[Show abstract][Hide abstract] ABSTRACT: To analyse changes in the quantity and quality of media reporting about dementia in Australian media between two time periods.
A media retrieval service collected all news items related to dementia. Quality ratings based on previously developed criteria were made for a stratified random sample of items - 1129 items for 2000/2001 and 1606 for 2006/2007. Nine items of quality were assessed. A summary score for quality was constructed. The content of the sampled media items was also coded.
Overall, the mean total quality score for dementia-related items significantly improved over the study period. There were very large improvements in quality of reporting of 'sensationalism', 'language' and 'provision of information about help services' and some small deterioration in quality for 'medical terminology' and 'illness versus person'.
A very positive finding here is that generally the quality of reporting dementia has improved over the period studied.
Australasian Journal on Ageing 06/2012; 31(2):96-101. · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BackgroundThe aim of this study is to estimate the appropriateness of recommended dispositions made in response to calls to after hours services offering telephone triage, usually involving nurses. The setting was five local trials sponsored by the Australian government aimed at addressing problems in after hours general practice service provision. All five trials offered telephone triage though the form of this varied considerably.MethodsThe study was a prospective service audit. Simulated patient calls using validated patient care scenarios with different levels of clinical significance were developed by a consensus panel of experts. Sixty telephone calls were monitored by a member of the research team to assess whether provider responses were in conformity with recommended dispositions.ResultsServices fell well short of a 100% appropriate response rate across all five trials. Services generally performed poorly for cases with high clinical implications such as presumed meningococcal meningitis and gastroenteritis with dehydration in a child. In general, problems of undertriage were more common than overtriage.ConclusionsThe safety of dispositions of telephone triage services requires further study. Simulated patient calls may be more useful for quality improvement purposes than the usual method of random audit of audiotaped calls of real patients using service records.
[Show abstract][Hide abstract] ABSTRACT: This review presents an overview of the published literature on the effectiveness of continuing professional education (CPE), which includes continuing medical education (CME) of different health care professionals in healthcare settings, for improving patient management and patient outcomes. This review summarizes key articles published on the subject, including those relating to dementia care.
A literature search was carried out using the National Library of Medicine's PubMed database, Cochrane database and Eric databases.
Studies on CPE generally provide conflicting evidence on their effectiveness in bringing about a change in professional practices and healthcare outcomes. However interactive, multifaceted interventions, and interventions with repeated inputs appear more effective in bringing about positive changes than traditional non-interactive techniques. There are relatively few studies specifically concerning CPE and dementia care.
This review shows that CPE in dementia care needs to be targeted carefully. Much can be learnt from examining education approaches in the wider professional and medical education literature.
International Psychogeriatrics 04/2009; 21 Suppl 1:S34-43. · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Australian government sponsored trials aimed at addressing problems in after hours primary medical care service use in five different parts of the country with different after hours care problems. The study's objective was to determine in four of the five trials where telephone triage was the sole innovation, if there was a reduction in emergency GP after hours service utilization (GP first call-out) as measured in Medicare Benefits Schedule claim data. Monthly MBS claim data in both the pre-trial and trial periods was monitored over a 3-year period in each trial area as well as in a national sample outside the trial areas (National comparator). Poisson regression analysis was used in analysis.
There was significant reduction in first call out MBS claims in three of the four study areas where stand-alone call centre services existed. These were the Statewide Call Centre in both its Metropolitan and Non-metropolitan areas in which it operated - Relative Risk (RR) = 0.87 (95% Confidence interval: 0.86 - 0.88) and 0.60 (95% CI: 0.54 - 0.68) respectively. There was also a reduction in the Regional Call Centre in the non-Metropolitan area in which it operated (RR = 0.46 (95% CI: 0.35 - 0.61) though a small increase in its Metropolitan area (RR = 1.11 (95% CI: 1.06 - 1.17). For the two telephone triage services embedded in existing organisations, there was also a significant reduction for the Deputising Service - RR = 0.62 (95% CI: 0.61 - 0.64) but no change in the Local Triage centre area.
