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1.
Implement Sci Commun ; 2(1): 128, 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789339

RESUMO

BACKGROUND: Smoking during pregnancy increases the risk of multiple serious adverse infant, child and maternal outcomes, yet nearly 10% of Australian women still smoke during pregnancy. Despite evidence-based guidelines that recommend routine and repeated smoking cessation support (SCS) for all pregnant women, the provision of recommended SCS remains poor. Guidance on developing complex interventions to improve health care recommends drawing on existing theories, reviewing evidence, undertaking primary data collection, attending to future real-world implementation and designing and refining interventions using iterative cycles with stakeholder input throughout. Here, we describe using the Behaviour Change Wheel (BCW) and the Theoretical Domains Framework to apply these principles in developing an intervention to improve the provision of SCS in Australian maternity services. METHODS: Working closely with key stakeholders in the New South Wales (NSW) health system, we applied the steps of the BCW method then undertook a small feasibility study in one service to further refine the intervention. Stakeholders were engaged in multiple ways-as a core research team member, through a project Advisory Group, targeted meetings with policymakers, a large workshop to review potential components and the feasibility study. RESULTS: Barriers to and enablers of providing SCS were identified in five of six components described in the BCW method (psychological capability, physical opportunity, social opportunity and reflective and automatic motivation). These were mapped to intervention types and we selected education, training, enablement, environmental restructuring, persuasion, incentivisation and modelling as suitable in our context. Through application of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects and Equity) in the stakeholder workshop, behaviour change techniques were selected and applied in developing the intervention which includes systems, clinician and leadership elements. The feasibility study confirmed the feasibility and acceptability of the midwifery component and the need to further strengthen the leadership component. CONCLUSIONS: Using the BCW method combined with strong stakeholder engagement from inception resulted in transparent development of the MOHMQuit intervention, which targets identified barriers to and enablers of the provision of SCS and is developed specifically for the context in which it will be implemented. The intervention is being trialled in eight public maternity services in NSW.

2.
Artigo em Inglês | MEDLINE | ID: mdl-34639821

RESUMO

Smoking in pregnancy remains a public health challenge. Our team developed a comprehensive intervention using the Behaviour Change Wheel to support clinicians' implementation of guidelines on supporting women to stop smoking in pregnancy. Integral to the intervention was a suite of evidence-based video and print materials. This paper describes the rationale and process for developing these materials. Comprehensive mixed methods research was undertaken to identify the key barriers and enablers for clinicians in implementing the guidelines. This research identified which behaviours required change, and which behaviour change techniques were best suited to effecting that change. Materials were developed based on this understanding, in a collaborative process with multiple stakeholders, and their feasibility and acceptability explored in a small trial. Materials developed included leadership, clinician and client resources. There are considerable advantages to systematically and collaboratively developing materials which are integral to a behaviour-change intervention even though it is resource intensive to do so.


Assuntos
Meios de Comunicação , Abandono do Hábito de Fumar , Feminino , Humanos , Gravidez , Fumar , Fumar Tabaco
3.
BMC Pregnancy Childbirth ; 20(1): 219, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295541

