Abstract: The urgency of the COVID-19 pandemic in Australia has seen the implementation of digital health technologies to support continuity of high-quality primary care provision. Digital health innovation has been used to operationalise the nation's pandemic preparedness principles by reducing risk of infection to both healthcare workers and at-risk patients, sustaining care for chronic and acute health conditions, and supporting the mental health of the population. In this perspective piece, we document the Australian Federal government's digital health response to ensure the ongoing delivery of high-quality primary care. This includes the implementation of telehealth, point-of-care testing, electronic records and e-prescriptions, national primary care data collection and analysis, and digital communication. Digital health has been a critical element of the pandemic response and paves the way for future primary care provision during disasters and emergencies. Further research is needed to capture the effectiveness, feasibility and acceptability of these innovations for both patients and primary care practitioners.

Abstract: Objective Stroke telemedicine improves the provision of reperfusion therapies in regional hospitals, yet evidence of its cost-effectiveness using patient-level data is lacking. The aim of this study was to estimate the cost per quality-adjusted life year (QALY) gained from stroke telemedicine. Methods As part of the Victorian Stroke Telemedicine (VST) program, stroke telemedicine provided to 16 hospitals in regional Victoria was evaluated using a historical-control design. Patient-level costs from a societal perspective (2018 Australian dollars (A$)) and QALYs up to 12 months after stroke were estimated using data from medical records, surveys at 3 months and 12 months after stroke and multiple imputation. Multivariable regression models and bootstrapping were used to estimate differences between periods. Results Costs and health outcomes were estimated from 1024 confirmed strokes suffered by patients arriving at hospital within 4.5 h of stroke onset (median age 76 years, 55% male, 83% ischaemic stroke; 423 from the control period). Total costs to 12 months post stroke were estimated to be A$82 449 per person for the control period and A$82 259 in the intervention period (P = 0.986). QALYs at 12 months were estimated to be 0.43 per person for the control period and 0.5 per person in the intervention period (P = 0.02). Following 1000 iterations of bootstrapping, in comparison to the control period, the VST intervention was more effective and cost saving in 50.6% of iterations and cost-effective (A$0 and A$50 000 per QALY gained) in 10.4% of iterations. Conclusion The VST program was likely to be cost saving or cost-effective. Our findings provide confidence in supporting wider implementation of telemedicine for acute stroke care in Australia.

Abstract: ObjectiveThis systematic review identified studies that provided an estimate of persistent opioid use following patient discharge from hospital settings in Australia.MethodsA literature search was performed on 5 December 2020, with no date restrictions to identify studies that reported a rate of persistent opioid use following patient discharge from Australian Hospitals. The search strategy combined all terms relating to the themes 'hospital patients', 'prescribing', 'opioids' and 'Australia'. Studies that dealt solely with cancer, palliative care or addiction medicine were excluded. The databases searched in this review were Embase, PubMed, Scopus, CINAHL, and International Pharmaceutical Abstracts. Studies were assessed for bias using the Newcastle-Ottawa Scale and considered against international literature.ResultsIn total, 13 publications are included for final analysis in this review. Of these, 11 articles relate to post-surgical opioid use. With one exception, studies were of a 'good' quality. Methods of data collection in included studies were a mixture of those conducting follow up of patients directly over time and those utilising dispensing databases. Persistent opioid use among surgical patients generally ranged from 3.9 to 10.5% at between 2 and 4 months after discharge.ConclusionsHow rates of persistent opioid use following hospital encounters in Australia are established, and how long after discharge rates are reported, is heterogeneous. Literature primarily relates to post-surgical patients, with very few studies investigating other settings such as encounters with the emergency department.

Abstract: Objective Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia. Methods This study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014-15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality. Results Our results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs. Conclusions OOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists' services.

Abstract: Objective To review implementation of the Comprehensive Care Standard (CCS) by evaluating assessment outcome data of Australian health service organisations (HSOs) from January 2019. The CCS was introduced with the National Safety and Quality Health Service (NSQHS) Standards (second edition). It has 36 actions and over 40 resources to support implementation. Methods Retrospective assessment outcome data submitted by accrediting agencies were examined to gauge progress of CCS implementation by considering met or other ratings of the CCS actions. Results There were 495 assessments completed between January 2019 and December 2020. Most (71% n = 352) HSOs met the requirements of the CCS after initial assessment. Seventy-four (15%) of the HSOs did not meet all the requirements and a further 58 (12%) HSOs were provided with recommendations to meet the actions. Conclusions There was indication of underperformance related to some actions in the CCS. The assessment data highlighted common issues for organisations including difficulties implementing governance processes, demonstrating effective care planning, implementing the end-of-life care actions and some minimising harm actions. Future evaluation of the implementation of the CCS may benefit from strengthening links between other safety and quality programs.

