Topics
Health services administration
Workplace-based assessment for international medical graduates: at what cost?
Weighing up the worth of a local program recommended for national rollout
Balakrishnan (Kichu) R Nair AM, MD, FRACP, FRCP · Andrew M Searles BEc, MMedStats, PhD · Rod I Ling PhD, MA, BCom · Julie Wein DipBus(Man) · Kathy Ingham DipTraining
Do outlier inpatients experience more emergency calls in hospital? An observational cohort study
Outlier patients may be at risk if their therapeutic and monitoring needs are only met on their home ward
John D Santamaria MD BS, FRACP, FCICM · Antony E Tobin MB BS, FRACP, FCICM · Matthew H Anstey MB BS, FCICM, FACEM · Roger J Smith BN, MPH · David A Reid
An audit of the use of ondansetron in general medical patients
To the Editor: Ondansetron is a 5-HT3 receptor antagonist and an effective antiemetic in the treatment of acute chemotherapy- or radiotherapy-induced nausea and vomiting1 and postoperative nausea and vomiting.2 However, there is no evidence to support the superiority of ondansetron in the empirical management of undifferentiated nausea and vomiting,1 although this appears to have become common practice. Trials comparing ondansetron and other antiemetics (such as ...
Penelope J Cotton · Samer Q Noaman
Australia is continuing to make progress against cancer, but the regional and remote disadvantage remains
CorrectionIncorrect footnote: In “Australia is continuing to make progress against cancer, but the regional and remote disadvantage remains” in the 4 November 2013 issue of the Journal (Med J Aust 2013; 199: 605-608), there was an error in Box 2 (page 607). There should be two separate footnotes for Box 2A and Box 2B: the footnote to Box 2A should state “Based on age- and sex-specific rates for ...
Michael D Coory MB BS, PhD, FAFPHM · Tsun Ho BE(Hons), PhD · Susan J Jordan MB BS, PhD
Difficult but necessary conversations — the case for advance care planning
Despite widespread professional and public endorsement, coupled with supporting legislation in every state and territory, uptake of advance care planning in Australia has been slow. All general practices, hospitals and residential care facilities need to commit to systematically eliciting, documenting and enacting patients’ future care preferences.
Ian A Scott FRACP, MHA, MEd · Geoffrey K Mitchell MB BS, FRACGP, PhD · Elizabeth J Reymond MB BS, FRACGP · Michael P Daly MB BS, MHA
Preoperative cardiac evaluation and management of patients undergoing elective non-cardiac surgery
Cardiac complications such as myocardial infarction, cardiac arrest and acute heart failure are a common cause of death and major morbidity in patients undergoing non-cardiac surgery. Part 6 of our Cardiology series looks at how preoperative evaluation and medical optimisation can improve outcomes for surgical patients.
Ian A Scott MB BS, FRACP, MHA · Hasan A Shohag MB BS, FRACP · Peter C A Kam MB BS, FANZCA · Michael V Jelinek FRACP, MD, FCSANZ · Golam M Khadem MB BS, FRACP
Chiropractic Observation and Analysis Study (COAST): providing an understanding of current chiropractic practice
A cross-sectional study using the BEACH (Bettering the Evaluation and Care of Health) methods for general practice assessed the clinical practices of chiropractors in Victoria and found that they manage a range of conditions, mostly musculoskeletal-related. This study’s results can be used by stakeholders of the chiropractic profession in workforce development, education and health care policy.
Simon D French PhD, MPH, BAppSc(Chiro) · Melanie J Charity MSc, BSc · Kirsty Forsdike BA(Hons), PgDipLaw, PgDipLegalPractice · Jane M Gunn PhD, FRACGP, MB BS · Barbara I Polus BAppSc(Chiro), MSc, PhD · Bruce F Walker DC, MPH, DrPH · Patty Chondros BSc(Hons), MSc, PhD · Helena C Britt BA, PhD
Antimicrobial stewardship in Victorian hospitals: a statewide survey to identify current gaps
Public regional and private hospitals need more antimicrobial stewardship support, particularly in the areas of policy development, antimicrobial approval systems, prescription review and auditing.
