Australian Health Review
Volume 48 Number 1 2024
AH24012Scope of practice regulation in medicine: balancing patient safety, access to care and professional autonomy
What is known about the topic? Scope of practice regulation in medicine is crucial for ensuring patient safety, standardisation and professional accountability. What does this paper add? This paper highlights the negative consequences of restrictive scope of practice regulation on medical negligence litigation, quality of care, flexibility of healthcare delivery, clinical innovation and professional autonomy. What are the implications for practitioners? A proactive, national, artificial intelligence-powered, real-time patient outcome monitoring system is proposed, which addresses some of the highlighted challenges and the associated blame culture that it helps to perpetuate.
AH23258Mitigating the consequences of electronic health record data breaches for patients and healthcare workers
What is known about this topic? Electronic health records, in common with business and healthcare data systems, are vulnerable to data breaches and have been recently targeted in Australia and internationally. What does this paper add? Electronic health records present particular cybersecurity data breach risks for patients and healthcare workers through the release of confidential information, identity theft, and associated psychological distress. What are the implications for practitioners? Electronic health record platforms need legislative regulation and personalised provision of support to patients and healthcare workers to mitigate the consequences of inevitable data breaches.
AH23185The burdensome logistics of data linkage in Australia – the example of a national registry for congenital heart disease
What is known about the topic? Data linkage is a very powerful research tool in epidemiology, however, establishing this can be a lengthy and intensive process. What does this paper add? We report on our own experiences in establishing a multi-jurisdictional data linkage project, and the numerous inconsistencies encountered, prior to being able to conduct linkage. What are the implications for practitioners? We propose several strategies which could be implemented to facilitate a more streamlined, centralised approach to data linkage. Further streamlining, establishing accountability, and greater collaboration between jurisdictions is needed to ensure data linkage is both accessible and feasible to researchers.
AH23092Investigating allied health professionals’ attitudes, perceptions and acceptance of an electronic medical record using the Unified Theory of Acceptance and Use of Technology
What is known about the topic? Numerous studies have investigated physician and nursing perspectives of health service electronic medical record (EMR) implementation, however, information on allied health professionals (AHPs) perspectives is limited. What does this paper add? This paper utilises a validated tool to investigate AHPs’ attitudes, perceptions and experience of an EMR, pre- and post-implementation and identifies changes after system utilisation. This is new information is specific to AHPs. What are the implications for practitioners? Understanding both the positive influences and barriers to EMR use and adoption by AHPs provides insights into how elements of the Unified Theory of Acceptance and Usage of Technology framework can be leveraged to improve future system implementations by enhancing system suitability for AHPs and thus optimising adoption through change management and training strategies.
AH23119What would it take to improve the uptake and utilisation of mHealth applications among older Australians? A qualitative study
What is known about the topic? mHealth apps have the enormous potential to promote patient-centred care, provide a tool for patient self-management and effectively empower and improve users' health and health behaviour. What does this paper add? This paper complements existing adoption research models by identifying further influencing factors that specifically address the characteristics of mHealth apps and the needs of older adults. What are the implications for practitioners? This research shows that the requirements of consumers, regulators and health professionals need to be addressed to improve the relevance of mHealth and enable greater support for mHealth apps in the health system by understanding the perceived influencing factors for mHealth adoption.
AH23237Medicare Benefits Schedule (MBS) Review Advisory Committee post-implementation review of MBS telehealth items: abolition of initial telehealth consultations for non-general practitioner specialists
What is known about this topic? The Medicare Benefits Schedule Review Advisory Committee has made recommendations to cease reimbursement of telehealth for initial consultations by non-general practitioner medical specialists. What does this paper add? The recommendations are contrary to the good medical practice guidelines on telehealth promulgated by the Medical Board of Australia. What are the implications for practitioners? The cessation of reimbursement will significantly impact private patient initial appointments and especially affect rural and remote patients.
AH23214An economic evaluation of point-of-care ultrasound for children presenting to the emergency department with suspected septic arthritis of the hip
What is known about the topic? Management of septic hip arthritis is optimised by expedient diagnosis. What does this paper add? Point-of-care ultrasound reliably identifies fluid in the hip joint and shortens the length of time to diagnosis when compared with ultrasound examinations performed in medical imaging departments. What are the implications for practitioners? The use point-of-care ultrasound for the diagnosis of septic hip arthritis may improve diagnostic efficiency and offer significant cost savings.