Abstract: Objective To describe self-reported general and psychological health for allied health practitioners at an Australian acute public health service over three time points within the coronavirus disease 2019 (COVID-19) pandemic. Methods This study collected data from cross-sectional online surveys at three time points: May-June 2020 (T 1 ), October-November 2020 (T 2 ) and November-December 2021 (T 3 ). The self-report questionnaire consisted of demographic questions, a general health question and the 21-item version of the Depression Anxiety Stress Scales (DASS-21). Results A total of 308 responses were received (T 1 n = 135, T 2 n = 78, T 3 n = 95) from representatives of eight allied health professions. The proportion of allied health practitioners reporting poor general health significantly increased over time, as did mean scores on all DASS-21 sub-scales. General health status was also significantly associated with DASS-21 subscale scores. Anxiety scores increased significantly between T 1 and T 2 , while depression scores increased significantly between T 2 and T 3 . Significant increases in stress scores were recorded across all time intervals. Between T 1 and T 3 , the proportion of allied health practitioners reporting moderate, severe, or extremely severe symptoms increased for depression (10.3-30.9%), anxiety (5.2-18.2%) and stress (13.3-36.3%). Conclusion The general and psychological health of allied health practitioners appears to be worsening as the COVID-19 pandemic continues. Organisational strategies to support the health of the allied health workforce in acute care settings must address the cumulative effects of prolonged pressure on their general and psychosocial health. Support strategies need to be responsive to changes in psychological wellbeing at different phases of the pandemic.

Abstract: Clinical free-text data represent a vast, untapped source of rich information. If more accessible for research it would supplement information captured in structured fields. Data need to be de-identified prior to being reused for research. However, a lack of transparency with existing de-identification software tools makes it difficult for data custodians to assess potential risks associated with the release of de-identified clinical free-text data. This case study describes the development of a framework for releasing de-identified clinical free-text data in two local health districts in NSW, Australia. A sample of clinical documents (n = 14 768 965), including progress notes, nursing and medical assessments and discharge summaries, were used for development. An algorithm was designed to identify and mask patient names without damaging data utility. For each note, the algorithm output the (i) note length before and after de-identification, (ii) the number of patient names and (iii) the number of common words. These outputs were used to iteratively refine the algorithm performance. This was followed by manual review of a random subset of records by a health information manager. Notes that were not correctly de-identified were fixed, and performance was reassessed until resolution. All notes in this sample were suitably de-identified using this method. Developing a transparent method for de-identifying clinical free-text data enables informed-decision making by data custodians and the safe re-use of clinical free-text data for research and public benefit.

Abstract: Objective To examine the impact of telehealth policy changes on general practitioner (GP) consultation activity in Australia, during the coronavirus disease 2019 (COVID-19) pandemic, from January 2019 to December 2021. Methods An interrupted time-series analysis was conducted to analyse the impact of two major policy changes, introduced through the Medicare Benefits Schedule (MBS), on GP consultation (in-person, videoconference, telephone) activity. The first policy change was the introduction of additional COVID-19 telehealth funding through the MBS on 30 March 2020. The second policy change was the limitation on telephone consultation length to under 20 min on 1 July 2021. The rate of GP telehealth provision and activity was compared between pre-and post-intervention periods, separated by these MBS policy changes. Results After the first policy change, there was a significant increase in telehealth provision, with a simultaneous decrease in in-person consultations (P < 0.0001). However, telehealth provision decreased in the months following this first policy change (P < 0.0001), while in-person activity increased. After the second policy change, the initial videoconference provision increased (P < 0.0001). However, all telehealth activity decreased afterwards. In the months following the second policy change, the decrease in monthly activity for in-person (P = 0.700), telephone (0.199) and videoconference (P = 0.178) consultations was not significant. Conclusions The introduction of additional telehealth funding and limitations on telephone consultation length encouraged the initial provision and growth of telehealth services. However, these policy changes did not sustain the long-term upward trajectory of telehealth activity. Telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services.

