Topics

Abstract

Objective: To assess graduates’ self-reported preparedness with reference to a range of clinical practice capabilities, including those related to patient-centred care.

Design: A retrospective survey of self-reported preparedness for practice, based on a survey developed by the Peninsula Medical School (United Kingdom) and adapted to account for Australian circumstances and to provide more information about patient-centred care-related capabilities.

Setting and participants: Launceston Clinical School, a regional clinical school for undergraduate medical students. Medical students who had graduated during 2005–2014 and were contactable by email were invited to participate in the study.

Main outcome measures: Graduates’ self-reported preparedness for practice in 44 practice areas, measured on a 5-point Likert scale.

Results: Responses from 135 graduates (50% of invited graduates, 38% of the eligible graduate population) were received. Most graduates felt prepared in 41 of the 44 practice areas; 80% felt at least well prepared in 17 areas. After clustering the 44 areas into six thematic groups, no differences were found between men and women who had graduated in the past 4 years. As male graduates become more experienced (5–10 years after graduation), retrospective perceptions of preparedness in some areas differed from those of more recent graduates; this was not found for female graduates.

Conclusion: The survey identified strengths and weaknesses in the preparation of doctors for practice. It could be more broadly applied in Australia to obtain longitudinal data for assessing the quality of learning for curriculum planning purposes, and for aligning graduates’ needs and expectations with those of the medical training and health care employment sectors.

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University of Tasmania, Launceston, TAS

Correspondence: Jenny.barr@utas.edu.au

Acknowledgements:

We acknowledge the contributions of Michelle Horder, research assistant for data collection, and Jessica Woodroffe, research fellow and contributor to methodological discussions.

Competing interests:

Kim Rooney is an Australian Medical Council Director, and Director of the Launceston Clinical School at the University of Tasmania.

1. Monrouxe L, Bullock A, Cole J, et al. How prepared are UK medical graduates for practice? Final report from a programme of research commissioned by the General Medical Council. June 2014. http://www.gmc-uk.org/How_Prepared_are_UK_Medical_Graduates_for_Practice_SUBMITTED_Revised_140614.pdf_58034815.pdf (accessed Dec 2016).
2. Smith C, Ferns S, Russell L. Conceptualising and measuring ‘employability’ — lessons from a national OLT project. Australian Collaborative Education Network Conference, Tweed Heads, 1-3 October 2014. http://acen.edu.au/2014Conference/wp-content/uploads/2014/10/Conceptualising-and-measuring-%E2%80%98employability%E2%80%99-%E2%80%93-lessons-from-a-National-OLT-Project.pdf (accessed Dec 2016).
3. Bleakley A, Brennan N. Does undergraduate curriculum design make a difference to readiness to practice as a junior doctor? Med Teach 2011; 33: 459-467.
4. Kecskes Z, Mitchell I. Teaching future doctors for modern health care. Med J Aust 2017; 206: 158-159. <MJA full text>
5. Lawson M, Bearman M. Medical education in Australia. What makes for success? Summary report: surveys, focus groups and interviews. Canberra: Department of Education, Employment and Workplace Relations, 2007. http://pandora.nla.gov.au/pan/121025/20100630-1610/www.deewr.gov.au/HigherEducation/Publications/HEReports/Documents/AMES-8.pdf (accessed Mar 2017).
6. Scott G. Transforming graduate capabilities and achievement standards for a sustainable future. Key insights from a 2014–16 Office for Learning & Teaching National Senior Teaching Fellowship. May 2016. Canberra: Office for Learning and Teaching, 2016. http://flipcurric.edu.au/sites/flipcurric/media/107.pdf (accessed July 2016).
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16. Morrow GN, Burford B, Rothwell C, et al. Preparedness for practice: the perceptions of medical graduates and clinical teams. Med Teach 2012; 34: 123-135.
17. Illing J, Morrow G, Rothwell C, et al. Perceptions of UK medical graduates’ preparedness for practice: a multi-centre qualitative study reflecting the importance of learning on the job. BMC Med Educ 2013; 13: 1.
18. General Medical Council. Be prepared: are new doctors safe to practise? General Medical Council, 2014. http://www.gmc-uk.org/Be_prepared___are_new_doctors_safe_to_practise_Oct_2014.pdf_58044232.pdf (accessed Dec 2016).
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20. Chopra A. JCU medical graduates’ preparedness for remote practice. Rural Remote Health 2015; 15: 3202.
21. Australian Health Ministers Advisory Council. National Intern Work Readiness Forum. Background Paper, 28 September 2016. http://www.coaghealthcouncil.gov.au/Portals/0/National%20Intern%20Work%20Readiness%20Forum%202016%20Background%20Paper.pdf (accessed Dec 2016).
22. Ochsmann EB, Zier U, Drexler H, Schmid K. Well prepared for work? Junior doctors’ self-assessment after medical education. BMC Med Educ 2011; 11: 2-9.
23. Surmon L, Bialocerkowski A, Hu W. Perceptions of preparedness for the first medical clerkship: a systematic review and synthesis. BMC Med Educ 2016; 16: 1.
24. Eva KW, Bordage G, Campbell C, et al. Towards a program of assessment for health professionals: from training into practice. Adv Health Sci Educ Theory Pract 2016; 21: 897-913.
25. Gordon A, Black, K. Doctors need to be taught how to discuss their patients’ excess weight. The Conversation [internet]. 17 Aug 2016. http://theconversation.com/doctors-need-to-be-taught-how-to-discuss-their-patients-excess-weight-63939 (accessed Aug 2016).
26. Bray G, Look M, Ryan D. Treatment of the obese patient in primary care: targeting and meeting goals and expectations. Postgrad Med 2013; 125: 67-77.
27. Walters L, Brooks K. Integration, continuity and longitudinality: the ‘what’ that makes patient-centred learning in clinical clerkships. Med Educ 2016; 50: 889-891.

