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Objectives: Little is known about the use of antidementia medications in Australia. Other countries have reported sociodemographic disparities in use. Our objective was to estimate prevalence, duration, and time to initiation of antidementia medication (cholinesterase inhibitors or memantine) among Australians with dementia in residential aged care facilities and to evaluate resident and facility factors associated with use.Methods: Dynamic retrospective cohort study of people with dementia in 68 residential aged care facilities during 2014 to 2017 using electronic health record and medication administration data. Regression evaluated relationships between medication use (prevalence, duration, and time to initiation) and resident and facility characteristics.Results: Five thousand three hundred fifty-four residents with dementia were included in the analyses. Annual prevalence of antidementia medication use was less than 10% each year and decreased during the study period by 2-percentage points by 2017 (relative to 2014). Antidementia medication use varied by sociodemographic characteristics (3-points lower for single, 4-points lower for divorced relative to married residents, and 3-points higher for Australian-born). Each point in ADL score was associated with 0.1-point lower medication use. Antidementia medication use was lower in outer regional facilities. Most comorbidities were associated with lower antidementia medication use (myocardial infarction, cerebrovascular disease and heart failure 3-points lower, respiratory disease, and diabetes 2-points lower). Age had a complex relationship with antidementia medication use that varied by sex and if medication was started before or after admission. After admission, males initiated antidementia medication earlier than females.Conclusions: Antidementia medication use in Australian facilities was lower than in other countries and varied by clinical and sociodemographic factors. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to assess comparative emergency department (ED) resource utilisation across age groups. Methods: A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess comparative ED resource utilisation across six age groups (0–14, 15–35, 36–64, 65–74, 75–84 and ≥85 years) with previously used surrogate markers of ED resource utilisation. Results: Older people had significantly higher resource utilisation for their individual ED episodes of care than younger people, with the effect increasing with advancing age. Conclusion: With ED care of older people demonstrated to be more resource intensive than care for younger people, the projected increase in older person presentations anticipated with population aging will have a magnified effect on ED services. These predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people. What is known about the topic?: Current Australian ED funding models do not adjust for patient age. Several regional studies have suggested higher resource utilisation of ED patients aged ≥65 years. Anticipated rapid population aging mandates that contribution of age to ED visit resource utilisation be further explored. What does this paper add?: The present study of national Australian ED presentations compared ED resource utilisation across age groups using surrogate markers of ED cost. Older people were found to have significantly higher resource utilisation in the ED, with the effect increasing further with advancing age. What are the implications for practitioners?: The higher resource utilisation of older people in the ED warrants a review of current ED funding models to ensure that they will continue to meet the needs of an aging population. [ABSTRACT FROM AUTHOR]

This study aimed to describe patient-related characteristics of those attending the diabetes telehealth service delivered from a tertiary hospital and compare these with the characteristics of patients attending face-to-face visits at the same hospital's diabetes outpatient service. This analysis could inform diabetes telehealth service improvements. To our knowledge, there has been no prior evaluation of a diabetes telehealth service in Australia. A cross-sectional survey was conducted as part of the Australian National Diabetes Audit in May 2016 for all patients attending the diabetes telehealth service and diabetes outpatient service. The diabetes telehealth service was serving a greater proportion of females, indigenous people and patients with a longer mean duration of type 2 diabetes mellitus. Type 2 diabetes mellitus patients in the diabetes telehealth service group had a higher average glycated haemoglobin of 9.1% (76 mmol/mol) vs 8.1% (65 mmol/mol) in the diabetes outpatient service group. The diabetes telehealth service had more people with initial visits; had higher self-reported smoking rates in type 2 diabetes mellitus patients; and had adequate access to allied health supports as recommended for diabetes management. Diabetes telehealth service patients had more complex diabetes as evidenced by a higher proportion of indigenous clients, higher glycated haemoglobin and longer mean duration of diabetes. [ABSTRACT FROM AUTHOR]

Small rural hospitals admit and manage older adults who, in city hospitals, would usually be offered geriatrician-supported comprehensive geriatric assessment and coordinated subacute care if required. Distance and diseconomies of scale prohibit access to the conventional in-person approach. A telegeriatric service model involving a geriatrician consulting remotely using wireless, mobile, high-definition videoconferencing; a trained host nurse at the rural site; structured geriatric assessment configured on a web-based clinical decision support system; routine weekly virtual rounds; and support from a local multidisciplinary team was established to overcome these barriers. This was a prospective observational study to examine the feasibility and sustainability of the model. Patient characteristics were recorded using the interRAI Acute Care assessment system. Usage patterns were derived from health service data sets and a service statistics database. Patients had characteristics that are consistent with characteristics of individuals typically referred for geriatric assessment. Overall, 53% of patients had cognitive impairment, 75% had limitations with activities of daily living, and the average Frailty Index was 0.44 ± 0.12. Stable patterns of consultation occurred within 6 months of start-up and continued uninterrupted for the remainder of the 24-month observation period. The estimated overall rate of initial consultation was 1.83 cases per occupied bed per year and 2.66 review cases per occupied bed per year. The findings indicate that the model was feasible and was sustained throughout and beyond the study period. This telegeriatric service model appears suitable for use in small rural hospitals. [ABSTRACT FROM AUTHOR]

Background: A large proportion of diabetes patients do not receive a basic minimum of standard care. Telemedicine holds the promise of improving access to health care. However, the validity of remote consultation for diabetes has not been well researched. This pilot randomized control trial was designed to evaluate the agreement on prescription decisions of endocrinologists between two consultation formats: videoconferencing and face-to-face (in-person) consultation. Patients and Methods: Seventy-three patients were randomized to telemedicine ( n=36) and reference group ( n=37). Each study patient in the telemedicine group received one face-to-face consultation and one video consultation. The reference group received two face-to-face consultations. The paired consultations for each patient were performed by two different endocrinologists. The level of agreement between endocrinologists was evaluated by comparing their recommendations on antidiabetes and cardioprotective medications. Results: The level of agreement between two endocrinologists on changing antidiabetes drugs was 64% in the telemedicine group and 78% in the reference group. Although the level of agreement was lower when one of the consultations was provided via videoconference, the difference was not significant. The level of agreement on changing cardiovascular drugs was 78% in the telemedicine group and 76% in the reference group, again not significantly different. Conclusions: The results of this study demonstrate the preliminary evidence on the validity of recommendations made by endocrinologists via video consultation. Known limitations of videoconferencing for clinical purposes did not have remarkable impact on the outcome of consultation in terms of adjustment of patient's medications. Video teleconsultation can substitute for a considerable proportion of conventional outpatient specialty consultations for people with diabetes. [ABSTRACT FROM AUTHOR]

The article discusses the opportunities and challenges in the use of mobile health for diabetes care.