Rodney S James BMedSci, BMed, FRCPA · Kylie A McIntosh BPharm(Hons), PhD · Susan B Luu BPharm, MPH · Menino O Cotta BPharm · Caroline Marshall MB BS, FRACP, PhD · Karin A Thursky MB BS, FRACP, MD · Kirsty L Buising MB BS, FRACP, MD
Building Queensland's human capital: the case for health advocacy
In light of recent cuts to public health expenditure, we need effective evidence-based government health policy and legislative reform. This can only be achieved with input from non-government actors.
Claire E Brolan MA, LLB(Hons), BA · Jo Durham PhD
Australia is continuing to make progress against cancer, but the regional and remote disadvantage remains
A comparison of mortality rates in regional and remote areas with those in metropolitan areas from 2001 to 2010 found 8878 excess cancer deaths; no improvement in age-standardised mortality ratios (SMRs) in men, and an increase in SMRs in women; and a slower decrease in the age-standardised cancer death rate in regional and remote areas, compared with metropolitan areas.
Michael D Coory MB BS, PhD, FAFPHM · Tsun Ho BE(Hons), PhD · Susan J Jordan MB BS, PhD
Human papillomavirus vaccine coverage among female Australian adolescents: success of the school-based approach
Objective: To describe quadrivalent human papillomavirus (HPV) vaccination coverage achieved in the HPV vaccination catch-up program for girls aged 12–17 years.Design: Analysis of data from the Australian National HPV Vaccination Program Register.Participants: Girls aged 12–17 years as at 30 June 2007.Main outcome measures: HPV vaccine coverage by dose (1, 2 and 3), age and state of residence, using Australian Bureau of ...
Julia M L Brotherton BMed(Hons), MPH(Hons), FAFPHM · Sharron L Murray RN, RM, GradDipChildHealth · Madeline A Hall MPH · Lynne K Andrewartha BHSc(Nur) · Carolyn A Banks · Dennis Meijer BA, MHL · Helen C Pitcher · Megan M Scully BSc(Nsg), DPH, MHA · Luda Molchanoff BN
Estimated impacts of alternative Australian alcohol taxation structures on consumption, public health and government revenues
Is there a politically feasible way to meet the urgent need for reducing alcohol-related harm in Australia?
Christopher M Doran BEc(Hons), PhD · Joshua M Byrnes MHealthEcon, MEcon, PhD · Linda J Cobiac PhD · Brian Vandenberg BAppSc, BA(Hons), MPH · Theo Vos PhD
The medical workforce of the future
Doctors training now will have a very different world of practice. They will need to understand team care, patient engagement in decision making and clinician leadership as well as the rapidly changing health system. But what an exciting environment to be entering, with all the advances in care available and expanding into the future — as long as we can afford them.
Bruce G Robinson MD, MSc, FRACP · Peter M Brooks MD, FRACP, FRCP(Glas)
The medical workforce in 2025: what’s in the numbers?
Summary Key trends in Australian medical workforce supply include increasing overall supply levels and an increasing number of medical graduates, but also reduced workforce effort and a large cohort of doctors approaching traditional retirement age. Although prevocational and vocational training programs are beginning to expand, there are significant bottlenecks in the postgraduate training pathway for the sizeable cohorts of new graduates. The ...
Catherine M Joyce BA(Hons), MPsych, PhD
Towards best practice in national health workforce planning
Summary Health Workforce Australia (HWA) was established by the Council of Australian Governments through its 2008 National Partnership Agreement on Hospital and Health Workforce Reform, as the national agency to progress health workforce reform and address the challenges of providing a skilled, innovative and flexible health workforce in Australia. The Australian Health Ministers’ Conference commissioned HWA to undertake a workforce planning exercise for doctors, ...
