Measuring Mental Health Service Accessibility for Indigenous Populations: a Systematic Review.

Indigenous populations have experienced inequality of accessing mental health services compared with their non-Indigenous counterparts, although the way of measuring mental health service accessibility for Indigenous populations is unclear. This systematic review examines measures of mental health service accessibility for Indigenous people, including the diversity of mental health services that are available to them and the barriers to accessing mental healthcare. Using a systematic search procedure, we identified 27 studies that explored Indigenous populations' mental health service access. Our review shows that 18 studies used interview-based methods to explore how Indigenous people use mental health services, and only nine studies used quantitative methods to measure the uptake of mental health services. While advanced methods for quantifying geographical access to healthcare services are widely available, these methods have not been applied in the current literature to explore the potential access to mental health services by Indigenous populations. This is partially due to limited understanding of how Indigenous populations seek mental healthcare, barriers that prevent Indigenous people from accessing diverse types of mental health services, and scarcity of data that are available to researchers. Future research could focus on developing methods to support spatially explicit measuring of accessibility to mental health services for Indigenous populations.

Association of sensory impairment with healthcare use and costs among middle-aged and older adults in China.

OBJECTIVES: This study aimed to explore the association of visual, hearing, or dual sensory impairment with healthcare use and costs. STUDY DESIGN: This is a cohort study. METHODS: These research data were from the China Health and Retirement Longitudinal Study spanning 2011-2018 and included 8982 community-dwelling middle-aged and older adults (aged ≥45 years at baseline). Sensory impairment was measured according to self-reported assessment of visual and hearing functions, and healthcare use and costs were ascertained via self-report. The associations of sensory impairment with healthcare use and costs were estimated using the mixed-effects regression models. RESULTS: Of the 8982 respondents, 4346 (48.39%) were females and their mean (standard deviation) age at baseline was 57.03 (8.26) years. Individuals with hearing impairment (HI) only, visual impairment (VI) only, and dual sensory impairment (DSI) were all at significantly higher risks of healthcare use and catastrophic health expenditure than those without sensory impairment (all P < 0.05), except that VI only non-significantly prolonged inpatient days. Compared with no impairment, DSI was associated with increases in outpatient (ß = 50.67, 95% confidence interval [CI] = 17.47-83.86) and inpatient out-of-pocket costs (ß = 40.35, 95% CI = 5.94-74.76), while VI only or HI only did not show significant effects. Further stratification analyses indicated that the associations between sensory impairment and outpatient use were more pronounced among males than among females but that age group did not moderate the associations with any healthcare outcomes. CONCLUSIONS: HI and VI were independently and together associated with higher risks of healthcare use and catastrophic health expenditure. Dual sensory impairment was the only category consistently associated with increased outpatient and inpatient costs.

Catastrophic Health Expenditure Associated With Frailty in Community-Dwelling Chinese Older Adults: A Prospective Cohort Analysis.

Background: Catastrophic health expenditure (CHE) represents a key indicator for excessive financial burden due to out-of-pocket (OOP) healthcare costs, which could push the household into poverty and is highly pronounced in households with members at an advanced age. Previous studies have been devoted to understanding the determinants for CHE, yet little evidence exists on its association with frailty, an important geriatric syndrome attracting growing recognition. We thus aim to examine the relationship between frailty and CHE and to explore whether this effect is moderated by socioeconomic-related factors. Methods: A total of 3,277 older adults were drawn from two waves (2011 and 2013) of the China Health and Retirement Longitudinal Study (CHARLS). CHE was defined when OOP healthcare expenditure exceeded a specific proportion of the capacity of the household to pay. Frailty was measured following the Fried Phenotype (FP) scale. Mixed-effects logistic regression models were employed to assess the longitudinal relationship between frailty and CHE, and stratification analyses were conducted to explore the moderation effect. Results: The incidence of CHE among Chinese community-dwelling older adults was 21.76% in 2011 and increased to 26.46% in 2013. Compared with non-frail individuals, prefrail or frail adults were associated with higher odds for CHE after controlling for age, gender, residence, education, marriage, income, health insurance, smoking, drinking, and comorbidity (prefrail: odds ratio (OR) = 1.32, 95%CI = 1.14-1.52; frail: OR = 1.67, 95%CI = 1.13-2.47). Three frailty components including weakness, exhaustion, and shrinking contributed to a significantly increased likelihood of CHE (all p < 0.05), while the other two components including slowness and inactivity showed a non-significant effect (all p > 0.05). Similar effects from frailty on CHE were observed across socioeconomic-related subgroups differentiated by gender, residence, education, household income, and social health insurance. Conclusions: Frailty is a significant predictor for CHE in China. Developing and implementing cost-effective strategies for the prevention and management of frailty is imperative to protect households from financial catastrophe.

