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Aim: This paper explores the principles of co‐design with Aboriginal and Torres Strait Islander communities by reflecting on the literature, learning from experiences of allied health professionals, and considering how co‐design can be applied in rural and remote allied health practice. Context: This paper has been authored by a working group from Services for Rural and Remote Allied Health (SARRAH). SARRAH is a member‐based allied health organisation, working to improve health outcomes for rural and remote Australians. SARRAH has been representing and supporting allied health professionals in rural and remote Australia for over 20 years, with a member base that includes students, practitioners, programme managers, policy makers and academics. As a non‐Indigenous organisation, SARRAH works in partnership and receives guidance from the peak organisation, Indigenous Allied Health Australia (IAHA). Approach: Over a period of 3 months, a group of eleven SARRAH members and staff came together to review available literature, seek member perspectives and share their experiences and understandings of co‐design. Working group discussions were grounded in the knowledge and experiences shared by two Aboriginal and Torres Strait Islander group members. Conclusion: This paper proposes that successful co‐design with Aboriginal and Torres Strait Islander communities places legitimate value on different knowledge systems, is built on strong and trusting relationships, promotes inclusive involvement and requires authentic partnerships. Using these principles, SARRAH will engage with members and stakeholders to influence meaningful change in allied health practice in rural and remote Australia. [ABSTRACT FROM AUTHOR]

In response to the recent Productivity Commission report into mental health, the previous Federal Government announced its intention to produce a new national agreement that lays the platform for Australia's sixth national mental health plan. It has been recommended mental health move to a more regional model of governance and planning, away from a centralised, top‐down approach, partly in response to broader reforms affecting health care, and partly in direct response to consistent inquiry evidence that the mental health system remains in crisis. The past 30 years of mental health planning have been centralised. Successive national plans set a broad framework, with real decisions about mental health funding and service allocation made in the health departments of our capital cities. Will the next plan sponsor or inhibit regionality in mental health planning? This paper assesses Australia's historical approach to health planning particularly as it affected mental health and the costs arising. In learning these lessons, we propose the necessary ingredients to facilitate a regional, innovative, and effective approach to decentralised planning, for better mental health outcomes. We cannot afford to replicate the failed planning approaches of the past. Summary at a glance Mental health has been challenged to replace historical, centralised approaches for decentralised regional planning approaches to foster choice, innovation, and effective service provision. The past 30 years of central planning have demonstrated its limitations. Federal and State governments should create an enabling environment to free‐up local implementation and operationalise a social determinants approach. [ABSTRACT FROM AUTHOR]

What is known about the topic? When assessing real growth in costs, it is important to adjust for inflation through indexation to the Consumer Price Index (CPI). The change in prices or costs over time can be calculated in constant currency amounts by adjusting by a ratio of the CPI in the year of interest to the CPI in the baseline year. What does this paper add? Rosenberg et al. (2022) did not calculate out-of-pocket costs in constant currency, which does not give an accurate estimation of costs adjusted for inflation. What are the implications for practitioners? We calculated examples to illustrate the impact of such adjustments, which substantially impact the results of the study. [ABSTRACT FROM AUTHOR]

This paper sets out the Collaborative Service Design Playbook, to guide planning, design, and implementation of co-created health services. Successful health service development and implementation is best guided by theoretically informed approaches; however, organisations often lack design and implementation know-how and have difficulty applying it. This study seeks to improve health service design and potential for scale-up by proposing a tool to guide an end-to-end process, drawing together service design, co-design, and implementation science; and exploring the tool's feasibility to establish a sustainable service solution developed with participants and experts that is scalable and sustainable. The Collaborative Service Design Playbook phases include, (1) Define the opportunity and initiatives, (2) Design the concept and prototype, (3) Deliver to scale and evaluate; and (4) Optimise to transform and sustain. This paper has implications for health marketing through providing an end-to-end approach with phased guidance for health service development, implementation, and scale up. [ABSTRACT FROM AUTHOR]

Objective: Pharmacotherapeutic Follow-up is the Professional Pharmaceutical Care Service aimed at detecting Drug-Related Problems for the prevention and resolution of negative medicine outcomes. The Dader Method is considered a clear and simple tool to develop Pharmacotherapeutic Follow-up. This research aims to analyze the evolution of the international scientific production related to Pharmacotherapeutic Follow-up and the Dader Method to show the current situation of this Professional Pharmacy Assistance Service. In addition, from the data obtained, we give a critical perspective on the implementation of the Dader Method in Community Pharmacy, considering its advantages and disadvantages based on the published scientific literature. Methods: Using bibliometrics tools, indicators were obtained to analyze the international production of scientific articles on Pharmacotherapeutic Follow-up and the Dader Method during the period (1999-2022) through the Scopus database. Results: The results showed a growth in the international scientific production of publications on Pharmacotherapeutic Follow-up, obtaining 30,287 papers, placing the United States, the United Kingdom, Australia, Canada and Spain as the five most productive countries. The publication of 83 papers on the Dader Method places Spain with the highest number of publications, followed by other Spanish or Portuguese speaking countries, among which Brazil and Colombia have the most prominent number of published papers in Latin America. The most frequent international journal covering the topic of Pharmacotherapeutic Follow-up was the American Journal of Health-Pharmacy (12.4%), while on the Dader Method, the journal Pharmaceutical Care Spain (21.7%) is in the first position, followed by Farmacia Hospitalaria (8.4%). Conclusion: The publications on the Dader method highlighs the greater productivity of the University of Granada and the author María José Faus Dáder. The inclusion of patients in the PTF service using the Dader Method, is more frequent in the hospital context, and is based on the presence of defined chronic pathologies (mainly diabetes), polymedication or specialized care follow-up, with elderly population being the most represented in all cases. [ABSTRACT FROM AUTHOR]

People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing. [ABSTRACT FROM AUTHOR]

