Ladies in waiting: the timeliness of first trimester services in New Zealand

<p>Abstract</p> <p>Background</p> <p>Termination of pregnancy (TOP) services are a core service in New Zealand. However, compared to other developed countries, TOP services are accessed significantly later in the first trimester, increasing the risk for complications. The aim of this study is to examine the timeliness of access to first trimester TOP services and establish the length of delay between different points in the care pathway for these services.</p> <p>Methodology</p> <p>Data were collected from all patients attending nine TOP clinics around the country between February and May 2009 (N = 2950). Patient records were audited to determine the timeline between the first point of entry to the health system to the date of termination. In addition, women were invited to fill out a questionnaire to identify personal level factors affecting access to services (N = 1086, response rate = 36.8%).</p> <p>Results</p> <p>Women waited an average of almost 25 days between the date of the first visit with the referring doctor and the date of their termination procedure. There was a delay of 10 days between the first visit with the referring doctor and the date that the appointment for the procedure was booked, and a further 10 days delay between the date the appointment was booked and the first appointment date. Over half of the women in this study had their pregnancy terminated at ten weeks or above.</p> <p>Conclusion</p> <p>Women in New Zealand are subject to a lengthy delay while seeking TOP services. Efforts should be made by TOP clinics as well as referring doctors to reduce the waiting times for this service.</p

Australian health policy and end of life care for people with chronic disease: An analysis

End of life care for people with advanced chronic disease is a growing international imperative, with the majority of deaths in the world now related to chronic disease. The provision of care that meets the needs of people with advanced chronic disease must be guided by appropriate policy. The key policy areas impacting directly on end of life care are related to chronic disease, palliative care and, increasingly, aged care. This paper describes the outcomes of an audit of Australian chronic disease and end of life/palliative care policies. We identified that chronic disease health policies/strategies demonstrate a focus on prevention, early intervention and management, with scant recognition of end of life care needs. The majority assume that a referral to palliative care will address end of life care needs for people with chronic disease. By contrast, palliative care policies recognise the need for the incorporation of a palliative approach into advanced chronic disease care, but there are few connections between these two policy areas. Whilst palliative care policies intersect with carer and advance care planning policies, chronic disease policy does not. Key concerns requiring consideration when developing policy in this area are discussed and possible policy options identified.Teresa Burgess, Annette Braunack-Mayer, Gregory B. Crawford, Justin Beilb

Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population

BACKGROUND: Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. AIM: To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data. DESIGN: Retrospective cohort study. SETTING/PARTICIPANTS: The cohort consisted of 23,852 people aged 20 years and over who died in Western Australia between 1 January 2009 and 31 December 2010 after excluding deaths related to pregnancy or trauma. Within this cohort, the number, proportion and characteristics of people who died from one or more of 10 medical conditions considered amenable to palliative care were identified using linked hospital records and death certificate data. RESULTS: Depending on the information source(s) used, between 43% and 73% of the 23,852 people who died had a condition potentially amenable to palliative care identified. The median age at death and the sex distribution of the decedents by condition also varied with the information source. CONCLUSION: Health service planners and researchers need to be aware of the limitations when using hospital records and death certificate data to determine a potential palliative care population. The use of Emergency Department and other administrative data sources could further exacerbate this variation

Selecting interventions to promote fruit and vegetable consumption: from policy to action, a planning framework case study in Western Australia

The Department of Health in Western Australia identified access to, and daily consumption of recommended amounts of fruit and vegetables, as priority health determinants. The numerous factors that influence supply and consumption of fruit and vegetables indicated that a comprehensive approach would be required. A government and non-government sector steering group was set up to select priority interventions using the National Public Health Partnership\u27s Framework for Implementing Public Health Strategies. This structured framework was used for developing strategies to improve fruit and vegetable consumption and supply, and to identify implementation priorities. After one year a desktop audit of progress on framework interventions was undertaken

Creating change in government to address the social determinants of health: how can efforts be improved?

Background - The evidence base for the impact of social determinants of health has been strengthened considerably in the last decade. Increasingly, the public health field is using this as a foundation for arguments and actions to change government policies. The Health in All Policies (HiAP) approach, alongside recommendations from the 2010 Marmot Review into health inequalities in the UK (which we refer to as the ‘Fairness Agenda’), go beyond advocating for the redesign of individual policies, to shaping the government structures and processes that facilitate the implementation of these policies. In doing so, public health is drawing on recent trends in public policy towards ‘joined up government’, where greater integration is sought between government departments, agencies and actors outside of government. Methods - In this paper we provide a meta-synthesis of the empirical public policy research into joined up government, drawing out characteristics associated with successful joined up initiatives. - We use this thematic synthesis as a basis for comparing and contrasting emerging public health interventions concerned with joined-up action across government. Results - We find that HiAP and the Fairness Agenda exhibit some of the characteristics associated with successful joined up initiatives, however they also utilise ‘change instruments’ that have been found to be ineffective. Moreover, we find that – like many joined up initiatives – there is room for improvement in the alignment between the goals of the interventions and their design. Conclusion - Drawing on public policy studies, we recommend a number of strategies to increase the efficacy of current interventions. More broadly, we argue that up-stream interventions need to be ‘fit-for-purpose’, and cannot be easily replicated from one context to the next

