1,601 research outputs found
Response to Setting the record straight on obstetric gaps
No full textWe write in reply to the letter ‘Setting the Record Straight on Obstetric Gaps’.2 We thank the author for his reply to our previously published short commentary ‘Changes in out‐of‐pocket charges associated with obstetric care provided under Medicare in Australia’ (ANZJOG 2018; 58; 362–365). Overwhelmingly what ‘Setting the Record Straight on Obstetric Gaps’ highlights is the lack of transparency regarding the setting of fees that are charged to women, and the influence of ministerial decisions and lobbying on the fees that are paid from the woman's purse at the end of a private specialist consultation.No Full Tex
Disparities in experiences of emergency department care for people with a mental health condition
No full textBackground: The aim of this study was to explore differences in experiences of care in Emergency Departments (EDs) for people with and without mental health conditions. Methods: Secondary analyses of a survey of 15,995 patients from 82 EDs in New South Wales, Australia was conducted focusing on the most positive responses for 53 questions across nine dimensions of experiences. Logistic regression was used to compare experiences between people with and without a self-reported mental health condition, regardless of the reason for presentation. Results: Most patients reported positive experiences, with 60% rating care as ‘very good’. However, fewer people with mental health conditions gave ‘very good’ ratings (52%). Their experiences were significantly less positive for 40 of 53 questions. For overall impressions of professionals, physical comfort, and continuity dimensions, experiences for those with mental health conditions were at least eight percentage points lower than those with no condition. Differences were minimal for other questions such as experiences with facilities (e.g. clean treatment areas). Conclusions: Regardless of the reason for their visit, improvements in experiences for people with mental health conditions should focus on interactions with healthcare professionals, comfort, engagement and continuity. Improving experiences of this group can help improve their outcomes of care.No Full Tex
Selecting and Implementing Patient-Reported Outcome and Experience Measures to Assess Health System Performance.
No full textIMPORTANCE: Psychometrically robust patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are critical to evaluating quality and performance across health services and systems. However, the adoption and implementation of PROMs and PREMs remain a challenge in many countries. The aim of this guide is to support instrument selection and implementation to measure health system performance. OBSERVATIONS: The guide is split into 3 step-by-step sections. Step 1: Knowing What to Measure discusses what PROMs and PREMs capture and how they differ from related instruments. Step 2: Choosing the Right Instrument describes the critical psychometric properties of validity, reliability, and responsiveness, and provides resources to support instrument selection and evaluation. Step 3: Mitigating Potential PROM and PREM Implementation Barriers outlines key barriers and supports for instrument implementation at system, service, and individual levels. CONCLUSIONS AND RELEVANCE: This guide aims to provide practical resources for the identification of psychometrically robust PROMs and PREMs, as well as support for their implementation to drive improvements across health systems globally
Income support for parents of children with chronic conditions and disability: where do we draw the line? A policy review.
No full textOBJECTIVE: The aim of this review was to identify and describe whether parents who have had to stop paid employment to care for a child with a chronic condition or disability are eligible for unemployment, family and children, and disability and carer government-provided financial benefits. DESIGN: Policy review. SETTING: Group of seven high-income countries. MAIN OUTCOME MEASURES: All policies related to unemployment, family and children, and disability and carer benefits were included. Information regarding the policy type and description, parent/carer qualification, amount of financial support payable, eligibility criteria and information source were extracted. Payment schedules were converted into 2020 US dollars, using Purchasing Power Parities. Maximum monthly benefit payments were compared with standardised per capita monthly costs of living to determine payment support suitability. RESULTS: Fifty-eight policies relevant to unemployment, family and children, and disability and carer benefit supports were identified. Germany had the highest number of welfare policies for individuals not in employment (n=11), followed by the USA (n=6). Parents or carers of children with chronic conditions or disability who were not in employment qualified for 31 of the 58 policies (53.4%). Most policies required a child to have an impaired ability to function, not just a chronic condition or disability. CONCLUSIONS: Greater support for parents and carers to continue their paid employment alongside caring responsibilities is necessary. Graded benefit schedules will also be critical to supporting the spectrum of childhood chronic conditions and disability, and the subsequent spectrum of caring responsibility
Comparison of several author indices for gauging academic productivity
No full textBackground
Many author indices exist to gauge academic productivity. Several of these indices are calculated based upon an author's scholarly publication record, but the measurement methodology to calculate each index varies considerably, and the precise function being used, as well as the end result, is often complex and difficult to assess.