Dental caries, a non-communicable disease, is one of the most prevalent diseases globally and share common modifiable risk factors with obesity such as excess sugar intake. However, prioritization by governments to improve population oral health has been limited and is typically excluded from the discourse of public health policy development. Therefore, interventions that target dental caries can have other co-benefits including obesity prevention. In Victoria, Australia, local government authorities have a regulatory requirement to develop their Municipal Health and Wellbeing Plans. The aim of this paper is to identify whether prioritization for oral health by local government authorities in Victoria has changed through the subsequent renewal of the Victorian Public Health and Wellbeing Plans 2011–2015 and 2019–2023. Three desktop audits for all publicly available Municipal Health and Wellbeing Plans by local government authorities in Victoria were conducted between 2014 and 2022. Key terms related to oral health was searched within these policy documents and categorized into six indicators: (i) included oral health as a priority, (ii) linked healthy eating and oral health, (iii) supported the Achievement Program, (iv) included the Smiles 4 Miles program, (v) advocated for fluoridated drinking water, and (vi) included other strategies related to oral health. Overall, there was statistically significant reduction in five of the six indicators, with the exception for prioritization of other strategies related to oral health such as targeting excess sugar intake and smoking. A multi-sectoral approach, that includes oral health would be advantageous to address the growing burden of non-communicable diseases. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide an overview of consumer and community engagement in health service planning, quality improvement and programme evaluation in Australia, and key components and importance of a strong suite of tools for achieving effective outcomes. Design/methodology/approach: This paper is a non-systematic review of Australian national, state and territory websites in relation to policy commitment to consumer engagement, best practice framework for consumer engagement and recent project example. Findings: Consumer engagement is a recognised component of the Australian health system. It is reflected in the national and state health policy and is a mandatory requirement of hospital accreditation. The application of co-design principles is gaining increasing popularity in health service planning and programme evaluation. Co-design is an important enabler of patient/community-centred service planning and evaluation; however, on its own it may lead to poorer outcomes. Co-design must occur within a broader systemic framework. Practical implications: The research identifies a conceptual framework, approaches and tools of value to health service management and planners. Originality/value: Consumer and community engagements are critical to the development of consumer-centric services. However, this should complement and add value to, not divert attention away from established principles of service planning, continuous quality improvement and programme evaluation. To do so may result in poorer quality health and well-being outcomes, reduced efficiency and ultimately reduced consumer and community satisfaction with services. This paper examines consumer and community engagement within the broader planning and quality improvement framework and practical implications for keeping planning, research and evaluation on track. [ABSTRACT FROM AUTHOR]

Objective: Studies of Australian health workforce demographics tend to be limited to single professions, a set geographic area, or based on incomplete data. This study aims to comprehensively describe changes to the demographic characteristics of Australia's regulated health professions over 6 years. Methods: Data were sourced from the Australian Health Practitioner Regulation Agency (Ahpra) registration database, and a retrospective analysis of 15 of the 16 regulated health professions between 1 July 2015 and 30 June 2021 was conducted. Variables including profession, age, gender and state/territory locations for the practitioners' principal places of practice were analysed descriptively and via appropriate statistical tests. Results: Changes in age, gender representation, and place of practice varied significantly and in different ways across the 15 professions. The total number of registered health practitioners increased by 141 161 (22%) from 2016 to 2021. The number of registered health practitioners per 100 000 population increased by 14% from 2016, with considerable variation across the professions. In 2021, women accounted for 76.3% of health practitioners across the 15 health professions, a significant increase of 0.5% points since 2016. Conclusions: Changes to demographics, especially in ageing workforces and feminising professions, can have implications for workforce planning and sustainability. Future research could build on this demographic trend data by investigating causes or undertaking workforce supply or demand modelling. What is known about the topic? Several studies have demonstrated changes in the demography of the Australian health workforce, they tend to focus on individual professions, prescribed geographic areas, or are based on data that are dated or incomplete. What does this paper add? This study presents a national picture of 15 regulated health professions' demographic changes in Australia across a 6-year period and allows for comparisons between professions. What are the implications for practitioners? Future research could build on this demographic trend data by investigating causes or undertaking workforce supply or demand modelling. [ABSTRACT FROM AUTHOR]

Regional integrated service planning has been identified as a key priority for improving the mental health system in Australia. The National Mental Health Service Planning Framework (NMHSPF) is an integrated planning tool that estimates the resources required to deliver the optimal mix of mental health services to a population. In 2016, Queensland Health commissioned a trial application of the NMHSPF for joint mental health planning between a Primary Health Network (PHN) and the corresponding state Hospital and Health Services (HHSs) in a regional area. The aim of this work was to collaborate with stakeholders from each organisation to collect available data on the delivery and resources of existing mental health services in the region and compare these to NMHSPF estimates to identify potential priority areas for planning. This paper provides mental health planners with an exemplar model for using the NMHSPF to support integrated planning at the regional level and describes the barriers, facilitators and key outcomes of this work. Integrated regional planning has been identified by governments in Australia as a key objective for the mental health system. This paper describes the processes, barriers and facilitators, and key outcomes of a joint regional planning exercise between different health networks using a purpose-built national integrated mental health planning tool. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a major and growing public health issue. Multidisciplinary tertiary pain services cannot meet patient demand and greater involvement of primary care is needed. The aims of this study were to understand the needs and priorities of Australian primary health networks (PHNs) related to the management and secondary prevention of chronic pain; map current PHN chronic pain initiatives and identify gaps; highlight key enablers to implementation; and highlight solutions identified by PHNs to increase capacity to commission initiatives. Methods: Mixed methods were used, including: a review of PHN needs assessments; and consultation with PHN executive-level staff and program managers from 27 out of the 28 PHNs, and the WA Primary Health Alliance (WAPHA – a state alliance between three Western Australian PHNs) via telephone interviews, online surveys, a workshop, a deliberative dialogue and email consultation. Results: Chronic pain was identified as a health and/or service need by approximately half of PHNs. Barriers for PHNs to identifying chronic pain as a need or priority are highlighted. Gaps identified by the mapping included: initiatives related to the secondary prevention of chronic pain (post-surgery or post-injury), digitally enabled consumer and health professional chronic pain initiatives, and chronic pain initiatives for specific populations groups such as Aboriginal and Torres Strait Islander people. Among existing PHN practice, two exemplar evidence-based initiatives suitable for scale-up across PHNs in Australia were identified: multidisciplinary community-based pain programs, and an online health professional capacity-building initiative, Project ECHO (chronic pain). Solutions identified by PHNs to increase capacity to commission initiatives included: co-funding initiatives across different PHN funding streams, collaborative initiatives between PHNs, and co-commissioning with government and non-government partners. Conclusions: Chronic pain has been classified as a disease in itself through the World Health Organization. PHNs recognising chronic pain as a distinct condition in PHN needs analysis and data collection would lead to more dedicated funding. PHNs could do more to improve the secondary prevention and management of chronic pain. A self-identified need for greater collaboration across PHNs and co-commissioning with local and state governments and non-government partners would help to build PHN capacity. Few studies focus on Australian Primary Health Networks (PHNs) and little is known about the needs, priorities and scope of work of PHNs related to the management and secondary prevention of chronic pain. This paper describes the needs and priorities of PHNs; maps current PHN chronic pain initiatives and identifies gaps; and highlights key enablers to implementation. It also highlights solutions identified by PHNs to increase capacity to commission initiatives. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged the mental health of communities worldwide, with the triple pressures of financial insecurity, lockdowns, and worry about the infection. Australia rapidly deployed resources to protect the mental wellbeing of the community through supplementing existing services, supporting at-risk groups, investing in social supports, embracing technology, and supporting the health workforce. This paper describes the Australian Government's investment in mental health during the COVID-19 pandemic in relation to the 10 priority areas identified in Australia's National Mental Health Pandemic Response Plan. The COVID-19 pandemic and associated public health measuresgenerated substantial and ongoing challenges for the mental health and wellbeing of Australian communities. Australian Government funded initiatives were rapidly instituted between different levels of government and with community mental health organisations. These policy actions aimed to provide agile responses to promote community resilience and strengthen services for vulnerable groups, including older people, those with existing mental health conditions, Aboriginal and Torres Strait Islander peoples, and health and essential service providers. [ABSTRACT FROM AUTHOR]

