Topics
Health services administration
Financial toxicity in clinical care today: a “menu without prices”
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Bogda Koczwara · Louisa Gordon · Ian N Olver
Female representation at Australasian specialty conferences
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Bridget Effeney · Nicole Phillips · David Sturgess
Female representation at Australasian specialty conferences
In reply
Lucy J Modra · Sarah Ann Yong · Danielle E Austin
Clinical variation: why it matters
Understanding variation in care is an important step in improving patient health outcomes through appropriate care
Anne Duggan · Elizabeth Koff · Villis Marshall
English lessons: can publishing an atlas of variation stimulate the discussion on appropriateness of care?
Health systems around the world are facing the twin pressures of increasing demand for services, and a lack of resources as a consequence of economic slowdown in many countries
Philip DaSilva · JA Muir Gray
Clinical care standards: appropriate care everywhere — acute coronary syndromes as an example
Australian practice data from clinical audits and other research have clearly shown that dissemination of high quality clinical practice guidelines is not enough to ensure everyone with a particular clinical condition receives appropriate care
Derek P Chew · Robert Herkes · Meredith A Page
Restructuring primary health care in Australia
When appropriately resourced, medical homes can deliver the system-wide benefits of truly integrated primary care
John M Dwyer · Stephen J Duckett
Antimicrobial use in Australian hospitals: how much and how appropriate?
Antimicrobial agents play a central role in modern health care, especially in the hospital setting
John D Turnidge · Karin Thursky · Caroline S Chen · Vicki R McNeil · Irene J Wilkinson
Clinical quality registries have the potential to drive improvements in the appropriateness of care
The effectiveness of clinical quality registries to monitor and benchmark patient outcomes is well established
Nick Wilcox · John J McNeil
Paying hospitals for quality: can we buy better care?
Economic theory predicts that changing financial rewards will change behaviour. This is valid in terms of service use; higher costs reduce health care use
Jane P Hall · Kees C van Gool
Health care variation: time to act
Why are knee replacement rates in Australia over four times higher than they are in Israel? Or the rate for caesarean sections nearly twice as high as in Finland?
Heather A Buchan · Anne Duggan · Jenny Hargreaves · Ian A Scott · Luke Slawomirski
Appropriateness of care: why so much variation
Broad descriptions of variation are a useful way of finding disparities, but to generate change they need to be carefully analysed and applied
Richard C Madden · Andrew Wilson · Philip Hoyle
A review of maturity onset diabetes of the young (MODY) and challenges in the management of glucokinase-MODY
Maturity onset diabetes of the young (MODY), the most common monogenic form of diabetes, accounts for 1–2% of all diabetes diagnoses. Glucokinase (GCK)-MODY (also referred to as MODY2) constitutes 10–60% of all MODY cases and is inherited as an autosomal dominant heterozygous mutation, resulting in loss of function of the GCK gene. Patients with GCK-MODY generally have mild, fasting hyperglycaemia that is present from birth, are commonly leaner and diagnosed at a younger age than patients with type 2 diabetes, and rarely develop complications from diabetes. Hence, treatment is usually unnecessary and may be ceased. Therefore, genetic screening is recommended in all young patients (< 40 years) with an autosomal dominant family history of diabetes and who lack features of the metabolic syndrome and type 1 diabetes. Further, treatment discontinuation should be discussed with the patient as part of the informed consent process, as the realisation that prior treatment may have not been necessary — or that it could have been less burdensome — may have psychological implications for the patient. This is true for other forms of MODY, such as hepatocyte nuclear factor 1A mutations (MODY3) where hyperglycaemia is managed with low dose sulfonylurea rather than insulin. Patients with GCK-MODY, in line with trends in the general population, are becoming older and more overweight and obese, and are concomitantly developing features of insulin resistance and glucose intolerance. Therefore, controversy exists as to whether such “treatment-exempt” patients should be reassessed for treatment later in life. As testing becomes more accessible, clinicians and patients are likely to embrace genetic screening earlier in the course of diabetes, which may avert the consequences of delayed testing years after diagnosis and treatment initiation.
Ramy H Bishay · Jerry R Greenfield
A decade of Australian methotrexate dosing errors
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Monisha Gupta · Marius Rademaker · John R Sullivan · Peter Foley
A decade of Australian methotrexate dosing errors
In reply
Rose Cairns · Jared A Brown · Nicholas A Buckley
Pioneering digital disruption: Australia’s first integrated digital tertiary hospital
Digital transformation has started in Australian hospitals
Clair Sullivan · Andrew Staib · Stephen Ayre · Michael Daly · Renea Collins · Michael Draheim · Richard Ashby
Aiming for the truth: understanding the difference between validity and precision
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John R Attia · Michael P Jones · Belinda Suthers
NHMRC funding of mental health research
A case for better alignment of research funding with burden of disease
Philip J Batterham · John McGrath · Patrick D McGorry · Frances J Kay-Lambkin · Ian B Hickie · Helen Christensen
Models of maternity care: evidence for midwifery continuity of care
Despite demonstrated benefits of midwife-led continuity of care for women and babies, implementation is proving challenging
Caroline SE Homer
Improving maternity services for Indigenous women in Australia: moving from policy to practice
Funding is needed for developing culturally competent maternity care
Sue Kildea · Sally Tracy · Juanita Sherwood · Fleur Magick-Dennis · Lesley Barclay