Abstract: ObjectiveThis study set out to present data on out-of-pocket payments for Medicare mental health services provided by general practitioners (GP), psychiatrists, clinical psychologists and other psychologists, to explore how much is spent on out-of-pocket payments for mental health; if any trends could be seen; and what variations exist across regions.MethodsWe performed secondary analysis of publicly available data on Medicare-subsidised GP, allied health and specialist health care across Australia. We merged and interrogated data covering the period 2013-19 and 2019-21 to create a data set covering eight full years of Medicare mental health services, arranged by profession and by region.ResultsOut-of-pocket payments for mental health care in Australia have been rising consistently over the period 2013-21, at a considerably faster rate than overall expenditure on mental health care. There is wide variation in out-of-pocket payments depending on where you live.ConclusionsThe impact of out-of-pocket payments on community access to mental health care is growing. This has implications, especially in poorer communities, for access to care. This should be an important consideration taken as the Australian Government considers next steps in national mental health reform, including the Better Access Program, currently under evaluation.

Abstract: Objectives To examine: the impact of the coronavirus disease 2019 (COVID-19) pandemic on access to health services by middle-aged and older Australians; and the use of telehealth services during the COVID-19 pandemic and its ongoing usefulness. Methods A cross-sectional survey was conducted among participants who completed the COVID-19 supplement in the 45 and Up Study 2020 Survey. Multivariable logistic regression analysis was used to examine the association between socio-demographic characteristics and health conditions with missed/delayed access to health services, changes in health outcomes resulting from missed/delayed access, and use of telehealth services. Results Data for 45 071 participants were analysed (56% female, 72% aged ≥65 years). Almost half (42.2%) reported they had missed/delayed access to health care due to COVID-19; mainly for dental services (26.1%), visits to a general practitioner (GP) (16.3%) and specialists (12.6%). Missed/delayed visits to GPs and specialists were more likely among females, participants from non-English-speaking backgrounds, with disability/illness, living in outer regional/remote areas or with chronic health conditions. People with a disability or high/very high psychological distress were twice as likely to report worse health as a result of missed/delayed care. Half (48.0%) the study participants used telehealth during the COVID-19 pandemic and 81.9% indicated telehealth would be useful post-pandemic. Conclusions The COVID-19 pandemic impacted access to healthcare services, particularly for people with a disability, and chronic or mental health issues who also reported worse health. This may account for their higher use of telehealth services as an alternate way of accessing health care. Ongoing evaluation of telehealth services for vulnerable groups post-pandemic is required.

Abstract: AHR explores major national and international health issues and questions. Our readership includes managers, policy makers and clinical staff in health organisations including government departments, hospitals, community centres and aged-care facilities as well as all others with an interest in the health industry. It enables health professionals to keep their fingers on the pulse of the nation´s health decisions and to know what the most influencial commentators and decision makers are thinking. It also publishes new research from practitioners - managers and clinicians - and reports of breakthrough projects that demonstrate better ways of delivering care.

Abstract: Objective To determine the accuracy of discharge summary (DS) medication lists across a broad cross-section of hospital inpatients and to determine what factors may be associated with errors in this document. Methods A retrospective medical record audit was undertaken at five metropolitan hospitals that utilise an electronic medication management system (eMMS) at the point of discharge. Four hospitals utilised an eMMS for inpatient medication management, with the fifth utilising the paper-based National Inpatient Medication Chart (NIMC). Any inpatients discharged during the first week of February, May, August and November 2020 and February 2021 were included if they received both a DS and either a pharmacy-generated patient-friendly medication list or interim medication administration chart. Results Eight-hundred and one DSs were included, of which 525 (66%) had one or more medication errors and 220 (27%) had one or more high-risk medication errors. A higher proportion of patients with polypharmacy (five or more medications) had one or more errors compared to patients without polypharmacy (67% vs 54%, P < 0.01). DSs generated from the site with paper NIMCs were less likely to have one or more errors when compared to sites using an inpatient eMMS (58% vs 68%, P < 0.01). Age, sex, language spoken and preparing the DS post-discharge were not associated with differing rates of errors. Of the 2609 individual medication errors (390 high-risk errors), the most common types were 'omitted drug or dose' (34%) and 'unnecessary drug' (33%). Conclusion Medication errors in the DS are common and more likely to occur in patients with polypharmacy.

