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Introduction: Centralisation of head and neck surgical services means that patients in regional and remote Australia need to travel long distances for treatment and follow‐up, imparting a significant financial burden on patients and the health system. Objective: To estimate costs of travel to local outreach clinics and determine potential cost savings to patients and the health system by avoiding patient travel to major cities for head and neck surgical care. Design: Retrospective audit of three head and neck surgery outreach clinics in New South Wales, Australia over 4 years (2017–2020). Direct costs of travel from a patient's residence to their local outreach clinic were estimated. Costs of travel and accommodation to Sydney for an appointment were calculated for different travel modes. Estimated reimbursements for travel through government support schemes were calculated based on published rates. Findings: Some 657 patients attended the three clinics, accounting for 1981 appointments. Depending on mode of travel, the estimated median cost of return travel (including accommodation) to Sydney was $379 to $739 per patient per trip and the median government reimbursement ranged from $182 to $279 per trip. In comparison, the cost of return travel by car to local outreach clinics ranged from $28 to $163 per appointment. Outreach clinics were estimated to save patients a median of $285 per trip and avoided government reimbursements of $215 per trip. Discussion: Despite uptake in telehealth, outreach medical services remain an important asset for people living in regional areas to address inequities in access. However, the cost benefits are likely to be underestimated as our approach did not account for indirect costs associated with travel. Conclusion: Outreach head and neck surgical services located in regional areas can reduce the financial burden on both patients and the healthcare system. Greater investment in outreach clinics could ensure sustainability of services to promote equitable access to specialised surgical services. [ABSTRACT FROM AUTHOR]

Background: Older people subject to homelessness face many challenges including poor health status, geriatric syndromes, and depression, coupled with barriers in accessing health and aged care services. Many are in need of formal aged care at a younger age than the general population, yet, in Australia, specialised aged-care services to support this vulnerable cohort are limited. Methods: This study was an evaluation of a new purpose-built aged care home for people with high care needs and who are homeless or at risk of homelessness. Over the first 12 months post-admission, the study examined: (1) changes in residents' physical, mental, psychological and social health, and (2) the costs incurred by the study cohort, including any cost benefit derived. Results: Thirty-five residents enrolled in the study between March 2020 – April 2021. At admission, almost half of residents were within the range for dementia, the majority were frail, at high risk for falls, and had scores indicative of depression. Over time, linear mixed-effect models showed significant improvement in personal wellbeing scores, with clinically significant improvements in overall health related quality of life. Levels of physical functional independence, frailty, and global cognition were stable, but cognitive functional ability declined over time. Comparison of 12 month pre- and post- admission cost utility data for a smaller cohort (n = 13) for whom complete data were available, suggested an average per resident saving of approximately AU$32,000, while the QALY indicators remained stable post-admission. Conclusion: While this was a small study with no control group, these preliminary positive outcomes add to the growing body of evidence that supports the need for dedicated services to support older people subject to homelessness. [ABSTRACT FROM AUTHOR]

To identify client and service factors associated with changes in health-related quality of life following community rehabilitation. We conducted a retrospective observational cohort study within a community rehabilitation program. Health-related quality of life was measured using the EuroQol five Dimensions, five response level version (EQ-5D-5L). Our primary outcome was the Visual Analogue Scale (VAS) rating of overall health. Analyses were stratified by diagnostic group: traumatic orthopaedic, elective orthopaedic, neurological, medical, and other. The association between client and service factors and discharge VAS scores, adjusted for baseline scores were determined using multivariable regression. EQ-5D-5L data were available for 981 of 1350 participants. Treatment intensity was associated with a seven-point increase (β = 7.22, 95%CI 2.28–12.2, p = 0.004) in VAS scores for traumatic orthopaedic participants. For neurological participants, there was a positive interaction between comorbidities and intensity of therapy (β = 7.9, 95%CI 2.75–13.1, p = 0.003), indicating that greater therapy intensity in those with higher comorbidity scores was associated with an improvement in VAS scores. Age was negatively associated with VAS scores for traumatic orthopaedic participants and socioeconomic status was positively associated with VAS scores for elective orthopaedic participants. Treatment intensity is a modifiable service factor that may positively influence health-related quality of life. In addition to providing information on client progress towards attainment of individual treatment goals, routine collection of patient reported outcome measures within a community rehabilitation program can elicit information that can inform rehabilitation service improvement. Clients of a community rehabilitation program with a neurological or medical condition demonstrate the least improvement in overall health profile and may require additional rehabilitation or supports. Across all diagnostic groups, problems with anxiety and depression were least likely to improve following receipt of community rehabilitation. Improving access to psychological services and associated referral pathways in community rehabilitation services could improve these outcomes. Initiatives aimed at increasing intensity of therapy such as targeted triage and resource allocation, may improve health-related quality of life for clients of a community rehabilitation program with traumatic orthopaedic conditions. For clients with a neurological condition, initiatives aimed at increasing intensity of therapy may improve health-related quality of life in more complex patients with comorbid health conditions. [ABSTRACT FROM AUTHOR]