Although the theoretical underpinnings and analytical framework for needs-based health workforce planning are well developed and tested, its uptake in national planning processes is still limited. Towards the development of open-access needs-based planning model for national workforce planning, we conducted a systematic scoping review of analytical applications of needs-based health workforce models. Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) checklist, a systematic scoping review was conducted. A systematic search of peer-reviewed literature published in English was undertaken across several databases. Papers retrieved were assessed against predefined inclusion criteria, critically appraised, extracted and synthesized. Twenty-five papers were included, which showed increasing uptake of the needs-based health workforce modelling, with 84% of the studies published within the last decade (2010-20). Three countries (Canada, Australia and England) accounted for 48% of the publications included whilst four studies (16%) were based on low-and-middle-income countries. Only three of the studies were conducted in sub-Saharan Africa. Most of the studies (36%) reported analytical applications for specific disease areas/programs at sub-national levels; 20% focused on the health system need for particular categories of health workers, and only two (8%) reported the analytical application of the needs-based health workforce approach at the level of a national health system across several disease areas/programs. Amongst the studies that conducted long-term projections, the time horizon of the projection was an average of 17 years, ranging from 3 to 33 years. Most of these studies had a minimum time horizon of 10 years. Across the studies, we synthesized six typical methodological considerations for advancing needs-based health workforce modelling. As countries aspire to align health workforce investments with population health needs, the need for some level of methodological harmonization, open-access needs-based models and guidelines for policy-oriented country-level use is not only imperative but urgent., (© The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Approaches to design comprehensive support systems for people in need of long-term care (LTC) have appeared on the policy agenda of European countries from the 1990ies. Austria was one of the first to implement such a system separate from health care. In this last significant expansion of its social protection system, the country established a universal and tax-funded LTC system, departing from Austria's Bismarckian tradition while carrying along the familialist logic and federalist structure in this policy field. Thirty years later, Austria now joins other countries in creating solutions to important contemporary challenges by discussing another major revamp of its LTC system. This paper renders a country case study to explain the development of Austrian LTC policies in greater depth and from a dynamic perspective. The two-step approach, starts with presenting the logics and major building blocks of Austria's LTC system, and provides an update on its benefits and services. The second part identifies and discusses a raft of current and planned measures for three areas that appear critical in terms of future proofing LTC: (i) responses to staffing challenges, (ii) policy pilots to support informal carers, and finally, (iii) the role of digital transformation for LTC in Austria. This showcase exercise fosters policy learning and thus supports innovation and refinement of LTC systems. It could also serve as a futile starting point for comparative LTC policy research that moves beyond the outer hull of care-regime typologies to explore more specific system features and policy interventions. [ABSTRACT FROM AUTHOR]

The novel coronavirus (COVID-19) has rapidly impacted all of our lives following its escalation to pandemic status on 11 March 2020. Government guidelines and restrictions implemented to mitigate the risk of COVID-19 community transmission have forced radiation therapy departments to promptly adjust to the significant impact on our ability to deliver best clinical care. The inherent nature of our tri-partied professions relies heavily on multidisciplinary teamwork and patient-clinician interactions. Teamwork and patient interaction are critical to the role of a radiation therapist. The aim of this paper is to describe the experience of the Peter MacCallum Cancer Centre's (Peter Mac) radiation therapy services during the preliminary stages of the COVID-19 pandemic in minimising risk to patients, staff and our clinical service. Four critical areas were identified in developing risk mitigation strategies across our service: (a) Workforce planning, (b) Workforce communication, (c) Patient safety and wellbeing, and (d) Staff safety and wellbeing. Each of these initiatives had a focus on continuum of clinical care, whilst minimising risk of cross infection for our radiation therapy workforce and patients alike. Initiatives included, but were not limited to, establishing COVID-Eclipse clinical protocols, remote access to local applications, implementation of Microsoft Teams, personal protective equipment (PPE) guidelines and virtual 'Division of Radiation Oncology' briefing/updates. The COVID-19 pandemic has dictated change in conventional radiation therapy practice. It is hoped that by sharing our experiences, the radiation therapy profession will continue to learn, adapt and navigate this period together, to ensure optimal outcomes for ourselves and our patients., (© 2020 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Background: Middle ear disease (otitis media) is endemic among Aboriginal and Torres Strait Islander children in Australia and represents an important cause of hearing loss. The disease is the result of a mix of biological, environmental and host risk factors that interact in complex, non-linear ways along a dynamic continuum. As such, it is generally recognised that a holistic, systems approach is required to reverse the high rates of otitis media in Aboriginal and Torres Strait Islander children. The objective of this paper is to examine the alignment between efforts designed to address otitis media in Aboriginal and Torres Strait Islander children in Queensland, Australia and core concepts of systems thinking. This paper’s overall purpose is to identify which combination of activities, and at which level, hold the potential to facilitate systems changes to better support ear health among Aboriginal and Torres Strait Islander children. Methods: We began with a review of documents identified in consultation with stakeholders and an online search. In addition, key informants were invited to participate in an online survey and a face-to-face or phone interview. Qualitative interviews using a semi-structured interview guide were used to explore survey responses in more depth. We also undertook interviews at the community level to elicit a diverse range of views. Ideas, statements or activities reported in the documents and interviews as being performed under the Intervention Level Framework were identified using qualitative thematic and content analysis. A quantitative descriptive analysis was also undertaken, whereby data was extracted into an Excel spreadsheet and coded under the relevant strategic directions and performance indicators of the Framework. Subsequently, we coded activities against the five-level intervention framework developed by Malhi and colleagues, that is: 1) paradigm; 2) goals; 3) system structure; 4) feedback and delays; and 5) structural elements. Results: Overall, twenty documents were reviewed. We examined surveys and interviews with six key informants. Twenty-four individual and 3 group interviews were conducted across central and community level informants. One hundred and four items were coded from the 20 documents and 156 items from interview data. For both data sets, the majority of activities were coded at the structural elements level. The results suggested three key areas where further work is needed to drive sustained improvements: 1) build the governance structures needed for paradigm shift to achieve a multi-sectoral approach; 2) develop shared system level goals; 3) develop system-wide feedback processes. Conclusions: Sustained progress in improving ear health within Aboriginal and Torres Strait Islander children requires a holistic, system-wide approach. To advance such work, governance structures for multi-sectoral collaboration including the development of joint goals and monitoring and feedback are required. Intervening at these higher leverage points could have a profound effect on persistent public health issues. [ABSTRACT FROM AUTHOR]