How much can our universities do in the development of cultural intelligence? A cross-sectional study among health care students.

BACKGROUND: Cultural intelligence reflects the competence to adapt to new cultural settings. Universities offer students various opportunities to gain cultural learning and develop cultural intelligence. However, there has been little empirical research to compare the effects of cultural learning and other related psycho-social factors in this process. OBJECTIVE: This study explores the importance of cultural learning and identifies the unique contribution of cultural education in universities to health care students' cultural intelligence. DESIGN: Cross-sectional survey study. METHODS: 271 health care students completed a survey measuring social desirability, demographics, personality, prior cultural exposure, previous cultural learning and cultural intelligence. RESULTS: Hierarchical regressions showed that cultural learning could affect cultural intelligence and its three components (i.e., metacognition, cognition, motivation, and behaviour) under the control for related psycho-social factors. However, its effect on the behavioral component was not significant. Considering the different types of cultural learning, overseas study experiences were more related to cultural intelligence, compared to in-class cultural learning. CONCLUSION: Cultural learning, especially overseas study experiences, plays a significant role in the development of health care students' cultural intelligence.

Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia.

BACKGROUND: This study aims to examine the costs associated with a Hospital in the Nursing Home (HiNH) program in Queensland Australia directed at patients from residential aged care facilities (RACFs) with emergency care needs. METHODS: A cost analysis was undertaken comparing the costs under the HiNH program and the current practice, in parallel with a pre-post controlled study design. The study was conducted in two Queensland public hospitals: the Royal Brisbane and Women's Hospital (intervention hospital) and the Logan Hospital (control hospital). Main outcome measures were the associated incremental costs or savings concerning the HiNH program provision and the acute hospital care utilisation over one year after intervention. RESULTS: The initial deterministic analysis calculated the total induced mean costs associated with providing the HiNH program over one year as AU$488,116, and the total induced savings relating to acute hospital care service utilisation of AU$8,659,788. The total net costs to the health service providers were thus calculated at -AU$8,171,671 per annum. Results from the probabilistic sensitivity analysis (based on 10,000 simulations) showed the mean and median annual net costs associated with the HiNH program implementation were -AU$8,444,512 and-AU$8,202,676, and a standard deviation of 2,955,346. There was 95% certainty that the values of net costs would fall within the range from -AU$15,018,055 to -AU$3,358,820. CONCLUSIONS: The costs relating to implementing the HiNH program appear to be much less than the savings in terms of associated decreases in acute hospital service utilisation. The HiNH service model is likely to have the cost-saving potential while improving the emergency care provision for RACF residents.

Incidence and outcome of subarachnoid haemorrhage in the general and emergency department populations in Queensland from 2010 to 2014.