Although the basic PubMed search is often helpful, the results may sometimes be non-specific. For more control over the search process you can use the Advanced Search Builder interface. This allows a targeted search in specific fields, with the convenience of being able to select the intended search field from a list. It also provides a history of your previous searches. The search history is useful to develop a complex search query by combining several previous searches using Boolean operators. For indexing the articles in MEDLINE, the NLM uses a controlled vocabulary system called MeSH. This standardised vocabulary solves the problem of authors, researchers and librarians who may use different terms for the same concept. To be efficient in a PubMed search, you should start by identifying the most appropriate MeSH terms and use them in your search where possible. My NCBI is a personal workspace facility available through PubMed and makes it possible to customise the PubMed interface. It provides various capabilities that can enhance your search performance. [ABSTRACT FROM AUTHOR]

The way that PubMed results are displayed can be changed using the Display Settings drop-down menu in the result screen. There are three groups of options: Format, Items per page and Sort by, which allow a good deal of control. The results from several searches can be temporarily stored on the Clipboard. Records of interest can be selected on the results page using check boxes and can then be combined, for example to form a reference list. The Related Citations is a valuable feature of PubMed that can provide a set of similar articles when you have identified a record of interest among the results. You can easily search for RCTs or reviews using the appropriate filters or field tags. If you are interested in clinical articles, rather than basic science or health service research, then the Clinical Queries tool on the PubMed home page can be used to retrieve them. [ABSTRACT FROM PUBLISHER]

Background: The purpose of this study was to identify the clinimetric characteristics of specialist outpatient consultations for people with diabetes and to evaluate the possibility of providing such consultations remotely using telemedicine. Materials and Methods: The process of care was analyzed during the specialist consultations provided by five endocrinologists in a tertiary hospital diabetes outpatient clinic. The specialists' opinion of the possibility of providing each consultation remotely was also sought. Results: In total, 50 consultations were analyzed. The patients had type 1 and type 2 diabetes in 28% and 64% of the cases, respectively; 68% had at least one diabetes complication. Diabetic neuropathy was the most prevalent (42%) complication. Physical examination was not performed by the specialists in 34% of cases. General foot inspection, the most frequent examination, was performed in 54% of the consultations. After 'general advice,' ordering laboratory tests was the most frequent recommendation (80%), followed by adjustment of an insulin regimen (52%). In 86% of consultations, the specialists believed that it would have been possible to provide that consultation remotely via videoconferencing to a patient with the general practitioner present. In their opinion, communicating with the patients through e-mail was the least possible alternative means of providing the consultations. Conclusions: Endocrinologists with little telemedicine experience believe that a considerable proportion of outpatient specialty consultations for people with diabetes can be provided remotely via videoconferencing. The clinimetric analysis of 50 consultations supports this opinion. [ABSTRACT FROM AUTHOR]

PubMed provides free access via the Internet to more than 23 million records, of which over 19 million are from the MEDLINE database of journal articles. PubMed also provides access to other databases, such as the NCBI Bookshelf. To perform a basic search, you can simply enter the search terms or the concept that you are looking for in the search box. However, taking care to clarify your key concepts may save much time later on, because a non-specific search is likely to produce an overwhelming number of result hits. One way to make your search more specific is to specify which field you want to search using field tags. By default, the results of a search are sorted by the date added to PubMed and displayed in summary format with 20 result hits (records) on each page. In summary format, the title of the article, list of authors, source of information (e.g. journal name followed by date of publication, volume, issue, pages) and the unique PubMed record number called the PubMed identifier (PMID) are shown. Although information is stored about the articles, PubMed/MEDLINE does not store the full text of the papers themselves. However, PubMedCentral (PMC) stores more than 2.8 million articles (roughly 10% of the articles in PubMed) and provides access to them for free to the users. [ABSTRACT FROM PUBLISHER]

We analysed 56 video consultations provided in a 5-month period by two endocrinologists from the tele-endocrinology clinic of a tertiary teaching hospital in Brisbane. The patients were suffering from type 1 or type 2 diabetes, and 41% of them had at least one diabetic complication. Their mean age was 51 years and 45% were female. The consultations were provided to ten cities located 210-1800 km from Brisbane. A questionnaire was developed for analysing the video visits. It comprised 26 questions, arranged in six sections: (1) Patient characteristics, (2) Reason for referral, (3) Procedures and findings, (4) Recommendations, (5) Telehealth logistics, (6) Consultant's opinion. In 66% of consultations a nurse accompanied the patient. The specialist requested the nurse to perform a physical examination in 18% of these cases. No change in medications was made in 36% of the consultations. The most frequent recommendations were requesting laboratory tests (75%), insulin dose adjustments (39%) and referrals to an allied health professional (13%). Out of 56 consultations, the specialists indicated the need to perform a physical examination for 12 patients that was not possible remotely. However, they requested an in-person (face-to-face) visit for three patients. Nevertheless they believed that in 34% of the cases they could have made a better decision if the consultation had been in-person. Video consultation can substitute for a large proportion of in-person specialist consultations for people with diabetes who are referred to endocrinology specialists. [ABSTRACT FROM AUTHOR]

We analysed 56 video consultations provided in a 5-month period by two endocrinologists from the tele-endocrinology clinic of a tertiary teaching hospital in Brisbane. The patients were suffering from type 1 or type 2 diabetes, and 41% of them had at least one diabetic complication. Their mean age was 51 years and 45% were female. The consultations were provided to ten cities located 210–1800 km from Brisbane. A questionnaire was developed for analysing the video visits. It comprised 26 questions, arranged in six sections: (1) Patient characteristics, (2) Reason for referral, (3) Procedures and findings, (4) Recommendations, (5) Telehealth logistics, (6) Consultant’s opinion. In 66% of consultations a nurse accompanied the patient. The specialist requested the nurse to perform a physical examination in 18% of these cases. No change in medications was made in 36% of the consultations. The most frequent recommendations were requesting laboratory tests (75%), insulin dose adjustments (39%) and referrals to an allied health professional (13%). Out of 56 consultations, the specialists indicated the need to perform a physical examination for 12 patients that was not possible remotely. However, they requested an in-person (face-to-face) visit for three patients. Nevertheless they believed that in 34% of the cases they could have made a better decision if the consultation had been in-person. Video consultation can substitute for a large proportion of in-person specialist consultations for people with diabetes who are referred to endocrinology specialists. [ABSTRACT FROM AUTHOR]

Minimising the harm from inappropriate prescribing in older populations is a major urgent concern for modern healthcare systems. In everyday encounters between prescribers and patients, opportunities should be taken to identify patients at high risk of harm from polypharmacy and reappraise their need for specific drugs. Attempts to reconcile life expectancy, comorbidity burden, care goals and patient preferences with the benefits and harms of medications should be made in every patient at significant risk. Drugs identified by this process of reconciliation as conferring little or no benefit and/or excessive risk of harm should be candidates for discontinuation. Evidence supporting a structured approach to drug discontinuation (or deprescribing) is emerging, and while many barriers to deprescribing exist in routine practice, various enabling strategies can help overcome them. [ABSTRACT FROM AUTHOR]