RESUMO

BACKGROUND: Smoking is the most important preventable cause of adverse pregnancy outcomes, but provision of smoking cessation support (SCS) to pregnant women is poor. We examined the association between midwives' implementation of SCS (5As - Ask, Advise, Assess, Assist, Arrange follow-up) and reported barriers/enablers to implementation. METHODS: On-line anonymous survey of midwives providing antenatal care in New South Wales (NSW), Australia, assessing provision of the 5As and barriers/enablers to their implementation, using the Theoretical Domains Framework (TDF). Factor analyses identified constructs underlying the 5As; and barriers/enablers. Multivariate general linear models examined relationships between the barrier/enabler factors and the 5As factors. RESULTS: Of 750 midwives invited, 150 (20%) participated. Respondents more commonly reported Asking and Assessing than Advising, Assisting, or Arranging follow-up (e.g. 77% always Ask smoking status; 17% always Arrange follow-up). Three 5As factors were identified- 'Helping', 'Assessing quitting' and 'Assessing dependence'. Responses to barrier/enabler items showed greater knowledge, skills, intentions, and confidence with Assessment than Assisting; endorsement for SCS as a priority and part of midwives' professional role; and gaps in training and organisational support for SCS. Nine barrier/enabler factors were identified. Of these, the factors of 'Capability' (knowledge, skills, confidence); 'Work Environment' (service has resources, capacity, champions and values SCS) and 'Personal priority' (part of role and a priority) predicted 'Helping'. CONCLUSION: The TDF enabled systematic identification of barriers to providing SCS, and the multivariate models identified key contributors to poor implementation. Combined with qualitative data, these results have been mapped to intervention components to develop a comprehensive intervention to improve SCS.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Tocologia , Cuidado Pré-Natal/normas , Abandono do Hábito de Fumar , Estudos Transversais , Análise Fatorial , Humanos , New South Wales , Gestantes , Inquéritos e Questionários
4.
Hum Resour Health ; 18(1): 1, 2020 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915029

RESUMO

BACKGROUND: Resuscitation of patients with time-critical and life-threatening illness represents a cognitive challenge for emergency room (ER) clinicians. We designed a cognitive aid, the Emergency Protocols Handbook, to simplify clinical management and team processes. Resuscitation guidelines were reformatted into simple, single step-by-step pathways. This Australian randomised controlled trial tested the effectiveness of this cognitive aid in a simulated ER environment by observing team error rates when current resuscitation guidelines were followed, with and without the handbook. METHODS: Resuscitation teams were randomised to manage two scenarios with the handbook and two without in a high-fidelity simulation centre. Each scenario was video-recorded. The primary outcome measure was error rates (the number of errors made out of 15 key tasks per scenario). Key tasks varied by scenario. Each team completed four scenarios and was measured on 60 key tasks. Participants were surveyed regarding their perception of the usefulness of the handbook. RESULTS: Twenty-one groups performed 84 ER crisis simulations. The unadjusted error rate in the handbook group was 18.8% (121/645) versus 38.9% (239/615) in the non-handbook group. There was a statistically significant reduction of 54.0% (95% CI 49.9-57.9) in the estimated percentage error rate when the handbook was available across all scenarios 17.9% (95% CI 14.4-22.0%) versus 38.9% (95% CI 34.2-43.9%). Almost all (97%) participants said they would want to use this cognitive aid during a real medical crisis situation. CONCLUSION: This trial showed that by following the step-by-step, linear pathways in the handbook, clinicians more than halved their teams' rate of error, across four simulated medical crises. The handbook improves team performance and enables healthcare teams to reduce clinical error rates and thus reduce harm for patients. TRIAL REGISTRATION: ACTRN12616001456448 registered: www.anzctr.org.au. Trial site: http://emergencyprotocols.org.au/.


Assuntos
Técnicas de Apoio para a Decisão , Ressuscitação/educação , Treinamento por Simulação , Austrália , Cuidados Críticos , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente , Inquéritos e Questionários
5.
Pain ; 161(5): 1012-1018, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31895264

RESUMO

This study models the economic costs of informal caring for people with back pain, using a microsimulation model, Care&WorkMOD, from 2015 to 2030. Care&WorkMOD was based on 3 national Australian Surveys of Disability, Ageing and Carers (2003, 2009, 2012) data sets for individuals aged 15 to 64 years. Estimated national income loss due to caring for people with back pain was AU$258 million in 2015, increasing to $398 million in 2030 (54% increase). Lost income tax revenue to the Australian government due to informal care of people with back pain was estimated to be AU$78 million in 2015, increasing to AU$118 million in 2030 (50% increase), and additional welfare payments were estimated to rise from $132 million in 2015 to AU$180 in 2030 (36% increase). Larger growth in lost income, compared with the increase in welfare payments, means that there would be an increasing income gap between those out of the labour force providing informal care and noncarers who are in the labour force, leading to increased inequality. Informal carers are defined as providers of informal, unpaid assistance to someone with a health condition, for at least 6 months. Informal carers of people with back pain who are out of the labour force incur substantial economic costs. Furthermore, back pain is a large economic burden on national governments. Policies addressing back pain prevention and treatment, and supporting carers, may offset government welfare expenditure, while improving the socioeconomic well-being of carers and patients.