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Research

Reducing cardiovascular disease risk in diabetes: a randomised controlled trial of a quality improvement initiative

Santhi Chalasani, David P Peiris, Tim Usherwood, Julie Redfern, Bruce C Neal, David R Sullivan, Stephen Colagiuri, Nicholas A Zwar, Qiang Li and Anushka Patel

Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00332
Published online: 5 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Endocrine system diseases

Cardiovascular diseases

Environment and public health

General medicine

Abstract

Objectives: To describe the management of cardiovascular disease (CVD) risk in Australian patients with diabetes; to compare the effectiveness of a quality improvement initiative for people with and without diabetes.

Research design and methods: Subgroup analyses of patients with and without diabetes participating in a cluster randomised trial.

Setting and participants: Indigenous people (≥ 35 years old) and non-Indigenous people (≥ 45 years old) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months.

Intervention: Quality improvement initiative comprising point-of-care electronic decision support with audit and feedback tools.

Main outcome measures: Adherence to CVD risk screening and prescribing guidelines.

Results: Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0% v 39.5%; P < 0.001). Baseline rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5% v 39.6%; P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA_1c levels who were not prescribed the corresponding therapy at baseline were 28%, 44% and 24% respectively. The intervention was associated with improved screening rates, but the effect was smaller for patients with diabetes than for those without diabetes (rate ratio [RR], 1.14 v 1.28; P = 0.01). It was associated with improved guideline-recommended prescribing only for undertreated individuals at high risk; the effect size was similar for those with and without diabetes (RR, 1.63 v 1.53; P = 0.28).

Conclusions: Adherence to CVD risk management guidelines was better for people with diabetes, but there is room for improvement. The intervention was modestly effective in people with diabetes, but further strategies are needed to close evidence–practice gaps.

Australian and New Zealand Clinical Trials Registry number: ACTRN12611000478910.

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1 The George Institute for International Health, University of Sydney, Sydney, NSW
2 Sydney Medical School, University of Sydney, Sydney, NSW
3 Royal Prince Alfred Hospital, Sydney, NSW
4 Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW
5 UNSW Australia, Sydney, NSW

Correspondence: shanth_c@hotmail.com

Acknowledgements:

We gratefully acknowledge the support of the general practices and Aboriginal Community Controlled Health Services that participated in this study. We also acknowledge the support of the Queensland Aboriginal and Islander Health Council, the Aboriginal Health and Medical Research Council, and the Western Sydney, Inner West Sydney, South Eastern Sydney, Eastern Sydney, South Western Sydney and Nepean–Blue Mountains Medicare Locals. We acknowledge Maria Agaliotis, Sharon Parker, Genevieve Coorey, Lyn Anderson and Melvina Mitchell for supporting the execution of the study. We thank Pen Computer Systems for their support in developing the software tools, and the Improvement Foundation for their support in developing and hosting the quality improvement portal. The National Health and Medical Research Council (NHMRC) and the New South Wales Department of Health funded the study, but had no role in its design or conduct, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of this article. David Peiris was supported by an NHMRC Translating Research into Practice fellowship and is now an NHMRC Postdoctoral Fellow (1054754). Anushka Patel is supported by an NHMRC Senior Research Fellowship (632938). Julie Redfern is funded by an NHMRC Career Development Fellowship (1061793) co-funded with a National Heart Foundation Future Fellowship (G160523).

