Australian health review : a publication of the Australian Hospital Association
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Objectives Healthcare expenditure is growing at an unsustainable rate in developed countries. A recent scoping review identified several alternative healthcare delivery models with the potential to improve health system sustainability. Our objective was to obtain input and consensus from an expert Delphi panel about which alternative models they considered most promising for increasing value in healthcare delivery in Australia and to contribute to shaping a research agenda in the field. ⋯ What are the implications for practitioners? Decision makers seeking to optimise the efficiency and sustainability of healthcare service delivery in Australia could consider the alternative models rated as high priority by the expert stakeholder panel in this Delphi study. These models reflect the most promising alternatives for increasing value in the delivery of health care in Australia based on stakeholders' knowledge of the health system. Although they indicate areas where stakeholder engagement is likely to be high, further research is needed to demonstrate the effectiveness and cost-effectiveness of some of these models.
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Objective Health practitioners' Codes of Conduct and Codes of Ethics articulate practice standards across multiple domains, including the domain of cultural safety. As key tools driving individual practice and systems reform, Codes are integral to improving health outcomes for Aboriginal and Torres Strait Islander peoples. It is, therefore, critical that their contents specify meaningful cultural safety standards as the norm for institutional and individual practice. ⋯ This analysis provides a baseline for future improvements and confirms that although some current health practitioner Codes of Conduct and Codes of Ethics have begun the journey of recognising the importance of cultural safety in ensuring good health outcomes for Australia's Indigenous peoples, there is broad scope for change. What are the implications for practitioners? The gaps identified in this analysis provide a roadmap for improvement and inclusion of Aboriginal and Torres Strait Islander Health and cultural safety as a required standard in Codes of Conduct and Codes of Ethics for all registered health practitioners. Although it is recognised that Codes alone may not change hearts and minds, codifying the clinical competency of cultural safety provides a portal, and a requirement, for each individual practitioner to engage meaningfully and take responsibility to improve practice individually and organisationally.
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Observational Study
Allied health primary contact services: results of a 2-year follow-up study of clinical effectiveness, safety, wait times and impact on medical specialist out-patient waitlists.
Objective Long specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a medical specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on medical specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on medical specialist out-patient waitlists. ⋯ Possibilities for efficiency gains are identified and discussed. What are the implications for practitioners? Health service managers should consider allied health primary contact services as a viable option to increase specialist out-patient capacity. Service model characteristics that maximise impact on medical specialist out-patient waitlist management are highlighted to inform resource allocation.
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Objective To describe the perceptions of healthcare workers employed at a metropolitan public health service, with respect to how they identify, manage and care for refugee patients. Methods This study surveyed healthcare workers using a cross-sectional, mixed methods descriptive design, which partially replicates a previous Australian study. A total of 215 responses to a brief online survey were received (n=48 medical, n=100 nursing and midwifery, n=50 allied health, n=4 other). ⋯ Compared to previous research, respondents of this study saw refugee patients more frequently in their practice, and also reported fewer negative effects from working with them. Most demographic characteristics had no significant effect on worker-reported confidence in this study; however, greater experience of working with refugees and good self-perceived awareness of community services were both identified as positive influences. What are the implications for practitioners? Practitioners should prioritise remedying barriers that are consistently identified as affecting the service provided to refugee patients (communication, health literacy and healthcare worker capacity) as part of their quality and service improvement efforts.
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ObjectiveThis study assessed the impact of the COVID-19 pandemic on emergency departments (EDs) in South Australia, measured by changes in the number and casemix of patients in the system over time. MethodsData from the South Australia Emergency Department Dashboard, updated every 30min, were analysed for the period 4 October-21 December 2020. The Dashboard reports live counts of the number and type of patients in each of the six adult metropolitan public EDs in Adelaide, South Australia. ⋯ In the context of an overall decline in presentation numbers, the number of mental health-related presentations has not changed significantly, suggesting that this trend should be closely monitored. The findings corroborate the national concern that unwell people have avoided accessing emergency medical care during the pandemic, leading to worse outcomes and increased need for healthcare resources at a later date. It will be important to monitor and quickly detect further changes in ED usage using real-time data as the pandemic evolves, as well as in any future significant health crises.