Method
Two straightforward methods to weigh author productivity from the publication and citation record were evaluated as possible means for providing a clearer assessment of scholarly activity. The author characteristic index (termed c-index) assigns author rank for each publication based upon author position. The characteristic prime (c') -index normalizes author rank from author position, so that the total weight per publication is unity. The top 10 scholars with keyword 'celiac disease' in the Google Scholar database were then assessed using these metrics. Rankings according to total number of publications, h-index, and c- and c'-indices were compared, then tabulated along with total papers included for assessment, and mean values per paper for author position, number of authors, citations, and year of publication.
Results
The order of the top ten authors with keyword 'celiac disease' varied substantially depending upon whether the h-index, c-index, or c'-index was used as a gauge. The characteristic indices assign credit to authors according to their position in an author list. The affiliated metrics provided a more complete picture of scholarly activity.
Conclusions
Academic achievement by scholars, based upon quantitative publication characteristics, has recently become of interest for evaluating job candidates, for determining work performance, and for bestowing awards and honors. The characteristic indices as described herein are readily calculated and interpreted, and may improve the assessment of scholarly activity
The cost of Hypertensive Disorders of Pregnancy to the Australian healthcare system
No full textIn Australia, Hypertensive Disorders of Pregnancy are one of the leading causes of maternal death. Additionally, mothers and babies can experience significant morbidity associated with Hypertensive Disorders of Pregnancy. Currently, there is little understanding about the resources spent on this pregnancy complication in Australia. Therefore, using a linked administrative dataset from the Queensland population in Australia, this study aims to determine the difference in government expenditure between mothers that have Hypertensive Disorders of Pregnancy and mothers who do not. The total government expenditure on mothers that had HDP was significantly higher than in mothers who did not have HDP (11,395 respectively). Most notably, the greatest difference in costs were experienced during the time of birth (6509).No Full Tex
Inequities in vulnerable children's access to health services in Australia
No full textINTRODUCTION: Children born into families at risk of becoming or remaining poor are at significant risk of experiencing childhood poverty, which can impair their start to life, and perpetuate intergenerational cycles of poverty. This study sought to quantify health service utilisation, costs and funding distribution amongst children born into vulnerable compared to non-vulnerable families. METHODS: This study used a large linked administrative dataset for all women giving birth in Queensland, Australia between July 2012 and July 2018. Health service use included inpatient, emergency department (ED), general practice, specialist, pathology and diagnostic imaging services. Costs included those paid by public hospital funders, private health insurers, Medicare and out-of-pocket costs. RESULTS: Vulnerable children comprised 34.1% of the study cohort. Compared with non-vulnerable children, they used significantly higher average numbers of ED services during the first 5 years of life (2.52±3.63 vs 1.97±2.77), and significantly lower average numbers of specialist, pathology and diagnostic imaging services. Vulnerable children incurred significantly greater costs to public hospital funders compared with non-vulnerable children over the first 5 years of life (10 247), and significantly lower private health insurer, Medicare and out-of-pocket costs. CONCLUSION: There are clear inequities in vulnerable children's health service utilisation in Australia. Greater examination of the uptake and cost-effectiveness of maternal and child services is needed, as these services support children's development in the critical first 1000 days of life.Full Tex
Experiences of maternity care in New South Wales among women with mental health conditions
No full textBackground: High quality maternity care is increasingly understood to represent a continuum of care. As well as ensuring a positive experience for mothers and families, integrated maternity care is responsive to mental health needs of mothers. The aim of this paper is to summarize differences in women's experiences of maternity care between women with and without a self-reported mental health condition.
Methods: Secondary analyses of a randomized, stratified sample patient experience survey of 4787 women who gave birth in a New South Wales public hospital in 2017. We focused on 64 measures of experiences of antenatal care, hospital care during and following birth and follow up at home. Experiences covered eight dimensions: overall impressions, emotional support, respect for preferences, information, involvement, physical comfort and continuity. Multivariable logistic regression was used to compare experiences of women with and without a self-reported longstanding mental health condition.