Abstract: AHR explores major national and international health issues and questions. Our readership includes managers, policy makers and clinical staff in health organisations including government departments, hospitals, community centres and aged-care facilities as well as all others with an interest in the health industry. It enables health professionals to keep their fingers on the pulse of the nation´s health decisions and to know what the most influencial commentators and decision makers are thinking. It also publishes new research from practitioners - managers and clinicians - and reports of breakthrough projects that demonstrate better ways of delivering care.

Abstract: Since 2015 a whole-of-community program to promote advance care planning (ACP) within one Queensland Hospital and Health Service (HHS) catchment has spread statewide, financed by Queensland Health (QH) agencies and led by the Statewide Office of Advance Care Planning (SOACP). The program aims to identify ACP-eligible patients, invite and finalise ACP discussions, and ensure documented care preferences are easily retrievable by clinicians to guide future care if a person loses capacity. The SOACP established a digital infrastructure whereby quality-audited ACP documents are uploaded to a software platform accessible to all QH clinicians, private medical specialists, ambulance paramedics, general practitioners (GPs), and registered nurses, including those in residential aged care facilities (RACFs). The SOACP also hosts a website providing resources for clinicians and patients, delivers educational events and mentorship to GPs and hospital and RACF staff, and employs ACP facilitators working across all QH HHSs. The program has seen yearly increases in the numbers of ACP documents uploaded from around the state, with up to 79% of eligible patients in some hospitals receiving ACP, significant ACP uptake in RACFs, and acceptance by GPs to engage in ACP. Audits reveal high concordance between stated preferences and hospital care received, and ACP patients, compared to matched non-ACP controls, more frequently die out of hospital, have fewer inpatient days during their last 6 months of life, and receive less invasive care, with similar results seen among same-patient cohorts post-ACP. Barriers and enablers to ACP have been identified which will inform program evolution.

Abstract: AHR explores major national and international health issues and questions. Our readership includes managers, policy makers and clinical staff in health organisations including government departments, hospitals, community centres and aged-care facilities as well as all others with an interest in the health industry. It enables health professionals to keep their fingers on the pulse of the nation´s health decisions and to know what the most influencial commentators and decision makers are thinking. It also publishes new research from practitioners - managers and clinicians - and reports of breakthrough projects that demonstrate better ways of delivering care.

Abstract: In this era of 'Choosing Wisely,' we present a four-step action plan to reduce unnecessary pathology testing and the associated patient harm (blood loss through repeated phlebotomy), economic cost and environmental impact. The authors are experts from the CODA group; a medical education and health-promotion charity that aims to build on the Choosing Wisely initiative to provide meaningful and sustainable actions to reduce the carbon footprint of healthcare, globally. Pathology testing is expensive and carbon-intensive, with as many as half of all tests being not clinically indicated. Reducing unnecessary testing is the only effective way to decrease the carbon footprint and other associated costs, as opportunities to reuse and recycle pathology specimens are limited. The four key steps for action are (i) auditing local practice; (ii) defining unnecessary testing including developing a clinical guideline for rational ordering; (iii) educating stakeholders; and (iv) measuring the impact of the intervention through re-audit. This proven method is designed to be used in any healthcare setting around the world; having a small group of passionate 'champions' is thought to be as important as strong clinical governance and more important than access to sophisticated equipment. Electronic medical record systems and other technological solutions offer new ways to help establish a sustainability mindset and reduce unnecessary testing. The Codachange.org/coda-earth/ website provides a dynamic crowdsourcing platform through which we can collectively learn to meet the diverse needs of our international medical community. Self-reported outcomes are gamified through collaborative feedback, amplification via social media and the ability to earn rewards, be uploaded to the CODA website, or added to the template as a success story. By combining our existing local networks with the emerging international CODA community, we can initiate meaningful change now and enter the era of environmental stewardship.

