Publications
Books
World Health Organization 2015, Framework for a public health emergency operations centre, World Health Organization, Geneva.
Journal articles
Agar, M, Beattie, E, Luckett, T, Phillips, J, Luscombe, G, Goodall, S, Mitchell, G, Pond, D, Davidson, PM & Chenoweth, L 2015, 'Pragmatic cluster randomised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol', BMC PALLIATIVE CARE, vol. 14, no. 1.
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© 2015 Agar et al. Background: Care for people with advanced dementia requires a palliative approach targeted to the illness trajectory and tailored to individual needs. However, care in nursing homes is often compromised by poor communication and limited staff expertise. This paper reports the protocol for the IDEAL Project, which aims to: 1) compare the efficacy of a facilitated approach to family case conferencing with usual care; 2) provide insights into nursing home-and staff-related processes influencing the implementation and sustainability of case conferencing; and 3) evaluate cost-effectiveness. Design/Methods: A pragmatic parallel cluster randomised controlled trial design will be used. Twenty Australian nursing homes will be randomised to receive either facilitated family case conferencing or usual care. In the intervention arm, we will train registered nurses at each nursing home to work as Palliative Care Planning Coordinators (PCPCs) 16 h per week over 18 months. The PCPCs' role will be to: 1) use evidence-based 'triggers' to identify optimal time-points for case conferencing; 2) organise, facilitate and document case conferences with optimal involvement from family, multi-disciplinary nursing home staff and community health professionals; 3) develop and oversee implementation of palliative care plans; and 4) train other staff in person-centred palliative care. The primary endpoint will be symptom management, comfort and satisfaction with care at the end of life as rated by bereaved family members on the End of Life in Dementia (EOLD) Scales. Secondary outcomes will include resident quality of life (Quality of Life in Late-stage Dementia [QUALID]), whether a palliative approach is taken (e.g. hospitalisations, non-palliative medical treatments), staff attitudes and knowledge (Palliative Care for Advanced Dementia [qPAD]), and cost effectiveness. Processes and factors influencing implementation, outcomes and sustainability will be explored ...
Austin, K, Chambers, GM, de Abreu Lourenco, R, Madan, A, Susic, D & Henry, A 2015, 'Cost‐effectiveness of term induction of labour using inpatient prostaglandin gel versus outpatient Foley catheter', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 55, no. 5, pp. 440-445.
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Bainbridge, R, Tsey, K, McCalman, J, Kinchin, I, Saunders, V, Watkin Lui, F, Cadet-James, Y, Miller, A & Lawson, K 2015, 'No one’s discussing the elephant in the room: contemplating questions of research impact and benefit in Aboriginal and Torres Strait Islander Australian health research', BMC Public Health, vol. 15, no. 1. © 2015 Bainbridge et al. Background: There remains a concern that Indigenous Australians have been over-researched without corresponding improvements in their health; this trend is applicable to most Indigenous populations globally. This debate article has a dual purpose: 1) to open a frank conversation about the value of research to Indigenous Australian populations; and 2) to stimulate ways of thinking about potential resolutions to the lack of progress made in the Indigenous research benefit debate. Discussion: Capturing the meaning of research benefit takes the form of ethical value-oriented methodological considerations in the decision-making processes of Indigenous research endeavours. Because research practices come from Western knowledge bases, attaining such positions in research means reconciling both Indigenous and Western knowledge systems to produce new methodologies that guide planning, evaluating and monitoring of research practices as necessary. Increasingly, more sophisticated performance measures have been implemented to ensure academic impact and benefits are captured. Assessing societal and other non-academic impacts and benefits however, has not been accorded corresponding attention. Research reform has only focussed on research translation in more recent years. The research impact debate must take account of the various standards of accountability (to whom), impact priorities (for whom), positive and negative impacts, and biases that operate in describing impact and measuring benefit. Summary: A perennial question in Indigenous research discourse is whether the abundance of research conducted; purportedly to improve health, is justified and benefits Indigenous people in ways that are meaningful and valued by them. Different research stakeholders have different conceptions of the value and nature of research, its conduct, what it should achieve and the kinds of benefits expected. We need to work collaboratively and listen more close... Buecheler, JW, Howard, CB, de Bakker, CJ, Goodall, S, Jones, ML, Win, T, Peng, T, Tan, CH, Chopra, A, Mahler, SM & Lim, S 2015, 'Development of a protein nanoparticle platform for targeting EGFR expressing cancer cells', JOURNAL OF CHEMICAL TECHNOLOGY AND BIOTECHNOLOGY, vol. 90, no. 7, pp. 1230-1236. Burgess, L, Knox, SA, Street, DJ & Norman, R 2015, 'Comparing Designs Constructed With and Without Priors for Choice Experiments: A Case Study', Journal of Statistical Theory and Practice, vol. 9, no. 2, pp. 330-360. This article describes the second stage of an empirical comparison of the performance of designs for a discrete choice experiment. Six designs were chosen to represent the range of construction techniques that are currently popular for choice experiments, with some of the designs incorporating into the design generation process prior knowledge of the parameters gained from the previous stage of this experiment. Each design had 320 respondents, each of whom completed 16 choice sets. The results indicate that efficient designs constructed using several different strategies all identify various types of heterogeneity with similar levels of precision. Specifying the right model to best describe the underlying preferences of respondents in each sample may then become the limiting factor in the estimation of more complex generalized multinomial models, rather than the design per se. Copyright © Grace Scientific Publishing, LLC. Carinci, F, Van Gool, K, Mainz, J, Veillard, J, Pichora, EC, Januel, JM, Arispe, I, Kim, SM, Klazinga, NS & Indicators, OHCQ 2015, 'Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators', INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, vol. 27, no. 2, pp. 137-146. Chenoweth, L, Vickland, V, Stein-Parbury, J, Jeon, Y-H, Kenny, P & Brodaty, H 2015, 'Computer modeling with randomized-controlled trial data informs the development of person-centered aged care homes', Neurodegenerative Disease Management, vol. 5, no. 5, pp. 403-412. Church, JL, Haas, MR & Goodall, S 2015, 'Cost Effectiveness of Falls and Injury Prevention Strategies for Older Adults Living in Residential Aged Care Facilities', PHARMACOECONOMICS, vol. 33, no. 12, pp. 1301-1310. Comino, EJ, Harris, MF, Islam, MDF, Tran, DT, Jalaludin, B, Jorm, L, Flack, J & Haas, M 2015, 'Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study', BMC Health Services Research, vol. 15, no. 1, pp. 1-13. © 2015 Comino et al. Background: The increased prevalence of diabetes and its significant impact on use of health care services, particularly hospitals, is a concern for health planners. This paper explores the risk factors for all-cause hospitalisation and the excess risk due to diabetes in a large sample of older Australians. Methods: The study population was 263,482 participants in the 45 and Up Study. The data assessed were linked records of hospital admissions in the 12 months following completion of a baseline questionnaire. All cause and ambulatory care sensitive admission rates and length of stay were examined. The associations between demographic characteristics, socioeconomic status, lifestyle factors, and health and wellbeing and risk of hospitalisation were explored using zero inflated Poisson (ZIP) regression models adjusting for age and gender. The ratios of adjusted relative rates and 95% confidence intervals were calculated to determine the excess risk due to diabetes. Results: Prevalence of diabetes was 9.0% (n = 23,779). Age adjusted admission rates for all-cause hospitalisation were 631.3 and 454.8 per 1,000 participant years and the mean length of stay was 8.2 and 7.1 days respectively for participants with and without diabetes. In people with and without diabetes, the risk of hospitalisation was associated with age, gender, household income, smoking, BMI, physical activity, and health and wellbeing. However, the increased risk of hospitalisation was attenuated for participants with diabetes who were older, obese, or had hypertension or hyperlipidaemia and enhanced for those participants with diabetes who were male, on low income, current smokers or who had anxiety or depression. Conclusions: This study is one of the few studies published to explore the impact of diabetes on hospitalisation in a large non-clinical population, the 45 and Up Study. The attenuation of risk associated with some factors is likely to be due to correlation ... Comino, EJ, Islam, MDF, Tran, DT, Jorm, L, Flack, J, Jalaludin, B, Haas, M & Harris, MF 2015, 'Association of processes of primary care and hospitalisation for people with diabetes: A record linkage study', Diabetes Research and Clinical Practice, vol. 108, no. 2, pp. 296-305. Aims: To explore the association of primary care and hospitalisation for people with diabetes. Methods: The study comprised 20,433 diabetic participants in the Sax Institute's 45 and Up Study. Data on processes of care at recruitment (15 months) were extracted from the Department of Human Services Medicare database. Processes included continuity of primary care (47.1%), and claims for completion of an annual cycle of care (25.0%), GP management plan/team care arrangement (GPMP/TCA, 41.3%), review of GPMP/TCA (24.0%), and monitoring including HbA1c (62.7%). Hospitalisation (12 months) following recruitment was extracted from administrative data held by NSW Ministry of Health. Adjusted incidence rate ratios (aIRR) with 95% confidence interval were calculated. Results: A hospital admission was reported for 33.0% of participants. Continuity of care (aIRR: 0.92 (95%CI: 0.89-0.96)), or claims for an annual cycle of care (aIRR: 0.77 (0.74-0.80)) or HbA1c testing (aIRR: 0.92 (0.89-0.96) were associated with a reduced likelihood of hospitalisation. While claims for preparation of GPMP/TCA were not associated with hospitalisation, a claim for review of GPMP/TCA was associated with a reduced likelihood of hospitalisation (aIRR: 0.92 (95%CI: 0.89 0.96)). Conclusions: This study has implications for hospital avoidance programmes suggesting that strengthening primary care may be more important than care coordination for this group of patients. De Abreu Lourenco, R, Kenny, P, Haas, MR & Hall, JP 2015, 'Factors affecting general practitioner charges and Medicare bulk‐billing: results of a survey of Australians', Medical Journal of Australia, vol. 202, no. 2, pp. 87-90. Eakin, EG, Hayes, SC, Haas, MR, Reeves, MM, Vardy, JL, Boyle, F, Hiller, JE, Mishra, GD, Goode, AD, Jefford, M, Koczwara, B, Saunders, CM, Demark-Wahnefried, W, Courneya, KS, Schmitz, KH, Girgis, A, White, K, Chapman, K, Boltong, AG, Lane, K, McKiernan, S, Millar, L, O’Brien, L, Sharplin, G, Baldwin, P & Robson, EL 2015, 'Healthy Living after Cancer: a dissemination and implementation study evaluating a telephone-delivered healthy lifestyle program for cancer survivors', BMC Cancer, vol. 15, no. 1. © 2015 Eakin et al. Background: Given evidence shows physical activity, a healthful diet and weight management can improve cancer outcomes and reduce chronic disease risk, the major cancer organisations and health authorities have endorsed related guidelines for cancer survivors. Despite these, and a growing evidence base on effective lifestyle interventions, there is limited uptake into survivorship care. Methods/Design: Healthy Living after Cancer (HLaC) is a national dissemination and implementation study that will evaluate the integration of an evidence-based lifestyle intervention for cancer survivors into an existing telephone cancer information and support service delivered by Australian state-based Cancer Councils. Eligible participants (adults having completed cancer treatment with curative intent) will receive 12 health coaching calls over 6 months from Cancer Council nurses/allied health professionals targeting national guidelines for physical activity, healthy eating and weight control. Using the RE-AIM evaluation framework, primary outcomes are service-level indicators of program reach, adoption, implementation/costs and maintenance, with secondary (effectiveness) outcomes of patient-reported anthropometric, behavioural and psychosocial variables collected at pre- and post-program completion. The total participant accrual target across four participating Cancer Councils is 900 over 3 years. Discussion: The national scope of the project and broad inclusion of cancer survivors, alongside evaluation of service-level indicators, associated costs and patient-reported outcomes, will provide the necessary practice-based evidence needed to inform future allocation of resources to support healthy living among cancer survivors. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527(registered on 24/08/2015) Essue, BM, Kimman, M, Svenstrup, N, Lindevig Kjoege, K, Lea Laba, T, Hackett, ML & Jan, S 2015, 'The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review', Bulletin of the World Health Organization, vol. 93, no. 2, pp. 102-112B. © 2014 by Institute of Fundamental Technological Research. Objective: To determine the nature, scope and effectiveness of interventions to reduce the household economic burden of illness or injury.Methods: We systematically reviewed reports published on or before 31 January 2014 that we found in the CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE and PsycINFO databases. We extracted data from prospective controlled trials and assessed the risk of bias. We narratively synthesized evidence.Findings: Nine of the 4330 studies checked met our inclusion criteria – seven had evaluated changes to existing health-insurance programmes and two had evaluated different modes of delivering information. The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population. However, the reductions only represented marginal changes in the total expenditures of patients. We found no studies that had been effective in addressing broader household economic impacts – such as catastrophic health expenditure – in the disease populations investigated.Conclusion: In general, interventions designed to reduce the complex household economic burden of illness and injury appear to have had little impact on household economies. We only found a few relevant studies using rigorous study designs that were conducted in defined patient populations. The studies were limited in the range of interventions tested and they evaluated only a narrow range of household economic outcomes. There is a need for method development to advance the measurement of the household economic consequences of illness and injury and facilitate the development of innovative interventions to supplement the strategies based on health insurance. Gardner, T, Refshauge, K, McAuley, J, Goodall, S, Hübscher, M & Smith, L 2015, 'Patient led goal setting in chronic low back pain—What goals are important to the patient and are they aligned to what we measure?', Patient Education and Counseling, vol. 98, no. 8, pp. 1035-1038. Goodall, S, Howard, CB, Jones, ML, Munro, T, Jia, Z, Monteiro, MJ & Mahler, S 2015, 'An Goodall, S, Jones, ML & Mahler, S 2015, 'Monoclonal antibody‐targeted polymeric nanoparticles for cancer therapy – future prospects', Journal of Chemical Technology & Biotechnology, vol. 90, no. 7, pp. 1169-1176. Gu, Y, García-Pérez, S, Massie, J & van Gool, K 2015, 'Cost of care for cystic fibrosis: an investigation of cost determinants using national registry data', The European Journal of Health Economics, vol. 16, no. 7, pp. 709-717. Cystic fibrosis (CF) is a progressive disease with treatments intensifying as patients get older and severity worsens. To inform policy makers about the cost burden in CF, it is crucial to understand what factors influence the costs and how they affect the costs. Based on 1,060 observations (from 731 patients) obtained from the Australian Data Registry, individual annual health care costs were calculated and a regression analysis was carried out to examine the impact of multiple variables on the costs. A method of retransformation and a hypothetical patient were used for cost analysis. We show that an additional one unit improvement of FEV1pp (i.e., forced expiratory volume in 1 s as a percentage of predicted volume) reduces the costs by 1.4 %, or for a hypothetical patient whose FEV1pp is 73 the cost reduction is A$252. The presence of chronic infections increases the costs by 69.9-163.5 % (A$12,852-A$30,047 for the hypothetical patient) depending on the type of infection. The type of CF genetic mutation and the patient's age both have significant effects on the costs. In particular, being homozygous for p.F508del increases the costs by 26.8 % compared to all the other gene mutations. We conclude that bacterial infections have a very strong influence on the costs, so reducing both the infection rates and the severity of the condition may lead to substantial cost savings. We also suggest that the patient's genetic profile should be considered as an important cost determinant. Haas, M & De Abreu Lourenco, R 2015, 'Pharmacological Management of Chronic Lower Back Pain: A Review of Cost Effectiveness', PharmacoEconomics, vol. 33, no. 6, pp. 561-569. Lower back pain is one of the most prevalent musculoskeletal conditions in the developed world and accounts for significant health services use. The American College of Physicians and the American Pain Society have published a joint clinical guideline that recommends providing patients with information on prognosis and self-management, the use of medications with proven benefits and, for those who do not improve, consideration be given to the use of spinal manipulation (for acute lower back pain only), interdisciplinary rehabilitation, exercise, acupuncture, massage, yoga, cognitive behavioural therapy or relaxation. The purpose of this review was to evaluate published economic evaluations of pharmacological management for chronic lower back pain. A total of seven studies were eligible for inclusion in there view. The quality of the economic evaluations undertaken in the included studies was not high. This was primarily because of the nature of the underlying clinical evidence, most of which did not come from rigorous randomised controlled trials (RCTs), and the manner in which it was incorporated into the economic evaluations. All studies provided reasonable information about what aspects of healthcare and other resource use were identified, measured and valued. However, the reporting of total costs was not uniform across studies. Measures of pain and disability were the most commonly collected outcomes measures. Two studies collected information on quality of life directly from participants while two studies modelled this information based on the literature. Future economic evaluations of interventions for chronic lower back pain, including pharmacological interventions, should be based on the results of well-conducted RCTs where the measurement of costs and outcomes such as quality of life and quality-adjusted life-years is included in the trial protocol, and which have a follow-up period sufficient to capture meaningful changes in both costs and outcomes. In ... Hall, J 2015, 'Australian Health Care — The Challenge of Reform in a Fragmented System', New England Journal of Medicine, vol. 373, no. 6, pp. 493-497. The Australian health care system appears remarkably successful in delivering good health outcomes with reasonable cost control. Australians enjoy one of the longest life expectancies and a long healthy life expectancy, while costs as a proportion of the gross domestic product remain around the median among countries in the Organization for Economic Cooperation and Development (OECD; see table
Selected Characteristics of the Health Care System and Health Outcomes in Australia. and case histories; to compare this country with others, see the interactive graphic).1 Universal, tax-financed comprehensive health insurance, Australian Medicare, has been largely stable for three decades. Yet this performance has been achieved through, or despite, the interplay of public and private financing, public and private service provision, and a division of responsibilities between the federal and state governments. The main political parties clash over the role of government and whether national health insurance in its current form should continue.