Results: Compared to women without a condition, women with a longstanding mental health condition (n = 353) reported significantly less positive experiences by eight percentage points on average, with significant differences on 41 out of 64 measures after adjusting for age, education, language, parity, type of birth and region. Disparities were pronounced for key measures of emotional support (discussion of worries and fears, trust in providers), physical comfort (assistance, pain management) and overall impressions of care. Most women with mental health conditions (75% or more) reported positive experiences for measures related to guidelines for maternity care for women with mental illness (discussion of emotional health, healthy behaviours, weight gain). Their experiences were not significantly different from those of women with no reported conditions.
Conclusions: Women with a mental health condition had significantly less positive experiences of maternity care across all stages of care compared to women with no condition. However, for some measures, including those related to guidelines for maternity care for women with mental illness, there were highly positive ratings and no significant differences between groups. This suggests disparities in experiences of care for women with mental health conditions are not inevitable. More can be done to improve experiences of maternity care for women with mental health conditions
Quantifying the differences in birth outcomes and out-of-pocket costs between Australian Defence Force servicewomen and civilian women: A data linkage study.
No full textOBJECTIVES: Servicewomen in Defence Forces the world over are constrained in their health service use by defence healthcare policy. These policies govern a woman's ability to choose who she receives maternity care from and where. The aim of this study was to compare Australian Defence Force (ADF) servicewomen and children's birth outcomes, health service use, and out-of-pocket costs to those of civilian women and children. METHODS: Retrospective cohort study using linked administrative data for women giving birth between 1 July 2012 and 30 June 2018 in Queensland, Australia (n = 365,138 births). Women serving in the ADF at the time of birth were identified as having their care funded by the Department of Defence (n = 395 births). Propensity score matching was used to identify a mixed public/private civilian sample of women to allow for comparison with servicewomen, controlling for baseline characteristics. Sensitivity analysis was also conducted using a sample of civilian women accessing only private maternity care. FINDINGS: Nearly all servicewomen gave birth in the private setting (97.22%). They had significantly greater odds of having a caesarean section (OR 1.71, 95%CI 1.29-2.30) and epidural (OR 1.56, 95%CI 1.11-2.20), and significantly lower odds of having a non-instrumental vaginal birth (OR 0.57, 95%CI 0.43-0.75) compared to women in the matched public/private civilian sample. Compared to civilian children, children born to servicewomen had significantly higher out-of-pocket costs at birth (214.98 ± 403.45) and second (618.66 ± 779.67) despite similar health service use. CONCLUSIONS: ADF servicewomen have higher rates of obstetric intervention at birth and also pay significantly higher out-of-pocket costs for their children's health service utilisation up to 2-years of age. Given the high rates of obstetric intervention, greater exploration of servicewomen's maternity care experiences and preferences is warranted, as this may necessitate further reform to ADF maternity healthcare policy
Options for improving low birthweight and prematurity birth outcomes of indigenous and culturally and linguistically diverse infants: a systematic review of the literature using the social-ecological model.
No full textBACKGROUND: Prematurity and low birthweight are more prevalent among Indigenous and Culturally and Linguistically Diverse infants. METHODS: To conduct a systematic review that used the social-ecological model to identify interventions for reducing low birthweight and prematurity among Indigenous or CALD infants. Scopus, PubMed, CINAHL, and Medline electronic databases were searched. Studies included those published in English between 2010 and 2021, conducted in high-income countries, and reported quantitative results from clinical trials, randomized controlled trials, case-control studies or cohort studies targeting a reduction in preterm birth or low birthweight among Indigenous or CALD infants. Studies were categorized according to the level of the social-ecological model they addressed. FINDINGS: Nine studies were identified that met the inclusion criteria. Six of these studies reported interventions targeting the organizational level of the social-ecological model. Three studies targeted the policy, community, and interpersonal levels, respectively. Seven studies presented statistically significant reductions in preterm birth or low birthweight among Indigenous or CALD infants. These interventions targeted the policy (n = 1), community (n = 1), interpersonal (n = 1) and organizational (n = 4) levels of the social-ecological model. INTERPRETATION: Few interventions across high-income countries target the improvement of low birthweight and prematurity birth outcomes among Indigenous or CALD infants. No level of the social-ecological model was found to be more effective than another for improving these outcomes
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