Assuntos
Dor nas Costas , Adolescente , Adulto , Austrália , Dor nas Costas/terapia , Cuidadores , Efeitos Psicossociais da Doença , Humanos , Renda , Pessoa de Meia-Idade , Assistência ao Paciente , Adulto Jovem
6.
Fam Pract ; 37(3): 390-394, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-31848589

RESUMO

BACKGROUND: Potentially preventable hospitalizations (PPH) are defined as unplanned hospital admissions which could potentially have been prevented with the provision of effective, timely outpatient care. To better understand and ultimately reduce rates of PPH, a means of identifying those which are actually preventable is required. The Preventability Assessment Tool (PAT) was designed for use by hospital clinicians to assess the preventability of unplanned admissions for chronic conditions. OBJECTIVE: The present study examined the ability of the PAT to distinguish between those unplanned admissions which are preventable and those which are not, compared to the assessments of an Expert Panel. METHODS: Data were collected between November 2014 and June 2017 at three hospitals in NSW, Australia. Participants were community-dwelling patients with unplanned hospital admissions for congestive heart failure, chronic obstructive pulmonary disease, diabetes complications or angina pectoris. A nurse and a doctor caring for the patient made assessments of the preventability of the admission using the PAT. Expert Panels made assessments of the preventability of each admission based on a comprehensive case report and consensus process. RESULTS: There was little concordance between the hospital doctors and nurses regarding the preventability of admissions, nor between the assessments of the Expert Panel and the hospital nurse or the Expert Panel and the hospital doctor. CONCLUSIONS: The PAT demonstrated poor concurrent validity and is not a valid tool for assessing the preventability of unplanned hospital admissions. The use of Expert Panels provides a more rigorous approach to assessing the preventability of such admissions.


Assuntos
Doença Crônica , Hospitalização/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Br J Psychiatry ; 215(5): 654-660, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31524109

RESUMO

BACKGROUND: Intellectual disability and autism spectrum disorder (ASD) influence the interactions of a person with their environment and generate economic and socioeconomic costs for the person, their family and society. AIMS: To estimate costs of lost workforce participation due to informal caring for people with intellectual disability or autism spectrum disorders by estimating lost income to individuals, lost taxation payments to federal government and increased welfare payments. METHOD: We used a microsimulation model based on the Australian Bureau of Statistics' Surveys of Disability, Ageing and Carers (population surveys of people aged 15-64), and projected costs of caring from 2015 in 5-year intervals to 2030. RESULTS: The model estimated that informal carers of people with intellectual disability and/or ASD in Australia had aggregated lost income of AU$310 million, lost taxation of AU$100 million and increased welfare payments of AU$204 million in 2015. These are projected to increase to AU$432 million, AU$129 million and AU$254 million for income, taxation, and welfare respectively by 2030. The income gap of carers for people with intellectual disability and/or ASD is estimated to increase by 2030, meaning more financial stress for carers. CONCLUSIONS: Informal carers of people with intellectual disability and/or ASD experience significant loss of income, leading to increased welfare payments and reduced taxation revenue for governments; these are all projected to increase. Strategic policies supporting informal carers wishing to return to work could improve the financial and psychological impact of having a family member with intellectual disability and/or ASD. DECLARATION OF INTEREST: None.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Deficiência Intelectual , Austrália/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Efeitos Psicossociais da Doença , Humanos
8.
Health Soc Care Community ; 27(2): 493-501, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30378213

RESUMO

We estimated the economic costs of informal care in the community from 2015 to 2030, using an Australian microsimulation model, Care&WorkMOD. The model was based on data from three Surveys of Disability, Ageing, and Carers (SDACs) for the Australian population aged 15-64 years old. Estimated national income lost was AU$3.58 billion in 2015, increasing to $5.33 billion in 2030 (49% increase). Lost tax payments were estimated at AU$0.99 billion in 2015, increasing to AU$1.44 billion in 2030 (45% increase), and additional welfare payments were expected to rise from $1.45 billion in 2015 to AU$1.94 in 2030 (34% increase). There are substantial economic costs both to informal carers and the government due to carers being out of the labour-force to provide informal care for people with chronic diseases. Health and social policies supporting carers to remain in the labour force may allow governments to make substantial savings, while improving the economic situation of carers.