Objective: Previous studies at child and youth mental health services (CYMHS) suggest that children with ADHD have poorer outcomes compared to those with other diagnoses. This study investigates this in more detail. Methods: Children with ADHD were compared to those with ASD and those with emotional disorders, on routinely collected outcomes at CYMHS in Australia (N = 2,513) and the Netherlands (N = 844). Results: Where the emotional disorders group reached a similar level of emotional symptoms at the end-of-treatment as the ADHD and ASD groups, the latter two groups still had higher scores on ADHD and ASD symptoms (attention and peer problems). The poorer outcomes were mainly explained by higher severity at baseline. In Australia, an ADHD and/or ASD diagnosis also independently contributed to worse outcomes. Conclusion: Those with neurodevelopmental disorders within both countries had poorer outcomes than those with emotional disorders. Services should aim to optimize treatment to ensure best possible outcomes. [ABSTRACT FROM AUTHOR]

Employment is frequently desired by persons who experience homelessness yet is often elusive. Little is known about the range and effectiveness of employment‐based interventions evaluated in existing literature on key psychosocial outcomes including employment participation, mental well‐being, housing tenure, community integration and substance use. To identify and synthesise existing studies, we conducted a systematic review of effectiveness using the methodology proposed by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Following the removal of duplicates, we screened 13,398 titles and abstracts, and reviewed 79 studies at the full‐text review stage using two independent raters. A total of 16 studies met criteria for inclusion in a narrative synthesis and were subjected to critical appraisal. The majority of studies were conducted in the US (n = 14; 87.5%) with other studies published in Canada (n = 1; 6.3%) and Australia (n = 1; 6.3%). Interventions evaluated in existing studies included combined substance use and vocational skills interventions (n = 7; 43.8%), supported employment (n = 6; 37.5%), and integrated supports including an employment component (n = 3; 18.8%). The effectiveness of these interventions on employment, mental well‐being, housing tenure, community integration, and substance use is presented. Findings suggest that research evaluating employment interventions for persons who experience homelessness is in an early stage of development. Researchers and practitioners may consider collaborating with persons with lived experiences of homelessness and practitioners in co‐designing and modifying existing approaches to target key outcomes more effectively. Policymakers may consider allocating resources to such initiatives to further the development of practice and research aimed at supporting persons who experience homelessness to secure and sustain employment during and following homelessness. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to provide a preliminary evaluation of the Winnunga Nimmityjah Health and Wellbeing Service which commenced operations at the Australian Capital Territory's adult prison in 2019., Methods: A mixed-method approach was utilised to evaluate the service from 1 January 2019 to 31 December 2020. The quantitative arm described health status and health care engagement of enrolled detainees, and included a comparison of preventative health measures with the Winnunga community-based service. A qualitative arm involved focussed, semi-structured interviews with Winnunga staff members who worked at the prison service., Results: There were 61 detainees enrolled (from 168 requests for enrolment), with 92% identifying as Aboriginal and/or Torres Strait Islander. Health needs among detainees were skewed towards mental illness and substance use. The provision of primary and preventative health care was comparable to or better than the community-based service. Qualitative analysis of staff interviews identified four themes: provision of holistic and community-led care, workforce constraints, access to opioid agonist treatment and challenges working within a correctional facility., Conclusions: Winnunga was the first Aboriginal Community Controlled Health Organisation to deliver holistic health care to First Nations people in an Australian prison. This evaluation highlights the service's achievements and provides recommendations for improvement and expansion., Implications for Public Health: Aboriginal community-controlled organisations can provide high quality, culturally safe health and wellbeing services for First Nations people in prison. The findings of this study provide evidence for the development of similar services in other jurisdictions., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To review the Hospital Outreach Post-suicidal Engagement (HOPE) service in the first six months of the pilot program in a metropolitan Melbourne setting, including a description of: (a) socio-demographic, health and psychosocial stressors of people referred; (b) method of presentation; (c) interventions provided and (d) outcomes measured. Method: A retrospective case file analysis reviewed the first six months of HOPE service operation. Results: Forty people received HOPE service during the study period, 60% female, mean age 35 years (range 17–58). The majority had previously engaged in self-harm (72.5%) or attempted suicide (67.5%). Stressors included social isolation, relationship breakdown, unemployment, financial stress, medical problems, history of mental illness, exposure to family violence and adverse childhood events. Statistically significant improvements occurred in the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) following intervention. There were no deaths by suicide during the study period. Conclusion: People referred to HOPE had significant health and psychosocial stressors. Engagement significantly improved subjective well-being and connection with supports. Findings highlighted the need for an integrated clinical and psychosocial model to promote hope and connection in life post suicide attempt. It remains unclear which interventions improved well-being and if this contributes to suicide prevention. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy, safety and acceptability as well as the patient demographics of three newly developed emergency department–embedded Psychiatric Assessment and Planning Units located in Metropolitan Melbourne at Austin, Peninsula and Eastern Health Services. Methods: The evaluation reviewed a 12-month period of service activity from 1 September 2017 to 31 August 2018, when all three Psychiatric Assessment and Planning Units services were operational. A 12-month period from 1 September 2014 to 31 August 2015 was compared as the pre-Psychiatric Assessment and Planning Units period. Mixed qualitative and quantitative methods were used. This included semi-structured interviews of 30 Psychiatric Assessment and Planning Units patients and 30 emergency department staff (10 of each for all 3 sites), patient survey, statistical analysis of Client Management Interface data for the emergency department and related Psychiatric Assessment and Planning Units as well as audit of RISKMAN registers. Results: There were 365 Austin, 567 Eastern and 791 Peninsula Psychiatric Assessment and Planning Units admissions. Psychiatric Assessment and Planning Units were generally well accepted by patients and emergency department staff, relatively safe, operating within the Key Performance Indicators with mixed effect on emergency department flow. Austin emergency department processing times improved post-Psychiatric Assessment and Planning Units (4 hours 57 minutes to 4 hours 19 minutes; p < 0.001) while deteriorating at Eastern and Peninsula. Adjustment Disorder and Depression and Borderline Personality Disorder were the most common admission diagnoses. While the Psychiatric Assessment and Planning Units had mixed utility on emergency department processing times, they appear to serve a demographic not previously accommodated in traditional emergency department psychiatry models. Conclusion: The emergency department–embedded Psychiatric Assessment and Planning Unit model of care appears effective on some measures, safe and acceptable to patients and staff. The Psychiatric Assessment and Planning Units seem to service a group not previously accommodated in traditional emergency psychiatry models. [ABSTRACT FROM AUTHOR]

We sought to examine the management and referral of nonhealing mouth ulcer presentations in Australian community pharmacies in the Greater Brisbane region. Trained simulated patients visited 220 randomly selected community pharmacies within the Greater Brisbane region in 2016. Simulated patients enacted two nonhealing (>1 month) mouth ulcer scenarios: A direct product request (DPR) (n = 110) and a symptom‐based request (SBR) (n = 110). Results were documented and evaluated against Australian national pharmacy practice standards. Referral rates for pharmacy staff (pharmacist, pharmacy assistant or mixed—pharmacist and assistant) were also assessed. Australian pharmacy practice standards recommend staff ask six key questions during SBR and DPR consultations to enable informed decision‐making. Two questions relating to identifying the patient and their symptoms were asked in the majority of interactions (76% and 69% respectively); the remaining four questions relating to symptom duration, treatments tried, other medications, and medical conditions were enquired in only 32%, 53%, 31%, and 27% of interactions, respectively. Simulated patients were referred to the doctor/dentist in only 11.8% of all interactions (both scenarios requiring referral). Overall, staff handling of nonhealing mouth ulcer consultations was suboptimal compared to national professional standards. In particular, duration of the nonhealing mouth ulcer was enquired in less than one‐third of consultations potentially resulting in low referral rates by staff. This study identifies the need for increased oral cancer awareness and education for community pharmacy staff and reinforcing the importance of practising according to professional standards to effectively screen for potentially cancerous nonhealing mouth lesions. [ABSTRACT FROM AUTHOR]