Australian Medicare was established in 1984, after a period of tumultuous change. Australia has moved through numerous approaches to health care financing: private insurance with public subsidies (pre-1974), publicly financed national universal health insurance (Medibank, 1974–1976), predominantly private insurance with public subsidies (1976–1984), publicly financed national universal health insurance (Medicare, 1984–1996), publicly financed national universal health insurance with publicly subsidized private health insurance (1996–2013), and publicly financed national universal health insurance with means testing for private insurance subsidies (2013 to present). The rationale for government subsidies for private insurers alongside a public universal insurance scheme has never seemed clear; perhaps it is best seen as the compromise between the “strife of interests masquerading as a conflict of principles” that, according to health p... Hall, L, Farrington, A, Mitchell, BG, Barnett, AG, Halton, K, Allen, M, Page, K, Gardner, A, Havers, S, Bailey, E, Dancer, SJ, Riley, TV, Gericke, CA, Paterson, DL & Graves, N 2015, 'Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial', Implementation Science, vol. 11, no. 1. Hayek, A, Joshi, R, Usherwood, T, Webster, R, Kaur, B, Saini, B, Armour, C, Krass, I, Laba, T-L, Reid, C, Shiel, L, Hespe, C, Hersch, F, Jan, S, Lo, S, Peiris, D, Rodgers, A & Patel, A 2015, 'An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: protocol for a cluster randomized controlled trial', Implementation Science, vol. 11, no. 1. © 2016 The Author(s). Background: Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin ± aspirin) for prescription when appropriate; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification. Methods: Following a systematic development process, the intervention will be evaluated in a pragmatic cluster randomized controlled trial including 70 general practices for a median period of 18months. The 35 general practices in the intervention group will work with a nominated partner pharmacy, whereas those in the control group will provide usual care without access to the intervention tools. The primary outcome is the proportion of patients at high CVD risk who were inadequately treated at baseline who achieve target blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels at the study end. The outcomes will be analyzed using data from electronic medical records, utilizing a validated extraction tool. Detailed process and economic evaluations will also be performed. Discussion: The study intends to establish evidence about an intervention that combines technological innovation with team collaboration between patients, pharmacists, and general practitioners (GPs) for CVD prevention. Trial registration: Australian New Zealand Clinical Trials Registry ACTR... Joshi, R, Patel, A, Peiris, D, Saini, B, Usherwood, T, Armor, C, Webster, R, Lo, S, Rodgers, A, Laba, T, Jan, S, Reid, C, Krass, I & Hespe, C 2015, 'INTegrated Electronic General practice support tool, phaRmacy led intervention And combination Therapy Evaluation trial (INTEGRATE)', Heart, Lung and Circulation, vol. 24, pp. S385-S385. Kecmanovic, M & Hall, JP 2015, 'The use of financial incentives in Australian general practice', MEDICAL JOURNAL OF AUSTRALIA, vol. 202, no. 9, pp. 488-491. Objective: To examine the uptake of financial incentive payments in
general practice, and identify what types of practitioners are more likely to
participate in these schemes.
Design and setting: Analysis of data on general practitioners and GP
registrars from the Medicine in Australia — Balancing Employment and Life
(MABEL) longitudinal panel survey of medical practitioners in Australia,
from 2008 to 2011.
Main outcome measures: Income received by GPs from government
incentive schemes and grants and factors associated with the likelihood of
claiming such incentives.
Results: Around half of GPs reported receiving income from financial
incentives in 2008, and there was a small fall in this proportion by 2011.
There was considerable movement into and out of the incentives schemes,
with more GPs exiting than taking up grants and payments. GPs working in
larger practices with greater administrative support, GPs practising in rural
areas and those who were principals or partners in practices were more
likely to use grants and incentive payments.
Conclusions: Administrative support available to GPs appears to be an
increasingly important predictor of incentive use, suggesting that the
administrative burden of claiming incentives is large and not always worth
the effort. It is, therefore, crucial to consider such costs (especially relative
to the size of the payment) when designing incentive payments. As market
conditions are also likely to influence participation in incentive schemes, the
impact of incentives can change over time and these schemes should be
reviewed regularly Kendig, H & Woods, M 2015, ' Kinchin, I, Jacups, S, Tsey, K & Lines, K 2015, 'An empowerment intervention for Indigenous communities: an outcome assessment', BMC Psychology, vol. 3, no. 1. Background: Empowerment programs have been shown to contribute to increased empowerment of individuals and build capacity within the community or workplace. To-date, the impact of empowerment programs has yet to be quantified in the published literature in this field. This study assessed the Indigenous-developed Family Wellbeing (FWB) program as an empowerment intervention for a child safety workforce in remote Indigenous communities by measuring effect sizes. The study also assessed the value of measurement tools for future impact evaluations. Methods: A three-day FWB workshop designed to promote empowerment and workplace engagement among child protection staffwas held across five remote north Queensland Indigenous communities. The FWB assessment tool comprised a set of validated surveys including the Growth and Empowerment Measure (GEM), Australian Unity Wellbeing Index, Kessler psychological distress scale (K10) and Workforce engagement survey. The assessment was conducted pre-intervention and three months post-intervention. Results: The analysis of pre-and post-surveys revealed that the GEM appeared to be the most tangible measure for detecting positive changes in communication, conflict resolution, decision making and life skill development. The GEM indicated a 17 % positive change compared to 9 % for the Australian Unity Wellbeing Index, 5 % for the workforce engagement survey and less than 1 % for K10. Conclusions: This study extended qualitative research and identified the best measurement tool for detecting the outcomes of empowerment programs. The GEM was found the most sensitive and the most tangible measure that captures improvements in communication, conflict resolution, decision making and life skill development. The GEM and Australian Unity Wellbeing Index could be recommended as routine measures for empowerment programs assessment among similar remote area workforce. Laba, T-L, Essue, B, Kimman, M & Jan, S 2015, 'Understanding Patient Preferences in Medication Nonadherence: A Review of Stated Preference Data', The Patient - Patient-Centered Outcomes Research, vol. 8, no. 5, pp. 385-395. Laba, T-L, Howard, K, Rose, J, Peiris, D, Redfern, J, Usherwood, T, Cass, A, Patel, A & Jan, S 2015, 'Patient Preferences for a Polypill for the Prevention of Cardiovascular Diseases', Annals of Pharmacotherapy, vol. 49, no. 5, pp. 528-539. Laba, T-L, Lehnbom, E, Brien, J-A & Jan, S 2015, 'Understanding if, how and why non-adherent decisions are made in an Australian community sample: A key to sustaining medication adherence in chronic disease?', Research in Social and Administrative Pharmacy, vol. 11, no. 2, pp. 154-162. Laba, T-L, Usherwood, T, Leeder, S, Yusuf, F, Gillespie, J, Perkovic, V, Wilson, A, Jan, S & Essue, B 2015, 'Co-payments for health care: what is their real cost?', Australian Health Review, vol. 39, no. 1, pp. 33-33. Langton, JM, Srasuebkul, P, Reeve, R, Parkinson, B, Gu, Y, Buckley, NA, Haas, M, Viney, R & Pearson, S-A 2015, 'Resource use, costs and quality of end-of-life care: observations in a cohort of elderly Australian cancer decedents', Implementation Science, vol. 10, no. 1, pp. 1-14. © Commonwealth of Australia; licensee BioMed Central Ltd. Background: The last year of life is one of the most resource-intensive periods for people with cancer. Very little population-based research has been conducted on end-of-life cancer care in the Australian health care setting. The objective of this program is to undertake a series of observational studies examining resource use, costs and quality of end-of-life care in a cohort of elderly cancer decedents using linked, routinely collected data. Methods/Design: This study forms part of an ongoing cancer health services research program. The cohorts for the end-of-life research program comprise Australian Government Department of Veterans' Affairs decedents with full health care entitlements, residing in NSW for the last 18 months of life and dying between 2005 and 2009. We used cancer and death registry data to identify our decedent cohorts and their causes of death. The study population includes 9,862 decedents with a cancer history and 15,483 decedents without a cancer history. The median age at death is 86 and 87 years in the cancer and non-cancer cohorts, respectively. We will examine resource use and associated costs in the last 6 months of life using linked claims data to report on health service use, hospitalizations, emergency department visits and medicines use. We will use best practice methods to examine the nature and extent of resource use, costs and quality of care based on previously published indicators. We will also examine factors associated with these outcomes. Discussion: This will be the first Australian research program and among the first internationally to combine routinely collected data from primary care and hospital-based care to examine comprehensively end-of-life care in the elderly. The research program has high translational value, as there is limited evidence about the nature and quality of care in the Australian end-of-life setting. Li, S, Wu, Y, Du, X, Li, X, Patel, A, Peterson, ED, Turnbull, F, Lo, S, Billot, L, Laba, T & Gao, R 2015, 'Rational and design of a stepped-wedge cluster randomized trial evaluating quality improvement initiative for reducing cardiovascular events among patients with acute coronary syndromes in resource-constrained hospitals in China', American Heart Journal, vol. 169, no. 3, pp. 349-355. Liu, H, Laba, T, Massi, L, Jan, S, Usherwood, T, Patel, A, Hayman, NE, Cass, A, Eades, A, Lawrence, C & Peiris, DP 2015, 'Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services', Medical Journal of Australia, vol. 203, no. 1, pp. 24-27. © 2015, Australasian Medical Publishing Co. Ltd. All rights reserved. Objective: To identify facilitators and barriers to clinical trial implementation in Aboriginal health services. Design: Indepth interview study with thematic analysis. Setting: Six Aboriginal community-controlled health services and one government-run service involved in the Kanyini Guidelines Adherence with the Polypill (KGAP) study, a pragmatic randomised controlled trial that aimed to improve adherence to indicated drug treatments for people at high risk of cardiovascular disease. Participants: 32 health care providers and 21 Aboriginal and Torres Strait Islander patients. Results: A fundamental enabler was that participants considered the research to be governed