Abstract: In this era of 'Choosing Wisely,' we present a four-step action plan to reduce unnecessary pathology testing and the associated patient harm (blood loss through repeated phlebotomy), economic cost and environmental impact. The authors are experts from the CODA group; a medical education and health-promotion charity that aims to build on the Choosing Wisely initiative to provide meaningful and sustainable actions to reduce the carbon footprint of healthcare, globally. Pathology testing is expensive and carbon-intensive, with as many as half of all tests being not clinically indicated. Reducing unnecessary testing is the only effective way to decrease the carbon footprint and other associated costs, as opportunities to reuse and recycle pathology specimens are limited. The four key steps for action are (i) auditing local practice; (ii) defining unnecessary testing including developing a clinical guideline for rational ordering; (iii) educating stakeholders; and (iv) measuring the impact of the intervention through re-audit. This proven method is designed to be used in any healthcare setting around the world; having a small group of passionate 'champions' is thought to be as important as strong clinical governance and more important than access to sophisticated equipment. Electronic medical record systems and other technological solutions offer new ways to help establish a sustainability mindset and reduce unnecessary testing. The Codachange.org/coda-earth/ website provides a dynamic crowdsourcing platform through which we can collectively learn to meet the diverse needs of our international medical community. Self-reported outcomes are gamified through collaborative feedback, amplification via social media and the ability to earn rewards, be uploaded to the CODA website, or added to the template as a success story. By combining our existing local networks with the emerging international CODA community, we can initiate meaningful change now and enter the era of environmental stewardship.

Abstract: Clinical free-text data represent a vast, untapped source of rich information. If more accessible for research it would supplement information captured in structured fields. Data need to be de-identified prior to being reused for research. However, a lack of transparency with existing de-identification software tools makes it difficult for data custodians to assess potential risks associated with the release of de-identified clinical free-text data. This case study describes the development of a framework for releasing de-identified clinical free-text data in two local health districts in NSW, Australia. A sample of clinical documents (n = 14 768 965), including progress notes, nursing and medical assessments and discharge summaries, were used for development. An algorithm was designed to identify and mask patient names without damaging data utility. For each note, the algorithm output the (i) note length before and after de-identification, (ii) the number of patient names and (iii) the number of common words. These outputs were used to iteratively refine the algorithm performance. This was followed by manual review of a random subset of records by a health information manager. Notes that were not correctly de-identified were fixed, and performance was reassessed until resolution. All notes in this sample were suitably de-identified using this method. Developing a transparent method for de-identifying clinical free-text data enables informed-decision making by data custodians and the safe re-use of clinical free-text data for research and public benefit.

Abstract: ObjectiveOut-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia.MethodsThis study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014-15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality.ResultsOur results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs.ConclusionsOOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists' services.

Abstract: ObjectivesTo describe the quantity and cost of in-person and telehealth exercise physiology (EP) reimbursed under the Medicare Benefits Schedule (MBS) in Australia before and during the coronavirus disease 2019 (COVID-19) pandemic.MethodsThis study uses publicly available MBS data to describe EP services (in-person and telehealth) reimbursed by Medicare between January 2020 and December 2021. Data were extracted at state and national levels.ResultsDespite a reduction in quantity and cost in quartile (Q) 2 2020 (41% reduction), MBS-reimbursed EP services have remained relatively constant at a national level through the 2-year observation period. Service claims averaged 88 555 per quarter in 2020 and 95 015 in 2021. The proportion of telehealth consultations relative to total quarterly claims for EP was <1% in Q1 2020, 6.0% in Q2 2020, 2.4% in Q3 2020 and 1.7% in Q4 2020. This dropped to an average of 1.4% across 2021 (Q1-Q4). States undergoing lockdown periods reported decreased service rates relative to February 2020 (i.e. pre-lockdown). EP services were associated with a Medicare expenditure of AUD17.9M in 2020 (telehealth = 2.4% of total) and AUD19.7M (telehealth = 1.5% of total) in 2021.ConclusionsQuantity and cost of MBS-reimbursed EP services remained relatively constant throughout the height of service disruption due to COVID-19 (2020/21). Telehealth uptake during this time has been minimal for EP.

Abstract: Objective Examine the use of priority and provisional approval pathways by the Australian Therapeutic Goods Administration (TGA) for evaluating new medicines. Methods This observational study assessed all new medicines approved by the TGA between 1 January 2018 and 18 October 2021. It examined how frequently priority and provisional approval pathways are being used, the conditions which the medicines are being approved to treat, how long medicines are spending in the approval pathways, the additional therapeutic value of the medicines being approved through these pathways and how the use of the pathways compares with similar regulatory pathways used by Health Canada. Results The TGA approved 138 new medicines in the time period under study, of which 33 were approved through either the priority or provisional approval pathways. Sixteen were approved to treat cancer. It took the TGA a mean of 130 (95% CI 118, 143) and 144 (95% 101, 188) working days for priority and provisional pathways, respectively. Therapeutic evaluations were available for 16 of these medicines and 11 offered little to no therapeutic gain over existing medicines. There was moderate agreement between the TGA and Health Canada in their use of these pathways (Kappa = 0.5458, 95% CI 0.3900, 0.7016). Conclusions The priority and provisional approval pathways are now being used by the TGA for about one-third of all new medicine approvals. Although the medicines approved in these ways are moving through the review process more quickly than those approved through the standard approval pathway, the majority of these medicines, for which an evaluation of therapeutic value is available, do not offer any substantial additional therapeutic value over existing medicines.