Dedifferentiation represents the merging of the wider "intellectual disability" category with the broader one of "disability" generally; a product of the ascendance of the social model of disability. The recent re-emergence of the significance of impairment and embodiment in disability theory re-establishes the importance of situated experience and reinserts realities of difference in the dedifferentiation/difference debate. This paper highlights these issues by exploring the experiences of people with Profound Intellectual and Multiple Disabilities (PIMD) and their decision-making supporters in the context of the National Disability Insurance Scheme (NDIS) in Australia. Lived experiences accessing, planning for, and implementing NDIS supports illustrate some limitations of dedifferentiation in social services, highlighting the need for recognition of realities of embodied difference for people with PIMD. Here, our systems and theories are most uncomfortable, our ideals of inclusion are most challenged in practice, and some balance between realities of difference and ideals of dedifferentiation is most needed. [ABSTRACT FROM AUTHOR]

Aim: In New Zealand, there is a paucity of information on children with chronic conditions and disabilities (CCD). One reason is that many are managed in hospital outpatients where diagnostic coding of health-care events does not occur. This study explores the feasibility of coding paediatric outpatient data to provide health planners with information on children with CCD.Methods: Thirty-seven clinicians from six District Health Boards (DHBs) trialled coding over 12 weeks. In five DHBs, the International Classification of Diseases and Related Health Problems, 10th Edition, Australian Modification (ICD-10-AM) and Systematised Nomenclature of Medicine Clinical Terms (SNOMED-CT) were trialled for 6 weeks each. In one DHB, ICD-10-AM was trialled for 12 weeks. A random sample (30%) of ICD-10-AM coded events were also coded by clinical coders. A mix of paper and electronic methods were used.Results: In total 2,604 outpatient events were coded in ICD-10-AM and 693 in SNOMED-CT. Dual coding occurred for 770 (29.6%) ICD-10-AM events. Overall, 34% of ICD-10-AM and 40% of SNOMED-CT events were for developmental and behavioural disorders. Chronic medical conditions were also common. Clinicians were concerned about the workload impacts, particularly for paper-based methods. Coder's were concerned about clinician's adherence to coding guidelines and the poor quality of documentation in some notes.Conclusion: Coded outpatient data could provide planners with a rich source of information on children with CCD. However, coding is also resource intensive. Thus its costs need to be weighed against the costs of managing a much larger health budget using very limited information. [ABSTRACT FROM AUTHOR]

Objective: This paper draws attention to the rapidly growing number of Australian nonagenarians, presents previously unpublished information on this sub‐group of older people and explores the implications for future patterns of service delivery, planning and policy. Methods: Statistical analyses of Census data and other Australian Bureau of Statistics Surveys using Table Builder Pro, combined with analysis of de‐identified Australian Institute of Health and Welfare (AIHW) unit record data on aged care and AIHW GRIM (mortality) data. Results: Male nonagenarians almost doubled from 2006 to 2016, while their female counterparts grew by 55%. This cohort is the first to reap cumulative advantage from the dramatic reduction in death rates from 1970. Their demographic circumstances reveal both changes and continuities compared to the previous cohort. Conclusion: Men and women aged 90 and over use a substantial proportion of aged care services, and their characteristics and circumstances are highly relevant to planning current and future aged care services. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease, Queensland (CKD.QLD) is a multidisciplinary, collaborative research platform for CKD in Queensland. Most public renal services contribute towards the CKD Registry, including Toowoomba Hospital, which is a referral hospital for Darling Downs Health serving a largely regional population in Queensland. We aim to present the profile of the CKD cohort recruited to the CKD.QLD Registry from Toowoomba Hospital, the first comprehensive report on a pre‐dialysis population from regional Australia. Methods: Study subjects were patients in the Darling Downs Health Service who consented to be included in the CKD.QLD registry from June 2011 to December 2016. Those who were on renal replacement therapy (RRT) were excluded. Patients were followed until date of RRT, death, discharge or loss to follow up or a censor date of 30th June 2017. Results: Overall 1051 subjects, representing 13% of all CKD.QLD Registry patients gave consent of whom, 42.7% were ≥70 years of age. The mean age was 63.8 ± 15.1 years (median age 67 years) with male predominance (55.4%). The majority were born in Australia (86.4%). Aboriginal and Torre Strait Islanders (A&TSI) constituted 9.6% of the cohort. The predominant CKD stages were 3b (28.9%) and 4 (27.7%). Hypertension and diabetes were noted in 91% and 44% of subjects, respectively. Diabetic nephropathy was the leading cause of CKD (26.7%) followed by renovascular disease (17.3%) and glomerulonephritis (14.8%). In 12%, the diagnosis was uncertain. Major co‐morbidities included coronary artery disease (24.7%) chronic lung disease (14.8%), cerebrovascular disease (11.6%) and peripheral vascular disease (8.9%). Non‐vascular co‐morbidities included arthritis (24.6%), gout (23.6%) and gastro‐oesophageal reflux disease (19%). The multi‐morbidity profile was differed by gender, diabetic status and age. Over a follow‐up period upto 72 months, 93 (8.8%) started RRT and 175 (16.6%) died. Of those 82% died without RRT and 18% died after RRT. Conclusion: This CKD Registry cohort from regional Queensland consisted mainly of older Caucasians with male predominance. A&TSI patients were overrepresented compared to the overall population. A significant proportion had cardio‐vascular disease and multiple co‐morbidities which differed by gender, diabetic status and age. This report provides valuable data for health services planning and delivery in regional Queensland. SUMMARY AT A GLANCE: This paper reports the profile of patients with chronic kidney disease (CKD) in a regional population of Australia registered in the Queensland CKD registry. The cohort mainly comprises older Caucasian males but with over representation of Australian indigenous people. Not unexpectedly, CKD was associated with significant comorbidities, in particular cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Tire places where we live out our daily lives have a pivotal role in facilitating our physical and mental health. This is supported by an international body of research evidence. To combat the epidemic of chronic diseases associated with sedentary and busy urban lifestyles, the built environment needs to be planned and managed to enable people to be physically active, socially connected and to have ready access to affordable, fresh and nutritious food. Our paper is set against this backdrop, which contextualizes the pressing urgency for Australian urban planners to create a health supportive environment. Following a brief historical overview of healthy planning in Australia, the focus shifts to how different levels of government, together with the not-for-profit and private sectors, are embracing healthy planning across the nation. The paper concludes with a consideration of the future for healthy planning so that it becomes accepted 'core business' in Australian planning policy and practice. [ABSTRACT FROM AUTHOR]

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT).Methods: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake.Results: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners.Conclusions: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice. [ABSTRACT FROM AUTHOR]