The four telephone triage services were associated with reduced GP MBS claims for first callout after hours care in most study areas. It is possible that other factors could be responsible for some of this reduction, for example, MBS submitted claims for after hours GP services being reclassified from 'after hours' to 'in hours'. The goals of stand-alone call centres which are aimed principally at meeting population needs rather than managing demand may be being met only in part.
Australia and New Zealand Health Policy 02/2007; 4:21.
[Show abstract][Hide abstract] ABSTRACT: Policy addressing the provision of primary care after hours (AH) is currently in flux because of concerns about equity of access and cost. In this study we examine the effects of socioeconomic disadvantage on access to AH care and episodes of not seeking AH care when needed among users and non-users of AH care. The effects of health on these relationships were also explored. The total sample consisted of 5538 users of AH care and 891 non-users of AH care who were randomly selected for telephone interviews. Factors determining AH care included accessibility that is structural barriers to use of care such as distance and transport, as well as affordability and availability. Logistic regression was used to determine the impact of financial disadvantage on episodes of not seeking AH care. Barriers to use of AH care and household health were subsequently added to the models to assess their impact. The results suggested that there were inequities in access to AH care but these were a function of barriers to AH care use rather than financial disadvantage per se. Accessibility and availability were significant barriers to use of AH clinics among both user and non-user samples. Affordability was only a significant barrier among users of AH care. The study suggests that policy aimed at reducing these barriers may effectively address inequities in AH care but that to be optimally effective policy change would also need to be accompanied by changes in consumer awareness.
Health Policy 12/2006; 79(1):16-23. · 1.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The After Hours Primary Medical Trials were initiated by the Australian government to redress difficulties in after hours (AH) GP care in areas of high need. The study's objective is to study the impact of two standalone call centres and one GP cooperative offering comprehensive services, in improving consumer access to services for residents of a defined geographic area.
A pre-post design was used to evaluate their impact after adjusting for secular trend at a national level. Access was considered in terms of availability, accessibility, affordability, acceptability and responsiveness of care. Unmet need and ease of obtaining AH telephone professional medical advice were also considered. Pre-trial and post-trial telephone surveys of two separate random samples of approximately 350 households using AH services in each trial area as well as in a national sample outside the trial areas.
Consumer acceptability and affordability increased in residents in the area served by the GP cooperative. Access, however measured, did not improve in either of the standalone call centre areas. Reduction in unmet need approached but did not achieve statistical significance in most but not all trial areas.
Improvements in access in the GP cooperative conformed to expectations based on current and pre-existing AH care arrangements put in place. Absence of improvements in access in the standalone call centres did not conform to expectations but may be partly explained by the reductions in consumer acceptability, following introduction of telephone triage systems reported elsewhere.
Family Practice 09/2006; 23(4):453-60. · 1.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent increases in the bulk-billing rate have been taken as an indication that the Federal government's Strengthening Medicare initiative, and particularly the bulk-billing incentives, are 'working'. Given the enduring geographic differences in the supply of general practitioners (GPs) it is timely to reconsider the impact that this increase in the provision of 'free care' will have on access to Medicare-funded GP services in rural and urban areas of Australia. Utilisation has been modelled as two different stochastic processes: the decision to consult and the frequency of consultation.
In the decision to consult model the supply of FFS GPs is a more important predictor of utilisation than the bulk-billing rate. Paradoxically the modelling predicts that ceteris paribus increases in either GP supply or the bulk-billing rate appear to have perverse effects in some areas by decreasing utilisation. In the frequency of consultation model, GP density is not a predictor and increasing the bulk-billing rate will unambiguously increase the frequency of consultation across all areas. In both models, the positive impacts associated with changes in supply and cost are constrained outside the inner metropolitan area by reduced geographic accessibility to Medicare-funded GP services. The modelling also shows that people are more likely to consult a GP in areas of high socioeconomic disadvantage, although socioeconomic status is not a predictor of frequency of consultation.
Bulk-billing rates and the supply of FFS GPs are important features of the Australian health care system that are, potentially, amenable to policy manipulation. The implications of this research are that government policies designed to achieve similarity in these characteristics across geographic areas will not result in equity of access because they fail to address problems caused by geographic inaccessibility in rural and remote areas. Attempting to increase bulk-billing rates in some of these areas may, in fact, reduce access to FFS GP services.