Abstract: ObjectiveTo examine the impact of telehealth policy changes on general practitioner (GP) consultation activity in Australia, during the coronavirus disease 2019 (COVID-19) pandemic, from January 2019 to December 2021.MethodsAn interrupted time-series analysis was conducted to analyse the impact of two major policy changes, introduced through the Medicare Benefits Schedule (MBS), on GP consultation (in-person, videoconference, telephone) activity. The first policy change was the introduction of additional COVID-19 telehealth funding through the MBS on 30 March 2020. The second policy change was the limitation on telephone consultation length to under 20 min on 1 July 2021. The rate of GP telehealth provision and activity was compared between pre-and post-intervention periods, separated by these MBS policy changes.ResultsAfter the first policy change, there was a significant increase in telehealth provision, with a simultaneous decrease in in-person consultations (P < 0.0001). However, telehealth provision decreased in the months following this first policy change (P < 0.0001), while in-person activity increased. After the second policy change, the initial videoconference provision increased (P < 0.0001). However, all telehealth activity decreased afterwards. In the months following the second policy change, the decrease in monthly activity for in-person (P = 0.700), telephone (0.199) and videoconference (P = 0.178) consultations was not significant.ConclusionsThe introduction of additional telehealth funding and limitations on telephone consultation length encouraged the initial provision and growth of telehealth services. However, these policy changes did not sustain the long-term upward trajectory of telehealth activity. Telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services.

Abstract: ObjectiveTo explore out-of-pocket (OOP) costs within specialties and individual specialists, and use of Medicare Benefits Schedule (MBS) data for potential price transparency initiatives.MethodsWe conducted a cross-sectional descriptive study of claims for a 10% random sample of Medicare enrolees for out-of-hospital MBS-billed subsequent and initial consultations between 1 January 2014 and 31 December 2014, specific to cardiologist, oncologist and ophthalmologists (with at least 10 patient visits in 2014). Our main outcomes were the number of locations per provider, number of unique OOP consultation costs per provider and provider-location, and the proportion of bulk-billed visits for these visits.ResultsWe studied 970 cardiologists, 913 ophthalmologists and 376 oncologists. At least 67% of specialists across each specialty had at least two practice locations: cardiologists had a median of three (interquartile range [IQR]: 2-4) and ophthalmologists and oncologists both had a median of two (IQR: 1-3). For subsequent consultations, cardiologists had a median of three unique costs per location (IQR: 2-3), whereas ophthalmologists had a median of four unique costs per location (IQR: 3-5). In contrast, oncologists had a median of one unique cost per location (IQR: 1-2) (57.6% of oncologists' provider-locations charged only the bulk-billing amount).ConclusionsSpecialists have distinct fee lists that can vary based on location. Summary statistics on price transparency websites based on a single amount (like a median or mean OOP charge) might mask substantial variation in costs and lead to bill shock for individual patients.

Abstract: The COVID-19 pandemic has changed forever how we plan, respond to, and deliver health care. The lived experience of hospital infrastructure design to support a pandemic is currently not well described in the literature. Much of what is known covers generic elements of hospital design and/or assumptions about in-built disaster design features. The Central Adelaide Local Health Network became a key stakeholder in South Australia's response when the Royal Adelaide Hospital (RAH) became the designated receiving hospital for the state. Preparation for a pandemic commenced back in 2007 when a new build for the RAH was announced. Several disaster response infrastructure design features were incorporated into the RAH design specifications to provide a resilient facility that could respond to any type of disaster event while continuing to provide core clinical services. Key pandemic design elements included patient room design, pandemic air handling capability, and a 7-step scalability function. We describe these key elements based on real-time experience along with the key lessons learnt as the pandemic response evolved with the aim of guiding future hospital building design to not only support the more frequent time-limited disasters but, more specifically, a pandemic response. The RAH capitalised on its key design features to support its pandemic response and contributed to the overall success of South Australia's pandemic response.