Background/aim: The delivery of evidence‐based health care requires the routine adoption of outcome measures that are valid and reliable. The Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs‐OT) was developed in Australia to capture a global snapshot of status for any client, and has preliminary psychometric evidence to support use. Building on the psychometric evidence of the AusTOMs‐OT will provide therapists and researchers with further information as to how best to apply the AusTOMs‐OT in their field. This study reports on the reliability of the 12 AusTOMs‐OT scales, which are each scored on the four domains of Impairment, Activity Limitation, Participation Restriction and Distress/Wellbeing. Methods: A total of 31 occupational therapists rated 12 written case studies on two occasions, separated by two weeks. Test–retest reliability, inter‐rater reliability, intra‐rater reliability (using intra‐class correlation coefficients (ICCs)) and measurement error were calculated, in line with the COnsensus‐based guidelines for the Selection of health Measurement Instruments (COSMIN). Results: The ICCs for inter‐rater reliability for all domains for all scales ranged from 0.531 to 0.922 suggesting moderate to very high reliability. Therapist intra‐rater reliability ranged from ICC 0.675 to 1.000, suggesting moderate to high consistency. The stability of the scales was demonstrated with test–retest ICCs coefficients ranging from 0.616 to 0.960. The measurement error was found to be below 0.5 point for all scales and domains except for Scale 1, Impairment (just over at 0.604) and similarly the error range for each scale was also all below 1 point except Scale 1, Impairment. Conclusion: The AusTOMs‐OT scales possess moderate to very high reliability across the 12 scales. Occupational therapists can continue to use AusTOMs‐OT with confidence with all clients to establish global outcomes and to build evidence to underpin practice. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Appointment non‐attendance contributes added cost to the healthcare sector through wasted resource allocations. Medical imaging departments commonly schedule appointments for most modalities; however, no study has quantified patient attendance rates in the Australian regional setting. This is despite evidence that regional, rural and remote Australians tend to demonstrate poorer health than metropolitan counterparts. This study aims to identify the factors that influence appointment non‐attendance at a teaching hospital in regional Australia. Methods: Categories restricted to age, gender, indigenous status, distance from investigation site, referral source and imaging modality were collected for all appointments (N = 13,458) referred to the medical imaging department in 2015. The likelihood of each of these factors correlating with a patient not attending a scheduled appointment was calculated using the chi‐squared analysis and binary logistic regression. Results: Gender, indigenous status as well as specific imaging modalities, referral sources and age categories were significantly associated with non‐attendance. Overall, male patients were 1.57 (P < 0.001) times more likely to miss a scheduled appointment than female patients. Patients who identified as Aboriginal and Torres Strait Islander were 2.66 (P < 0.001) times more likely to miss a scheduled appointment than patients who did not identify as Aboriginal and Torres Strait Islander. Conclusions: Several key factors appear to affect medical imaging appointment non‐attendance. Key factors include indigenous status, gender, image modality, referral source and age. Further improvement is required to better meet the needs of underrepresented patient demographics. [ABSTRACT FROM AUTHOR]

The perinatal period is a time of great vulnerability for many women, in particular those with a range of psychosocial vulnerabilities and mental health risk factors. This paper outlines the psychosocial and mental health profile of consumers and their partners of a perinatal and infant mental health ( PIMH) service in Australia. To establish the consumer profile, we analysed client vulnerabilities and demographical information maintained over a 6-year period for 406 consumers. Consumer information, including mental health problems, psychosocial vulnerabilities and demographical information, was entered into a standalone database by the allocated clinicians upon service allocation and throughout treatment. The women accepted by PIMH presented with an average of nine different vulnerabilities. Frequently endorsed risk factors included depression (72.66%), anxiety (71.43%), comorbid depression and anxiety (58.13%), self-harm (past, 7.88%, present, 16.26%), a history of family mental health issues (39.66%), childhood trauma (57.88%), limited support (68.84%), relationship conflict with partners (38.92%) and financial stress (47.29%). The women's partners also presented with a range of vulnerabilities, in particular childhood trauma (34.11%) and mental health issues (30.81%). This study contributes to our understanding of the profile of vulnerable women in the perinatal period, and in particular contributes to the literature by highlighting that in addition to depression, anxiety, self-harm and trauma are also significant in PIMH service delivery. [ABSTRACT FROM AUTHOR]