Competing interests:

No relevant disclosures.

1. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047-1053.
2. Access Economics, for Diabetes Australia. The growing cost of obesity in 2008: three years on. Canberra: Diabetes Australia, 2008. https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/7b855650-e129-4499-a371-c7932f8cc38d.pdf (accessed Mar 2017).
3. Cholesterol Treatment Trialists Collaborators; Kearney PM, Blackwell L, Collins R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371: 117-125.
4. Emdin CA, Rahimi K, Neal B, et al. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA 2015; 313: 603-615.
5. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. Canberra: National Vascular Disease Prevention Alliance, 2012. https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf (accessed Mar 2017).
6. Furler J, Hii JW, Liew D, et al. The “cost” of treating to target: cross-sectional analysis of patients with poorly controlled type 2 diabetes in Australian general practice. BMC Fam Pract 2013; 14: 32.
7. Wan Q, Harris MF, Jayasinghe UW, et al. Quality of diabetes care and coronary heart disease absolute risk in patients with type 2 diabetes mellitus in Australian general practice. Qual Saf Health Care 2006; 15: 131-135.
8. Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004; 291: 335-342.
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10. Braga M, Casanova A, Teoh H, et al. Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada. Can J Cardiol 2010; 26: 297-302.
11. Peiris D, Usherwood T, Panaretto K, et al. Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: the treatment of cardiovascular risk using electronic decision support cluster-randomized trial. Circ Cardiovasc Qual Outcomes 2015; 8: 87-95.
12. Peiris D, Usherwood T, Panaretto K, et al. The Treatment of cardiovascular Risk in Primary care using Electronic Decision suppOrt (TORPEDO) study-intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare. BMJ Open 2012; 2: e002177.
13. Peiris DP, Joshi R, Webster RJ, et al. An electronic clinical decision support tool to assist primary care providers in cardiovascular disease risk management: development and mixed methods evaluation. J Med Internet Res 2009; 11: e51.
14. National Vascular Disease Prevention Alliance. Australian absolute cardiovascular risk calculator. http://www.cvdcheck.org.au/ (accessed Aug 2016).
15. Peiris D, Agaliotis M, Patel B, Patel A. Validation of a general practice audit and data extraction tool. Aust Fam Physician 2013; 42: 816-819.
16. Prevost G, Phan TM, Mounier-Vehier C, Fontaine P. Control of cardiovascular risk factors in patients with type 2 diabetes and hypertension in a French national study (Phenomen). Diabetes Metab 2005; 31: 479-485.
17. Webster RJ, Heeley EL, Peiris DP, et al. Gaps in cardiovascular disease risk management in Australian general practice. Med J Aust 2009; 191: 324-329. <MJA full text>
18. Peiris DP, Patel AA, Cass A, et al. Cardiovascular disease risk management for Aboriginal and Torres Strait Islander peoples in primary health care settings: findings from the Kanyini Audit. Med J Aust 2009; 191: 304-309. <MJA full text>
19. Kellow N, Khalil H. A review of the pharmacological management of type 2 diabetes in a rural Australian primary care cohort. Int J Pharm Pract 2013; 21: 297-304.
20. Hoerger TJ, Segel JE, Gregg EW, Saaddine JB. Is glycemic control improving in US adults? Diabetes Care 2008; 31: 81-86.
21. Pentakota SR, Rajan M, Fincke BG, et al. Does diabetes care differ by type of chronic comorbidity? An evaluation of the Piette and Kerr framework. Diabetes Care 2012; 35: 1285-1292.
22. Higashi T, Wenger NS, Adams JL, et al. Relationship between number of medical conditions and quality of care. N Engl J Med 2007; 356: 2496-2504.
23. Owen AJ, Retegan C, Rockell M, et al. Inertia or inaction? Blood pressure management and cardiovascular risk in diabetes. Clin Exp Pharmacol Physiol 2009; 36: 643-647.
24. Tricco AC, Ivers NM, Grimshaw JM, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet 2012; 379: 2252-2261.
25. Morgan MA, Coates MJ, Dunbar JA, et al. The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial. BMJ Open 2013; 3: e002171.
26. Primary Health Care Advisory Group. Better outcomes for people with chronic and complex health conditions. Report of the Primary Health Care Advisory Group, December 2015. Canberra: Department of Health, 2016. http://www.health.gov.au/internet/main/publishing.nsf/Content/76B2BDC12AE54540CA257F72001102B9/$File/Primary-Health-Care-Advisory-Group_Final-Report.pdf (accessed Apr 2016).
27. Osborn R, Moulds D, Schneider EC, et al. Primary care physicians in ten countries report challenges caring for patients with complex health needs. Health Aff (Millwood) 2015; 34: 2104-2112.
28. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander health services report 2011–12. Online services report: key results. Canberra: AIHW, 2013.
29. Royal Australian College of General Practitioners. Cholesterol and other lipids (RACGP guidelines for preventive activities in general practice. 9th edition) [website]. http://www.racgp.org.au/your-practice/guidelines/redbook/8-prevention-of-vascular-and-metabolic-disease/83-cholesterol-and-other-lipids/ (accessed July 2016).
30. Sacco RL, Roth GA, Reddy KS, et al. The Heart of 25 by 25: achieving the goal of reducing global and regional premature deaths from cardiovascular diseases and stroke: a modeling study from the American Heart Association and World Heart Federation. Circulation 2016; 133: e674-e690.