and endorsed by the local health service. That the research was perceived to address a health priority for communities was also highly motivating for both providers and patients. Enlisting the support of Aboriginal and Torres Strait Islander staff champions who were visible to the community as the main source of information about the trial was particularly important. The major implementation barrier for staff was balancing their service delivery roles with adherence to often highly demanding trial-related procedures. This was partially alleviated by the research team’s provision of onsite support and attempts to make trial processes more streamlined. Although more intensive support was highly desired, there were usually insufficient resources to provide this. Conclusion: Despite strong community and health service support, major investments in time and resources are needed to ensure successful implementation and minimal disruption to already overstretched, routine services. Trial budgets will necessarily be inflated as a result. Funding agencies need to consider these additional resource demands when supporting trials of a similar nature. Liu, H, Massi, L, Eades, A-M, Howard, K, Peiris, D, Redfern, J, Usherwood, T, Cass, A, Patel, A, Jan, S & Laba, T-L 2015, 'Implementing Kanyini GAP, a pragmatic randomised controlled trial in Australia: findings from a qualitative study', Trials, vol. 16, no. 1. © 2015 Liu et al. Background: Pragmatic randomised controlled trials (PRCTs) aim to assess intervention effectiveness by accounting for 'real life' implementation challenges in routine practice. The methodological challenges of PRCT implementation, particularly in primary care, are not well understood. The Kanyini Guidelines Adherence to Polypill study (Kanyini GAP) was a recent primary care PRCT involving multiple private general practices, Indigenous community controlled health services and private community pharmacies. Through the experiences of Kanyini GAP participants, and using data from study materials, this paper identifies the critical enablers and barriers to implementing a PRCT across diverse practice settings and makes recommendations for future PRCT implementation. Methods: Qualitative data from 94 semi-structured interviews (47 healthcare providers (pharmacists, general practitioners, Aboriginal health workers; 47 patients) conducted for the process evaluation of Kanyini GAP was used. Data coded to 'trial impact', 'research motivation' and 'real world' were explored and triangulated with data extracted from study materials (e.g. Emails, memoranda of understanding and financial statements). Results: PRCT implementation was facilitated by an extensive process of relationship building at the trial outset including building on existing relationships between core investigators and service providers. Health providers' and participants' altruism, increased professional satisfaction, collaboration, research capacity and opportunities for improved patient care enabled implementation. Inadequate research infrastructure, excessive administrative demands, insufficient numbers of adequately trained staff and the potential financial impact on private practice were considered implementation barriers. These were largely related to this being the first experience of trial involvement for many sites. The significant costs of addressing these barriers drew s... Liu, H, Massi, L, Laba, T-L, Peiris, D, Usherwood, T, Patel, A, Cass, A, Eades, A-M, Redfern, J, Hayman, N, Howard, K, Brien, J-A & Jan, S 2015, 'Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care', Circulation: Cardiovascular Quality and Outcomes, vol. 8, no. 3, pp. 301-308. Lourenco, RDA & Hall, J 2015, 'Paying for the expanding role of primary care in cancer control', LANCET ONCOLOGY, vol. 16, no. 12, pp. 1228-1229. Advances in cancer detection and treatment pose a challenge to traditional cancer services focused on the acute delivery of specialist care. In The Lancet Oncology Commission,1 Greg Rubin and colleagues set out an exhaustive charter for the role of primary care services, and the primary care physician (PCP). The authors suggest 18 action points for a greater role for the PCP from detection to palliation. Luxford, K, Axam, A, Hasnip, F, Dobrohotoff, J, Strudwick, M, Reeve, R, Hou, C & Viney, R 2015, 'Improving clinician-carer communication for safer hospital care: a study of the 'TOP 5' strategy in patients with dementia', International Journal for Quality in Health Care, vol. 27, no. 3, pp. 175-182. Objective
To examine the impact of implementing a clinician–carer communication tool for hospitalized patients with dementia.
Design
Surveys were conducted with clinicians and carers about perceptions and experiences. Implementation process and costs were explored through surveys of local staff. Time series analysis was conducted on incident-reported falls, usage of non-regular anti-psychotics and one-to-one nursing.
Setting
Twenty-one hospitals in Australia.
Participants
Surveys were returned by 798 clinicians, 240 carers and 21 local liaison staff involved in implementation.
Intervention
Implementation of a communication tool over 12 months.
Main outcome measures
The process of implementation was documented. Outcome measures included clinician and carer perceptions, safety indicators (incident-reported falls and usage of non-regular anti-psychotics), resource use and costs.
Results
Clinicians and carers reported high levels of acceptability and perceived benefits for patients. Clinicians rated confidence in caring for patients with dementia as being significantly higher after the introduction of TOP 5, (M = 2.93, SD = 0.65), than prior to TOP 5 (M = 2.74, SD = 0.75); F(1,712) = 11.21, P < 0.05. When analysed together, there was no change in incident-reported falls across all hospitals. At one hospital with a matched control ward, an average of 6.85 fewer falls incidents per month occurred in the intervention ward compared with the matched control ward (B = −6.85, P < 0.05).
Conclusions
Our findings indicate that the use of a simple, low-cost communication strategy for patient care is associated with improvements in clinician and carer experience with potential implications for patient safety. Minimally, TOP 5 represents ‘good practice’ with a low risk of harm for patients. Maggioni, AP, Van Gool, K, Biondi, N, Urso, R, Klazinga, N, Ferrari, R, Maniadakis, N & Tavazzi, L 2015, 'Appropriateness of Prescriptions of Recommended Treatments in Organisation for Economic Co-operation and Development Health Systems: Findings Based on the Long-Term Registry of the European Society of Cardiology on Heart Failure', VALUE IN HEALTH, vol. 18, no. 8, pp. 1098-1104. Objective This observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of patients with chronic heart failure (HF) across 15 countries. Methods Three data sets were used: European Society of Cardiology Heart Failure Registry, Organisation for Economic Co-operation and Development's Health System Characteristics Survey, and Organisation for Economic Co-operation and Development Health Statistics 2013. Patient and country variables were examined by multilevel, multiple logistic regression. The study population consisted of ambulatory patients with chronic HF and reduced ejection fraction. Inappropriateness of prescription of pharmacological treatments was defined as patients not prescribed at least one of the two recommended treatments (angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers and beta-blockers) or treated with both medications but at suboptimal dosage and in absence of documented contraindication/intolerance. Results Of 4605 patients, 1097 (23.8%) received inappropriate drug prescriptions with a large variation within and across countries, with 18.5% of the total variability accounted for by between-country health structure characteristics. Patient-level characteristics such as having mitral regurgitation (odds ratio 1.4; 95% confidence interval 1.1-1.7) was significantly associated with inappropriate prescription of recommended drugs, whereas chronic obstructive pulmonary disease (odds ratio 0.7; 95% confidence interval 0.5-0.9) was associated with more appropriate prescriptions. Among the country-level variables, incentives or obligation to comply with guidelines increased the probability of prescription appropriateness. Conclusions Combining clinical variables with health system characteristics is a promising exercise to explain the appropriateness of recommended drug prescriptions. Such an understanding can help decision makers to... McCluskey, A, Ada, L, Kelly, PJ, Middleton, S, Goodall, S, Grimshaw, JM, Logan, P, Longworth, M & Karageorge, A 2015, 'Compliance with Australian stroke guideline recommendations for outdoor mobility and transport training by post-inpatient rehabilitation services: An observational cohort study', BMC Health Services Research, vol. 15, no. 1. © 2015 McCluskey et al. Background: Community participation is often restricted after stroke, due to reduced confidence and outdoor mobility. Australian clinical guidelines recommend that specific evidence-based interventions be delivered to target these restrictions, such as multiple escorted outdoor journeys. The aim of this study was to describe post-inpatient outdoor mobility and transport training delivered to stroke survivors in New South Wales, Australia and whether therapy differed according to type, sector or location of service provider. Methods: Using an observational retrospective cohort study design, 24 rehabilitation service providers were audited. Provider types included outpatient (n = 8), day therapy (n = 9), home-based rehabilitation (n = 5) and transitional aged care services (TAC, n = 2). Records of 15 stroke survivors who had received post-hospital rehabilitation were audited per service, for wait time, duration, amount of therapy and outdoor-related therapy. Results: A total of 311 records were audited. Median wait time for post-hospital therapy was 13 days (IQR, 5-35). Median duration of therapy was 68 days (IQR, 35-109), consisting of 11 sessions (IQR 4-19). Overall, a median of one session (IQR 0-3) was conducted outdoors per person. Outdoor-related therapy was similar across service providers, except that TAC delivered an average of 5.4 more outdoor-related sessions (95 % CI 4.4 to 6.4), and 3.5 more outings into public streets (95 % CI 2.8 to 4.3) per person, compared to outpatient services. Conclusion: The majority of service providers in the sample delivered little evidence-based outdoor mobility and travel training per stroke participant, as recommended in national stroke guidelines. Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12611000554965. Merlo, G, Halton, K, Graves, N, Ratcliffe, J & Page, K 2015, 'Understanding The Underutilisation Of Evidence From Economic Evaluations In Healthcare: A Mixed Methods Design', Value in Health, vol. 18, no. 7, pp. A527-A527. Merlo, G, Page, K, Ratcliffe, J, Halton, K & Graves, N 2015, 'Bridging the Gap: Exploring the Barriers to Using Economic Evidence in Healthcare Decision Making and Strategies for Improving Uptake', Applied Health Economics and Health Policy, vol. 13, no. 3, pp. 303-309. Moseley, AM, Beckenkamp, PR, Haas, M, Herbert, RD, Lin, C-WC & Team, EXACT 2015, 'Rehabilitation After Immobilization for Ankle Fracture The EXACT Randomized Clinical Trial', JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, vol. 314, no. 13, pp. 1376-1385. Importance The benefits of rehabilitation after immobilization for ankle fracture are unclear.