Purpose: In Australia, national harmonisation of occupational health and safety (OHS) regulation was pursued through the development of model Work Health and Safety legislation. The model Work Health and Safety Regulations specify that construction works above a threshold cost of AU$250,000 are deemed to be construction projects requiring the appointment of a principal contractor with duties relating to OHS planning and coordination. The purpose of this paper is to explore the effectiveness of the monetary threshold as a suitable trigger for specific OHS planning and coordination duties. Design/methodology/approach: Interviews were conducted with 46 Australian construction industry stakeholders, including union representatives, employer groups, construction firm representatives and regulators, as well as four international construction OHS experts, to explore perceptions about the effectiveness of the monetary threshold. Two construction scenarios were also modelled to test for variability in operation of the threshold by geographical location of works and design conditions. Findings: The monetary threshold was perceived to be subject to two forms of capture problem, reflecting inadvertent capture of low risk works or failure to capture high risk works. Organisations were also reported to deliberately split contracts to avoid capture by the threshold. The cost-estimate modelling revealed inequalities and variation in the operation of the monetary threshold by geographic location and design specification. Practical implications: The analysis suggests that limitations inherent in the use of a monetary threshold to trigger duties relating to OHS planning and coordination in construction works. Opportunities to use more sophisticated risk-based mechanisms are considered. Originality/value: The study explores a fundamental challenge of risk-based OHS regulation, i.e., how to ensure that workers' health and safety are adequately protected without creating an unnecessarily high regulatory burden. The research provides evidence that using a monetary value as a proxy measure for OHS risk in construction projects may be problematic. [ABSTRACT FROM AUTHOR]

Objective: For people with aphasia (PWA) and their significant others, narratives are intricately intertwined with quality of life, culture, and social participation. This paper reports stories told by bilingual people with aphasia (bPWA), describing the events or consequences of a stroke on their lives. Patients and Methods: Six participants with chronic mild-moderate anomia (mean age 70 years) spontaneously produced a narrative recounting their personal experience of stroke in their native language (Greek) and in their second language (English). All bPWA had learned English in early adulthood upon migration from Greece to Australia, not through formal teaching but on the job (e.g., in the factory). The bPWA had lived in Australia for 46 years (average) and were less than 4 years post-stroke. Results: Narratives in the two languages underwent quantitative (number of propositions, noun/verb tokens) and qualitative analyses (ratings of coherence, ratings of clarity). Most bPWA produced coherent "tellable" stories despite disruptions in language because of aphasia. Overall, stories were better told (length, complexity of content, temporal-causal sequencing, reference) in Greek – their native language. Conclusion: The results have implications for policy-makers providing health and welfare services to ageing immigrant populations. The findings are also relevant to other countries that have large immigrant populations of stroke survivors. [ABSTRACT FROM AUTHOR]

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As governments worldwide turn to personalised budgets and market‐based solutions for the distribution of care services, the care sector is challenged to adapt to new ways of working. The Australian National Disability Insurance Scheme (NDIS) is an example of a personalised funding scheme that began full implementation in July 2016. It is presented as providing greater choice and control for people with lifelong disability in Australia. It is argued that the changes to the disability care sector that result from the NDIS will have profound impacts for the care sector and also the quality of care and well‐being of individuals with a disability. Once established, the NDIS will join similar schemes in the UK and Europe as one of the most extensive public service markets in the world in terms of numbers of clients, geographical spread, and potential for service innovation. This paper reports on a network analysis of service provider adaptation in two locations—providing early insight into the implementation challenges facing the NDIS and the reconstruction of the disability service market. It demonstrates that organisations are facing challenges in adapting to the new market context and seek advice about adaptation from a stratified set of sources. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Evidence-based decision-making is an important foundation for health policy and service planning decisions, yet there remain challenges in ensuring that the many forms of available evidence are considered when decisions are being made. Mobilising knowledge for policy and practice is an emergent process, and one that is highly relational, often messy and profoundly context dependent. Systems approaches, such as dynamic simulation modelling can be used to examine both complex health issues and the context in which they are embedded, and to develop decision support tools.Objective: This paper reports on the novel use of participatory simulation modelling as a knowledge mobilisation tool in Australian real-world policy settings. We describe how this approach combined systems science methodology and some of the core elements of knowledge mobilisation best practice. We describe the strategies adopted in three case studies to address both technical and socio-political issues, and compile the experiential lessons derived. Finally, we consider the implications of these knowledge mobilisation case studies and provide evidence for the feasibility of this approach in policy development settings.Conclusion: Participatory dynamic simulation modelling builds on contemporary knowledge mobilisation approaches for health stakeholders to collaborate and explore policy and health service scenarios for priority public health topics. The participatory methods place the decision-maker at the centre of the process and embed deliberative methods and co-production of knowledge. The simulation models function as health policy and programme dynamic decision support tools that integrate diverse forms of evidence, including research evidence, expert knowledge and localised contextual information. Further research is underway to determine the impact of these methods on health service decision-making. [ABSTRACT FROM AUTHOR]

The responsibility for Australian health services is shared between public and private sectors and three levels of governments. Service planning is difficult ; shifting of blame and costs endemic. It produces fine plans that are not matched by performance and the Federal Government is currently responding to a national review of the effectiveness and efficiency of health services completed in 2015. Health services in Australia chiefly focus on two of the four aims of health systems: individual patient care and provider efficiency. The failure to address population health and workforce issues results in a distorted and expensive system which largely fails to address prevention, early intervention or the use of low-intensity solutions. There are some signs of progress in the development of Primary Health Networks, charged with regional planning for mental health and suicide prevention services for defined populations, but many are just finding their feet. This paper will examine two partnerships. The Integrated Mental Health pact (IMHpact), as in agreement, has addressed this challenge for the rural Mid-North Coast (NSW) population by setting up an independent co-operative of public and NGO sector organisations with responsibilities to the community, not to any single organizational member in order to ensure its stability, sustainability and effectiveness. The Sydney Inner-city Urban Partnership for Health and Wellbeing (UP) addresses the needs of a vulnerable inner-city population with serious and persistent metal illnesses that are often combined with coexisting conditions and social adversities. The network combines a rich combination of clinicians, providers and sponsors from all sectors as it attempts to reframe service provision within a context where resources and incentives are poorly aligned with desired outcomes. Both models of care have been in development for about three years and adopt a place-based approach to care which attempts to shift attention from provider to beneficiary and to use principles of co-design to provide better care. The paper will present contrasting rural and urban research evidence to better understand the development of the partnerships and highlight the lessons learnt. [ABSTRACT FROM AUTHOR]

Background: The Neurotrauma Evidence Translation (NET) Trial aims to design and evaluate the effectiveness of a targeted theory-and evidence-informed intervention to increase the uptake of evidence-based recommended practices for the management of patients who present to an emergency department (ED) with mild head injuries. When designing interventions to bring about change in organisational settings such as the ED, it is important to understand the impact of the context to ensure successful implementation of practice change. Few studies explicitly use organisational theory to study which factors are likely to be most important to address when planning change processes in the ED. Yet, this setting may have a unique set of organisational pressures that need to be taken into account when implementing new clinical practices. This paper aims to provide an in depth analysis of the organisational context in which ED management of mild head injuries and implementation of new practices occurs, drawing upon organisational level theory., Methods: Semi-structured interviews were conducted with ED staff in Australia. The interviews explored the organisational context in relation to change and organisational factors influencing the management of patients presenting with mild head injuries. Two researchers coded the interview transcripts using thematic content analysis. The "model of diffusion in service organisations" was used to guide analyses and organisation of the results., Results: Nine directors, 20 doctors and 13 nurses of 13 hospitals were interviewed. With regard to characteristics of the innovation (i.e. the recommended practices) the most important factor was whether they were perceived as being in line with values and needs. Tension for change (the degree to which stakeholders perceive the current situation as intolerable or needing change) was relatively low for managing acute mild head injury symptoms, and mixed for managing longer-term symptoms (higher change commitment, but relatively low change efficacy). Regarding implementation processes, the importance of (visible) senior leadership for all professions involved was identified as a critical factor. An unpredictable and hectic environment brings challenges in creating an environment in which team-based and organisational learning can thrive (system antecedents for innovation). In addition, the position of the ED as the entry-point of the hospital points to the relevance of securing buy-in from other units., Conclusions: We identified several organisational factors relevant to realising change in ED management of patients who present with mild head injuries. These factors will inform the intervention design and process evaluation in a trial evaluating the effectiveness of our implementation intervention.