OBJECTIVES: To determine: (i) incidence and outcome of subarachnoid haemorrhage (SAH) in the general population; and (ii) proportions of SAH in both the general ED population and in ED patients presenting with headache. METHODS: A population-based study in Queensland from January 2010 to December 2014 was conducted. Data were sourced from the Australian Bureau of Statistics, Queensland Hospital Admitted Patient Data Collection linked to the Queensland death registry and ED Information System. Admitted patients with SAH were identified from ICD-10-AM codes. Inter-hospital transfers and repeat admissions for previously diagnosed SAH were excluded. Pre-hospital deaths from SAH were included. ED patients with headache were identified from ICD-10-AM codes and finding 'headache' in the triage free-text entry. The incidence of SAH, in-hospital mortality, proportions of SAH in the general ED population and ED patients with headache were calculated. RESULTS: There were 1975 incident cases of SAH in admitted patients and 294 pre-hospital deaths from SAH. The incidence of SAH was 9.9 (95% confidence interval [CI] 9.5-10.4) per 100 000 person-years. The incidence standardised to the 'World Standard Population' was 7.0 per 100 000 person-years. The in-hospital mortality was 23.8% (95% CI 22.0-25.8%). SAH was found in 1407 (1.9%, 95% CI 1.8-2.0) of ED patients with headache. Overall, there were 2.4 (95% CI 2.3-2.5) SAH per 10 000 of all ED attendances. CONCLUSIONS: The incidence of SAH was similar to that previously reported for Australia. One in 50 ED patients with headache had SAH. Ten in 50 000 ED attendances had a SAH. These estimates can assist in the risk assessment for SAH.

Qualitative study of patients' choice between public and private hospital emergency departments.

OBJECTIVE: The aim of this study was to gather patients' perceptions regarding their choice between public and private hospital EDs for those who hold private health insurance. The findings of this study will contribute to knowledge regarding patients' decision-making processes and therefore may contribute to the development of evidence based public policies. METHODS: An in-depth semi-structured guide was used to interview participants at public and private hospital EDs. Questions sought to identify the issues that were considered by the participants to decide to attend that hospital ED, previous ED experience, expectations of ED services and perceived benefits and barriers to accessing services. Interviews were audio recorded, transcribed verbatim and analysed using content and thematic approaches. RESULTS: Four core themes emerged: prior good experience with the hospital, perceived quality of care, perceived waiting times and perceived costs that may explain patients' choice. Patients' choice between public and private EDs can be explained by the interaction of these core themes. The principal issues appear to be concern for gap payments at private hospital ED and waiting times at public hospital ED. CONCLUSIONS: Patients who choose to attend public EDs appear to value financial concern over waiting time; those who choose to attend private EDs appear to value waiting time ahead of financial concerns.

Subjective reasons why immigrant patients attend the emergency department.

BACKGROUND: Some patients visit a hospital's emergency department (ED) for reasons other than an urgent medical condition. There is evidence that this practice may differ among patients from different backgrounds. The objective of this study was to examine the reasons why patients from a non-English speaking background (NESB) and patients with an English speaking background but not born in Australia (ESB-NBA) visit the ED, as compared to patients from English-speaking backgrounds but born in Australia (ESB-BA). METHODS: A cross-sectional survey was conducted at the ED of a tertiary hospital in metropolitan Brisbane, Queensland, Australia. Over a four-month period patients who were assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed. Pearson chi-square test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB patients' reported reasons for attending the ED. RESULTS: A total of 828 patients participated in this study. Compared to ESB-BA patients NESB patients were less likely to consider contacting a general practitioner (GP) before attending the ED (Odds Ratios (OR) 0.6 (95% Confidence Interval (CI) 0.4-0.8, p < .05) While ESB-NBA were more likely to consider contacting a GP 1.7 (1.1-2.5, p < .05). Both the NESB patients and the ESB-NBA patients were far more likely than ESB-BA patients to report that they had visited the ED either because they do not have a GP (OR 7.9, 95% CI 4.7-13.4, p < .001) and 2.2 (95% CI 1.1-4.4, p < .05) respectively and less likely to think that the ED could deal with their problem better than a GP (OR 0.5 (95% CI 0.3-0.8, p < .05) and 0.7 (0.3-0.9, p < .05) respectively. The NESB patients also thought it would take too long to make an appointment to consult a GP (OR 6.2, 95% CI 3.7-10.4, p < 0.001). CONCLUSIONS: NESB patients were the least likely to consider contacting a GP before attending hospital EDs. Educational interventions may help direct NESB people to the appropriate health services and therefore reduce the burden on tertiary hospitals ED.

Psychological distress may affect nutrition indicators in Australian adults.