Child abuse commonly occurs within the context of multiple risk factors, in particular parental mental health and/or drug and alcohol problems. As no one agency can address all these factors, inter‐agency collaboration is paramount to the protection of vulnerable children, especially in families with a complex array of problems. This paper outlines a range of recommendations to improve collaboration between child protection workers and mental health/drug & alcohol (MH/D&A) clinicians from the perspective of Keep Them Safe‐Whole Family Team (KTS‐WFT) clinicians. Taking referrals from child protection, the KTS‐WFT offers interventions to families with parental MH/D&A problems where there are child protection concerns. As part of a larger evaluation of a KTS‐WFT site, 10 KTS‐WFT clinicians participated in in‐depth interviews. Analysis of the interviews identified collaboration with child protection as a primary theme. Participants reported a number of barriers to effective collaboration; in particular, participants reported challenges with information sharing and confidentiality, inconsistency in terms of the level and style of collaboration, tensions between the different theoretical paradigms that underpin practice for MH/D&A clinicians vs. child protection workers, and insufficient clarity around processes and expectations. Consistent with the identified barriers, primary recommendations to improve collaboration were to improve information sharing, overcome silo ways of thinking, manage risk together more consistently, and develop consistent processes and expectations. [ABSTRACT FROM AUTHOR]

Men's Sheds and similar community programmes are known to encourage help-seeking behaviour and thus improve the health and well-being outcomes for the men who attend. This paper investigates this issue through a community needs assessment of a Men's Shed programme in inner-regional Australia. The immediate purpose of this research was to help direct future funding initiatives, and provide recommendations for potential changes and improvements to the programme. A community-level needs assessment is a systematic process used to determine and address gaps or needs between current and desired conditions within a particular community. We sought to explore how particular formats and structures of Men's Sheds programmes contribute to improve social and medical well-being, and whether there are key programme characteristics that could be emulated. In total, 22 surveys and 20 interviews were conducted with the men who participated in the programme. The report finds 95% of men are satisfied with the current running of the programme. While there were areas that have been identified for improvement, most men reported that they are content with the current format and would not like to see major changes to its implementation. The results of this research confirm the known benefits of these types of programmes. This paper provides other community programmes with some insight into the key success factors for running a Men's Shed. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate a specialised service designed to improve parenting capacity, child safety and family functioning in the context of parental mental health, drug and alcohol and child protection concerns.Method: Client data was collected over a period of 3 years and 3 months, including demographic characteristics, service usage, presenting issues and pre and post revised North Carolina Family Assessment Scale (NCFAS-G) scores.Results: A significant improvement between intake and discharge occurred on the majority of the 58 NCFAS-G subscale items (32/58). In particular, most significant change occurred in the domains 'family safety' (p < 0.001) and 'family interactions' (p < 0.001).Conclusion: Specialised programs can assist families with child safety concerns suffering from mental health and/or drug and alcohol problems. [ABSTRACT FROM AUTHOR]

Purpose: Dysphagia is a common and debilitating side effect for head and neck cancer (HNC) patients undergoing radiotherapy (RT) with or without chemotherapy ([C]RT) and is associated with nutritional and emotional comorbidities. Emotional sequelae and distress are also known to affect carers of HNC patients. A weekly, joint speech pathology/dietetic (SP/DN) service-delivery model has been employed to manage swallowing/nutritional and associated emotional issues during (C)RT. This study aimed to conduct a service evaluation of the weekly SP/DN clinical model.Methods: Cross-sectional sampling of core service metrics and perceptions of key stakeholders (70 HNC patients, 30 carers, and 10 clinicians) were collated from the Metro South Radiation Oncology Service in Brisbane, Australia. Data from each source was examined separately and then triangulated.Results: An average of 28 patients (SD = 5.54) attended SP/DN appointments per week, with 58% reporting swallowing and/or nutritional issues. Distress was reported by 27% of patients and 30% of carers. Clinicians felt able to adequately identify and manage swallowing and nutrition 90% of the time but only 10% of the time for distress. Seventy-six percent of scheduled SP/DN sessions were perceived as necessary by either patients, clinicians or both.Conclusions: Findings demonstrated a third of patients and their carers had a high level of distress during HNC [C]RT, supporting need for the provision of a weekly SP/DN service in a select cohort. However, the routine weekly SP/DN assessment model for all patients undergoing HNC treatment demonstrates the potential for over-servicing. Alternative service-delivery models warrant further evaluation. [ABSTRACT FROM AUTHOR]