Simple Summary: A cancer diagnosis during adolescence or young adulthood presents unique medical and psychosocial challenges which must be addressed in the provision of quality, comprehensive cancer care. Tailoring services to the needs of this population requires careful work to identify, monitor and evaluate areas of care; however, published work in this area to guide service priorities is limited. This paper presents work done by the Australian Youth Cancer Services to operationalise and deliver quality care to adolescents and young adults with cancer, focusing on nationally coordinated service improvement initiatives and activity data collection in four areas that are of particular concern to young people diagnosed with cancer: clinical trial enrolment, oncofertility, psychosocial care and survivorship. This account may be instructive for health services seeking to improve the delivery and monitoring of cancer care provided to adolescents and young adults. Adolescents and young adults (aged 15–25 years) diagnosed with cancer have unique medical and psychosocial experiences and care needs, distinct from those of paediatric and older adult patients. Since 2011, the Australian Youth Cancer Services have provided developmentally appropriate, multidisciplinary and comprehensive care to these young patients, facilitated by national service coordination and activity data collection and monitoring. This paper reports on how the Youth Cancer Services have conceptualised and delivered quality youth cancer care in four priority areas: clinical trial participation, oncofertility, psychosocial care and survivorship. National activity data collected by the Youth Cancer Services between 2016–17 and 2019–20 are used to illustrate how service monitoring processes have facilitated improvements in coordination and accountability across multiple indicators of quality youth cancer care, including clinical trial participation, access to fertility information and preservation, psychosocial screening and care and the transition from active treatment to survivorship. Accounts of both service delivery and monitoring and evaluation processes within the Australian Youth Cancer Services provide an exemplar of how coordinated initiatives may be employed to deliver, monitor and improve quality cancer care for adolescents and young adults. [ABSTRACT FROM AUTHOR]

Copyright of Health Policy & Planning is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase. [ABSTRACT FROM PUBLISHER]

Background: World-wide, health service providers are moving towards innovative models of clinical home-based care services as a key strategy to improve equity of access and quality of care. To optimise existing and new clinical home-based care programs, evidence informed approaches are needed that consider the complexity of the health care system across different contexts. Methods: We present a protocol for working with health services and their partners to perform rapid identification, prioritisation, and co-design of content-appropriate strategies to optimise the delivery of healthcare at home for older people in rural and regional areas. The protocol combines Systems Thinking and Implementation Science using a Consensus Mapping and Co-design (CMC) process delivered over five workshops. Discussion: The protocol will be implemented with rural and regional healthcare providers to identify digital and non-digital solutions that have the potential to inform models of service delivery, improve patient experience, and optimise health outcomes. The combination of system and implementation science is a unique approach for optimising healthcare at home for older populations, especially in the rural context where need is high. This is the first protocol to integrate the use of systems and implementation science into one process and articulating these methods will help with replicating this in future practice. Results of the design phase will translate into practice through standard health service planning methods to enhance implementation and sustainability. The delivery of the protocol will include building capacity of health service workers to embed the design, implementation, and evaluation approach into normal practice. This protocol forms part of the DELIVER (Delivering Enhanced heaLthcare at home through optImising Virtual tools for oldEr people in Rural and regional Australia) Project. Funded by Australia's Medical Research Future Fund, DELIVER involves a collaboration with public health services of Western Victoria, Australia. [ABSTRACT FROM AUTHOR]

Advance Care Planning (ACP) relates to the process of thinking about, discussing, and potentially documenting future wishes and preferences relating to personal and health matters. Existing literature has explored ACP from the perspective of health care professionals and older people. However, data exploring the broader process of Advance Personal Planning (APP), which also accounts for plans relating to legal and financial matters, are limited. This article reports on an interview study that explored barriers to APP engagement, factors influencing the quality and future use of instruments, and opportunities for improving APP processes for older adults from the perspectives of key informants working in the fields of law, health, and aged care. Data were coded in NVivo and analysed thematically. Opportunities for improvement include education, normalising conversations, integration into usual practice, and reform. Recommendations are made at professional, community, and structural levels, with the aim of improving APP outcomes for all involved. [ABSTRACT FROM AUTHOR]

Objective. This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25 000 people across Australia, and presents the findings of this process. Methods. Health departments and the national government's websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives. Results. In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to generate an accurate national picture. The nature of information about maternity services held centrally by jurisdictions varied, and different frameworks were used to describe minimum requirements for service levels. Service networks appeared to be based on a combination of individual links, geography and transport infrastructure. Conclusions. The lack of readily available centralised and comparable information on rural and remote maternity services has implications for policy review and development, equity, safety and quality, network development and planning. Accountability for services and capacity to identify problems is also compromised. [ABSTRACT FROM AUTHOR]

Objectives. To project the prevalence of people receiving dialysis in Australia for 2021–30 to inform service planning and health policy. Methods. Estimates were based on data from 2011 to 2020 from the Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry and the Australian Bureau of Statistics. We projected dialysis and functioning kidney transplant recipient populations for the years 2021–30. Discrete-time, non-homogenous Markov models were built on probabilities for transition between three mutually exclusive states (Dialysis, Functioning Transplant, Death), for five age groups. Two scenarios were employed – stable transplant rate vs a continued increase – to assess the impact of these scenarios on the projected prevalences. Results. Models projected a 22.5–30.4% growth in the dialysis population from 14 554 in 2020 to 17 829 (‘transplant growth’) – 18 973 (‘transplant stable’) by 2030. An additional 4983–6484 kidney transplant recipients were also projected by 2030. Dialysis incidence per population increased and dialysis prevalence growth exceeded population ageing in 40–59 and 60–69 year age groups. The greatest dialysis prevalence growth was seen among those aged ≥70 years. Conclusion. Modelling of the future prevalence of dialysis use highlights the increasing demand on services expected overall and especially by people aged ≥70 years. Appropriate funding and healthcare planning must meet this demand. [ABSTRACT FROM AUTHOR]