What is known about the topic? Suicide rates in Australia have increased over the past 10 years, with some sub-populations known to experience a greater risk of suicide. What does this paper add? A policy review was undertaken to examine the distribution of this suicide prevention funding across jurisdictions and years, the types of interventions funded, and whether funding is targeted toward groups with a recognised higher risk of suicide. What are the implications for practitioners? The findings of this paper may be used by practitioners to better understand the service funding priorities for suicide prevention in Australia.
AH23178Healthcare costs attributable to e-cigarette use and subsequent uptake of cigarette smoking by Australians who have never smoked
What is known about the topic? The economic effects of the harms of e-cigarette use are unknown. What does this paper add? Based on the transition from e-cigarette use to cigarette smoking (among never smokers), high and avoidable healthcare costs are predicted with e-cigarette-initiated smoking, primarily for lung diseases, and are driven by small increments in e-cigarette uptake. What are the implications for practitioners? Strong support for regulating the use of e-cigarettes to limit use, other than for smoking cessation, is of paramount importance to reduce the economic burden on health care.
AH23216National Disability Insurance Scheme timeframes and functional outcomes for inpatient rehabilitation patients: a 5-year retrospective audit
What is known about the topic? Increased length of stay has been described for hospital inpatients referred to the National Disability Insurance Scheme (NDIS). What does the paper add? NDIS-referred rehabilitation inpatients had increased length of stay and lower Functional Independence Measure efficiency with reference to benchmarked expected length of stay predictions. NDIS-referred rehabilitation inpatients had increased length of stay compared with non-NDIS-referred patients. What are the implications for practitioners? Rehabilitation units managing inpatients referred to the NDIS incur a significant opportunity cost that is unaccounted for in current benchmarking and funding arrangements.
AH23206Reforming allied health service provision in residential aged care to improve the rehabilitation reach: a feasibility study
What is known about the topic? At present, residents in aged care are largely inactive and only 22% of facilities in Australia provide physiotherapy-based rehabilitation or short-term restorative care. What does this paper add? My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents in aged care and has the potential to improve the rehabilitation reach of allied health services in this setting. What are the implications for practitioners? Through My Therapy, allied health teams in residential aged care can better align with the Royal Commission’s Aged Care Quality and Safety recommendation of providing resident rehabilitation.
What is known about the topic? Health services must engage with research to ensure evidence-based practice, but they often encounter barriers to facilitating research within this setting. What does the paper add? The research reveals that health service teams were perceived as barriers for research culture and were significantly lower than individual and organisational perceptions of research culture and capacity. This highlights the importance of investigating challenges faced by team leaders in facilitating research and providing support or training. What are the implications for practitioners? Health service organisations should focus on supporting and training team leaders to enhance research culture and capacity and enable clinicians to engage in research.
AH23157Clinical innovation and scope of practice regulation: a case study of the Charlie Teo decision
What is known about the topic? Health profession regulatory mechanisms have traditionally been slow to respond to evolution and change in professional scopes of practice. What does this paper add? This paper explores how individual practitioners may find themselves in a ‘grey zone’ between the new clinical frontier and the normative practice of their professional peer group. What are the implications for practitioners? We propose a theoretical approach providing a clear framework through which to guide the adoption of clinical innovations and profession-level scope of practice change, progression and evolution.
AH23160The role of law in end-of-life decision-making in emergency departments and intensive care units: a retrospective review of current practice in a Queensland health service
What is known about the topic? Working within the law is a central feature of quality care. There have been concerted efforts to support healthcare professionals’ knowledge of the law that applies to end-of-life decision-making. However, knowing the law is not the same as applying the law. What does this paper add? This paper describes how end-of-life decisions are made and documented in emergency departments and intensive care units in one Queensland health service. We found that healthcare professionals rely on clinical judgement about what is in the best interest of the patient when making end-of-life decisions, and compliance with the law may be coincidental. What are the implications for practitioners? In addition to seeking to achieve consensus on end-of-life decision-making, healthcare professionals need to ensure that consent for an end-of-life decision is provided by the legal decision-maker.
