processing has changed the way radiology delivers services. The Australian community is in the middle of a shift towards an aging population, with a greater numbers of residents in RACFs. It has been suggested in previous studies that mobile X-ray reduces the rate of delirium in patients who require X-ray.What does this paper add? There is an unmet demand for MXS to residents of RACFs. MXS may reduce presentations by elderly residents of RACFs to hospital EDs for X-rays. MXS may assist general practitioners, and other innovative programs, such as Hospital in the Home and Inreach, to better manage care for patients in RACFs.What are the implications for practitioners? Providers of radiology services should examine the opportunities and benefits of establishing MXS. Funders of services should examine ways of rebating MXS to encourage further development. Hospitals (Hospital in the Home and Inreach services), RACFs and general practitioners should use mobile X-ray and integrate these services into their management of aged care delivered in RACFs.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH15059
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    ABSTRACT: Objective The aim of the present study was to identify opportunities to improve the reach and impact of the Australian Medicare 75+ Health Assessment (75+HA) to detect early functional decline (FD).Methods A comparison of two published review articles produced two outputs: (1) assessments identified in the systematic review that underpinned the 75+HA items were ranked for evidence of effectiveness and compared with the volume of research into assessment areas identified by a recent review on indicators of early FD; and (2) items in the 75+HA were compared with those in the recent review.Results The review underpinning the 75+HA found 19 assessment areas, with strongest evidence of effectiveness for vision/hearing, teeth/oral, balance/gait, cognitive and service use. The more recent review reported on six domains (eight subdomains) of FD assessment: physical and cognitive elements of the performance capacity domain were the least well assessed, whereas the most comprehensively assessed domains were health service use, performance capacity (mental subdomain), participation (motivation/volition subdomain) and demographics. The 75+HA addresses only some items related to early FD as identified by the recent literature.Conclusion Reassessment of the 75+HA with a view to including current evidence-based assessments for early FD is recommended. Updating the 75+HA items with ways to detect FD earlier may increase its relevance to Australia's ageing population.What is known about the topic? There are consistent predictions of increasing lifespan of Australians, increasing numbers of older Australians wanting to live independently in the community and the increasing burden on already scarce hospital resources associated with managing the ramifications of declining function in older Australians. The 75+HA is now 15 years old and has not been updated. The imperative is to identify and address early FD in primary care before it becomes a problem.What does this paper add? This paper highlights how the 75+HA can be updated to support a comprehensive and multifactorial assessment of early FD, making it more relevant to the current climate of aging Australians and their desire to age in place. Adding the elements suggested in this paper to the 75+HA may assist in increasing the relevance of the assessment and in the earlier detection of FD.What are the implications for practitioners? A regular comprehensive assessment of key antecedents and features of early FD from multiple stakeholder perspectives will provide a stronger and more evidence-based framework within which to support older Australians to age in place.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH15011
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    ABSTRACT: Objectives A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia.Methods A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Framework for Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity.Results Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment - the Dying with Dignity Victoria Advance Healthcare Directive.Conclusions More research is needed to understand how online resources can optimally elicit and record consumers' individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement.What is known about the topic? Online availability of ACD templates provides consumers with an opportunity for advance care planning outside of formal healthcare settings. While online availability has advantages, there is a risk that templates may be biased either for or against medical treatment and may not elicit directives that are appropriately informed by reflection on personal values and discussion with family and health professionals.What does this paper add? This is the first attempt at monitoring the quality and bias of online ACD templates designed for use in Australia.What are the implications for practitioners? The results of this review provide a description and quality index to assist consumers and clinicians in deciding which online ACD template to use or recommend.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH14187
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    ABSTRACT: Objective This paper reports on the experiences and perspectives of community members in relation to advance healthcare directives and enduring power of attorney, including the factors that encourage or discourage engagement in advance care planning (ACP).Methods A qualitative methodology was used involving 26 in-depth telephone interviews with community members (mean age 66 years). The aims of the interview question were to gain an understanding of: (1) motivations for engaging in ACP; (2) barriers that prevent people from engaging in ACP; and (3) suggestions for promoting ACP.Results The findings suggest that: (1) community members lack knowledge about ACP; (2) forms appear inaccessible and complex; (3) community members avoid ACP due to fear, mistrust and concerns over control; and (4) there are misperceptions regarding the relevance of ACP based on age and