Reforms that grow the capabilities of the health workforce are critical to improving outcomes for populations residing in rural and remote areas of Australia. Nurses are central to improving the accessibility of health care for populations in these areas. The Australian Government's recent release of The National Rural and Remote Nursing Generalist Framework 2023-2027 is timely for identifying opportunities to strengthen the rural and remote nursing workforce. Further consideration of how the nursing workforce can be supported to translate aspects of the framework into practice is required. To achieve this, it is necessary to identify strategies to support registered nurses to develop capabilities stipulated within the framework. A logical vehicle for this translation is through the continued support of the Australian Government's Rural Health Multidisciplinary Training program, which includes an established network of 19 University Departments of Rural Health. Leveraging from this national network that is geographically expansive and has a long-term strategic impetus for growing the rural and remote nursing workforce, provides an opportunity for translating aspects of the framework at a national scale. [ABSTRACT FROM AUTHOR]

Introduction: There have been significant advancements in risk identification and treatment for ovarian cancer over the last decade. However, their impact on health services costs is unclear. This study estimated the direct health system costs (government perspective) for women diagnosed with ovarian cancer in Australia during 2006–2013, as a benchmark prior to opportunities for precision-medicine approaches to treatment, and for health care planning. Methods: Using cancer registry data, we identified 176 incident ovarian cancers (including fallopian tube and primary peritoneal cancer) in the Australian 45 and Up Study cohort. Each case was matched with four cancer-free controls on sex, age, geography, and smoking history. Costs were derived from linked health records on hospitalisations, subsidised prescription medicines and medical services to 2016. Excess costs for cancer cases were estimated for different phases of care relative to cancer diagnosis. Overall costs for prevalent ovarian cancers in Australia in 2013 were estimated based on 5-year prevalence statistics. Results: At diagnosis, 10% of women had localised disease, 15% regional spread and 70% distant metastasis (5% unknown). The mean excess cost per ovarian cancer case was $40,556 in the initial treatment phase (≤12 months post-diagnosis), $9,514 per annum in the continuing care phase and $49,208 in the terminal phase (up to 12 months before death). Hospital admissions accounted for the greatest proportion of costs during all phases (66%, 52% and 68% respectively). Excess costs were higher for patients diagnosed with distant metastatic disease, particularly during the continuing care phase ($13,814 versus $4,884 for localised/regional disease). The estimated overall direct health services cost of ovarian cancer in 2013 was AUD$99million (4,700 women nationally). Conclusion: The excess health system costs of ovarian cancer are substantial. Continued investment in ovarian cancer research, particularly prevention, early detection and more effective personalised treatments is necessary to reduce the burden of disease. [ABSTRACT FROM AUTHOR]

Urbanisation presents specific mental health challenges, requiring a better understanding of service availability in urban areas for mental health care planning. Our objective is to analyse patterns of urban mental healthcare provision in Australia, and compare these with relevant national and international regions to inform urban mental healthcare policy and planning. Following a health ecosystems approach, we use a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE), and Mental Health Care Atlases, to compare the availability, bed capacity and diversity of services providing specialised mental health or psychosocial care that are universally accessible (ie provided at no or low cost only in all relevant care sectors in four Australian and three international urban regions. We used a heuristics approach and an homogeneity test. Applicability to local policy was assessed using the Adoption Impact Ladder. Community care was less developed in Australia than internationally, except in the case of residential care in Australian Capital Territory, our reference area. Alternatives to hospitalisation were scarce across all regions. The Atlas was applicable to regional and local mental health planning. Differences in pattern of care between regions has implications for planning, equality of access to care and prioritisation of resources. An ecosystems approach is relevant to service planning in mental healthcare at local level. [ABSTRACT FROM AUTHOR]

Home health care (HHC) refers to the delivery of social, medical and paramedical services to people in their homes. Caregivers are assigned and routed to perform various tasks such as personal care and household chores at the client's homes. Minimising the total cost and satisfying the client requirements and preferences are critical in HHC. In this paper, we present a mixed-integer linear programming model for HHC routing and scheduling problems, which considers fair and balanced workload allocation of caregivers while minimising the total cost and addressing the client's needs. Due to the complexity of the problem, using a commercial solver is not practical for real size instances. Therefore, we develop a multi-steps clustering approach using Ordering Points and Agglomerative Hierarchical Clustering to solve the model. The proposed solution approach is applied on several test instances to examine its performance. We also apply the proposed model and solution approach on a case study in Australia. • Home health care planning problem with practical constraints is considered. • Clients and caregivers' satisfaction and balanced workload are considered. • A cluster-based framework is introduced to solve large-sized instances. • A standard benchmark for home care planning problem with preferences is generated. • Extensive numerical experiments based on real-life data are presented. [ABSTRACT FROM AUTHOR]

Background: Mature evidence exists supporting the integration of palliative care in cancer care, but translation of evidence into practice is less well understood. Aim: We sought to understand current access to palliative care and its timing for people with cancer and to compare practices over time. Design: We conducted a retrospective population cohort study using routinely collected administrative health data sets in Victoria, Australia. Setting/Participants: All adult cancer decedents in 2018 were identified and clinical, demographic, palliative care access and quality of end of life care indices collected. Comparisons between a historic cohort of lung, breast and prostate cancer patients who died between the years 2005 and 2009 and those with these diagnoses in the current cohort. Results: In 2018 there were 10,245 Victorian decedents with a cancer-coded cause of death, of these 3689 had lung, prostate or breast cancer. In 2018, access to palliative care increased (66% vs 54%) and greater numbers accessed palliative care more than 3 months before death (18% vs 10%) than in 2005–2009. Indices of end of life quality improved across most domains. However the median time between first palliative care and death was shorter in 2018 (22 vs 25 days) and more people first accessed palliative care in the hospitalisation during which they died (43% vs 33%). Conclusion: Despite established benefits of early palliative care, the important task of translation of this evidence into practice remains. [ABSTRACT FROM AUTHOR]

Currently, individuals living in rural and remote areas experience 1.4 times the total burden of chronic disease, including an 80% greater risk of late-life cognitive impairment and dementia, 2.5 times the number of preventable hospitalisations and a reduced life expectancy of up to 12 years compared to their metropolitan counterparts. Traditionally, health service planning and public health interventions have been largely built on the needs and characteristics of metropolitan populations. This disproportional focus can contribute to significant physical and cognitive health status disparities for rural and remote communities. This article focuses on existing challenges and strategies surrounding the cognitive health of rural and remote populations and provides short and long-term opportunities involving Australian public health policy and clinical practice to innovate dementia prevention for rural and remote communities. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) is Australia's most common life limiting genetic condition, characterised by declining health and quality of life (QoL) over time. Despite improvements in treatment, there remains no cure. Adolescents and young adults (AYAs) with CF experience broad impacts to psychosocial functioning and QoL, as well as major transitions in care, all at a time of significant developmental change. The importance of developmentally tailored approaches to youth health care and self‐management for young people with CF are well understood. However, to date, models of youth specific self‐management have been lacking and motivation for young people with CF has not been well explored. This qualitative study, based on a social constructionist epistemological framework, addresses this gap. A total of 21 AYAs aged 15–30 years were recruited through one paediatric and one adult Australian CF centre. Demographic, clinical and distress data were captured to describe health complexity. Semi‐structured interviews were audio‐recorded, transcribed and analysed using thematic analysis. Participants were representative of Australian AYAs with CF by demography and clinical status. Alarmingly, over a third reported clinically significant distress. Two themes emerged. The first Identified impacts to motivation and self‐management resulting from the challenges of managing CF, life and care. These included time and competing priorities, changing health statis, mental health, social factors, unmet needs and health system complexity. The second identified factors that support motivation including: achievement, meaning and purpose; consequence avoidance; and accountability. These results illustrate the importance of AYA specific, theoretically founded, holistic self‐management models which extend beyond current theoretical approaches that aim to understand behaviour change or address barriers, in isolation from motivation. Improved approaches to care based on these findings are essential to foster positive behavioural change, support self‐management and foster the best health outcomes for young people living with CF. [ABSTRACT FROM AUTHOR]