Objectives To determine the effectiveness of a supervised exercise program and advice (rehabilitation) compared with advice alone and to determine if effects are moderated by fracture severity or age and sex.
Design, Setting, and Participants The EXACT trial was a pragmatic, randomized clinical trial conducted from December 2010 to June 2014. Patients with isolated ankle fracture presenting to fracture clinics in 7 Australian hospitals were randomized on the day of removal of immobilization. Of 571 eligible patients, 357 chose not to participate and 214 were allocated to rehabilitation (n = 106) or advice alone (n = 108), with 194 (91%) followed up at 1 month, 173 (81%) at 3 months, and 170 (79%) at 6 months. There were no withdrawals attributed to adverse effects. Recruitment terminated early on December 31, 2013 (planned enrollment, 342; actual, 214), because funding was exhausted.
Interventions Supervised exercise program and advice about self-management (rehabilitation) (individually tailored, prescribed, monitored, and progressed) or advice alone, both delivered by a physical therapist.
Main Outcomes and Measures Primary outcomes were activity limitation assessed using the Lower Extremity Functional Scale (score range, 0-80; higher scores indicate better activity), and quality of life assessed using the Assessment of Quality of Life (score range, 0-1; higher scores indicate better quality of life), measured at baseline and at 1, 3 (primary time point), and 6 months.
Results Mean activity limitation and quality of life at baseline were 30.1 (SD, 12.5) and 0.51 (SD, 0.24), respectively, for advice and 30.2 (SD, 13.2) and 0.54 (SD, 0.24) for rehabilitation, increasing to 64.3 (SD, 13.5) and 0.85 (SD, 0.17) for advice vs 64.3 (SD, 15.1) and 0.85 (SD, 0.20) for rehabilitation at 3 months. Rehabilitation was not more effective than advice for activity limitati... Mu, C, Kecmanovic, M & Hall, J 2015, 'Does Living Alone Confer a Higher Risk of Hospitalisation?', ECONOMIC RECORD, vol. 91, no. S1, pp. 124-138. Mulhern, B, Brazier, J & Bjorner, JB 2015, 'Developing Sf-6d-V2: Examining The Dimensionality Of The Sf-36 Using Large Multinational Datasets', Value in Health, vol. 18, no. 3, pp. A27-A27. Mulhern, B, O’Gorman, H, Rotherham, N & Brazier, J 2015, 'Comparing the measurement equivalence of EQ-5D-5L across different modes of administration', Health and Quality of Life Outcomes, vol. 13, no. 1. Murray, SR, Murchie, P, Campbell, N, Walter, FM, Mazza, D, Habgood, E, Kutzer, Y, Martin, A, Goodall, S, Barnes, DJ & Emery, JD 2015, 'Protocol for the CHEST Australia Trial: a phase II randomised controlled trial of an intervention to reduce time-to-consult with symptoms of lung cancer', BMJ OPEN, vol. 5, no. 5. © 2015, BMJ Publishing Group. All rights reserved. Introduction: Lung cancer is the most common cancer worldwide, with 1.3 million new cases diagnosed every year. It has one of the lowest survival outcomes of any cancer because over two-thirds of patients are diagnosed when curative treatment is not possible. International research has focused on screening and community interventions to promote earlier presentation to a healthcare provider to improve early lung cancer detection. This paper describes the protocol for a phase II, multisite, randomised controlled trial, for patients at increased risk of lung cancer in the primary care setting, to facilitate early presentation with symptoms of lung cancer. Methods/analysis: The intervention is based on a previous Scottish CHEST Trial that comprised of a primary-care nurse consultation to discuss and implement a self-help manual, followed by selfmonitoring reminders to improve symptom appraisal and encourage help-seeking in patients at increased risk of lung cancer. We aim to recruit 550 patients from two Australian states: Western Australia and Victoria. Patients will be randomised to the Intervention (a health consultation involving a self-help manual, monthly prompts and spirometry) or Control (spirometry followed by usual care). Eligible participants are long-term smokers with at least 20 pack years, aged 55 and over, including ex-smokers if their cessation date was less than 15 years ago. The primary outcome is consultation rate for respiratory symptoms. Ethics and dissemination: Ethical approval has been obtained from The University of Western Australia's Human Research Ethics Committee (RA/4/1/6018) and The University of Melbourne Human Research Committee (1 441 433). A summary of the results will be disseminated to participants and we plan to publish the main trial outcomes in a single paper. Further publications are anticipated after further data analysis. Findings will be presented at national and ... Page, K, Barnett, AG, Campbell, M, Brain, D, Martin, E, Fulop, N & Graves, N 2015, 'Response to Grayson's Letter to the Editor: ‘Response to K. Page et al., ‘Costing the Australian National Hand Hygiene Initiative’’', Journal of Hospital Infection, vol. 89, no. 2, pp. 138-139. Palfreyman, S & Mulhern, B 2015, 'The psychometric performance of generic preference-based measures for patients with pressure ulcers', Health and Quality of Life Outcomes, vol. 13, no. 1. © 2015 Palfreyman and Mulhern. Background: Pressure ulcers are wounds that result from reduced mobility, and can have a significant impact on morbidity, mortality and quality of life. As pressure ulcers are a consequence of a wide range of conditions and interventions, it is unclear whether the best means of capturing the quality of life impacts is via generic or condition specific Patient Reported Outcome Measures (PROMs). The aim of this study was to investigate the psychometric performance of the generic EQ-5D and SF-6D amongst patients identified as having or being at risk of developing pressure ulceration. Methods: A survey of patients who were using pressure relieving mattresses and other equipment was undertaken within inpatient and community settings using a handheld tablet and postal survey. Data on EQ-5D-3L, SF-12 (used to calculate SF-6D), an EQ-5D dignity bolt-on question, demographic and wound specific questions were collected. Convergent validity was assessed using Spearman's correlations, and agreement using Bland-Altman plots. Known group validity was assessed by examining whether the instruments discriminated between different pressure ulcer severity groups. Multivariate linear regression was used to examine the impact of a range of pressure ulcer related variables. Results: The total number of participants was 307, including 273 from the acute setting (52% response rate) and 41 from the community (32%). SF-6D and EQ-5D were moderately correlated (0.61), suggesting that both instruments were capturing similar quality of life impacts. Both measures were able to significantly discriminate between groups based on the ulcer grade. Presence of a pressure ulcer and number of comorbidities were significant explanatory variables of EQ-5D and SF-6D score. Conclusions: The results suggest that generic PROMs can effectively capture the impact of pressure ulcers on quality of life, although there are significant challenges in collecting data from t... Parkinson, B, Sermet, C, Clement, F, Crausaz, S, Godman, B, Garner, S, Choudhury, M, Pearson, S-A, Viney, R, Lopert, R & Elshaug, AG 2015, 'Disinvestment and Value-Based Purchasing Strategies for Pharmaceuticals: An International Review', PHARMACOECONOMICS, vol. 33, no. 9, pp. 905-924. Pearce, A, Haas, M, Viney, R, Haywood, P, Pearson, S-A, van Gool, K, Srasuebkul, P & Ward, R 2015, 'Can administrative data be used to measure chemotherapy side effects?', Expert Review of Pharmacoeconomics & Outcomes Research, vol. 15, no. 2, pp. 215-222. Preston, A & Yu, S 2015, 'Is there a part-time/ full-time pay differential in Australia?', Journal of Industrial Relations, vol. 57, no. 1, pp. 24-47. Rowen, D, Mulhern, B, Banerjee, S, Tait, R, Watchurst, C, Smith, SC, Young, TA, Knapp, M & Brazier, JE 2015, 'Comparison of General Population, Patient, and Carer Utility Values for Dementia Health States', Medical Decision Making, vol. 35, no. 1, pp. 68-80. Sangster, J, Church, J, Haas, M, Furber, S & Bauman, A 2015, 'A Comparison of the Cost-effectiveness of Two Pedometer-based Telephone Coaching Programs for People with Cardiac Disease', Heart, Lung and Circulation, vol. 24, no. 5, pp. 471-479. Introduction: Following a