Australia and New Zealand Health Policy 09/2005; 2:18.
[Show abstract][Hide abstract] ABSTRACT: The Australian government sponsored five local trials aimed at addressing problems in after hours (AH) primary medical care (PMC). The study's objective was to determine if the four trials, where telephone triage was the sole innovation, led to a reduction in AH service utilisation and change in service mix towards AH GP clinics. Changes in utilisation and mix of AH GP clinic and home visits, ED and ambulance use were monitored in the trial areas, and in a national sample to adjust for the effects of secular trend. Pre- and post-trial telephone surveys of two separate random samples of approximately 350 AH PMC user households in each area were conducted.
Some types of AH PMC use became more frequent in both of the standalone services using nurse-administered proprietary call centre software, which were aimed at better addressing population need (Statewide call centre; Regional call centre). Service use overall (95%CI: 1.03-1.83) and GP clinic use (95%CI: 1.07-2.00) increased in the metro area of the Statewide call centre and in GP clinic (95%CI: 1.04-2.14) and home visits (95%CI: 1.03-3.91) in the non-metro area of the Regional call centre. Service mix only changed in the non-metro area of the Regional call centre with increased contact in GP home visits (95%CI: 1.02-4.38). Levels of use remained unchanged in both embedded services using other than proprietary software, which were established to support the GP workforce (Deputising service; Local triage centre). Service mix only changed in the Deputising service with a change away from AH GP clinics in both contact (95%CI: 0.39-0.97) and frequency (95% CI: -2.12 - -0.7).
Bearing in mind limitations in estimating AH PMC utilisation levels and mix, it is concluded that the impacts of telephone triage were generally smaller in Australia than reported elsewhere. There were different impacts on levels of service utilisation and service mix in standalone call centres and embedded services. Impacts of telephone triage on service utilisation and mix are influenced by the type of telephone triage offered, the goals of the agency providing the service, as well as local factors.
Australia and New Zealand Health Policy 02/2005; 2:30.
[Show abstract][Hide abstract] ABSTRACT: A program of care co-ordination (CC) in Melbourne for individuals with a history of high use of in-patient services was evaluated. The intervention involved care planning by a general practitioner (GP) and graduated case management depending on client health status. Services were purchased from pooled funds of participating health care agencies. A randomised control trial of 2,742 participants demonstrated no significant differences between the intervention and usual care group for two quality of life measures, the SF-36 and the AQoL (assessment of quality of life), and no difference in mortality rates. Total resource usage in the CC group was substantially higher, principally due to the extra costs for care planning and case management and for administering the CC model. Results conform to the higher costs typically found in other CC trials, although the failure to demonstrate improved client outcomes is less often reported. The reasons for this failure, whether in trial design, implementation, or theoretical underpinnings are explored in a companion paper.
Health Policy 09/2004; 69(2):201-13. · 1.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study investigated why the goals of the Australian Coordinated Care trials for clients with complex care needs were not achieved. Significantly higher health service use and costs were incurred in the absence of clear evidence of improved client health outcomes. The validity of assumptions underpinning trial design and the success of implementation at each step in application of the model were examined. There were failures in both design and implementation. Many clients did not require care coordination. The funds pooling arrangements contributed to limited possibilities for service substitution and training of GP care coordinators was inadequate. Trial design did not focus on either clinical guidelines or consumer empowerment. Furthermore, the expectations of the overall national trial were unrealistic both in trial design and expected outcomes given the rigidities and realities of the Australian health care system. Broader system reform in the form of funds pooling and health services planning at the regional level, based on large populations, may be a more effective means to address problems of care coordination and an inflexible supply system.
