Health services administration

Tension between the need for an integrated national health system and the self-interest of states has led to negative consequences, including discrimination against junior doctors.

Dev A S Kevat · Fiona J Lander

To the Editor: Clinical practice is constantly evolving, and while doctors are accomplished in recognising the need for continual personal development and improvement, they traditionally have been difficult to engage in health care system redesign.1,2 Quality improvement (QI) initiatives are often met with disengagement, owing to a perception that they provide little clinical benefit and that resources could be better spent elsewhere.1 While QI initiatives certainly ...

Nicholas M Cheng · Ned W R Douglas

To the Editor: Potentially avoidable hospital admissions are a key concern for every health care system. Admissions for ambulatory care-sensitive conditions (ACSCs) have been used as a proxy measure of potentially avoidable admissions in research and in policy and program development since the early 1990s. Older patients with chronic conditions are the greatest contributors to ACSC admissions, and hospital admissions for ACSCs are particularly burdensome ...

Jo M Longman · Megan E Passey · Dan P Ewald

Objective: To better understand the non-reporting of reportable deaths by determining the frequency and nature of reportable deaths referred to the Coroners Court of Victoria (CCOV) by the Registry of Births, Deaths and Marriages (BDM).Design and setting: Review of referrals from BDM to the CCOV between 2003 and 2011 where an external cause of death was recorded on the death certificate, with detailed ...

Sandra L Neate MB BS, DA(UK), FACEM · Lyndal C Bugeja BA(Hons), PhD · George A Jelinek MD, DipDHM, FACEM · Heather M Spooner LLB · Luke Ding BCom, LLB · David L Ranson BM BS, LLB, FRCPA

Integrating research with clinical care and education improves patient outcomes, but bringing this about successfully is no mean feat in a system where fragmentation and scrabbling for funding have been the order of the day.

Stephen Leeder

Embedding research into patient care and education for health-related professionals is the right approach, but it requires flexible and tailored solutions to funding and governance.

Garry L R Jennings MD, FRACP · Michael K Walsh MB BS, BHA, MPA

Five years on from the establishment of the National Health and Hospitals Reform Commission, it is timely to review the context for reform, actions taken to date, and to highlight remaining areas of concern.

Christine C Bennett MB BS, MPaed, FRACP

While improvements in drinking behaviour are apparent from the results of this study, women who are at high risk of having babies with alcohol-related birth defects need public health policies and programs that will reach them.

Cate M Cameron PhD, MPH, BSocWk(Hons) · Tamzyn M Davey PhD, MPH, BPsych(Hons) · Elizabeth Kendall BA, DipPsych, PhD · Andrew Wilson MB BS, PhD, FRACP · Roderick J McClure MB BS, BA, PhD

More than 40% of women taking parental leave during their specialist training experienced negative comments about their leave in the workplace, and more than 25% reported being questioned about their intentions for future pregnancies in relation to job applications.

Caroline M de Costa PhD, FRANZCOG, FRCOG · Michael Permezel MD, MRCP(UK), FRANZCOG · Louise M Farrell MB BS, FRANZCOG, FRCOG · Anne E Coffey MB BS, FRANZCOG · Ajay Rane PhD, MD, FRANZCOG

With consumer demand for storage of cord blood increasing, regulatory bodies need to develop policies to enable research that may lead to novel uses of cord blood.

Michael X Han · Maria E Craig MB BS, PhD, FRACP

Spinal steroid injections are increasing in popularity, but not in therapeutic benefit; placebos work just as well, and the procedure itself carries risks, some quite serious.

Ian A Harris MB BS, MMed(ClinEpi), PhD · Rachelle Buchbinder MB BS(Hons), PhD, FRACP

To the Editor: Until recently, Australian medical workforce planning has seemed a rather ad-hoc affair. We have self-induced an undersupply of doctors (having actually reduced student numbers in the mid 1990s,1 taken a decade to increase production, and now have crashed into entirely foreseeable undersupply of intern placements). The establishment of Health Workforce Australia has promulgated some much needed detailed, future-focused planning, although the fragmented ...

Dev A Kevat · Shanti Raman

Australian health policy can and should address, as a core aim, cardiovascular health in less economically advanced nations

Stephen R Leeder MD, PhD, FRACP

Hospital governance that prioritises waiting times or patient throughput does not adequately address health care qualityAt the 2007 federal election, Kevin Rudd announced plans to reform the health system. The National Health and Hospitals Reform Commission (NHHRC) was established the following year to find solutions. In 2010, Rudd presented his response to the NHHRC’s report, proposing local hospital networks interfacing with primary health care, with governance ...

David G Penington AC, DM, FRCP

Overcoming the barriers and seizing the opportunities to provide more equitable health care for Australia’s rural populationAustralia’s rural population, which comprises a third of our total population, presents distinct challenges for health care delivery. The low population density of much of rural Australia, the great distances involved, and the limited number of larger centres offering high-level medical care make equitable health care delivery difficult to ...

Gabriel J Shannon BSc, MB BS, FRACP

In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute individual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and ...

Nick Glozier MB BS, FRANZCP, PhD · Geoffrey H Tofler MB BS, MD, FRACP · David M Colquhoun MB BS, FRACP, FCSANZ · Stephen J Bunker RN, PhD · David M Clarke PhD, FRACGP, FRANZCP · David L Hare DPM, FRACP, FCSANZ · Ian B Hickie MD, FRANZCP, FASSA · James Tatoulis MB BS, MD, FRACS · David R Thompson MA, PhD, FRCN · Alison Wilson MBA · Maree G Branagan MPH

As the costs of both medical care and clinical trials continue to rise, do our current research endeavours represent good value for money? In this article, the last in a series based on the MJA Clinical Trials Research Summit, the authors propose a new model for funding investigator-initiated studies.

Ingrid M Winship MB ChB, MD, FRACP · John McNeil AM, MB BS, PhD · R John Simes MB BS, SM, FRACP

When considering this controversial procedure, how do we weigh the results of patient satisfaction surveys with those of clinical trials?

Wayne Adams

In reply: We thank Adams for providing private health insurance data that confirm the continued use of arthroscopic surgery for patients with osteoarthritis. We agree that the patient’s view of the benefits of the procedure is fundamental to assessing treatment success. We do not doubt that many patients are happy with the results of arthroscopic knee surgery, but this does not necessarily imply that the surgery ...

Rachelle Buchbinder · Ian A Harris