Timeliness and clinical impact of hospital-initiated medication reviews

Background: Medication-related problems often occur in the immediate post-discharge period. To reduce medication misadventure the Commonwealth Government funds home medicines reviews (HMRs). HMRs are initiated when general practitioners refer consenting patients to their community pharmacists, who then engage accredited pharmacists to review patients' medicines in their homes. Aim: To determine if hospital-initiated medication reviews (HIMRs) can be implemented in a more timely manner than HMRs; and to assess the impact of a bespoke referral form with comorbidity-specific questions on the quality of reports. Method: Eligible medical inpatients at risk of medication misadventure were referred by the hospital liaison pharmacist to participating accredited pharmacists post-discharge from hospital. Social, demographic and laboratory data were collected from medical records and during interviews with consenting patients. Issues raised in the HIMR reports were categorised: intervention/action, information given or recommendation, and assigned a rank of clinical significance. Results: HIMRs were conducted within 11.6 6.6 days postdischarge. 36 HIMR reports were evaluated and 1442 issues identified - information given (n = 1204), recommendations made (n = 88) and actions taken (n = 150). The majority of issues raised (89%) had a minor clinical impact. The bespoke referral form prompted approximately half of the issues raised. Conclusion: HIMRs can be facilitated in a more timely manner than post-discharge HMRs. There was an associated positive clinical impact of issues raised in the HIMR reports

Supporting evaluation and implementation of musculoskeletal Models of Care: A globally-informed framework for judging 'readiness' and 'success'.

Objective To develop a globally-informed framework to evaluate 'readiness' for implementation and 'success' after implementation of musculoskeletal Models of Care (MoCs). Methods Three-phases were undertaken: 1) qualitative study with 27 Australian subject matter experts (SMEs) to develop a draft Framework; 2) eDelphi study with an international panel of 93 SMEs across 30 nations to evaluate face validity, refine and establish consensus on the Framework components; and 3) translation of the Framework into a user-focused resource and evaluation of its acceptability with the eDelphi panel. Results A comprehensive evaluation framework was developed for judging 'readiness' and 'success' of musculoskeletal MoCs. The Framework consists of nine domains, with each domain containing a number of themes underpinned by detailed elements. In the first Delphi round, scores of 'partly agree' or 'completely agree' with the draft Framework ranged from 96.7-100%. In the second round, 'essential' scores ranged from 58.6-98.9%, resulting in 14 of 34 themes being classified as essential. SMEs strongly agreed or agreed that the final Framework was useful (98.8%), usable (95.1%), credible (100%) and appealing (93.9%). Overall, 96.3% strongly supported or supported the final structure of the Framework as it was presented, while 100%, 96.3% and 100% strongly supported or supported the content within the readiness, initiating implementation and success streams, respectively. Conclusions An empirically-derived framework to evaluate the readiness and success of musculoskeletal MoCs was strongly supported by an international panel of SMEs. The Framework provides an important internationally-applicable benchmark for the development, implementation and evaluation of musculoskeletal MoCs. This article is protected by copyright. All rights reserved

Needle and syringe distribution trends in Western Australia, 1990 to 2009

Introduction and Aims To describe needle and syringe distribution trends of needle and syringe programs (NSP) between 1990 and 2009 in Western Australia, and explore contributing factors within the national and state strategic and legislative environment. Design and Methods The number of needles and syringes distributed by each of the four NSP types [needle and syringe exchange program (NSEP); health service; pharmacy; vending machine] between 1990 and 2009 were stratified by time period and geographic location using Microsoft Excel. Results Total needle and syringe distribution over the 20-year period increased by eight-fold. Regional areas experienced the highest growth: 20-fold increase compared with seven-fold increase in metropolitan areas. The proportion of needles and syringes distributed through NSEPs increased from 33% to 62% between 1990 and 2009, and through health services increased from 3% to 8% between 1994 and 2009. The proportion distributed through pharmacies decreased from 67% to 28% between 1990 and 2009, and through vending machines from 7% to 1.3% between 1992 and 2009. National and state HIV and hepatitis C strategies guided NSP provision at an early stage, and expedited legislative amendments to allow for the operation of approved NSPs. Discussion and Conclusions The majority of growth occurred through the NSEPs and health service NSPs, which are publicly funded NSPs and provide injecting equipment either on ‘exchange’ or free-of-charge respectively. The Health Department of Western Australia recognises the increasing reliance on publicly funded NSPs and the need to continue this cost-effective public health program