cardiac event it is recommended that cardiac patients participate in cardiac rehabilitation (CR) programs. However, little is known about the relative cost-effectiveness of lifestyle-related interventions for cardiac patients. This study aimed to compare the cost-effectiveness of a telephone-delivered Healthy Weight intervention to a telephone-delivered Physical Activity intervention for patients referred to CR in urban and rural Australia. Methods: A cost-utility analysis was conducted alongside a randomised controlled trial of the two interventions. Outcomes were measured as Quality Adjusted Life Years (QALYs) gained. Results: The estimated cost of delivering the interventions was $201.48 per Healthy Weight participant and $138.00 per Physical Activity participant. The average total cost (cost of health care utilisation plus patient costs) was $1,260 per Healthy Weight participant and $2,112 per Physical Activity participant, a difference of $852 in favour of the Healthy Weight intervention. Healthy Weight participants gained an average of 0.007 additional QALYs than did Physical Activity participants. Thus, overall the Healthy Weight intervention dominated the Physical Activity intervention (Healthy Weight intervention was less costly and more effective than the Physical Activity intervention). Subgroup analyses showed the Healthy Weight intervention also dominated the Physical Activity intervention for rural participants and for participants who did not attend CR. Conclusions: The low-contact pedometer-based telephone coaching Healthy Weight intervention is overall both less costly and more effective compared to the Physical Activity intervention, including for rural cardiac patients and patients that do not attend CR. Sangster, J, Furber, S, Allman-Farinelli, M, Phongsavan, P, Redfern, J, Haas, M, Church, J, Mark, A & Bauman, A 2015, 'Effectiveness of a Pedometer-Based Telephone Coaching Program on Weight and Physical Activity for People Referred to a Cardiac Rehabilitation Program', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 35, no. 2, pp. 124-129. PURPOSE: To determine the effectiveness of a pedometer-based telephone lifestyle coaching intervention on weight and physical activity.
METHODS: A randomized controlled trial was conducted with 313 patients referred to cardiac rehabilitation in rural and urban Australia. Participants were allocated to a healthy weight (HW) (4 telephone coaching sessions on weight and physical activity) or a physical activity (PA) intervention (2 telephone coaching sessions on physical activity). Weight and physical activity were assessed by self-report at baseline, short-term (6-8 weeks), and medium-term (6-8 months).
RESULTS: More than 90% of participants completed the trial. Over the medium-term, participants in the HW group decreased their weight compared with participants in the PA group (P = .005). Participants in the HW group with a body mass index of ≥25 kg/m2 had a mean weight loss of 1.6 kg compared with participants in the PA-only group who lost a mean of 0.4 kg (P = .015). Short-term, both groups increased their physical activity time, and the PA group maintained this increase at the medium-term.
CONCLUSIONS: Participants in the HW group achieved modest improvements in weight, and those in the PA group demonstrated increased physical activity. Low-contact, telephone-based interventions are a feasible means of delivering lifestyle interventions for underserved rural communities, for those not attending cardiac rehabilitation, or as an adjunct to cardiac rehabilitation. Santatiwongchai, B, Chantarastapornchit, V, Wilkinson, T, Thiboonboon, K, Rattanavipapong, W, Walker, DG, Chalkidou, K & Teerawattananon, Y 2015, 'Methodological Variation in Economic Evaluations Conducted in Low- and Middle-Income Countries: Information for Reference Case Development', PLOS ONE, vol. 10, no. 5, pp. e0123853-e0123853. © 2015 Santatiwongchai et al. Information generated from economic evaluation is increasingly being used to inform health resource allocation decisions globally, including in low- and middle- income countries. However, a crucial consideration for users of the information at a policy level, e.g. funding agencies, is whether the studies are comparable, provide sufficient detail to inform policy decision making, and incorporate inputs from data sources that are reliable and relevant to the context. This review was conducted to inform a methodological standardisation workstream at the Bill and Melinda Gates Foundation (BMGF) and assesses BMGF-funded cost-per-DALY economic evaluations in four programme areas (malaria, tuberculosis, HIV/AIDS and vaccines) in terms of variation in methodology, use of evidence, and quality of reporting. The findings suggest that there is room for improvement in the three areas of assessment, and support the case for the introduction of a standardised methodology or reference case by the BMGF. The findings are also instructive for all institutions that fund economic evaluations in LMICs and who have a desire to improve the ability of economic evaluations to inform resource allocation decisions. Shah, K, Devlin, N, Mulhern, B & van Hout, B 2015, 'Directly Eliciting Personal Utility Functions: A New Way To Value Health-Related Quality Of Life', Value in Health, vol. 18, no. 3, pp. A37-A37. Shah, K, te Marvelde, L, Collins, M, De Abreu Lourenco, R, D’Costa, I, Coleman, A, Fua, T, Liu, C, Rischin, D, Lau, E & Corry, J 2015, 'Safety and cost analysis of an 18FDG-PET-CT response based follow-up strategy for head and neck cancers treated with primary radiation or chemoradiation', Oral Oncology, vol. 51, no. 5, pp. 529-535. Background: Prognostic information can rationalise clinical follow-up after radical cancer treatment. This retrospective cohort study of radical head and neck (chemo)radiotherapy patients examines the clinical safety and cost implications of stratifying follow-up intensity by post-treatment 18FDG-PET-CT response. Methods: In 2008 clinical review after radical head and neck radiotherapy was reduced from 3- to 6-monthly for patients with complete 18FDG-PET-CT response at 3months. 184 patients treated after this change ("PET Stratified", 2009-11) were compared to 178 patients treated before ("Standard", 2005-7). Clinical safety was assessed by the time to detection of recurrence, overall survival and potential for radical treatment of recurrence. A hospital cost analysis was performed using individual patient data. Results: 127 of 178 Standard and 148 of 184 PET Stratified patients achieved complete response on post-treatment imaging. Baseline clinical characteristics were comparable. Median follow-up from response assessment was 4.8. years in the Standard cohort and 2.1. years for PET Stratified. PET Stratified patients had a mean 4.4 outpatient visits in 2. years, compared to 7.0 among Standard patients. Over 90% of patients remained free of recurrence at 2. years in both cohorts. Time to detection of recurrence was similar between two cohorts (HR1.05, 95%CI 0.45-2.52), as was overall survival (HR0.91, 95%CI 0.36-2.29). The proportion of radically treatable recurrences was also similar (42% Standard vs. 47% PET Stratified). The hospital cost savings per patient from reduced review were AUD$2606 over 2. years, AUD$5012 over five. Conclusion: 18FDG-PET-CT to stratify follow-up intensity after radical radiotherapy for head and neck cancer reduces costs with no apparent clinical detriment. Tan, S, Erens, B, Wright, M & Mays, N 2015, 'Patients' experiences of the choice of GP practice pilot, 2012/2013: a mixed methods evaluation', BMJ Open, vol. 5, no. 2, pp. e006090-e006090. Thiboonboon, K, Leelahavarong, P, Wattanasirichaigoon, D, Vatanavicharn, N, Wasant, P, Shotelersuk, V, Pangkanon, S, Kuptanon, C, Chaisomchit, S & Teerawattananon, Y 2015, 'An Economic Evaluation of Neonatal Screening for Inborn Errors of Metabolism Using Tandem Mass Spectrometry in Thailand', PLOS ONE, vol. 10, no. 8, pp. e0134782-e0134782. © 2015 Thiboonboon et al. Background: Inborn errors of metabolism (IEM) are a rare group of genetic diseases which can lead to several serious long-term complications in newborns. In order to address these issues as early as possible, a process called tandem mass spectrometry (MS/MS) can be used as it allows for rapid and simultaneous detection of the diseases. This analysis was