Health Policy 09/2004; 69(2):215-28. · 1.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The comparison of disparate interventions for the prevention and management of osteoarthritis (OA) is limited by the quality and quantity of published efficacy studies and the use of disparate measures for reporting clinical trial outcomes. The "transfer to utility" technique was used to translate published trial outcomes into a health-related quality-of-life (utility) scale, creating a common metric which supported comparisons between disparate interventions. Total hip replacement (THR) and total knee replacement (TKR) surgery were the most effective treatments and also highly cost-effective, at estimated cost per quality-adjusted life-year (QALY) of 7500 dollars for THR and 10000 dollars for TKR (best estimate). Other apparently highly cost-effective interventions were exercise and strength training for knee OA (< 5000 dollars/QALY), knee bracing, and use of capsaicin or glucosamine sulfate (< 10000 dollars/QALY). The cost per QALY estimates of non-specific and COX-2 inhibitor non-steroidal anti-inflammatory drugs were affected by treatment-related deaths and highly sensitive to the discounting of life-years lost. OA interventions that have been shown to be ineffective (eg, arthroscopy) are targets for redistribution of healthcare resources. OA interventions which lack efficacy studies (eg, prevention programs) require further research to assist priority setting. The application of the Health-sector Wide model to OA demonstrates its role as an evidence-based model that can be successfully applied to identify marginal interventions - those to be expanded and contracted to reduce the expected burden of disease, within current healthcare resources.
The Medical journal of Australia 03/2004; 180(5 Suppl):S11-7. · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Population Health Division of the Australian Government Department of Health and Ageing commissioned a research project into priority setting to be completed in two stages. The first stage involved a review of priority setting models by Segal and Chen1. The second stage involved case study of the application of the best performing Health Sector Wide Disease Based Model (HsW). Osteoarthritis (OA) was chosen as a suitable case study for application and further refinement of the model. It is an extremely common condition, affecting 2.2 million Australians, and responsible for a substantial reduction in their quality of life. An estimated $1,000 million is spent each year on the management of OA, largely to address symptoms. The number of potential modalities for reducing disease burden in persons at risk and those with established disease is large, covering primary care, pharmacological interventions, physical therapies, surgical interventions and population health initiatives. The major focus of interventions is to enhance quality of life, largely to control pain and extend physical function, thus a priority setting exercise in OA provides a unique opportunity to explore methods for the measurement and comparison of quality of life outcomes.
Monash University, Centre for Health Economics, Centre for Health Economics Research Papers. 01/2004;
[Show abstract][Hide abstract] ABSTRACT: The organization of after-hours primary medical care services is changing in many countries. Increasing demand, economic considerations and changes in doctors' attitudes are fueling these changes. Information for policy makers in this field is needed. However, a comprehensive review of the international literature that compares the effects of one model of after-hours care with another is lacking.
The aim of this study was to carry out a systematic review of the international literature to determine what evidence exists about the effect of different models of out-of-hours primary medical care service on outcome.
Original studies and systematic reviews written since 1976 on the subject of 'after-hours primary medical care services' were identified. Databases searched were Medline/Premedline, CINAHL, HealthSTAR, Current Contents, Cochrane Reviews, DARE, EBM Reviews and EconLit. For each paper where the optimal design would have been an interventional study, the 'level' of evidence was assessed as described in the National Health and Medical Research Council Handbook. 'Comparative' studies (levels I, II, III and IV pre-/post-test studies) were included in this review.
Six main models of after-hours primary care services (not mutually exclusive) were identified: practice-based services, deputizing services, emergency departments, co-operatives, primary care centres, and telephone triage and advice services. Outcomes were divided into the following categories: clinical outcomes, medical workload, and patient and GP satisfaction. The results indicate that the introduction of a telephone triage and advice service for after-hours primary medical care may reduce the immediate medical workload. Deputizing services increase immediate medical workload because of the low use of telephone advice and the high home visiting rate. Co-operatives, which use telephone triage and primary care centres and have a low home visiting rate, reduce immediate medical workload. There is little evidence on the effect of different service models on subsequent medical workload apart from the finding that GPs working in emergency departments may reduce the subsequent medical workload. There was very little evidence about the advantages of one service model compared with another in relation to clinical outcome. Studies consistently showed patient dissatisfaction with telephone consultations.
The rapid growth in telephone triage and advice services appears to have the advantage of reducing immediate medical workload through the substitution of telephone consultations for in-person consultations, and this has the potential to reduce costs. However, this has to be balanced with the finding of reduced patient satisfaction when in-person consultations are replaced by telephone consultations. These findings should be borne in mind by policy makers deciding on the shape of future services.
Family Practice 07/2003; 20(3):311-7. · 1.83 Impact Factor