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Perspectives

Hip arthroscopy for femoroacetabular impingement: use escalating beyond the evidence

Flavia M Cicuttini, Andrew J Teichtahl and Yuanyuan Wang

Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00821
Published online: 5 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Urologic diseases

Musculoskeletal diseases

There is a concerning lack of data comparing surgical with non-surgical management of femoroacetabular impingement

Femoroacetabular impingement (FAI) is a common cause of groin pain in physically active young adults, accompanied by limited hip movements. It occurs when bony anatomical abnormalities of the femoral head-neck junction (cam deformity) and acetabular rim (pincer deformity) result in abnormal contact between the two joint surfaces during hip motion. Radiological evidence of FAI is present in about 25% of asymptomatic young adults in the general community.1 FAI increases the risk of end-stage hip osteoarthritis (OA) in later life and is a long term risk factor for joint replacement;2 it may be very disabling. The quality of life of young adults with FAI is comparable to that of older adults who had a total hip replacement for OA.3

1 Monash University, Melbourne, VIC
2 Baker IDI Heart and Diabetes Institute, Melbourne, VIC
3 Alfred Health, Melbourne, VIC

Correspondence: flavia.cicuttini@monash.edu

Acknowledgements:

Andrew Teichtahl is the recipient of a National Health and Medical Research Council (NHMRC) Early Career Fellowship (no. 1073284). Yuanyuan Wang is the recipient of an NHMRC Career Development Fellowship (Clinical Level 1, no. 1065464).

Competing interests:

No relevant disclosures.

1. Ergen FB, Vudali S, Sanverdi E, et al. CT assessment of asymptomatic hip joints for the background of femoroacetabular impingement morphology. Diagn Interv Radiol 2014; 20: 271-276.
2. Nicholls AS, Kiran A, Pollard TC, et al. The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case–control study. Arthritis Rheum 2011; 63: 3392-3400.
3. Davis AM, Perruccio AV, Canizares M, et al. Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthritis Cartilage 2009; 17: 843-847.
4. Montgomery SR, Ngo SS, Hobson T, et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy 2013; 29: 661-665.
5. Palmer AJ, Malak TT, Broomfield J, et al. Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013. BMJ Open Sport Exerc Med 2016; 2: e000082.
6. Fairley J, Wang Y, Teichtahl AJ, et al. Management options for femoroacetabular impingement: a systematic review of symptom and structural outcomes. Osteoarthritis Cartilage 2016; 24: 1682-1696.
7. Harris JD, Erickson BJ, Bush-Joseph CA, Nho SJ. Treatment of femoroacetabular impingement: a systematic review. Curr Rev Musculoskelet Med 2013; 6: 207-218.
8. Nwachukwu BU, Rebolledo BJ, McCormick F, et al. Arthroscopic versus open treatment of femoroacetabular impingement: a systematic review of medium- to long-term outcomes. Am J Sports Med 2016; 44: 1062-1068.
9. Wall PD, Fernandez M, Griffin DR, Foster NE. Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. PM R 2013; 5: 418-426.
10. Siebenrock KA, Ferner F, Noble PC, et al. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res 2011; 469: 3229-3240.
11. Teichtahl AJ, Wang Y, Smith S, et al. Bone geometry of the hip is associated with obesity and early structural damage - a 3.0 T magnetic resonance imaging study of community-based adults. Arthritis Res Ther 2015; 17: 112.
12. Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347: 81-88.
13. Bohensky MA, Sundararajan V, Andrianopoulos N, et al. Trends in elective knee arthroscopies in a population-based cohort, 2000–2009. Med J Aust 2012; 197: 399-403. <MJA full text>
14. Hawker G, Guan J, Judge A, Dieppe P. Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. J Bone Joint Surg Am 2008; 90: 2337-2345.
15. Kim S, Bosque J, Meehan JP, et al. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93: 994-1000.
16. Katz JN, Losina E. Surgery versus physical therapy for meniscal tear and osteoarthritis. N Engl J Med 2013; 369: 677-678.
17. Wang Y, Dempsey AR, Lloyd DG, et al. Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2012; 20: 970-978.
18. Mezhov V, Teichtahl AJ, Strasser R, et al. Meniscal pathology — the evidence for treatment. Arthritis Res Ther 2014; 16: 206.
19. Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med 2012; 40: 1015-1021.
20. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013; 369: 2515-2524.