Assuntos
Doença Crônica/economia , Efeitos Psicossociais da Doença , Pessoas com Deficiência/estatística & dados numéricos , Financiamento Governamental/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Seguridade Social/economia , Adolescente , Adulto , Austrália/epidemiologia , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/economia , Adulto Jovem
9.
Aust J Prim Health ; 2018 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-30078392

RESUMO

Developing and targeting interventions to reduce hospital admissions for ambulatory care sensitive (ACS) chronic conditions for older people is a key focus for improvement of the health system. To do this, an understanding of any modifiable factors that may contribute to such admissions is needed. To date, the literature on ACS admissions has rarely included the patient perspective. This qualitative study involved one-to-one telephone interviews with 24 patients aged ≥45 years who had had an unplanned admission for an ACS chronic condition to one of two participating regional hospitals between February and August 2015. Data were transcribed and analysed thematically. Most participants did not perceive their admission to be preventable, yet they described a series of interlinking factors, which may have contributed to their admission and which may offer potential points of leverage. Key interlinked themes interpreted were: 'support deficits', 'non-adherence to treatment' (including medication), 'mental health' and 'lack of awareness or understanding of condition'. Improving system-, clinician- and patient-level factors within a framework of appropriately resourced and supported comprehensive primary health care that is accessible, affordable, holistic, practical and evidence-based may contribute to improving patients' quality of life and to delaying or preventing hospital admission.

10.
Public Health Res Pract ; 28(2)2018 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-29925084

RESUMO

BACKGROUND: Smoking during pregnancy is three times as common among Aboriginal women as non-Aboriginal women, with consequent higher rates of adverse health outcomes. Effective interventions to support Aboriginal women to quit smoking have not yet been identified. OBJECTIVES: To assess the feasibility and acceptability of implementing a culturally tailored, intensive smoking cessation program, including contingency-based financial rewards (CBFR), for pregnant Aboriginal women. METHODS: The structured program included frequent support with individually tailored counselling, free nicotine replacement therapy, engagement with household members, specially developed resources, CBFR and peer support groups. It was implemented by three rural Aboriginal Maternal and Infant Health Services sites. Women were eligible if they or their partner were Aboriginal; and if they were: current smokers or had quit since becoming pregnant; >=16 years old; at <20 weeks gestation; and locally resident. Data included demographics, obstetrics, initial smoking behaviour, program implementation and quitting behaviour. Self-reported quitting was confirmed by expired carbon monoxide (CO). Women and staff were interviewed about their experiences. RESULTS: Twenty-two of 38 eligible women (58%) enrolled in the program, with 19 (86% remaining at the end of their pregnancy. The program was highly acceptable to both women and providers. Feasibility issues included challenges providing twice-weekly visits for 3 weeks and running fortnightly support groups. Of the 19 women who completed the program, 15 (79%) reported a quit attempt lasting >=24 hours, and 8 (42%) were CO-confirmed as not smoking in late pregnancy. The rewards were perceived to help motivate women, but the key to successful quitting was considered to be the intensive support provided. CONCLUSIONS: 'Stop Smoking in its Tracks' was acceptable and is likely to be feasible to implement with some modifications. The program should be tested in a larger study.