Background: While frameworks exist to assist clinicians in prescribing appropriately in older patients at risk of adverse drug reactions, their impact on prescribing is uncertain. Objective: The aim of the study was to determine the effects of a ten-step drug minimization guide on clinician prescribing intentions involving a hypothetical older patient receiving multiple drugs. Methods: A total of 61 hospital clinicians were presented with clinical information about a hypothetical case: an 81-year-old female with 12 chronic diseases, receiving 19 different medications. On a standardized, anonymous form, each participant indicated, as a pre-test, which drugs they felt strongly inclined to discontinue or continue, and which drugs they were uncertain about. The ten-step guide was then presented and applied to the case, and participants repeated the drug selection process. Results: Sixty evaluable forms were analysed from 19 consultant physicians, 17 medical registrars, 7 interns/residents and 17 pharmacists. Among the entire cohort, the mean (±SD) number of drugs selected for discontinuation increased from 6.0 (±2.7) pre-test to 9.6 (±3.2) post-test (p<0.001), with the greatest increases seen among consultant physicians (6.6 [±2.3] to 11.5 [±2.9], p<0.001) and clinical pharmacists (5.3 [±2.6] to 8.9 [±2.2], p<0.001). The number of drugs associated with uncertainty decreased from 3.7 (±2.9) pre-test to 1.8 (±2.3) post-test (p<0.001) for the whole cohort, with the greatest decreases seen among consultant physicians (4.8 [±2.6] to 1.8 [±2.5], p <0.001) and clinical pharmacists (4.5 [±3.3] to 1.9 [±2.0], p=0.003). Conclusion: This self-report study involving a hypothetical case provides evidence that a drug minimization guide may reduce inappropriate pre- scribing and uncertainty around drug indications. [ABSTRACT FROM AUTHOR]

Specialist care consultations were identified by two research nurses using documentation in patient records, appointment diaries, electronic billing services and on-site observations at a 441-bed long term care facility. Over a six-month period there were 3333 consultations (a rate of 1511 consultations per year per 100 beds). Most consultations were for general practice (n = 2589, 78%); these consultations were mainly on site (99%), with only 27 taking place off site. There were 744 consultations for specialities other than general practice. A total of 146 events related to an emergency or unplanned hospital admission. The remaining medical consultations (n = 598, 18%) related to 23 medical specialities. The largest number of consultations were for surgery (n = 106), podiatry (n = 100), nursing services including wound care (n = 74), imaging (n = 41) and ophthalmology (n = 40). Many services which are currently being provided on site to metropolitan long-term care facilities could be provided by telehealth in both urban and rural facilities. [ABSTRACT FROM AUTHOR]

Background: Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific. Methods: From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system. Results: The rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations. Conclusion: This comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training. [ABSTRACT FROM AUTHOR]

Skype is a popular and free software application that allows PCs and mobile devices to be used for video communication over the Internet. We reviewed the literature to determine whether the clinical use of Skype is supported by evidence. One small (n = 7) controlled clinical trial had assessed the effect of nursing communication using Skype on elderly patients with dementia and their carers. However, we were unable to identify any large, well-designed studies which had formally evaluated the safety, clinical effectiveness, security and privacy of Skype for the routine delivery of patient care. While there were many case reports and small studies, no firm evidence either in favour of, or against the use of Skype for clinical telehealth was found. The risks and benefits of using Skype for clinical purposes are not known. [ABSTRACT FROM AUTHOR]

Background: This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. Methods: Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. Results: Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. Conclusions: This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts. [ABSTRACT FROM AUTHOR]

Residents of aged care services can experience safety incidents resulting in preventable serious harm. Accreditation is a commonly used strategy to improve the quality of care; however, narrative information within accreditation reports is not generally analysed as a source of safety information to inform learning. In Australia, the Aged Care Quality and Safety Commission (ACQSC), the sector regulator, undertakes over 500 accreditation assessments of residential aged care services against eight national standards every year. From these assessments, the Aged Care Quality and Safety Commission generates detailed Site Audit Reports. In over one-third (37%) of Site Audit Reports, standards relating to Personal and Clinical Care (Standard 3) are not being met. The aim of this study was to identify the types of resident Safety Risks that relate to Personal and Clinical Care Standards not being met during accreditation or re-accreditation. These data could inform priority setting at policy, regulatory, and service levels. An analytical framework was developed based on the World Health Organization's International Classification for Patient Safety and other fields including Clinical Issue (the issue related to the incident impacting the resident, e.g. wound/skin or pain). Information relating to safety incidents in the Site Audit Reports was extracted, and a content analysis undertaken using the analytical framework. Clinical Issue and the International Classification for Patient Safety–based classification were combined to describe a clinically intuitive category ('Safety Risks') to describe ways in which residents could experience unsafe care, e.g. diagnosis/assessment of pain. The resulting data were descriptively analysed. The analysis included 65 Site Audit Reports that were undertaken between September 2020 and March 2021. There were 2267 incidents identified and classified into 274 types of resident Safety Risks. The 12 most frequently occurring Safety Risks account for only 32.3% of all incidents. Relatively frequently occurring Safety Risks were organisation management of infection control; diagnosis/assessment of pain, restraint, resident behaviours, and falls; and multiple stages of wounds/skin management, e.g. diagnosis/assessment, documentation, treatment, and deterioration. The analysis has shown that accreditation reports contain valuable data that may inform prioritization of resident Safety Risks in the Australian residential aged care sector. A large number of low-frequency resident Safety Risks were detected in the accreditation reports. To address these, organizations may use implementation science approaches to facilitate evidence-based strategies to improve the quality of care delivered to residents. Improving the aged care workforces' clinical skills base may address some of the Safety Risks associated with diagnosis/assessment and wound management. [ABSTRACT FROM AUTHOR]

Abstract: The increasing burden of harm resulting from the use of multiple drugs in older patient populations represents a major health problem in developed countries. Approximately 1 in 4 older patients admitted to hospitals are prescribed at least 1 inappropriate medication, and up to 20% of all inpatient deaths are attributable to potentially preventable adverse drug reactions. To minimize this drug-related iatrogenesis, we propose a quality use of medicine framework that comprises 10 sequential steps: 1) ascertain all current medications; 2) identify patients at high risk of or experiencing adverse drug reactions; 3) estimate life expectancy in high-risk patients; 4) define overall care goals in the context of life expectancy; 5) define and confirm current indications for ongoing treatment; 6) determine the time until benefit for disease-modifying medications; 7) estimate the magnitude of benefit versus harm in relation to each medication; 8) review the relative utility of different drugs; 9) identify drugs that may be discontinued; and 10) implement and monitor a drug minimization plan with ongoing reappraisal of drug utility and patient adherence by a single nominated clinician. The framework aims to reduce drug use in older patients to the minimum number of essential drugs, and its utility is demonstrated in reference to a hypothetic case study. Further studies are warranted in validating this framework as a means for assisting clinicians to make more appropriate prescribing decisions in at-risk older patients. [Copyright &y& Elsevier]

