Australian health review : a publication of the Australian Hospital Association
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In January 2006 the Maryborough Base Hospital in Queensland faced imminent closure of its emergency department (ED) due to a shortage of senior medical staff. At the same time patient confidence in Queensland Health was low. ⋯ In search of a solution, the Fraser Coast District Health Service asked Maryborough general practitioners to work in the Maryborough Hospital ED and/or in the internal medicine ward as Visiting Medical Officers. While this represented a solution to the problem, there was much to be considered before such a plan could be put into place.
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High-reliability organisations are those, such as within the aviation industry, which operate in complex, hazardous environments and yet despite this are able to balance safety and effectiveness. Crew resource management (CRM) training is used to improve the non-technical skills of aviation crews and other high-reliability teams. ⋯ The purpose of this discussion paper is to examine the application of CRM to acute, ward-based multidisciplinary health care teams and more broadly to argue for the repositioning of health-based CRM to address effective everyday function, of which "crisis events" form just one part. It is argued that CRM methodology could be applied to evaluate ward-based health care teams and design non-technical skills training to increase their efficacy, promote better patient outcomes, and facilitate a range of positive personal and organisational level outcomes.
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To help develop criteria to identify older patients suitable for admission to medical short-stay units, by determining predictors of length of stay (LOS) of 3 days or less. ⋯ Preserved function, measured using the MBI and TUG, and the absence of delirium are strong predictors of short LOS. In conjunction with early, skilled clinical evaluation, these criteria could be used to select older patients presenting to the emergency departments for admission to short-stay units.
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Comparative Study
High prices for generics in Australia - more competition might help.
It is commonly believed that dispensed prices of medicines in Australia are substantially lower than those in other developed countries, particularly the US. This article reports the results of an analysis comparing dispensed prices for the most commonly prescribed and the highest cost items in Australia with dispensed prices in the US. Although a large majority of items are less expensive in Australia than in the US, Australian prices are higher for a substantial number of products, particularly generic drugs. ⋯ Prices offered by the individual supplier would apply until the next pricing review. The PBS would continue to subsidise up to the price of the lowest priced brand, with brand premiums applying to all brands priced higher than the benchmark price. Such an approach would provide opportunity for players in the market to capture market share by being the lowest priced brand.
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In this paper we argue that Australia's pharmaceutical cost sharing policy has been applied as if cost sharing is unproblematic for medicine affordability and good health outcomes. Australian and international experience with pharmaceutical cost sharing strongly suggests a negative impact on affordability and quality use of medicines, disproportionately affecting low income patients. We argue that Australia's use of cost sharing reflects the currency of a cognitively powerful and morally charged idea - moral hazard. ⋯ Applied to pharmaceuticals, this means that low out-of-pocket cost will lead to waste. Moral hazard mixes the explanatory power of price with the intuitively cogent notion that if people do not experience consequences they will behave irresponsibly. Cost sharing policy has gone unscrutinised and uncontested not because cost sharing is unproblematic, but because in the light of the idea of moral hazard it has all the question-deadening weight of common sense.