OBJECTIVE: The purpose of this research was to explore which demographic and health status variables moderated the relationship between psychological distress and three nutrition indicators: the consumption of fruits, vegetables and takeaway. METHOD: We analysed data from the 2009 Self-Reported Health Status Survey Report collected in the state of Queensland, Australia. Adults (N = 6881) reported several demographic and health status variables. Moderated logistic regression models were estimated separately for the three nutrition indicators, testing as moderators demographic (age, gender, educational attainment, household income, remoteness, and area-level socioeconomic status) and health status indicators (body mass index, high cholesterol, high blood pressure, and diabetes status). RESULTS: Several significant interactions emerged between psychological distress, demographic (age, area-level socio-economic status, and income level), and health status variables (body mass index, diabetes status) in predicting the nutrition indicators. Relationships between distress and the nutrition indicators were not significantly different by gender, remoteness, educational attainment, high cholesterol status, and high blood pressure status. CONCLUSIONS: The associations between psychological distress and several nutrition indicators differ amongst population subgroups. These findings suggest that in distressed adults, age, area-level socio-economic status, income level, body mass index, and diabetes status may serve as protective or risk factors through increasing or decreasing the likelihood of meeting nutritional guidelines. Public health interventions for improving dietary behaviours and nutrition may be more effective if they take into account the moderators identified in this study rather than using global interventions.

Psychological well-being status among medical and dental students in Makkah, Saudi Arabia: a cross-sectional study.

OBJECTIVES: Medical and dental students experience poor psychological well-being relative to their peers. This study aimed to assess the psychological well-being among medical and dental students in Saudi Arabia, identify the high-risk groups and assess the association between the psychological well-being and the academic performance. METHODS: In this cross-sectional study, 422 preclinical medical and dental students at Umm Al-Qura University, Saudi Arabia, were recruited to assess their depression, anxiety, stress, self-efficacy and satisfaction with life levels using 21-items Depression Anxiety Stress Scale (DASS-21), General Self-Efficacy (GSE) scale and Satisfaction With Life Scale (SWLS). Students' academic weighted grades were obtained later. Descriptive statistics and univariate general linear model were used to analyse data. RESULTS: High levels of depression (69.9%), anxiety (66.4%) and stress (70.9%) were indicated, whereas self-efficacy (mean = 27.22, sd = 4.85) and life satisfaction (mean = 23.60, sd = 6.37) were within the normal range. Female medical students had higher psychological distress in contrast to dental students. In general, third-year students were more depressed and stressed in comparison with second-year students, except for stress among dental students. Moreover, all females had higher self-efficacy than males. Life satisfaction was higher within the second-year and high family income students. Depression was the only psychological variable correlated with the academic performance. CONCLUSION: High levels of psychological distress were found. Female medical students had higher psychological distress than males, whereas male dental students had higher distress than female. Medical students at third year were more depressed and stressed. Dental students were more depressed in the third year, but more stressed in the second year. Attention should be directed towards reducing the alarming levels of depression, anxiety and stress among medical and dental students.

Progress and challenges of disaster health management in China: a scoping review.

BACKGROUND: Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. OBJECTIVE: This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. DESIGN: A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. RESULTS: The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. CONCLUSIONS: One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Private hospital emergency departments in Australia: challenges and opportunities.

BACKGROUND: Public hospital EDs in Australia have become increasingly congested because of increasing demand and access block. Six per cent of ED patients attend private hospital EDs whereas 45% of the population hold private health insurance. OBJECTIVES: This study describes the patients attending a small selection of four private hospital EDs in Queensland and Victoria, and tests the feasibility of a private ED database. METHODS: De-identified routinely collected patient data were provided by the four participating private hospital and amalgamated into a single data set. RESULT: The mean age of private ED patients was 52 years. Males outnumbered females in all age groups except > 80 years. Attendance was higher on weekends and Mondays, and between 08.00 and 20.00 h. There were 6.6% of the patients triaged as categories 1 and 2, and 60% were categories 4 or 5. There were 36.4% that required hospital admission. Also, 96% of the patients had some kind of insurance. Furthermore, 72% were self-referred and 12% were referred by private medical practitioners. Approximately 25% arrived by ambulance. There were 69% that completed their ED treatment within 4 h. CONCLUSION: This study is the first public description of patients attending private EDs in Australia. Private EDs have a significant role to play in acute medical care and in providing access to private hospitals which could alleviate pressure on public EDs. This study demonstrates the need for consolidated data based on a consistent data set and data dictionary to enable system-wide analysis, benchmarking and evaluation.