Objectives: This study aimed to systematically review and summarize economic evaluations of noninvasive remote patient monitoring (RPM) for chronic diseases compared with usual care.Methods: A systematic literature search identified economic evaluations of RPM for chronic diseases, compared with usual care. Searches of PubMed, Embase, CINAHL, and EconLit using keyword synonyms for RPM and economics identified articles published from up until September 2021. Title, abstract, and full-text reviews were conducted. Data extraction of study characteristics and health economic findings was performed. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist.Results: This review demonstrated that the cost-effectiveness of RPM was dependent on clinical context, capital investment, organizational processes, and willingness to pay in each specific setting. RPM was found to be highly cost-effective for hypertension and may be cost-effective for heart failure and chronic obstructive pulmonary disease. There were few studies that investigated RPM for diabetes or other chronic diseases. Studies were of high reporting quality, with an average Consolidated Health Economic Evaluation Reporting Standards score of 81%. Of the final 34 included studies, most were conducted from the healthcare system perspective. Eighteen studies used cost-utility analysis, 4 used cost-effectiveness analysis, 2 combined cost-utility analysis and a cost-effectiveness analysis, 1 used cost-consequence analysis, 1 used cost-benefit analysis, and 8 used cost-minimization analysis.Conclusions: RPM was highly cost-effective for hypertension and may achieve greater long-term cost savings from the prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings differed according to disease severity and there was limited economic evidence for diabetes interventions. [ABSTRACT FROM AUTHOR]

Background: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life.Objective: In this study (CareTrack Aged, CT Aged), we aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes in aged care.Methods: Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multiround modified Delphi process to develop a consensus on what constitutes appropriate care.Results: From 139 CPGs, 5609 recommendations were used to draft 630 indicators. Clinical experts (n = 41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment; bladder and bowel problems; cognitive impairment; depression; dysphagia and aspiration; end of life/palliative care; hearing and vision; infection; medication; mobility and falls; nutrition and hydration; oral and dental care; pain; restraint use; skin integrity and sleep.Conclusions: The suite of CT Aged clinical indicators can be used for research and assessment of the quality of care in individual facilities and across organizations to guide improvement and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved. [ABSTRACT FROM AUTHOR]

Background An estimated 366 million people are living with diabetes worldwide and it is predicted that its prevalence will increase to 552 million by 2030. Management of this disease and its complications is a challenge for many countries. Optimal glycaemic control is necessary to minimize complications, but less than 70% of diabetic patients achieve target levels of blood glucose, partly due to poor access to qualified health care providers. Telemedicine has the potential to improve access to health care, especially for rural and remote residents. Video teleconsultation, a real-time (or synchronous) mode of telemedicine, is gaining more popularity around the world through recent improvements in digital telecommunications. If video consultation is to be offered as an alternative to face-to-face consultation in diabetes assessment and management, then it is important to demonstrate that this can be achieved without loss of clinical fidelity. This paper describes the protocol of a randomised controlled trail for assessing the reliability of remote video consultation for people with diabetes. [ABSTRACT FROM AUTHOR]

Context: In an international context of cost reduction, it is necessary to measure nursing outcomes with reliable and valid instruments to produce indicators of effectiveness, improve the quality of care and ensure accountability. Aim: To validate the International Resident Assessment Instrument -- Acute Care (InterRAI-AC) for the Portuguese population. Methodology: Longitudinal, descriptive and correlational study. Data were collected between March and July 2012 by nurses of 26 medical and surgical services of four hospitals in the Central Region of Portugal. The sample was composed of 1764 patients hospitalized for a period equal to or greater than three days. All ethical procedures were observed. Results: The instrument has proved to be valid and reliable, and can be used to obtain data for different purposes: quality indicators; care planning; evidence base for decision-making, among others. Conclusion: The main barrier identified was the time required for its completion, but it proved to be a key tool in the process of collecting information on patients. [ABSTRACT FROM AUTHOR]

Context: In an international context of cost reduction, it is necessary to measure nursing outcomes with reliable and valid instruments to produce indicators of effectiveness, improve the quality of care and ensure accountability. Aim: To validate the International Resident Assessment Instrument - Acute Care (InterRAI-AC) for the Portuguese population. Methodology: Longitudinal, descriptive and correlational study. Data were collected between March and July 2012 by nurses of 26 medical and surgical services of four hospitals in the Central Region of Portugal. The sample was composed of 1764 patients hospitalized for a period equal to or greater than three days. All ethical procedures were observed. Results: The instrument has proved to be valid and reliable, and can be used to obtain data for different purposes: quality indicators; care planning; evidence base for decision-making, among others. Conclusion: The main barrier identified was the time required for its completion, but it proved to be a key tool in the process of collecting information on patients. [ABSTRACT FROM AUTHOR]

Context: In an international context of cost reduction, it is necessary to measure nursing outcomes with reliable and valid instruments to produce indicators of effectiveness, improve the quality of care and ensure accountability. Aim: To validate the International Resident Assessment Instrument -- Acute Care (InterRAI-AC) for the Portuguese population. Methodology: Longitudinal, descriptive and correlational study. Data were collected between March and July 2012 by nurses of 26 medical and surgical services of four hospitals in the Central Region of Portugal. The sample was composed of 1764 patients hospitalized for a period equal to or greater than three days. All ethical procedures were observed. Results: The instrument has proved to be valid and reliable, and can be used to obtain data for different purposes: quality indicators; care planning; evidence base for decision-making, among others. Conclusion: The main barrier identified was the time required for its completion, but it proved to be a key tool in the process of collecting information on patients. [ABSTRACT FROM AUTHOR]

We analysed the costs of two kinds of dementia clinic. In the conventional clinic, held in a rural area, the specialist travels to the clinic from the city. In the videoconferencing clinic, patients are also seen in a rural area, but the specialist conducts the assessment by video from the city. The fixed costs common to both modalities, such as clinic infrastructure, were ignored. The total fixed cost of a monthly conventional clinic was $522 and the total fixed cost of a monthly videoconferencing clinic was $881. The additional variable cost of the specialist travelling to the conventional clinic was $2.62 per minute of the specialist's travelling time. The break-even point at which the cost of the two modalities is the same was just over two hours (138 min round trip). A sensitivity analysis showed that the break-even point was not particularly sensitive to changes in staff wages, but slightly more sensitive to the non labour costs of videoconferencing. Air travel is not an efficient alternative to travel by car. Reducing the number of clinics to six per year results in a much higher cost of running the videoconferencing service compared to the conventional service. Videoconferencing for the purpose of diagnosing dementia is both a reliable and cost effective method of health service provision when a specialist is required to drive for more than about two hours (round trip) to provide a memory disorder clinic service. [ABSTRACT FROM AUTHOR]