Assuntos
Promoção da Saúde/métodos , Motivação , Grupo com Ancestrais Oceânicos/psicologia , Gestantes/psicologia , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Adolescente , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem
11.
BMJ Glob Health ; 3(3): e000683, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29862056

RESUMO

Efforts to strengthen health systems require the engagement of diverse, multidisciplinary stakeholder networks. Networks provide a forum for experimentation and knowledge creation, information exchange and the spread of good ideas and practice. They might be useful in addressing complex issues or 'wicked' problems, the solutions to which go beyond the control and scope of any one agency. Innovation platforms are proposed as a novel type of network because of their diverse stakeholder composition and focus on problem solving within complex systems. Thus, they have potential applicability to health systems strengthening initiatives, even though they have been predominantly applied in the international agricultural development sector. In this paper, we compare and contrast the concept of innovation platforms with other types of networks that can be used in efforts to strengthen primary healthcare systems, such as communities of practice, practice-based research networks and quality improvement collaboratives. We reflect on our ongoing research programme that applies innovation platform concepts to drive large-scale quality improvement in primary healthcare for Aboriginal and Torres Strait Islander Australians and outline our plans for evaluation. Lessons from our experience will find resonance with others working on similar initiatives in global health.

12.
BMC Public Health ; 18(1): 654, 2018 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-29793478

RESUMO

BACKGROUND: While the direct (medical) costs of arthritis are regularly reported in cost of illness studies, the 'true' cost to indivdiuals and goverment requires the calculation of the indirect costs as well including lost productivity due to ill-health. METHODS: Respondents aged 45-64 in the ABS Survey of Disability, Ageing and Carers 2003, 2009 formed the base population. We projected the indirect costs of arthritis using Health&WealthMOD2030 - Australia's first microsimulation model on the long-term impacts of ill-health in older workers - which incorporated outputs from established microsimulation models (STINMOD and APPSIM), population and labour force projections from Treasury, and chronic conditions trends for Australia. All costs of arthritis were expressed in real 2013 Australian dollars, adjusted for inflation over time. RESULTS: We estimated there are 54,000 people aged 45-64 with lost PLYs due to arthritis in 2015, increasing to 61,000 in 2030 (13% increase). In 2015, people with lost PLYs are estimated to receive AU$706.12 less in total income and AU$311.67 more in welfare payments per week than full-time workers without arthritis, and pay no income tax on average. National costs include an estimated loss of AU$1.5 billion in annual income in 2015, increasing to AU$2.4 billion in 2030 (59% increase). Lost annual taxation revenue was projected to increase from AU$0.4 billion in 2015 to $0.5 billion in 2030 (56% increase). We projected a loss in GDP of AU$6.2 billion in 2015, increasing to AU$8.2 billion in 2030. CONCLUSIONS: Significant costs of arthritis through lost PLYs are incurred by individuals and government. The effectiveness of arthritis interventions should be judged not only on healthcare use but quality of life and economic wellbeing.


Assuntos
Artrite/economia , Efeitos Psicossociais da Doença , Pessoas com Deficiência/educação , Seguridade Social/economia , Adulto , Idoso , Artrite/epidemiologia , Austrália/epidemiologia , Doença Crônica/economia , Pessoas com Deficiência/estatística & dados numéricos , Eficiência , Emprego/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Humanos , Renda/estatística & dados numéricos , Pessoa de Meia-Idade , Seguridade Social/estatística & dados numéricos , Impostos/economia
13.
Midwifery ; 58: 137-144, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29367150

RESUMO

OBJECTIVE: this study aimed to explore the enablers and barriers to implementation of the Australian smoking cessation in pregnancy guidelines. These guidelines direct clinicians to follow the 5As of cessation: Ask, Advise, Assess, Assist and Arrange follow-up. DESIGN: semi-structured interviews based on the Theoretical Domains Framework (TDF) elicited clinicians' views and experiences of implementing the guidelines. SETTING: antenatal care in the NSW public health system. PARTICIPANTS: 27 maternity service managers, obstetricians and midwives. FINDINGS: participants confirmed that implementation of the smoking cessation guidelines was sub-optimal. This was particularly the case with Assist and Arrange follow up at the initial visit, and with following any of the 5As at subsequent visits. Key barriers included systems which did not support implementation or monitoring, lack of knowledge, skills and training, perceived time restrictions, 'difficult conversations' and perceiving smoking as a social activity. Enablers included clinicians' knowledge of the harms of smoking in pregnancy, clinicians' skills in communicating with pregnant women, positive emotions, professional role and identity, the potential of training and of champions to influence practice, and systems that regulated behaviour. KEY CONCLUSIONS: these findings will contribute to the development of a multifaceted intervention to support clinicians in implementing the guidelines. IMPLICATIONS FOR PRACTICE: Building on existing strengths, antenatal care providers may be supported in implementing the guidelines by working with systems which remind and support implementation, the clear reframing of smoking as an addiction, knowledge and skills development and by realizing the potential of leadership to maximise the impact of reinforcement and social influence.