Language and utilisation of emergency care in Queensland.

OBJECTIVE: To compare access and utilisation of EDs in Queensland public hospitals between people who speak only English at home and those who speak another language at home. METHODS: A retrospective analysis of a Queensland statewide hospital ED dataset (ED Information System) from 1 January 2008 to 31 December 2010 was conducted. Access to ED care was measured by the proportion of the state's population attending EDs. Logistic regression analyses were performed to determine the relationships between ambulance use and language, and between hospital admission and language, both after adjusting for age, sex and triage category. RESULTS: The ED utilisation rate was highest in English only speakers (290 per 1000 population), followed by Arabic speakers (105), and lowest among German speakers (30). Compared with English speakers, there were lower rates of ambulance use in Chinese (odds ratio 0.50, 95% confidence interval, 0.47-0.54), Vietnamese (0.87, 0.79-0.95), Arabic (0.87, 0.78-0.97), Spanish (0.56, 0.50-0.62), Italian (0.88, 0.80-0.96), Hindi (0.61, 0.53-0.70) and German (0.87, 0.79-0.90) speakers. Compared with English speakers, German speakers had higher admission rates (odds ratio 1.17, 95% confidence interval, 1.02-1.34), whereas there were lower admission rates in Chinese (0.90, 0.86-0.99), Arabic (0.76, 0.67-0.85) and Spanish (0.83, 0.75-0.93) speakers. CONCLUSION: This study showed that there was a significant association between lower utilisation of emergency care and speaking languages other than English at home. Further researches are needed using in-depth methodology to investigate if there are language barriers in accessing emergency care in Queensland.

Impact of a government triple zero awareness campaign on emergency department patient characteristics.

OBJECTIVE: To evaluate the impact of a government triple zero community awareness campaign on the characteristics of patients attending an ED. METHODS: A study using Emergency Department Information System data was conducted in an adult metropolitan tertiary-referral teaching hospital in Brisbane. The three outcomes measured in the 3 month post-campaign period were arrival mode, Australasian Triage Scale and departure status. These measures reflect ambulance usage, clinical urgency and illness severity, respectively. They were compared with those in the 3 month pre-campaign period. Multivariate logistic regression models were used to investigate the impacts of the campaign on each of the three outcome measures after controlling for age, sex, day and time of arrival, and daily minimum temperature. RESULTS: There were 17,920 visits in the pre- and 17,793 visits in the post-campaign period. After the campaign, fewer patients arrived at the ED by road ambulance (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.80-1.00), although the impact of the campaign on the arrival mode was only close to statistical significance (Wald χ(2) -test, P= 0.055); and patients were significantly less likely to have higher clinical urgency (OR 0.86, 95% CI 0.79-0.94), while more likely to be admitted (OR 1.68, 95% CI 1.38-2.05) or complete treatment in the ED (OR 1.46, 95% CI 1.23-1.73) instead of leaving without waiting to be seen. CONCLUSIONS: The campaign had no significant impact on the arrival mode of the patients. After the campaign, the illness acuity of the patients decreased, whereas the illness severity of the patients increased.

Introduction of emergency medicine in China.

Over the past 20 years, emergency medicine (EM) in China has been through a period of rapid development. This included the formal establishment of professional association of EM in 1986 and the establishment of ED in all county-level hospitals across the country in the late 1990s. In line with the rapid economic development of China, ED have been equipped with appropriate 'hardware' equipment, but the 'software' part of the ED system remains underdeveloped. Doctors do not usually work exclusively in ED, but on a rotational basis, while also working as specialists in their own departments, such as medicine and surgery. EM in China remains underdeveloped, at least partly, for two main reasons: the current financial status of the health-care system and lack of sufficient numbers of qualified EM specialists. Chinese education and training systems are now beginning to produce high-quality emergency specialists, although there is not yet consistency across all courses. In Australia, the specialty of EM is well developed and, as such, this country is well placed to contribute to the development of ED in China.