Transitional housing programs aim to improve living skills and housing stability for tenuously housed patients with mental illness. 113 consecutive Transitional Housing Team (THT) patients were matched to 139 controls on diagnosis, time of presentation, gender and prior psychiatric hospitalisation and compared using a difference-in-difference analysis for illness acuity and service use outcomes measured 1 year before and after THT entry/exit. There was a statistically significant difference-in-difference favouring THT participants for bed days (mean difference in difference −20.76 days, SE 9.59, p = 0.031) and living conditions (HoNOS Q11 mean difference in difference −0.93, SE 0.23, p < 0.001). THT cost less per participant (I$14,024) than the bed-days averted (I$17,348). The findings of reductions in bed days and improved living conditions suggest that transitional housing programs can have a significant positive impact for tenuously housed patients with high inpatient service usage, as well as saving costs for mental health services. [ABSTRACT FROM AUTHOR]

Objective: There is increasing international evidence that crisis houses can reduce the time spent in acute psychiatric inpatient units for patients with severe and persistent mental illness, at a lower cost and in an environment preferable to patients. We evaluated the Alternatives to Hospitalisation (AtH) program, a crisis house operating in outer suburban Brisbane. Methods: One hundred and ninety-three AtH patients were compared to 371 matched controls admitted to a peer hospital district acute psychiatric unit. Hospitalisations, demographics and illness acuity were compared one year before and after an acute index episode of residential care involving hospital and/or AtH. Hospital bed-days during the index episode were compared between AtH participants and controls. The cost of bed-days averted was compared to the cost of providing the AtH program. Results: AtH participants spent 5.35 fewer days in hospital during the index episode than controls, after adjustment for illness acuity, living conditions, marital status and emergency department (ED) presentations. Per patient cost of averted psychiatric inpatient bed-days, $5948.22, was higher than the per patient cost of providing AtH, $3071.44. AtH participants had higher levels of illness acuity, ED presentations and acute psychiatric admissions than controls in the year after the index episode. Conclusions: For acutely unwell, stably housed patients, able to be managed outside of a secure facility, a crisis house program can reduce acute psychiatric bed-days, providing a cost saving for mental health services. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to describe the fundamental components of a system to ensure consumer participation in mental health service evaluation and quality improvement. Conclusions: The seven fundamental components identified provide the basis for a system to deliver national indicators for consumer participation in quality improvement under the National Health Performance domain of 'responsiveness to consumers'. The MH-CoPES Framework satisfies these criteria and may be drawn upon as the basis for developing local systems for consumer participation in quality improvement within mental health services. [ABSTRACT FROM AUTHOR]