Assuntos
Guias como Assunto/normas , Promoção da Saúde/normas , Abandono do Hábito de Fumar/métodos , Adulto , Atitude do Pessoal de Saúde , Feminino , Fidelidade a Diretrizes/normas , Pessoal de Saúde/tendências , Promoção da Saúde/métodos , Humanos , Pessoa de Meia-Idade , New South Wales , Papel do Profissional de Enfermagem/psicologia , Gravidez , Telefone
14.
BMJ Open ; 7(1): e013158, 2017 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-28069621

RESUMO

OBJECTIVES: To project the number of people aged 45-64 years with lost productive life years (PLYs) due to diabetes and related costs (lost income, extra welfare payments, lost taxation revenue); and lost gross domestic product (GDP) attributable to diabetes in Australia from 2015 to 2030. DESIGN: A simulation study of how the number of people aged 45-64 years with diabetes increases over time (based on population growth and disease trend data) and the economic losses incurred by individuals and the government. Cross-sectional outputs of a microsimulation model (Health&WealthMOD2030) which used the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers 2003 and 2009 as a base population and integrated outputs from two microsimulation models (Static Incomes Model and Australian Population and Policy Simulation Model), Treasury's population and labour force projections, and chronic disease trends data. SETTING: Australian population aged 45-64 years in 2015, 2020, 2025 and 2030. OUTCOME MEASURES: Lost PLYs, lost income, extra welfare payments, lost taxation revenue, lost GDP. RESULTS: 18 100 people are out of the labour force due to diabetes in 2015, increasing to 21 400 in 2030 (18% increase). National costs consisted of a loss of $A467 million in annual income in 2015, increasing to $A807 million in 2030 (73% increase). For the government, extra annual welfare payments increased from $A311 million in 2015 to $A350 million in 2030 (13% increase); and lost annual taxation revenue increased from $A102 million in 2015 to $A166 million in 2030 (63% increase). A loss of $A2.1 billion in GDP was projected for 2015, increasing to $A2.9 billion in 2030 attributable to diabetes through its impact on PLYs. CONCLUSIONS: Individuals incur significant costs of diabetes through lost PLYs and lost income in addition to disease burden through human suffering and healthcare costs. The government incurs extra welfare payments, lost taxation revenue and lost GDP, along with direct healthcare costs.


Assuntos
Diabetes Mellitus/epidemiologia , Adulto , Idoso , Austrália/epidemiologia , Efeitos Psicossociais da Doença , Diabetes Mellitus/economia , Pessoas com Deficiência/estatística & dados numéricos , Eficiência , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Previdência Social/estatística & dados numéricos , Seguridade Social/estatística & dados numéricos , Impostos/economia , Impostos/estatística & dados numéricos , Adulto Jovem
15.
Pain ; 157(12): 2816-2825, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27842049

RESUMO

This study projected the indirect costs of back problems through lost productive life years (PLYs) from the individual's perspective (lost disposable income), the governmental perspective (reduced taxation revenue, greater welfare spending), and the societal perspective (lost gross domestic product, GDP) from 2015 to 2030, using Health&WealthMOD2030-Australia's first microsimulation model on the long-term impacts of ill-health. Quantile regression analysis was used to examine differences in median weekly income, welfare payments, and taxes of people unable to work due to back problems with working full-time without back problems as comparator. National costs and lost GDP resulting from missing workers due to back problems were also projected. We projected that 90,000 people have lost PLYs due to back problems in 2015, increasing to 104,600 in 2030 (16.2% increase). People with lost PLYs due to back problems are projected to receive AU$340.91 less in total income and AU$339.77 more in welfare payments per week than full-time workers without back problems in 2030 and pay no income tax on average. National costs consisted of a loss of AU$2931 million in annual income in 2015, increasing to AU$4660 million in 2030 (60% increase). For government, extra annual welfare payments are projected to increase from AU$1462 million in 2015 to AU$1709 million in 2030 (16.9% increase), and lost annual taxation revenue to increase from AU$671 million in 2015 to $961 million in 2030 (43.2% increase). We projected losses in GDP of AU$10,543 million in 2015, increasing to AU$14,522 million in 2030 due to back problems.