Abstract: The COVID-19 pandemic has changed forever how we plan, respond to, and deliver health care. The lived experience of hospital infrastructure design to support a pandemic is currently not well described in the literature. Much of what is known covers generic elements of hospital design and/or assumptions about in-built disaster design features. The Central Adelaide Local Health Network became a key stakeholder in South Australia's response when the Royal Adelaide Hospital (RAH) became the designated receiving hospital for the state. Preparation for a pandemic commenced back in 2007 when a new build for the RAH was announced. Several disaster response infrastructure design features were incorporated into the RAH design specifications to provide a resilient facility that could respond to any type of disaster event while continuing to provide core clinical services. Key pandemic design elements included patient room design, pandemic air handling capability, and a 7-step scalability function. We describe these key elements based on real-time experience along with the key lessons learnt as the pandemic response evolved with the aim of guiding future hospital building design to not only support the more frequent time-limited disasters but, more specifically, a pandemic response. The RAH capitalised on its key design features to support its pandemic response and contributed to the overall success of South Australia's pandemic response.

Abstract: The United Nations Convention on the Rights of Persons with Disabilities and the Sendai Framework for Disaster Risk Management establish the importance of ensuring the equitable protection of human rights in disaster planning, relief, and recovery. However, internationally and within Australia, the reality is one of indignity, human rights violations, and corruption. Australia is living in a perpetual state of crisis, following 3years of environmental and health disaster events. Vulnerable Australian citizens, especially people with disability, are at a great risk of human rights violations and may have restricted access to resilience-building resources that would enable them to recover. Embedding dignity into disaster management and recovery can safeguard human rights and improve outcomes for people with disability.

Abstract: ObjectiveThe aims of this study were to explore and compare the perceptions of research capacity and culture (RCC) in metropolitan and non-metropolitan New South Wales (NSW) Local Health Districts (LHDs).MethodsThe Research Capacity and Culture Tool was delivered online to clinicians and health managers. A 10-point Likert scale of success or skill at organisational, team and individual level of research capacity was used. An independent t-test assessed differences in domain means between non-metropolitan and metropolitan LHDs.ResultsA total of 1243 participants responded. Responses to the survey indicated the perception of individual's research skills were greater than the perception of RCC at both the team and organisational levels. Participants from metropolitan locations had significantly higher mean scores across all three domains compared with non-metropolitan locations (P < 0.001).ConclusionResults indicated the perception of individual's research skills were greater than the team and organisational levels. Participants from metropolitan locations had significantly higher perceptions of RCC across all three domains compared with non-metropolitan locations. This was the largest study to date in Australia investigating RCC in NSW LHDs, and the first study to explore multiple professions across multiple organisations while comparing metropolitan and non-metropolitan settings. This research may inform targeted strategies for building research capacity in NSW LHDs.

Abstract: ObjectivesTo determine the total annual screening and further-investigation costs of investigating false-positive and true-positive mammograms in the Australian population breast-screening program.MethodsThis economic analysis used aggregate-level retrospective cohort data of women screened at a breast-screening clinic. Counts and frequencies of each diagnostic workup-sequence recorded were scaled up to national figures and costed by estimating per-patient costs of procedures using screening clinic cost data. Main outcomes and measures estimated were percentage share of total annual screening and further-investigation costs for the Australian population breast-screening program of investigating false-positive and true-positive mammograms. Secondary outcomes determined were average costs of investigating each false-positive and true-positive mammogram. Sensitivity analyses involved recalculating results excluding subgroups of patients below and above the screening age range of 50-74 years.ResultsOf 8235 patients, the median age was 60.35 years with interquartile range of 54.17-67.17 years. A total of 15.4% (ranging from 13.4 to 15.4% under different scenarios) of total annual screening and further-investigation costs were from investigating false-positive mammograms. This exceeded the share of costs from investigating true-positives (13%).ConclusionsWe have developed a transparent and non-onerous approach for estimating the costs of false-positive and true-positive mammograms associated with the national breast-screening program. While determining an optimal balance between false-positives and true-positive rates must rely primarily on health outcomes, costs are an important consideration. We recommend that future research adopts and refines similar approaches to facilitate better monitoring of these costs, benchmark against estimates from other screening programs, and support optimal policy development.