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Perspectives

Primum non nocere: rethinking our policies on out-of-home care in Australia

Peter D Jones

Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00864
Published online: 5 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Pediatric medicine

Health services administration

Are our child protection policies causing more harm to our most vulnerable children?

In Australia, there were 43 399 children in out-of-home care (OOHC) on 30 June 2015 (Box).1 Over the past 18 years, the rate at which Indigenous children have been placed in care has more than tripled and more than doubled for non-Indigenous children.1-3 This is disturbing, and particularly so for Indigenous children where one in 19 are in OOHC.1 A recent review of child maltreatment across various countries, including Australia, concluded that 40 years after contemporary child protection policies were introduced in the 1970s, there has been “no clear evidence for an overall decrease in child maltreatment”.4 Despite the call by this review for more evidence,4 there have been no studies planned to assess the effectiveness of our current OOHC policy in Australia.

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Bond University, Gold Coast, QLD

Correspondence: pejones@bond.edu.au

Competing interests:

No relevant disclosures.

1. Australian Institute of Health and Welfare. Child protection Australia 2014–15 (AIHW Cat. No. CWS 57; Child Welfare Series No. 63). Canberra: AIHW, 2016. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129554973 (accessed Nov 2016).
2. Australian Institute of Health and Welfare. Child protection Australia 2006–07 (Cat. No. CWS 31; Child Welfare Series No. 43). Canberra: AIHW, 2008. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455311 (accessed Nov 2016).
3. Australian Institute of Health and Welfare. Child protection Australia 1997–98 (AIHW Cat. No. CWS 8)Canberra: AIHW, 1999. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455176 (accessed Nov 2016).
4. Gilbert R, Fluke J, O’Donnell M, et al. Child maltreatment: variation in trends and policies in six developed countries. Lancet 2012; 379: 758-762.
5. Child Family Community Australia. Children in care. CFCA resource sheet — October 2016. https://aifs.gov.au/cfca/publications/children-care (accessed Nov 2016).
6. Tarren-Sweeney M, Hazell P. Mental health of children in foster and kinship care in New South Wales, Australia. J Paediatr Child Health 2006; 42: 89-97.
7. Royal Australian and New Zealand College of Psychiatrists. Position statement 59. The mental health needs of children in foster care. March 2015. https://www.ranzcp.org/Files/Resources/Submissions/PS-59-PPC-The-Mental-Health-Care-Needs-of-Children.aspx (accessed Nov 2016).
8. NSW Department of Community Services. Mental health of children in out-of-home care in NSW, Australia. July 2007. http://www.community.nsw.gov.au/__data/assets/pdf_file/0019/321715/researchnotes_mentalhealth_oohc.pdf (accessed Nov 2016).
9. Child Family Community Australia. Child deaths from abuse and neglect. CFCA resource sheet — May 2016. https://aifs.gov.au/cfca/publications/child-deaths-abuse-and-neglect (accessed Apr 2017).
10. Osborn A, Bromfield L. Outcomes for children and young people in care. National Child Protection Clearing House Research Brief 2007; (3): 1-15.
11. Osborn A, Delfabbro PH. Research article 4: an analysis of the social background and placement history of children with complex and multiple needs in Australian out-of-home care. Communities, Children and Families Australia 2006; 1: 33-42.
12. Townsend S, Hignight A, Rubovits D. Factors affecting permanency outcomes for foster children before and after passage of the Adoption and Safe Families Act of 1997. Illinois Child Welfare 2008; 4: 59-73.
13. Fernandez E, Atwool N. Child protection and out of home care: policy, practice, and research connections Australia and New Zealand. Psychosocial Intervention 2013; 22: 175-184.
14. Population Statistics New Zealand. http://maps.stats.govt.nz/apps/StatsMaps324/index.html?webmap=map_config.txt&viewer=July2015_EstimatedResidentialPopulation.txt (accessed Nov 2016).
15. Walsh T, Douglas H. Lawyers, advocacy and child protection. Melbourne University Law Review 2011; 35: 621-649.
16. Parliament of Australia. Senate Community Affairs References Committee. Report: out of home care. 19 Aug 2015. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Out_of_home_care/Report (accessed Oct 2016).
17. Australian Council of Social Service. Poverty in Australia in 2016. Sydney: ACOSS, 2016. http://www.acoss.org.au/wp-content/uploads/2016/10/Poverty-in-Australia-2016.pdf (accessed Apr 2017).
18. Greenhalgh EM, Bayly M, Winstanley MH. 1.3 Prevalence of smoking — adults. In: Scollo MM, Winstanley MH, editors. Tobacco in Australia: facts and issues. Melbourne: Cancer Council Victoria, 2015. http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-3-prevalence-of-smoking-adults (accessed Apr 2017).
19. Federal Office of Road Safety. The history of road fatalities in Australia. (Monograph 23, 1998). Canberra: FORS, 1998. https://www.tac.vic.gov.au/__data/assets/pdf_file/0005/66407/History-of-Road-Fatalities-from-1925.pdf (accessed Apr 2017).
20. National Road Safety Strategy 2011–2020. Implementation status report. November 2015. http://roadsafety.gov.au/performance/files/NRSS_Implementation_report_Nov2015.pdf (accessed Oct 2016).