Maureen V McCarty MBA · Bethany J Fenech BEc
Sustainable workforce and sustainable health systems for rural and remote Australia
Summary Adequate health workforce alone will not ensure optimal health service access. We consider what an effective and sustainable health system for rural and remote Australia might look like in 2025, briefly describe some of the barriers to achieving this vision and propose how these challenges may be overcome. More radical change is required on at least four fronts: changing the ...
John Wakerman MTH, FAFPHM, FACRRM · John S Humphreys BA, DipEd, PhD
International medical migration: what is the future for Australia?
Despite goals for self-sufficiency, migration seems certain to remain an imperative for Australia for the foreseeable futureAustralia has developed extraordinary reliance on international medical graduates (IMGs) compared with other OECD (Organization for Economic Co-operation and Development) countries. Based on analysis of an unprecedented range of secondary data, I aim to define the recent scale and sources of medical migration, IMGs’ immigration categories, their distribution, their ...
Lesleyanne Hawthorne PhD, MA, BA(Hons)
Paying for the health workforce
Payment systems should be considered more often as a policy intervention to improve health system performancePayment and funding are often regarded as administrative transfers; and yet, funding is rarely provided without strings attached. Where funding and remuneration are made conditional on certain behaviours (eg, working a set number of hours, seeing a certain number of patients, undertaking specific tasks or tasks of a certain standard, ...
Anthony Scott BA(Hons), MSc, PhD
Towards a sustainable and fit-for-purpose health workforce — lessons from New Zealand
Reforms underway in New Zealand are designed to significantly increase workforce productivityIt is true that most ill and injured New Zealanders currently receive appropriate and timely health care, but viewed as a whole, and considering health outcomes in Maori and poorer urban and rural communities,1,2 the New Zealand health system is something of a “curate’s egg”. I suggest that the New Zealand health workforce is ...
Des F Gorman MBChB, MD, PhD
Patient safety in hospitals — can we measure it?
Collection of data on adverse events is challenging, and part of the challenge is ensuring that the data are put to good use.
Neville Board RN, BA, MPH
Removing the GST exemption for fresh fruits and vegetables could cost lives
To the Editor: Since the Henry tax review recommended broadening the base of the goods and services tax (GST),2 there have been rumours that the current exemption for fresh foods, such as fruits and vegetables, might be removed.2 Changes in government are often accompanied by a review of policies, and broadening the tax base is appealing because it would increase efficiency and raise revenue. But ...
J Lennert Veerman · Linda J Cobiac
Measuring the incidence of hospital-acquired complications and their effect on length of stay using CHADx
The Classification of Hospital Acquired Diagnoses reporting system might seem complex, but this study shows that automating it can allow users to analyse complication rates by clinically meaningful factors, such as specialty or ward. Potential applications include assessing the benefits of patient safety initiatives and identifying ways of preventing lengthy hospital stays.
Kevin M Trentino BCom · Stuart G Swain BCM · Sally A Burrows BMath, GradDipMedStat · Peter C Sprivulis MB BS, PhD, FACEM · Frank F S Daly MB BS, FACEM, FLWA
The tale of out-of-pocket spending on health care
We need to develop a process for assessing the social value of health care interventions, and to subsidise those services that provide more value relative to the societal willingness to pay.
Jane P Hall PhD, FASSA
The economic evaluation of personalised oncology medicines: ethical challenges
Does the current evidence-based medicine model for assessing the clinical and cost-effectiveness of personalised therapies need revision?
Jan R R Lewis BPharm(Hons) · Wendy L Lipworth MB BS, MSc, PhD · Ian H Kerridge MPhil, FRACP, FRCPA · Richard O Day MD, FRACP
Can’t escape it: the out-of-pocket cost of health care in Australia
Out-of-pocket expenses account for almost a quarter of the total health care costs in Australia, with older households spending slightly more than younger households despite the older households having significantly lower income and more access to health care cards.
Farhat Yusuf BSc(Hons), MA, PhD · Stephen R Leeder MD, PhD, FRACP