Background: Recent rapid growth in urban areas and the desire to create liveable neighbourhoods has brought about a renewed interest in planning for compact cities, with concepts like the 20-minute neighbourhood (20MN) becoming more popular. A 20MN broadly reflects a neighbourhood that allows residents to meet their daily (non-work) needs within a short, non-motorised, trip from home. The 20MN concept underpins the key planning strategy of Australia's second largest city, Melbourne, however the 20MN definition has not been operationalised. This study aimed to develop and operationalise a practical definition of the 20MN and apply this to two Australian state capital cities: Melbourne (Victoria) and Adelaide (South Australia). Methods: Using the metropolitan boundaries for Melbourne and Adelaide, data were sourced for several layers related to five domains: 1) healthy food; 2) recreational resources; 3) community resources; 4) public open space; and 5) public transport. The number of layers and the access measures required for each domain differed. For example, the recreational resources domain only required a sport and fitness centre (gym) within a 1.5-km network path distance, whereas the public open space domain required a public open space within a 400-m distance along a pedestrian network and 8 ha of public open space area within a 1-km radius. Locations that met the access requirements for each of the five domains were defined as 20MNs. Results: In Melbourne 5.5% and in Adelaide 7.6% of the population were considered to reside in a 20MN. Within areas classified as residential, the median number of people per square kilometre with a 20MN in Melbourne was 6429 and the median number of dwellings per square kilometre was 3211. In Adelaide's 20MNs, both population density (3062) and dwelling density (1440) were lower than in Melbourne. Conclusions: The challenge of operationalising a practical definition of the 20MN has been addressed by this study and applied to two Australian cities. The approach can be adapted to other contexts as a first step to assessing the presence of existing 20MNs and monitoring further implementation of this concept. [ABSTRACT FROM AUTHOR]

The introduction of a National Disability Insurance Scheme (NDIS) in Australia has changed the basis of service provision for people with disability. This mixed-methods study presents the experiences of parents of children with hearing loss during national rollout of the NDIS. Surveys were completed by 100 parents, with 57 parents reporting their child received NDIS funding. Individual interviews of seven parents in different locations provided further information. Between-group comparisons were made and regression analysis examined the influence of parental disadvantage on NDIS experiences. Qualitative data were analysed for themes and findings were triangulated. The NDIS has improved services for some children with hearing loss but initial access and ongoing navigation can be challenging for others. Barriers included a complicated system, planning delays, poor communication and uninformed National Disability Insurance Agency (NDIA) staff. This study suggests areas of refinement and further investigation that may improve services for children with hearing loss. Parents of children with hearing loss in Australia had difficulty accessing the National Disability Insurance Scheme (NDIS) due to poor communication and delays. Parents reported the NDIS system was challenging and felt they needed high levels of education and advocacy skills to navigate the system and prepare information to justify necessary disability supports for their child. Parents were concerned that disadvantaged families would not receive adequate supports for their child with hearing loss due to the complexity of the NDIS. This small-scale national study indicates that recent and upcoming changes to the NDIS should be evaluated to ensure children with hearing loss can access equivalent funding packages and services regardless of family circumstances. [ABSTRACT FROM AUTHOR]

Purpose: To identify economic evaluation models and parameters that could be replicated or adapted to construct a generic model to assess cost-effectiveness of and prioritise a wide range of community-based oral disease prevention programmes in an Australian context.Methods: The literature search was conducted using MEDLINE, ERIC, PsycINFO, CINHAL (EBSCOhost), EMBASE (Ovid), CRD, DARE, NHSEED, HTA, all databases in the Cochrane library, Scopus and ScienceDirect databases from their inception to November 2012.Results: Thirty-three articles met the criteria for inclusion in this review (7 were Australian studies, 26 articles were international). Existing models focused primarily on dental caries. Periodontal disease, another common oral health problem, was lacking. Among caries prevention studies, there was an absence of clear evidence showing continuous benefits from primary through to permanent dentition and the long-term effects of oral health promotion.Conclusion: No generic model was identified from previous studies that could be immediately adopted or adapted for our purposes of simulating and prioritising a diverse range of oral health interventions for Australian children and adolescents. Nevertheless, data sources specified in the existing Australian-based models will be useful for developing a generic model for such purposes. [ABSTRACT FROM AUTHOR]

Regional South Australia has some of the highest rates of psychological distress, chronic disease and multimorbidity of any Australian State or Territory. Yet, the healthcare needs of this population are still not completely understood. To better understand the healthcare needs of regional South Australians, we invited adults living in the region to complete the 44‐item consumer utilisation, expectations and experiences of healthcare instrument (CONVERSATIONS), online or in hard‐copy. The survey was conducted between April 2017 and March 2018. A multi‐modal recruitment campaign was utilised to promote the survey. We examined associations between study outcomes and remoteness area, and drew comparisons between our findings and other surveys reporting pertinent outcomes in the urban SA population. The questionnaire was completed by 3,926 adults (52.5% females; 37.6% aged 60 + years). Among the 264 distinct health conditions reported by participants, the most prevalent were hypertension (31.6%), depression (25.7%), anxiety (23.5%) and hypercholesterolaemia (22.9%). The lifetime prevalence of these conditions among participants exceeded rates reported in urban SA. The largest regional‐urban health disparities were observed for eczema/dermatitis, skin cancer, other cancer types and cataracts, where prevalence rates were 2075%, 400%, 373% and 324% higher, respectively, than that reported in urban SA. Participants also reported higher levels of multimorbidity (37.7% higher) relative to urban South Australians. By contrast, participants appeared to be exposed to fewer lifestyle risk behaviours (e.g. smoking, alcohol, inadequate fruit or vegetable intake) than their urban counterparts. In summary, there was a high level of healthcare need, and considerable health disparity among participants when compared with urban settings (particularly for skin and eye conditions). These findings highlight the need for a more targeted approach to delivering health services and health promotion activities in regional areas. [ABSTRACT FROM AUTHOR]

The article focuses on the rural medical students' self-reported perceptions of preparedness to practice in the Aboriginal and Torres Strait Islander Health Context. Topics discussed include Australian Aboriginal and Torres Strait Islander peoples' health is affected by political, social and environmental issues that have occurred since colonization; and Australian medical schools recognize that there are problematic historical relationships between medical practitioners and Aboriginal.