What is known about the topic? The concept of medical futility and its impact are disputed issues. What does this paper add? The paper places futility in its medico legal context, it offers definitions, costs of futile medical treatment and highlights recent legal developments which re-define futility. What are the implications for practitioners? Practitioners need to be aware of the ongoing impact of definitional disputes relating to futility, the cost of futile treatment and that the nature of futility is changing.
The peer-reviewed and edited version of record published online before inclusion in an issue
AH23225Consumer perspectives of allied health involvement in a public hospital setting: cross-sectional survey and electronic health record review
What is known about the topic? Research on consumer acceptance of out-of-hours or weekend allied health services is lacking, with an assumption of consumer willingness and demand for these service models. What does this paper add? Hospital inpatients are generally indifferent to the day of allied health services, preferring weekday or weekend day equally, typically between 8 am and 4 pm, while outpatients favour weekday mornings. Although consumers reported that their needs were met by allied health services, there was a lack of awareness about the specific services they received. What are the implications for practitioners? Results highlight the importance of not only aligning service delivery with consumer preferences for timing, but also enhancing awareness and understanding of the available allied health services for consumers.
AH23235The impact of self-assessment and surveyor assessment on site visit performance under the National General Practice Accreditation scheme
What is known about the topic? There is a need to undertake more proactive and in-depth analyses of the general practice accreditation process and outcomes to improve the quality and safety within this healthcare sector. What does this paper add? Attempt of the self-assessment does not predict indicator conformity at the site visit overall, and appropriate levels of consistency of indicator assessment between surveyors at the site visit were identified. What are the implications for practitioners? We present empirical evidence as to the consistency of assessment with general practice accreditation to inform future standards and (re)accreditation assessments.
AH23231The impact of management option on out-of-pocket costs and perceived financial burden among men with localised prostate cancer in Australia within 6 months of diagnosis
What is known about the topic? International evidence suggests that men with low-risk prostate cancer managed with active surveillance initially incur lower out-of-pocket costs than those managed with active treatment. What does this paper add? Australian men with low-risk prostate cancer report low out-of-pocket costs and financial burden in the first 6 months post-diagnosis. Compared with those managed with active surveillance, men having active treatment had 6–7 times greater out-of-pocket expenses. What are the implications for practitioners? Being managed by active surveillance as the primary management option for low-risk prostate cancer reduces the financial burdens associated with a cancer diagnosis.
AH23228Private health insurance incentives and passive adverse selection: is Lifetime Health Cover responsible for the excess ageing of Australia’s hospital cover risk pool?
What is known about the topic? Since the introduction of Lifetime Health Cover (LHC) in mid-2000, the participation rate for private health insurance that includes hospital cover (PHI-HC) has remained relatively stable, but the PHI-HC population has aged faster than the general population. What does this paper add? This paper makes a novel distinction between ‘active’ and ‘passive’ age-based adverse selection to explain LHC’s role in the excess ageing of the PHI-HC risk pool. What are the implications for practitioners? Governments need to be vigilant for the emergence of distortions in the age distribution of the PHI-HC risk pool and respond with targeted interventions to normalise the age distribution, or risk problematic passive age-based adverse selection.
What is known about the topic? Voluntary assisted dying (VAD) legislation has now been passed in all Australian states. Although VAD has been operating internationally for a considerable time, there have been calls for more data to understand the resources required to implement VAD. What does this paper add? We found a paucity of empirically informed detail regarding the actual costs required to implement VAD. Hence, we tabulated a list of potential costs that could be used for subsequent evaluation and outline a research agenda. What are the implications for practitioners? Given that a significant number of practitioners may be directly or indirectly involved in VAD it is important that associated costs are clearly outlined so that appropriate resource allocation can be considered.
These articles have been peer reviewed and accepted for publication. They are still in production and have not been edited, so may differ from the final published form.
Adapting to Change: Exploring Perceptions and Demands of the COVID-19 Workforce Changes - An Australian Multi-Institutional Radiation Oncology Survey
Measuring clinician experience in value-based health care initiatives: A 10-item Core Clinician Experience Measure (CEM-10)
Clinical Research Imperatives: Principles and priorities from the perspective of Allied Health Service Executives and Managers.
PERSONAL AND ORGANISATIONAL ATTRIBUTES THAT SUPPORT TRANSFORMATIONAL LEADERSHIP IN ACUTE HEALTHCARE: SCOPING REVIEW
The development and implementation of the Northern Health lung cancer digital care pathway: A case study in service change
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