Background: A key goal for services treating older persons is improving Quality of Life (QoL). This study aimed to 1) determine the QoL and utility (i.e. satisfaction with own quality of life) for participants of a discharge program for older people following an extended hospital episode of care and 2) examine the impact of the intensity of this program on utility gains over time. Methods: A prospective observational cohort study with baseline and repeated measures follow up of 351 participants of the transition care program in six community sites in two states of Australia was conducted. All participants who gave consent to participate were eligible for the study. QoL and utility of the participants were measured at baseline, end of program, three and six months post baseline using the EQ-5D and ICECAP-O. Association between the intensity of the program, measured in hours of care given, and improvement in utility were tested using linear regression. Results: The ICECAP-O yielded consistently higher utility values than the EQ-5D at all time points. Baseline mean (sd) utility scores were 0.55 (0.20) and 0.75(0.16) and at six months were 0.60 (0.28) and 0.84 (0.25) for the EQ-5D and ICECAP-O respectively. The ICECAP-O showed a significant improvement over time. The intensity of the post-acute program measured by hours delivered was positively associated with utility gains in this cohort. Conclusions: A discharge program for older frail people following an extended hospital episode of care appears to maintain and generate improvements in QoL. The amount of gain was positively influenced by the intensity of the program. [ABSTRACT FROM AUTHOR]

We carried out a six month scoping study to ascertain current health service needs in the Queensland towns of Dalby, Chinchilla and Miles. The towns have a high proportion of their populations in the dependent age groups of over 65 years of age and less than 14 years of age. This implies a need for ready access to paediatric and geriatric specialist services. The hospitals in the three towns provided a range of health services, but patients still had to be referred to Toowoomba and Brisbane for specialist consultations. All three hospitals had videoconference facilities, but videoconferencing was mainly used for education, administration and training. General practitioners in the three towns did not use telehealth in their practice. The study reinforced the potential for telehealth services in three key domains: regional hospitals, residential aged-care facilities and general practice. [ABSTRACT FROM AUTHOR]

The rising of global geriatric population has contributed to increased prevalence of dementia. Dementia is a neurodegenerative disease, which is characterized by progressive deterioration of cognitive functions, such as judgment, language, memory, attention and visuospatial ability. Dementia not only has profoundly devastating physical and psychological health outcomes, but it also poses a considerable healthcare expenditure and burdens. Acetylcholinesterase inhibitors (AChEIs), or so-called anti-dementia medications, have been developed to delay the progression of neurocognitive disorders and to decrease healthcare needs. AChEIs have been widely prescribed in clinical practice for the treatment of Alzheimer's disease, which account for 70% of dementia. The rising use of AChEIs results in increased adverse drug reactions (ADRs) such as cardiovascular and gastrointestinal adverse effects, resulting from overstimulation of peripheral cholinergic activity and muscarinic receptor activation. Changes in pharmacokinetics (PK), pharmacodynamics (PD) and pharmacogenetics (PGx), and occurrence of drug interactions are said to be major risk factors of ADRs of AChEIs in this population. To date, comprehensive reviews in ADRs of AChEIs have so far been scarcely studied. Therefore, we aimed to recapitulate and update the diverse aspects of AChEIs, including the mechanisms of action, characteristics and risk factors of ADRs, and preventive strategies of their ADRs. The collation of this knowledge is essential to facilitate efforts to reduce ADRs of AChEIs. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate polypharmacy is common in residential aged care facilities (RACF). This is of particular concern among people with cognitive impairment who, compared with cognitively intact residents, are potentially more sensitive to the adverse effects of medications. Aim: To compare the patterns of medication prescribing of RACF residents based on cognitive status. Methods: De‐identified data collected during telehealth‐mediated geriatric consultations with 720 permanent RACF residents were analysed. Residents were categorised into cognitively intact, mild to moderate impairment and severe impairment groups using the interRAI Cognitive Performance Scale. The number of all regular and when‐required medications used in the past 3 days, the level of exposure to anti‐cholinergic/sedative medications and potentially inappropriate medications and the use of preventive and symptom control medications were compared across the groups. Results: The median number of medications was 10 (interquartile range (IQR) 8–14). Cognitively intact residents were receiving significantly more medications (median (IQR) 13 (10–16)) than those with mild to moderate (10 (7–13)) or severe (9 (7–12)) cognitive impairment (P < 0.001). Overall, 82% of residents received at least one anti‐cholinergic/sedative medication and 26.9% were exposed to one or more potentially inappropriate medications, although the proportions of those receiving such medications were not significantly different across the groups. Of 7658 medications residents were taking daily, 21.3% and 11.7% were classified as symptom control and preventive medications respectively with no significant difference among the groups in their use. Conclusion: Our findings highlight the need for optimising prescribing in RACF residents, with particular attention to medications with anti‐cholinergic effects. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the cost-effectiveness of remote patient monitoring (RPM) with First Nations peoples living with diabetes. This study was set at the Goondir Health Service (GHS), an Aboriginal and Torres Strait Islander Community-Controlled Health in South-West Queensland. Electronic medical records and RPM data were provided by the GHS. Clinical effectiveness was determined by comparing mean HbA1c before and after enrolment in the RPM service. Our analysis found no statistically significant effect between the mean HbA1c before and after enrolment, so this analysis focused on net-benefit and return on investment for costs from the perspective of the GHS. The 6-month RPM service for 84 clients cost AUD $67,841 to cover RPM equipment, ongoing technology costs, and a dedicated Virtual Care Manager, equating to $808 per client. There were 199 additional client–clinician interactions in the period after enrolment resulting in an additional $4797 revenue for the GHS. Therefore, the program cost the GHS $63,044 to deliver, representing a return on investment of around 7 cents for every dollar they spent. Whilst the diabetes RPM service was equally effective as usual care and resulted in increased interactions with clients, the cost for the service was substantially more than the additional revenue generated from increased interactions. This evidence highlights the need for alternative funding models for RPM services and demonstrates the need to focus future research on long-term clinical effects and the extra-clinical benefits resulting from services of this type. [ABSTRACT FROM AUTHOR]