health.Conclusions There is unnecessary fear, avoidance and mistrust around ACP activities, largely resulting from misinformation. There is an undoubted need for greater education and support to be offered to individuals and their families regarding ACP, its benefits and its limitations.What is known about the topic? There is a lack of awareness about ACP in Australia, which is compounded by issues in the accessibility of ACP information, forms and support in completing the often complex documentation. Further, studies have indicated health practitioners tend to avoid assisting patients with ACP decision making and formalisation of their wishes for health care should they lose testamentary capacity.What does this paper add? This paper contributes further understanding of the experiences and perceptions of people, particularly older Australians, in relation to ACP, including the motivating and discouraging factors for people in the uptake of advance healthcare directives and enduring power of attorney. People felt discomfort and mistrust about ACP, and lacked understanding of its relevance regardless of age or health status. Those who had engaged in ACP, prompted by family members or experiences in, or witnessing, ill health, felt a sense of security in having formalised their wishes.What are the implications for practitioners? It is now clear that people require improved provision of information and support around ACP-related activities. This support may best be offered by practitioners such as nurses and social workers who are knowledgeable regarding ACP and skilled in counselling. Without discussion of death and dying, and the role of ACP, people will continue to feel a mistrust and avoidance towards formalising their healthcare wishes in advance.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH14152
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    ABSTRACT: Objective The aim of the present study was to determine the association between clinician exposure to workplace aggression from any source in the previous 12 months and workforce participation intentions.Methods A cross-sectional survey, in the third wave of the Medicine in Australia: Balancing Employment and Life (MABEL) study, was conducted between March 2010 and June 2011. Respondents were a representative sample of 9449 Australian general practitioners (GPs) and GP registrars (n = 3515), specialists (n = 3875), hospital non-specialists (n = 1171) and specialists in training (n = 888). Associations between aggression exposure and workforce participation intentions were determined using logistic regression modelling.Results In adjusted models, aggression exposure was positively associated with a greater likelihood of intending to reduce clinical workload in the next 5 years (odds ratio (OR) = 1.15, 95% confidence interval (CI) 1.02-1.29) and intending to leave patient care within 5 years (OR = 1.20, 95% CI 1.07-1.35). When also accounting for well being factors, aggression exposure remained positively associated with intending to leave patient care within 5 years (OR = 1.13, 95% CI 1.00-1.27).Conclusions Exposure to workplace aggression presents a risk to the retention of medical practitioners in clinical practice and a potential risk to community access to quality medical care. More concerted efforts in preventing and minimising workplace aggression in clinical medical practice are required.What is known about the topic? Very few studies have addressed the impact of workplace aggression on workforce participation intentions of medical practitioners.What does this paper add? This paper provides evidence that exposure to workplace aggression from any source is associated with intentions to reduce clinical workload or leave patient care.What are the implications for practitioners? There is a need to prevent or minimise the risk of exposure to workplace aggression from any source because the impacts may extend beyond the known psychological or physical effects to practitioner decisions about ongoing participation in the provision of clinical services.
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH14246
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    ABSTRACT: Background: Migrants constitute 26 % of the total Australian population and although disproportionately affected by chronic diseases, they are underrepresented in health research. Objectives: To describe trends in Australian Research Council (ARC) and National Health and Medical Research Council (NHMRC)’s funded initiatives from 2002 to 2011 with a key focus on migration -related research funding. Methods: Data on all NHMRC and ARC funded initiatives between 2002 and 2011 were collected from the Research Funding Statistics and National Competitive Grants Program, data systems respectively. The research funding expenditures within these two schemes were categorised into two major groups: People-focused (Migrant-related and Mainstream-related) and Basic science-focused. Descriptive statistics were used to summarise the data and report the trends in NHMRC and ARC funding over the ten-year period. Results: Over 10 years, ARC funded 15,354 initiatives worth $5.5 billion, with 897 (5.8%) people-focused projects funded, worth $254.4 million. Migrant-related research constituted 7.8% of all people-focused research. NHMRC funded 12,399 initiatives worth $5.6 billion, with 447 (3.6%) people-focused projects funded, worth $207.2 million. Migrant-related research accounted for 6.2% of all people-focused initiatives. Conclusion: While migrant groups are disproportionately affected by social and health inequalities, this study shows migrant-related research is inadequately funded compared to mainstream-related research. Unless equitable research funding is achieved it will be impossible to build a strong evidence base for planning effective measures to reduce these inequalities among migrants
    Australian health review: a publication of the Australian Hospital Association 05/2015;
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    ABSTRACT: This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person.
    Australian health review: a publication of the Australian Hospital Association 05/2015; DOI:10.1071/AH15049