Purpose – The primary objective of this paper is to investigate the attitudes, feelings and perceptions of Australian consumers towards service frontline employees with accents that differ from Standard Australian English, taking into consideration service-country image and customer emotions. Design/methodology/approach – This paper reports on a qualitative study designed to uncover the attitudes and perceptions of Australians towards service personnel with foreign accents. Findings – The findings revealed that hearing a service provider with a foreign accent, particularly in services encounters without face-to-face contacts, often evokes a negative predisposition to certain accents, reduces the customers' level of tolerance and increases the perception of the service provider's lack of understanding. This negative stereotype bias seems to be moderated by the accent (a proxy of ethnicity) and service-country image and influenced by customer emotions in the service interaction. Research limitations/implications – Future studies could also use a controlled experimental design where accent could be used as a sensory cue to further test the validity and reliability of the current findings while controlling for factors such as ethnic background, employment, education and age. Further research should also take service types and service outcomes into consideration in examining the effect of accents on customer service evaluation. Practical implications – Accent as a service employee attribute influences customers' evaluation of the service encounter because of the stereotype customers have. Training in language skills, cross-cultural interpersonal skills and authority to deviate from the script should be given to minimise the negative effect of service employee accent. Service firms also need to develop strategies to manage customer emotions and reactions. Originality/value – This paper contributes to the service literature about service employee attributes and is particularly relevant to economies such as the USA, Canada, the UK, New Zealand and Australia where immigrants are a large part of the service workforce. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Substance misuse among Aboriginal Australians is both a symptom of disadvantage and suffering but also a cause of health and social problems. Few data are available on how mainstream drug and alcohol services meet the needs of Aboriginal Australians. We assessed acceptability and accessibility of mainstream services for Aboriginal Australians with alcohol or drug use disorders in an urban Area Health Service (AHS). We identified priorities for improvement and an implementation plan. Methods. We collected feedback via consultation with client groups, with the Aboriginal community and community organisations, with staff of the AHS and of the local Aboriginal Medical Service (AMS) and through direct observation. We examined attendance data. Results. Aboriginal people were well represented in this mainstream service, partly because of existing collaboration with the AMS. Good points in the service were reported to be priority appointments for new Aboriginal clients, professional and caring service and collaboration with the AMS. Suggested improvements included increased cultural sensitivity of communication, more appropriate physical surrounds and printed materials, having Aboriginal staff available, peer support groups and integration of health care for individual, family and community. The action plan included increased recruitment and career opportunities for Aboriginal staff, strengthened partnerships with the Aboriginal community, including ongoing collaboration with the AMS in improving and monitoring mainstream service quality. Discussion and Conclusions. Given the adverse impact of substance use disorders, there is a pressing need for services to work with Aboriginal communities to optimise the quality of mainstream treatment services. [Teasdale KE, Conigrave KM, Kiel KA, Freeburn B, Long G, Becker K. Improving services for prevention and treatment of substance misuse for Aboriginal communities in a Sydney Area Health Service. Drug Alcohol Rev 2008; 27:152-159] [ABSTRACT FROM AUTHOR]

Background: Inequalities in access to hospice care is a source of considerable concern; white, middle-class, middle-aged patients with cancer have traditionally been over-represented in hospice populations., Objective: To identify from the literature the demographic characteristics of those who access hospice care more often, focusing on: diagnosis, age, gender, marital status, ethnicity, geography and socioeconomic status., Design: Systematic literature review and narrative synthesis., Method: Searches of Medline, PsycINFO, CINAHL, Web of Science, Assia and Embase databases from January 1987 to end September 2019 were conducted. Inclusion criteria were peer-reviewed studies of adult patients in the UK, Australia, New Zealand and Canada, receiving inpatient, day, outpatient and community hospice care. Of the 45 937 titles retrieved, 130 met the inclusion criteria. Narrative synthesis of extracted data was conducted., Results: An extensive literature search demonstrates persistent inequalities in hospice care provision: patients without cancer, the oldest old, ethnic minorities and those living in rural or deprived areas are under-represented in hospice populations. The effect of gender and marital status is inconsistent. There is a limited literature concerning hospice service access for the LGBTQ+ community, homeless people and those living with HIV/AIDS, diabetes and cystic fibrosis., Conclusion: Barriers of prognostic uncertainty, institutional cultures, particular needs of certain groups and lack of public awareness of hospice services remain substantial challenges to the hospice movement in ensuring equitable access for all., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Carers of patients with high-grade primary malignant glioma (PMG) are known to face extraordinary challenges, as they care for patients with multiple profound and often devastating physical, cognitive and behavioural changes. This study aimed to understand the supportive and palliative care needs in this setting, with a particular focus upon care at the end-of-life, which has hitherto been neglected., Methods: This prospective qualitative study undertook in-depth interviews with 23 current and bereaved carers of adults with PMG. Carers were recruited from outpatient and inpatient services of two Australian metropolitan hospitals, including neurosurgery, oncology and palliative care. Thematic analysis was conducted by three independent researchers, using methods informed by grounded theory., Results: Carers described significant needs in relation to three distinct domains: the challenge of caring; the lack of support available to carers and the suffering of caring. The need for care coordination was highlighted as it may enable a series of recommendations for improved care, including: navigation between health providers, individualised, staged information; routine, proactive telephone needs-assessment and emotional support; and early routine integration of palliative care services., Conclusions: The results of this study shed new light on providing timely information and palliative care to support carers. We call for health services to reconsider the current medical model for this patient group, where patients are the centre of care, information and support, towards a more collaborative model which places carers and patients into a partnership.