Prevalence and correlates of advance care planning among Australian hospital inpatients.

The prevalence and factors associated with advance care planning (ACP) documents for Australian public hospital inpatients were determined through cross-sectional study of 123 Victorian hospitals between July 2016 and December 2018. Of the 611 786 included patients, 2.9% had an ACP document. Odds increased significantly in those comorbid, unpartnered, regional and >5 admissions, which supports future ACP conversations and document creation.

Functional outcomes following an in-hospital cardiac arrest: A retrospective cohort study.

BACKGROUND/PURPOSE: Whilst much is known about the survival outcomes of patients that suffer an in-hospital cardiac arrest (IHCA) in Australia very little is known about the functional outcomes of survivors. This study aimed to describe the functional outcomes of a cohort of patients that suffered an in-hospital cardiac arrest (IHCA) and survived to hospital discharge in a regional Australian hospital. METHODS: This is a single-centre retrospective observational cohort study conducted in a regional Australian hospital. All adult patients that had an IHCA in the study hospital between 1 Jan 2017 and 31 Dec 2019 and survived to hospital discharge were included in the study. Functional outcomes were reported using the Modified Rankin Scale (mRS), a six-point scale for which increasing scores represent increasing disability. Scores were assigned through a retrospective review of medical notes. RESULTS: Overall, 102 adult patients had an IHCA during the study period, of whom 50 survived to hospital discharge. The median age of survivors was 68 years, and a third had a shockable initial arrest rhythm. Of survivors, 47 were able to be assigned both mRS scores. At discharge, 81% of patients achieved a favourable functional outcome (mRS 0-3 or equivalent function at discharge equal to admission). CONCLUSIONS: Most survivors to hospital discharge following an IHCA have a favourable functional outcome and are discharged home. Although these results are promising, larger studies across multiple hospitals are required to further inform what is known about functional outcomes in Australian IHCA survivors.

The impact of telehealth on patient attendance and revenue within an Aboriginal Community Controlled Health Organisation during COVID-19.

BACKGROUND AND OBJECTIVES: Aboriginal Community Controlled Health Organisations (ACCHOs) provide culturally appropriate medical services to Aboriginal and/or Torres Strait Islander people. The aim of this study was to examine the impact of telehealth on patient attendance and revenue within an ACCHO during COVID-19. METHOD: This is a time-series study of general practitioner attendances at a regional Victorian ACCHO in two periods: March-June 2019 (pre-COVID-19) and March-June 2020 (during COVID-19). RESULTS: After adjusting for the number of available appointments, there was a 27% increased rate of attendances per appointment slot during the COVID-19 period when compared with the pre-COVID-19 period, and a 59% increase in Medicare Benefits Schedule items claimed during the COVID-19 period, compared with the pre-COVID-19 period. DISCUSSION: The findings indicate that the provision of services via telehealth increased the number of people able to access the medical clinic, and that this had a positive financial impact for the organisation.

Communication of advance care planning decisions: a retrospective cohort study of documents in general practice.

BACKGROUND: Doctors, particularly general practitioners, play a significant role in assisting patients to create advance care plans. When medically indicated, these documents are important tools to promote congruence between end-of-life care and patient's personal preferences. Despite this, little is known regarding the availability of these documents in hospitals. The aim of this study was to identify the proportion of people who died in hospital without an advance care plan and how many of these had advance care planning (ACP) documents in their general practice records. METHODS: A retrospective cohort study was conducted of patient hospital records with manual linkage to general practice records. The large regional hospital in Victoria, Australia has a catchment population in excess of 300,000 people. The study sample was patients aged 75 years and over who died in the hospital between 1 January 2016 and 31 December 2017. The hospital records of these patients were examined to identify those which did not have a system alert for ACP documents on the file. Alerted ACP documents were limited to those legislated in the state of Victoria: advance care plan, Enduring Power of Attorney (Medical Treatment) or Enduring Power of Guardianship. Where no ACP document system alert was found in the hospital record, the patient's nominated general practice was consented to participate and the corresponding general practice record was examined. Data were analysed using descriptive statistics. RESULTS: Of the 406 patients who died in hospital, 76.1% (309) did not have a system alert for any ACP document. Of the 309 hospital records without a system alert, 144 (46.7%) corresponding general practice records were examined. Of these, 14.6% included at least one ACP document, including four advance care plans, that were not available in hospital. CONCLUSIONS: Unless ACP documents are consistently communicated from general practice, patient's preferences may be unknown during end-of-life care. It is important that both doctors and patients are supported to use connected electronic health records to ensure that documents are readily available to healthcare staff when they are required.

Rural health services' relationships with patients: An enabler and a barrier to advance care planning.

OBJECTIVE: The barriers and enablers to the uptake of advance care plans has been well documented but more so in metropolitan health services. Rural and regional areas have their own challenges of higher rates of chronic illness and an aging population when considering end of life care. This study aimed to explore the creation of advance care plans in a regional location that has service links to smaller health services. DESIGN: A qualitative study involving thematic analysis of interview data. SETTING: A regional local government area in Victoria, Australia. PARTICIPANTS: Twelve representatives from rural and regional health services, including hospital, private practice and community organisation staff. MAIN OUTCOME MEASURES: Barriers and enablers to the creation of advance care planning documents. RESULTS: The data analysis yielded two main identified themes around Plan creation and communication of patient wishes: system and societal challenges to the creation and communication in advance care planning; and rural communities' expectation of the health service-patient relationship and advance care planning. CONCLUSION: Although barriers to advance care planning are well known, rural and regional practitioners need to be aware of the effect long-term continuity of care from health practitioners and connections with health services has on advance care plan creation, and whether the paucity of written Plans effects end-of-life care. A potential solution was seen in the pending linkages to the national electronic patient record.

Content and implementation of advance care plans: A retrospective cohort study

BACKGROUND AND OBJECTIVES: The development of advance care plans (Plans) in general practice can be time consuming. End-of-life care should reflect an individual's documented preferences. The aim of this study was to examine the content and implementation of Plans in hospital during end-of-life care. METHODS: A retrospective cohort study of the hospital medical records of decedents aged ≥75 years was performed to assess Plan content and implementation. RESULTS: Of the 536 decedents, 52 had a Plan. There were 17 cases where life-prolonging treatment was given and contradicted preferences listed in the Plan. This included instances of intubation, surgery and curative medication. DISCUSSION: General practice staff investment in advance care planning should be reflected in the utilisation of Plans and, where medically indicated, respect for patients' preferences.

High risk behaviour and fertility desires among heterosexual HIV-positive patients with a serodiscordant partner--two challenging issues.

AIM OF THE STUDY: To evaluate fertility intentions and condom use among HIV-positive persons. METHODS: Multicentre study based on anonymous data collection (questionnaire). RESULTS: 114 questionnaires providing complete information were evaluated. 45% of HIV-positive women and 38% of HIV-positive men expressed the desire for children. Irrespective of this wish, half the study participants felt that health care providers would not sufficiently address their concerns regarding relationship, sexuality and fertility intentions. In HIV-discordant heterosexual couples, consistent condom use was mentioned by 73% of respondents. Among study participants no significant relationship between HAART, viral load and inconsistent condom use was found. In contrast, information on condom use obtained from the Swiss HIV Cohort Study (SHCS), where the information is obtained by interview, gave higher estimates (88%) of consistent condom use. CONCLUSIONS: A significant proportion of HIV-infected individuals express a wish for parenthood. Issues related to fertility intentions and sexual relations need to be addressed more frequently by health care providers. Non-anonymous data collection on condom use may underestimate high risk behaviour.