Assuntos
Lesões nas Costas/economia , Lesões nas Costas/epidemiologia , Simulação por Computador , Efeitos Psicossociais da Doença , Produto Interno Bruto , Modelos Teóricos , Envelhecimento , Austrália/epidemiologia , Avaliação da Deficiência , Feminino , Avaliação do Impacto na Saúde/economia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
16.
BMJ Open ; 6(9): e011151, 2016 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-27660315

RESUMO

OBJECTIVES: To project the number of older workers with lost productive life years (PLYs) due to chronic disease and resultant lost income; and lost taxes and increased welfare payments from 2015 to 2030. DESIGN, SETTING AND PARTICIPANTS: Using a microsimulation model, Health&WealthMOD2030, the costs of chronic disease in Australians aged 45-64 were projected to 2030. The model integrates household survey data from the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers (SDACs) 2003 and 2009, output from long-standing microsimulation models (STINMOD (Static Incomes Model) and APPSIM (Australian Population and Policy Simulation Model)) used by various government departments, population and labour force growth data from Treasury, and disease trends data from the Australian Burden of Disease and Injury Study (2003). Respondents aged 45-64 years in the SDACs 2003 and 2009 formed the base population. MAIN OUTCOME MEASURES: Lost PLYs due to chronic disease; resultant lost income, lost taxes and increased welfare payments in 2015, 2020, 2025 and 2030. RESULTS: We projected 380 000 (6.4%) people aged 45-64 years with lost PLYs in 2015, increasing to 462 000 (6.5%) in 2030-a 22% increase in absolute numbers. Those with lost PLYs experience the largest reduction in income than any other group in each year compared to those employed full time without a chronic disease, and this income gap widens over time. The total economic loss due to lost PLYs consisted of lost income modelled at $A12.6 billion in 2015, increasing to $A20.5 billion in 2030-a 62.7% increase. Additional costs to the government consisted of increased welfare payments at $A6.2 billion in 2015, increasing to $A7.3 billion in 2030-a 17.7% increase; and a loss of $A3.1 billion in taxes in 2015, increasing to $A4.7 billion in 2030-a growth of 51.6%. CONCLUSIONS: There is a need for greater investment in effective preventive health interventions which improve workers' health and work capacity.

17.
BMJ Open ; 6(3): e010260, 2016 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-26988351

RESUMO

OBJECTIVE: To thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs). DESIGN: Systematic review and thematic synthesis. DATA SOURCES: Searches of MEDLINE, EBM Reviews (Cochrane Database of Systematic Reviews), PsycINFO, Global Health, CINAHL, Web of Science, Informit and EMBASE, combining terms for families, households and vulnerable populations; SFH and secondhand smoke; and qualitative research, were supplemented by searches of PhD theses, key authors, specialist journals and reference lists. STUDY SELECTION: We included 22 articles, reporting on 18 studies, involving 646 participants. INCLUSION CRITERIA: peer-reviewed; English language; published from 1990 onwards (to week 3 of April 2014); used qualitative data collection methods; explored participants' perspectives of home smoking behaviours; and the barriers, motivators and enablers to initiating and/or maintaining a SFH. DATA EXTRACTION: 1 of 3 authors extracted data with checking by a second. DATA SYNTHESIS: A thematic synthesis was performed to develop 7 core analytic themes: (1) knowledge, awareness and risk perception; (2) agency and personal skills/attributes; (3) wider community norms and personal moral responsibilities; (4) social relationships and influence of others; (5) perceived benefits, preferences and priorities; (6) addiction and habit; (7) practicalities. CONCLUSIONS: This synthesis highlights the complexity faced by many households in having a SFH, the practical, social, cultural and personal issues that need to be addressed and balanced by households, and that while some of these are common across study settings, specific social and cultural factors play a critical role in shaping household smoking behaviours. The findings can inform policy and practice and the development of interventions aimed at increasing SFHs. TRIAL REGISTRATION NUMBER: CRD42014014115.