Background: Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. Methods: In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006–2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. Results: Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. Conclusions: The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Many patients with diabetes require insulin therapy to achieve optimal glycemic control. Initiation and titration of insulin often require an insulin dose adjustment (IDA) program, involving frequent exchange of blood glucose levels (BGLs) and insulin prescription advice between the patient and healthcare team. This process is time consuming with logistical barriers. Objective: To develop an innovative mobile health (m-Health) mobile-based IDA program (mIDA) and evaluate the user adherence and experience through a proof-of-concept trial. Methods: In the program, an m-Health system was designed to be integrated within a clinical IDA service, comprising a Bluetooth-enabled glucose meter, smartphone application, and clinician portal. Insulin-requiring patients with type-2 diabetes mellitus and stable BGL were recruited to use the m-Health system to record and exchange BGL entries, insulin dosages, and clinical messages for 2 weeks. The user experience was evaluated by a Likert scale questionnaire. Results: Nine participants, aged 58 ± 14 years (mean ± SD), completed the trial with average daily records of 3.1 BGL entries and 1.2 insulin dosage entries. The participants recognized the potential value of the clinical messages. They felt confident about managing their diabetes and were positive regarding ease of use and family support of the system, but disagreed that there were no technical issues. Finally, they were satisfied with the program and would continue to use it if possible. Conclusions: The m-Health system for IDA showed promising levels of adherence, usability, perception of usefulness, and satisfaction. Further research is required to assess the feasibility and cost-effectiveness of using this system in outpatient settings. [ABSTRACT FROM AUTHOR]

Planning a research strategy and formulating the right research questions at various stages of developing a telehealth intervention are essential for producing scientific evidence. The aim of research at each stage should correspond to the maturity of the intervention and will require a variety of study designs. Although there are several published evaluation frameworks for telemedicine or telehealth as a subset of broader eHealth domain, there is currently no simple model to guide research planning. In this paper we propose a five-stage model as a framework for planning a comprehensive telehealth research program for a new intervention or service system. The stages are: (1) Concept development, (2) Service design, (3) Pre-implementation, (4) Implementation, (5) Post-implementation, and at each stage a number of studies are considered. Robust evaluation is important for the widespread acceptance and implementation of telehealth. We hope this framework enables researchers, service administrators and clinicians to conceptualise, undertake and appraise telehealth research from the point of view of being able to assess how applicable and valid the research is for their particular circumstances. [ABSTRACT FROM AUTHOR]

Background While medications may prolong life and prevent morbidity in older people, adverse effects of polypharmacy are increasingly recognised. As patients age and become frail, prescribing may be expected to focus more on symptom control and minimise potentially harmful preventive medication use that confer little benefit within a short lifespan. Whether prescribing practice shifts to one of symptom controls among the oldest old admitted to hospital remains unclear. Aim To determine, in the oldest old inpatients, whether preventive versus symptom control medication prescribing was associated with age or level of frailty. Methods Retrospective analysis of all patients aged ≥85 years referred for comprehensive geriatric assessment at a tertiary care hospital between May 2006 and December 2014 for whom all prescribed medications were documented. Medication use was assessed according to age group (85-89, 90-94, ≥95) and categories of frailty index calculated for patients based on 52 deficits (fitter, moderately frail, frail and severely frail). Results Seven hundred and eighty-three inpatients were assessed of mean ( SD) age 89.0 (3.4) and mean frailty index 0.45 ( SD 0.14) with a median of eight co-morbidities ( IQR 6-10) and who were prescribed a mean of 8.3 ( SD 3.8) regular medications per day. Polypharmacy (5-9 medications per day) was observed in 406 patients (51.9%) and hyper-polypharmacy (≥10 medications per day) in 268 patients (34.2%). While there was a significant decrease in number of prescribed medications as age increased, there were no differences across age groups or frailty categories in proportions of medications used for prevention versus symptom control. Conclusion Polypharmacy is prevalent in oldest old inpatients and prescribing patterns according to prevention versus symptom control appear unaffected by age and frailty status. [ABSTRACT FROM AUTHOR]

Objectives To determine whether geriatric triage decisions made using a comprehensive geriatric assessment ( CGA) performed online are less reliable than face-to-face ( FTF) decisions. Design Multisite noninferiority prospective cohort study. Two specialist geriatricians assessed individuals sequentially referred for an acute care geriatric consultation. Participants were allocated to one FTF assessment and an additional assessment ( FTF or online ( OL)), creating two groups-two FTF ( FTF- FTF, n = 81) or online and FTF ( OL- FTF, n = 85). Setting Three acute care public hospitals in two Australian states. Participants Admitted individuals referred for CGA. Intervention Nurse-administered CGA, based on the inter RAI Acute Care assessment system accessed online and other online clinical data such as pathology results and imaging enabling geriatricians to review participants' information and provide input into their care from a distance. Measurements The primary decision subjected to this analysis was referral for permanent residential care. Geriatricians also recorded recommendations for referrals and variations for medication management and judgment regarding prognosis at discharge and after 3 months. Results Overall percentage agreement was 88% (n = 71) for the FTF- FTF group and 91% (n = 77) for the OL- FTF group. The difference in agreement between the FTF- FTF and OL- FTF groups was −3%, indicating that there was no difference between the methods of assessment. Judgements made regarding diagnoses of geriatric syndromes, medication management, and prognosis (with regard to hospital outcome and location at 3 months) were found to be equally reliable in each mode of consultation. Conclusion Geriatric assessment performed online using a nurse-administered structured CGA system was no less reliable than conventional assessment in making clinical triage decisions. [ABSTRACT FROM AUTHOR]

Aims: frailty is proposed as a summative measure of health status and marker of individual vulnerability. We aimed to investigate the discriminative capacity of a frailty index (FI) derived from interRAI Comprehensive Geriatric Assessment for Acute Care (AC) in relation to multiple adverse inpatient outcomes. Methods: in this prospective cohort study, an FI was derived for 1,418 patients ≥70 years across 11 hospitals in Australia. The interRAI-AC was administered at admission and discharge by trained nurses, who also screened patients daily for geriatric syndromes. Results: in adjusted logistic regression models an increase of 0.1 in FI was significantly associated with increased likelihood of length of stay >28 days (odds ratio [OR]: 1.29 [1.10-1.52]), new discharge to residential aged care (OR: 1.31 [1.10-1.57]), in-hospital falls (OR: 1.29 [1.10-1.50]), delirium (OR: 2.34 [2.08-2.63]), pressure ulcer incidence (OR: 1.51 [1.23-1.87]) and inpatient mortality (OR: 2.01 [1.66-2.42]). For each of these adverse outcomes, the cut-point at which optimal sensitivity and specificity occurred was for an FI > 0.40. Specificity was higher than sensitivity with positive predictive values of 7-52% and negative predictive values of 88-98%. FI-AC was not significantly associated with readmissions to hospital. Conclusions: the interRAI-AC can be used to derive a single score that predicts multiple adverse outcomes in older inpatients. A score of ≤0.40 can well discriminate patients who are unlikely to die or experience a geriatric syndrome. Whether the FI-AC can result in management decisions that improve outcomes requires further study. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the present study was to describe trends in and age and gender distributions of presentations of older people to Australian emergency departments (EDs) from July 2006 to June 2011, and to develop ED utilisation projections to 2050. Methods. A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess trends in ED presentations. Three standard Australian Bureau of Statistics population growth models, with and without adjustment for current trends in ED presentation growth and effects of climate change, were examined with projections of ED presentations across three age groups (0-64, 65-84 and ⩾85 years) to 2050. Results. From 2006-07 to 2010-11, ED presentations increased by 12.63%, whereas the Australian population over this time increased by only 7.26%. Rates of presentation per head of population were greatest among those aged ⩾85 years. Projections of ED presentations to 2050 revealed that overall ED presentations are forecast to increase markedly, with the rate of increase being most marked for older people. Conclusion. Growth in Australian ED presentations from 2006-07 to 2010-11 was greater than that expected from population growth alone. The predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people. [ABSTRACT FROM AUTHOR]