performed to determine whether newborn screening by MS/MS is cost-effective in Thailand. Method: A cost-utility analysis comprising a decision-tree and Markov model was used to estimate the cost in Thai baht (THB) and health outcomes in life-years (LYs) and quality-adjusted life year (QALYs) presented as an incremental cost-effectiveness ratio (ICER). The results were also adjusted to international dollars (I$) using purchasing power parities (PPP) (1 I$ = 17.79 THB for the year 2013). The comparisons were between 1) an expanded neonatal screening programme using MS/MS screening for six prioritised diseases: phenylketonuria (PKU); isovaleric acidemia (IVA); methylmalonic acidemia (MMA); propionic acidemia (PA); maple syrup urine disease (MSUD); and multiple carboxylase deficiency (MCD); and 2) the current practice that is existing PKU screening. A comparison of the outcome and cost of treatment before and after clinical presentations were also analysed to illustrate the potential benefit of early treatment for affected children. A budget impact analysis was conducted to illustrate the cost of implementing the programme for 10 years. Results: The ICER of neonatal screening using MS/MS amounted to 1,043,331 THB per QALY gained (58,647 I$ per QALY gained). The potential benefits of early detection compared with late detection yielded significant results for PKU, IVA, MSUD, and MCD patients. The budget impact analysis indicated that the implementation cost of the programme was expected at approximately 2,700 million THB (152 million I$) over 10 years. Conclusion: At the current ceil... Vargas, C, Giglio, A, Soza, A & Espinoza, MA 2015, 'Estudio De Impacto Presupuestal De Daclatasvir Asociado A Asunaprevir Desde La Perspectiva Del Sistema De Salud Publico Chileno', Value in Health, vol. 18, no. 7, pp. A866-A866. Vargas, CL, Espinoza, MA, Giglio, A & Soza, A 2015, 'Cost Effectiveness of Daclatasvir/Asunaprevir Versus Peginterferon/Ribavirin and Protease Inhibitors for the Treatment of Hepatitis c Genotype 1b Naïve Patients in Chile', PLOS ONE, vol. 10, no. 11, pp. e0141660-e0141660. Ward, RL, Laaksonen, MA, van Gool, K, Pearson, S, Daniels, B, Bastick, P, Norman, R, Hou, C, Haywood, P & Haas, M 2015, 'Cost of cancer care for patients undergoing chemotherapy: The White, KM, Jimmieson, NL, Graves, N, Barnett, A, Cockshaw, W, Gee, P, Page, K, Campbell, M, Martin, E, Brain, D & Paterson, D 2015, 'Key beliefs of hospital nurses’ hand‐hygiene behaviour: protecting your peers and needing effective reminders', Health Promotion Journal of Australia, vol. 26, no. 1, pp. 74-78. White, KM, Jimmieson, NL, Obst, PL, Graves, N, Barnett, A, Cockshaw, W, Gee, P, Haneman, L, Page, K, Campbell, M, Martin, E & Paterson, D 2015, 'Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses', BMC Health Services Research, vol. 15, no. 1. © 2015 White et al. Background: Improving hand hygiene among health care workers (HCWs) is the single most effective intervention to reduce health care associated infections in hospitals. Understanding the cognitive determinants of hand hygiene decisions for HCWs with the greatest patient contact (nurses) is essential to improve compliance. The aim of this study was to explore hospital-based nurses ' beliefs associated with performing hand hygiene guided by the World Health Organization's (WHO) 5 critical moments. Using the belief-base framework of the Theory of Planned Behaviour, we examined attitudinal, normative, and control beliefs underpinning nurses' decisions to perform hand hygiene according to the recently implemented national guidelines. Methods: Thematic content analysis of qualitative data from focus group discussions with hospital-based registered nurses from 5 wards across 3 hospitals in Queensland, Australia. Results: Important advantages (protection of patient and self), disadvantages (time, hand damage), referents (supportive: patients, colleagues; unsupportive: some doctors), barriers (being too busy, emergency situations), and facilitators (accessibility of sinks/products, training, reminders) were identified. There was some equivocation regarding the relative importance of hand washing following contact with patient surroundings. Conclusions: The belief base of the theory of planned behaviour provided a useful framework to explore systematically the underlying beliefs of nurses ' hand hygiene decisions according to the 5 critical moments, allowing comparisons with previous belief studies. A commitment to improve nurses' hand hygiene practice across the 5 moments should focus on individual strategies to combat distraction from other duties, peer-based initiatives to foster a sense of shared responsibility, and management-driven solutions to tackle staffing and resource issues. Hand hygiene following touching a patient's surroundings c... White, KM, Starfelt, LC, Jimmieson, NL, Campbell, M, Graves, N, Barnett, AG, Cockshaw, W, Gee, P, Page, K, Martin, E, Brain, D & Paterson, D 2015, 'Understanding the determinants of Australian hospital nurses' hand hygiene decisions following the implementation of a national hand hygiene initiative', Health Education Research, vol. 30, no. 6, pp. 959-970. Wise, S, Fry, M, Duffield, C, Roche, M & Buchanan, J 2015, 'Ratios and nurse staffing: The vexed case of emergency departments', Australasian Emergency Nursing Journal, vol. 18, no. 1, pp. 49-55. Within Australia nursing unions are pursuing mandated nursepatient ratios tosafeguard patient outcomes and protect their members in healthcare systems where demandperpetually exceeds supply. Establishing ratios for an emergency department is more con-tentious than for hospital wards. The studys aim was to estimate average staffing levels, skillmix and patient presentations in all New South Wales (NSW) Emergency Departments (EDs). Wright, M 2015, 'Is there value in the Relative Value Study? Caution before Australian Medicare reform', Medical Journal of Australia, vol. 203, no. 8, pp. 331-333. Xie, F, Pickard, AS, Krabbe, PFM, Revicki, D, Viney, R, Devlin, N & Feeny, D 2015, 'A Checklist for Reporting Valuation Studies of Multi-Attribute Utility-Based Instruments (CREATE)', PharmacoEconomics, vol. 33, no. 8, pp. 867-877.
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Conferences
Butler, K, Reeve, R, Arora, S, Viney, R, Goodall, S, Van Gool, K & Burns, L 1970, 'THE COSTS AND CONSEQUENCES OF TARGETING ALCOHOL AND OTHER DRUG PATIENTS PRESENTING TO HOSPITAL EMERGENCY DEPARTMENTS', DRUG AND ALCOHOL REVIEW, APSAD Annual Scientific Alcohol and Drug Conference, Perth, pp. 17-17.
Cronin, P, Reeve, R, Goodall, S, McCabe, P & Viney, RC 1970, 'The impact of childhood language impairment on health service use and health care expenditure', IHEA, 11th World Congress on Health Economics, Milan, Italy.
Cronin, PA, Reeve, R, Goodall, S, McCabe, P & Viney, R 1970, 'The impact of childhood language impairment on health service use and health care expenditure-evidence from the Longitudinal Study of Australian Children', Childhood Language Symposium, Warwick, UK.
De Abreu Lourenco, R 1970, 'Drug reimbursement – a little bit of this…and a whole lot of that…', Hepatitis C Consumer Advocacy Workshop.
De Abreu Lourenco, R 1970, 'Drug Reimbursement in Australia: Through the looking Glass', HCA Consumer Workshop, Webinar hosted by ZEST.
De Abreu Lourenco, R 1970, 'Valuing meta-health effects: how we ask matters', 2nd International Academy of Health Preference Research meeting, Brisbane.
De Abreu Lourenco, R & Parish, K 1970, 'One of the team: research with, not just about, consumers', Sydney Catalyst, 2015 PostGraduate and Early Career Research Symposium.
Durks, D, Fernandez-Llimos, F, Hossain, L, Franco-Trigo, L, Ignlis, S, Benrimoj, SI & Sabater-Hernández, D 1970, 'Analysing the fundamentals of health promotion programs developed by means of Intervention Mapping aimed at changing healthcare providers’ practice in the the healthcare setting', International Pharmaceutical Federation (FIP) World Congress of Pharmacy and Pharmaceutical Sciences, Dusseldorf, Germany.
Franco-Trigo, L, Durks, D, Lutfun, NH, Fam, D, Benrimoj, S & Sabater-Hernández, D 1970, 'Identifying a planning group for the development, implementation and evaluation of a pharmacy service aimed at preventing cardiovascular diseases in Australia', 75th FIP World Congress of Pharmacy and Pharmaceutical Sciences, Dusseldorf, Germany.