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Research

Premature deaths of nursing home residents: an epidemiological analysis

Joseph E Ibrahim, Lyndal Bugeja, Melissa Willoughby, Marde Bevan, Chebiwot Kipsaina, Carmel Young, Tony Pham and David L Ranson

Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00873
Published online: 5 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Diagnostic techniques and procedures

Gerontology

Ethics and law

Abstract

Objectives: To conduct a descriptive epidemiological analysis of external cause deaths (premature, usually injury-related, and potentially preventable) of nursing home residents in Australia.

Design: Retrospective study of a cohort of nursing home residents, using coronial data routinely recorded by the National Coronial Information System.

Setting and participants: Residents of accredited Australian nursing homes, whose deaths were reported to coroners between 1 July 2000 and 30 June 2013, and determined to have resulted from external causes.

Main outcome measures: Causes of death, analysed by sex and age group, and by location of incidents leading to death and location of death. Rates of death were estimated on the basis of Australian Bureau of Statistics population and Australian Institute of Health and Welfare nursing home data.

Results: Of 21 672 deaths of nursing home residents, 3 289 (15.2%) resulted from external causes. The most frequent mechanisms of death were falls (2 679 cases, 81.5%), choking (261 cases, 7.9%) and suicide (146 cases, 4.4%). The incidents leading to death usually occurred in the nursing home (95.8%), but the deaths more frequently occurred outside the nursing home (67.1%). The annual number of external cause deaths in nursing homes increased during the study period (from 1.2 per 1000 admissions in 2001–02 to 5.3 per 1000 admissions in 2011–12).

Conclusion: The incidence of premature and potentially preventable deaths of nursing home residents has increased over the past decade. A national policy framework is needed to reduce the incidence of premature deaths among Australians living in nursing homes.

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1 Monash University, Melbourne, VIC
2 Victorian Institute of Forensic Medicine, Melbourne, VIC

Correspondence: Joseph.Ibrahim@monash.edu

Acknowledgements:

This work was supported by the federal Department of Social Services, the Victorian Department of Health and Human Services (Ageing and Aged Care Branch), and the Department of Forensic Medicine, Monash University. None of the funders influenced the design, methods, subject recruitment, data collection, analysis or preparation of the paper.

Competing interests:

We are affiliated with or employed by the Department of Forensic Medicine, Monash University, which was also a funding source.

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