We examined the procedures for implementing group videoconference (VC) education for older people delivered into the home environment to identify the most common themes affecting the optimum delivery of VC home-based groups to older people. Participants (n = 52) were involved in a six-week group VC patient education program. There were a total of 44 sessions, undertaken by nine groups, with an average of four participants (range 1-7) and the facilitator. Participants could see and hear each other in real-time whilst in their homes with customised tablets or a desktop computer. The data presented here are based on a program log maintained by the facilitator throughout the implementation phase of the project and post intervention. The VC group experience is influenced by factors including the VC device location, connection processes, meeting times, use of visual aids and test calls. Social presence can be improved by communication protocols and strategies. Robust information technology (IT) support is essential in mitigating technical problems to enhance users' experience. Group patient education can be delivered by VC into homes of older people. However, careful pre-program planning, training and support should be considered when implementing such programs. [ABSTRACT FROM AUTHOR]

The aim of this study was to report the time taken by geriatricians to reach triage decisions using an online assessment format compared with face-to-face (FTF) assessment. Patients (N = 166) were randomly allocated to two groups: online and FTF assessments (OF group); and dual FTF assessments (FF group). Case preparation was conducted by trained nurse assessors using a web-enabled clinical decision support system. Geriatricians allocated to perform an 'online' assessment had access to this information only. Geriatricians allocated FTF assessments reviewed this data, as well as the paper-based medical file and then consulted directly with the patient and attending staff. Data were collected in relation to time taken to complete OL assessments, compared with FTF assessments. A complete OL consultation averages 10 minutes, and a FTF consultation almost 26 minutes. In FTF consultations, less time is spent using the OL material when the geriatrician is aware that they will have access to the patient chart and need time to speak with the patient. The less time taken using the OL approach did not significantly alter the triage decisions made by the geriatricians. [ABSTRACT FROM AUTHOR]

Aim Frail older people typically suffer several chronic diseases, receive multiple medications and are more likely to be institutionalized in residential aged care facilities. In such patients, optimizing prescribing and avoiding use of high-risk medications might prevent adverse events. The present study aimed to develop a pragmatic, easily applied algorithm for medication review to help clinicians identify and discontinue potentially inappropriate high-risk medications. Methods The literature was searched for robust evidence of the association of adverse effects related to potentially inappropriate medications in older patients to identify high-risk medications. Prior research into the cessation of potentially inappropriate medications in older patients in different settings was synthesized into a four-step algorithm for incorporation into clinical assessment protocols for patients, particularly those in residential aged care facilities. Results The algorithm comprises several steps leading to individualized prescribing recommendations: (i) identify a high-risk medication; (ii) ascertain the current indications for the medication and assess their validity; (iii) assess if the drug is providing ongoing symptomatic benefit; and (iv) consider withdrawing, altering or continuing medications. Decision support resources were developed to complement the algorithm in ensuring a systematic and patient-centered approach to medication discontinuation. These include a comprehensive list of high-risk medications and the reasons for inappropriateness, lists of alternative treatments, and suggested medication withdrawal protocols. Conclusions The algorithm captures a range of different clinical scenarios in relation to potentially inappropriate medications, and offers an evidence-based approach to identifying and, if appropriate, discontinuing such medications. Studies are required to evaluate algorithm effects on prescribing decisions and patient outcomes. Geriatr Gerontol Int 2016; 16: 1002-1013. [ABSTRACT FROM AUTHOR]

Background: Low activity levels in inpatient rehabilitation are associated with adverse outcomes. The study aimed to test whether activity levels can be increased by the provision of monitored activity data to patients and clinicians in the context of explicit goal setting. Methods: A randomized controlled trial in three sites in Australia included 255 inpatients aged 60 and older who had a rehabilitation goal to become ambulant. The primary outcome was patients’ walking time measured by accelerometers during the rehabilitation admission. Walking times from accelerometry were made available daily to treating therapists and intervention participants to motivate patients to improve incidental activity levels and reach set goals. For the control group, ‘usual care’ was followed, including the setting of mobility goals; however, for this group, neither staff nor patients received data on walking times to aid the setting of daily walking time targets. Results: The median daily walking time in the intervention group increased from 10.3 minutes at baseline to 32.1 minutes at day 28, compared with an increase from 9.5 to 26.5 minutes per day in the control group. Subjects in the intervention group had significantly higher non-therapy walking time by about 7 minutes [mean (95% CI): 24.6 (21.7, 27.4)] compared to those in the control group [mean(95% CI): 17.3 (14.4, 20.3)] (p = 0.001). Conclusions: Daily feedback to patients and therapists using an accelerometer increased walking times during rehabilitation admissions. The results of this study suggest objective monitoring of activity levels could provide clinicians with information on clinically important, mobility-related activities to assist goal setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12611000034932 [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A review of telemedicine interventions in diabetes care," by L. S. Siriwardena and colleagues in the 2012 issue.

Objectives To validate the Pressure Ulcer Risk Scale ( PURS) to screen for pressure ulcer ( PU) outcomes in the acute hospital setting. Design Secondary data analysis was undertaken using a combined dataset from three prospective cohort studies. Setting General medical, surgical, and orthopedic wards in 11 hospitals in two states of Australia. Participants Individuals aged 70 and older admitted to the hospital for longer than 48 hours from July 2005 to May 2010 (N = 1418). Individuals in coronary or intensive care units, palliative care, or transferred out of the ward within 24 hours were excluded. Measurements Trained nurses used the international Resident Assessment Instrument (inter RAI) Acute Care ( AC) assessment tool to collect data at admission and discharge. Adverse outcomes were documented on daily ward visits. The PURS was calculated from inter RAI items, and its association with PU outcomes was tested using the c-statistic (area under the receiver operator characteristic curve). Results Complete data were available for 1,371 (96.7%) participants, 85 of whom (6.2%) had a PU at admission. Of the 1,286 without PUs at admission, 42 (3.3%) developed a new PU during their hospital stay. The association between PURS and outcomes had a c-statistic of 0.81 (standard error (SE) 0.02) for prevalent ulcers at admission and 0.70 (SE 0.04) for incidence of new PUs. Conclusion When derived from the inter RAI AC tool, the PURS demonstrated good to strong ability to screen for PU outcome in acute care. Assessment burden is reduced without loss of fidelity by integrating the risk scale into an existing assessment system. [ABSTRACT FROM AUTHOR]