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Intervention Mapping (IM) provides a comprehensive framework that can help pharmacy service planners overcome current challenges in pharmacy practice, such as the development, implementation and evaluation of pharmacy services. According to IM, pharmacy service planning must begin by establishing a stakeholder planning group.A group of 6-7 key informants will identify potential opportunities and gaps related to community pharmacy and cardiovascular health, and map a ‘preliminary list’ of stakeholders. A snowballing exercise will be conducted with the identified stakeholders to obtain a comprehensive ‘final list’. Lastly, mapping exercises will be performed to assess the relevance, interests and attitudes of the different stakeholders. This information will be used to identify key stakeholders to be included in the planning group.At the moment, the key informants have been identified, contacted and invited to attend the first workshop that has been structured in four parts. Qualitative methodologies (i.e., focus group/brainstorming) and social network analysis technique have been selected to identify the opportunities and gaps and obtain the preliminary list of stakeholders.The results of this study will provide a list of key stakeholders who can be part of the planning group for the development, implementation and evaluation of a pharmacy service in Australia.
Gardner, T, Refshauge, K, McAuley, J, Goodall, S, Huebscher, M & Smith, L 1970, 'Patient led goal setting in chronic low back pain: An effective approach', World Confederation for Physical Therapy Congress, Singapore.
Goodall, S, Kenny, P & Mu, C 1970, 'What influences the choice of General Practitioners? Evidence from a Discrete Choice Experiment in Australia and New Zealand', CAER Workshop.
Goodall, S, Kenny, P & Mu, C 1970, 'What influences the choice of General Practitioners? Evidence from a Discrete Choice Experiment in Australia and New Zealand', Primary Health Care Research Conference, Adelaide.
Goodall, S, Kenny, P & Mu, C 1970, 'What influences the choice of General Practitioners? Evidence from a Discrete Choice Experiment in Australia and New Zealand', iHEA 11th World Congress on Health Economics, Milan, July.
Haas, MR 1970, 'Health economics analysis using secondary data', TROG Annual Scientific Meeting.
Hall, JP 1970, 'GP visits on diabetes outcomes: methods and initial findings from WA and NSW person-linked data', 9th Health Services and Policy Research Conference (HSRAANZ), Health Services and Policy Research Conference (HSRAANZ), Melbourne.
Hall, JP & van Gool, K 1970, 'Ageing, health care expenditure and entitlement (invited)', CEPAR Annual Workshop on Health and Ageing.
Hall, JP & van Gool, K 1970, 'The impact of ageing on health care costs (invited)', CEDA, Sydney.
Hossain, L, Fernandez-Llimos, F, Durks, D, Franco-Trigo, L, Benrimoj, SI & Sabater-Hernández, D 1970, 'Identifying barriers and facilitators to the utilisation of community pharmacy services in Australia', International Pharmaceutical Federation (FIP) World Congress of Pharmacy and Pharmaceutical Sciences, Dusseldorf, Germany.
Kenny, PM 1970, 'Evidence from a Discrete Choice Experiment in Australia and New Zealand', HSRAANZ 9th Health Services & Policy Conference, Health Services and Policy Research Conference (HSRAANZ), Melbourne.
McCluskey, A, Ada, L, Kelly, PJ, Middleton, S, Goodall, S, Grimshaw, JM, Logan, P, Longworth, M & Karageorge, A 1970, 'The challenge of changing practice: Learning from the Out-and-About cluster randomised controlled trial involving community teams and stroke survivors', SSA/SmartStrokes, Melbourne.
McCluskey, A, Ada, L, Kelly, PJ, Middleton, S, Goodall, S, Grimshaw, JM, Logan, P, Longworth, M & Karageorge, A 1970, 'The Out-and-About implementation program did not change the practice of community stroke teams or increase outings by stroke survivors: A cluster randomised controlled trial', Occupation Therapy Australia 26th National Conference.
Norman, R, Mulhern, BJ & Viney, R 1970, 'The impact of different approaches to anchoring utility scores within the EQ-5D', EuroQol Group Plenary 2015, Krakow, Poland.
Page, K, Merlo, G, Ratcliffe, J, Halton, K & Graves, N 1970, 'What factors make Economic Evaluation more valuable as a service?', Value in Health, Elsevier BV, pp. A85-A85.
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Parkinson, B, Viney, RC, Goodall, S & Haas, M 1970, 'Real-world observational data in cost-effectiveness analyses: Herceptin as a case study', iHEA 11th World Congress on Health Economics, Milan, Italy.
Reeve, R, Butler, K, Burns, L, Viney, RC, Arora, S, Goodall, S & van Gool, K 1970, 'Using multi-methods to evaluate clinical services: A case study', International Evaluation Conference, Melbourne.
Saing, S, Church, J, Parkinson, B & Goodall, S 1970, 'Cost effectiveness of a community delivered infant sleep intervention', 9th Health Services and Policy Research Conference, Health Services and Policy Research Conference, Melbourne, Victoria.
Viney, R, Mulhern, BJ, Norman, R, Ratcliffe, J, Lorgelly, P, Lancsar, E & Brazier, J 1970, 'What is the impact of the order of EQ-5D-5L dimensions on health state values elicited using DCE with duration?', EuroQol Group Plenary 2015, Krakow, Poland.
Wong, C & Hall, J 1970, 'Does the quality of general practitioners affect the use of emergency departments? Evidence from a survey of Australian adults', Primary Health Care Research Conference, Adelaide.
Wright, MC 1970, 'Discontinuity in Australian general practice', iHEA, 11th World Congress on Health Economics, Milan, Italy.
Wright, MC 1970, 'Who uses more than one general practice?', Primary Health Care Research Conference, Adelaide.
Wright, MC & van Gool, K 1970, 'Trends in primary care use in Australia and challenges in designing payment systems', iIHEA, 11th World Congress on Health Economics, Milan, Italy.
Reports
De Abreu Lourenco, R, Haywood, P, Parkinson, B, van Gool, K & Viney, R CHERE 2015, The economic implications of a genomically guided approach to cancer: A report by the Centre for Health Economics Research and Evaluation for the Cancer Council, Sydney.
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This report examines how genomically based approaches may also alter the way that new technologies are funded and adopted in the health care system. In particular, how they challenge the routine pathways by which technologies are diffused into routine practice. The report also focuses on how genomically guided technologies challenge current coverage decisions. It examines the economic evidence-base for assessing the cost and benefits of such technologies. In doing so, the report highlights the current limitations in this field of research as identified through a systematic review of recommendations made by Australian policy-makers, as well as through a review of the literature. This analysis is then used to develop a framework for economic evaluations with special reference to genomically based technologies. Finally, the report also identifies a number of key policy challenges for the efficient diffusion of genomically guided cancer care into the Australian health care system.
Saing, S Commonwealth of Australia 2015, Magnetic resonance imaging (MRI) of liver lesions. MSAC Application 1372, Assessment Report, Canberra, ACT.
Van Gool, K, Woods, M, Hall, J, Haas, M & Yu, S CHERE 2015, Sustainability, efficiency and equity in health care: The role of funding arrangements in Australia. A report by the Centre for Health Economics Research and Evaluation for the Australian Healthcare and Hospitals Association (AHHA), Sydney.
Van Gool, K, Woods, M, Hall, J, Haas, M, Yu, S & Wright, M CHERE 2015, Primary Health Networks as a disruptive force for positive change: A report by the Centre for Health Economics Research and Evaluation for the Australian Healthcare and Hospitals Association (AHHA), Sydney.
Wheelahan, L, Buchanan, J & Yu, S National Centre for Vocational Education Research 2015, Linking qualifications and the labour market through capabilities and vocational streams, Canberra.
World Health Organization World Health Organization 2015, First consultation meeting on a framework for public health emergency operations centres: Meeting Report, Geneva.
World Health Organization World Health Organization 2015, Summary report of systematic reviews for public health emergency operations centres: Plans and procedures; communication technology and infrastructure; minimum datasets and standards; training, Geneva, Switzerland.
Yu, S Shop, Distributive and Allied Employees Association 2015, Evaluating the impact of Sunday penalty rates in the NSW retail industry.
Yu, S & Oliver, D Workplace Research Centre, University of Sydney 2015, The capture of public wealth by the for-profit VET sector, Sydney.
Other
Fiebig, D, Viney, RC, Haas, M, Knox, S, Street, D, Weisberg, E & Bateson, D 2015, 'Complexity and doctor choices when discussing contraceptives', Health, Econometrics and Data Group, University of York. WP15/14.
Shah, KL, Mulhern, BJ, Longworth, L & Janssen, B 2015, 'An empirical study of two alternative comparators for use in time trade-off studies. EuroQol Working Paper, 15001'.
UTS acknowledges the Gadigal people of the Eora Nation, the Boorooberongal people of the Dharug Nation, the Bidiagal people and the Gamaygal people, upon whose ancestral lands our university stands. We would also like to pay respect to the Elders both past and present, acknowledging them as the traditional custodians of knowledge for these lands.