Background: older people are high users of healthcare resources. The frailty index can predict negative health outcomes; however, the amount of extra resources required has not been quantified. Objective: to quantify the impact of frailty on healthcare expenditure and resource utilisation in a patient cohort who entered a community-based post-acute program and compare this to a cohort entering residential care. Methods: the interRAI home care assessment was used to construct a frailty index in three frailty levels. Costs and resource use were collected alongside a prospective observational cohort study of patients. A generalized linear model was constructed to estimate the additional cost of frailty and the cost of alternative residential care for those with high frailty. Results: participants (n = 272) had an average age of 79, frailty levels were low in 20%, intermediate in 50% and high in 30% of the cohort. Having an intermediate or high level of frailty increased the likelihood of re-hospitalisation and was associated with 22 and 43% higher healthcare costs over 6 months compared with low frailty. It was less costly to remain living at home than enter residential care unless >62% of subsequent hospitalisations in 6 months could be prevented. Conclusions: the frailty index can potentially be used as a tool to estimate the increase in healthcare resources required for different levels of frailty. This information may be useful for quantifying the amount to invest in programs to reduce frailty in the community. [ABSTRACT FROM AUTHOR]

Introduction: Small hospitals in rural areas usually have an insufficient caseload of frail old people to justify the regular presence of a geriatrician. This study examined the costs of providing a telegeriatric service by videoconference in a rural hospital, compared to the costs of a visiting geriatrician that travels to undertake in-person consultations.Methods: A cost analysis was undertaken to compare the costs of the telegeriatric service model with the costs of a visiting geriatrician service model. A recently established telegeriatric service at Warwick Hospital was used as a case study.Results: In the base case model (assuming four patients per round and a round-trip travel distance of 312 kilometres), an estimated AUD$131 per patient consultation can be saved in favour of the telegeriatric service model. Key drivers of costs are the number of patients per round and the travel distance and time in the visiting geriatrician model. At a workload of four patients per round, it is less expensive to conduct a telegeriatric service than a visiting geriatrician service when the round-trip travel time exceeds 76 minutes.Discussion: Even under quite conservative assumptions, a telegeriatric service offers an economically feasible approach to the delivery of specialist geriatric assessment in rural and remote settings. [ABSTRACT FROM AUTHOR]

Background: The Princess Alexandra Hospital Telehealth Centre (PAH-TC) is a project jointly funded by the Australian national government and Queensland Health. It seeks to provide a whole-of-hospital telehealth service using videoconferencing and store-and-forward capabilities for a range of specialities. The aim of this study was to investigate whether the introduction of a new telehealth coordination service provided by a tertiary hospital centre increased telehealth activities of a tertiary hospital. Evaluation included service delivery records and stakeholder satisfaction.Methods: Telehealth service delivery model before and after the establishment of the centre is described as well as the project implementation. The study retrieved data related to the number and scope of previous, and current, telehealth service episodes, to ascertain any change in activity levels following the introduction of the new telehealth coordination service. In addition, using a cross-sectional research design, the satisfaction of patients, clinicians and administrators was surveyed. The survey focused on technical utility and perceived clinical validity.Results: Introduction of a new centralised telehealth coordination service was associated with an increase in the scope of telehealth from five medical disciplines, in the year before the establishment, to 34 disciplines two years after the establishment. The telehealth consultations also increases from 412 (the year before), to 735 (one year after) and 1642 (two years after) the establishment of the centre. Respondents to the surveys included patients (27), clinicians who provided the consultations (10) and clinical or administrative staff who hosted the telehealth consultations in the remote site (8). There were high levels of agreement in relation to the telehealth option saving time and money, and an important health service delivery model. There was evidence from the remote site that modifying roles to incorporate this new service was challenging.Conclusion: The introduction of a centralised coordination for telehealth service of a tertiary hospital was associated with the increase in the scope and level of telehealth activity of the hospital. The project and model of health care delivery described in this paper can be adopted by tertiary hospitals to grow their telehealth activities, and potentially reduce costs associated with the delivery of services at a distance. [ABSTRACT FROM AUTHOR]

Telemedicine has been increasingly researched during the past few decades and the technology used by health care providers and recipients has changed dramatically. However, little has been published on technical characteristics of video consultations and how these characteristics have changed over time due to rapid advancement of information and communication technology. We aimed to summarize various types of technologies used for interactive videoconferencing between health care providers and patients, and identify the trend of their change from 2002 to 2012. A comprehensive electronic search was performed using PubMed, Embase and CINAHL databases which yielded 2,411 unique records. After screening at title/abstract level, full texts of 505 articles were retrieved and explored for technical information of videoconferencing. The trend of number of publications fluctuated between 41 and 47 articles with no specific pattern, though a dip in 2004 (n = 35) and drastic increase in 2012 (n = 68) was evident. The equipment used for videoconferencing was not mentioned in 15% of the papers. Dedicated VC systems (CODECs), were the most commonly used hardware, followed by computer/laptop/notebook. The connection speed (bandwidth) was not reported in 46% of the papers. The proportion of articles reporting the connection speed declined over time. Details of image quality and frame rate were mentioned in 11% and 5% of the papers, respectively. The results of this study showed that a high proportion of telemedicine papers lack sufficient technical details that limits their repeatability and generalizability. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the level of patient satisfaction with diabetes remote consultations via videoconferencing in a virtual outreach clinic. Materials and Methods: A cross-sectional observational survey was conducted of people with diabetes who were living in regional cities of Queensland, Australia, and remotely consulted by endocrinologists at the Princess Alexandra Hospital tele-endocrinology clinic in Brisbane during autumn 2013. A questionnaire with 15 multiple-choice questions and one open-ended question was developed for assessing patient satisfaction with videoconferencing for specialty consultation. The questionnaire items showed strong internal consistency (Cronbach's α=0.90). Patient satisfaction was assessed by this 16-item questionnaire exploring four dimensions: equipment/technical issues; communication and rapport; clinical assessment; and program evaluation. Results: In total, 62 questionnaires were mailed to the patients, with 24 (39%) surveys completed and returned. The quality of video had the highest satisfaction rate (100%). The lowest satisfaction scores were reported in the 'Clinical Assessment' dimension, in which 21% of respondents (five of 24) were concerned that the lack of physical contact could be a problem for managing their diabetes. The patients did not report any problem with building rapport with their consultant over the videoconference. Conclusions: The patients with diabetes who were seen remotely by endocrinologists via videoconferencing were generally satisfied with remote consultation. The questionnaire developed specifically for diabetes video teleconsultation in this study is useful for the measurement of patient satisfaction, and a modified version may be used in other clinical specialties. [ABSTRACT FROM AUTHOR]