Assuntos
Habitação , Motivação , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/prevenção & controle , Humanos , Pesquisa Qualitativa , Política Antifumo , Populações Vulneráveis
19.
BMJ Open ; 5(11): e009879, 2015 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-26597867

RESUMO

INTRODUCTION: Rates of potentially preventable hospitalisations (PPH) are used as a proxy measure of effectiveness of, or access to community-based health services. The validity of PPH as an indicator in Australia has not been confirmed. Available evidence suggests that patient-related, clinician-related and systems-related factors are associated with PPH, with differences between rural and metropolitan settings. Furthermore, the proportion of PPHs which are actually preventable is unknown. The Diagnosing Potentially Preventable Hospitalisations study will determine the proportion of PPHs for chronic conditions that are deemed preventable and identify potentially modifiable factors driving these, in order to develop effective interventions to reduce admissions and improve measures of health system performance. METHODS AND ANALYSIS: This mixed methods data linkage study of approximately 1000 eligible patients with chronic PPH admissions to one metropolitan and two regional hospitals over 12 months will combine data from multiple sources to assess the: extent of preventability of chronic PPH admissions; validity of the Preventability Assessment Tool (PAT) in identifying preventable admissions; factors contributing to chronic PPH admissions. Data collected from patients (quantitative and qualitative methods), their general practitioners, hospital clinicians and hospital records, will be linked with routinely collected New South Wales (NSW) Admitted Patient Data Collection, the NSW Registry of Births, Death and Marriages death registration and Australian Bureau of Statistics mortality data. The validity of the PAT will be assessed by determining concordance between clinician assessment and that of a 'gold standard' panel. Multivariable logistic regression will identify the main predictor variables of admissions deemed preventable, using study-specific and linked data. ETHICS AND DISSEMINATION: The NSW Population and Health Services Research Ethics Committee granted ethical approval. Dissemination mechanisms include engagement of policy stakeholders through a project Steering Committee, and the production of summary reports for policy and clinical audiences in addition to peer-review papers.


Assuntos
Doença Crônica/prevenção & controle , Coleta de Dados/métodos , Hospitalização/estatística & dados numéricos , Projetos de Pesquisa , Idoso , Idoso de 80 Anos ou mais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , New South Wales , Atenção Primária à Saúde
20.
BMC Health Serv Res ; 15: 472, 2015 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-26475293

RESUMO

BACKGROUND: Potentially preventable hospital admission (an admission deemed to be potentially preventable given appropriate care in the community-based healthcare setting) has been a topic of international research attention for almost three decades. Recently this has been largely driven by the imperative to reduce ever-increasing unplanned hospital admissions. However, identifying potentially preventable admissions is difficult. As a result, the population level indicator of admissions for ambulatory care sensitive conditions (ACSCs) has been used as a proxy measure for potentially preventable admission. The adoption of this measure has become common, and in Australia, the rate of admissions for chronic ACSCs is now an important component of measuring health system performance and accountability, and is directly linked to funding. Admission for a chronic ACSC is also used to identify individuals for targeting of interventions to reduce preventable admissions. DISCUSSION: Hospital admission for chronic ACSCs is a population measure based on admission diagnoses, it therefore should not be used to identify individual preventable admissions. At present we are unable to determine individual admissions that are deemed to be preventable or, therefore, articulate the factors associated with admissions which are preventable. As we are currently unable to identify individual admissions that are preventable, little is understood about the underlying causes and factors contributing to preventable admissions. A means of assessing preventability of individual admissions is required. Only then can we explore the antecedents, and patient and clinician perspectives on preventable admissions. Until we have a clearer understanding of this, our capacity to inform policy and program development remains compromised.


Assuntos
Instituições de Assistência Ambulatorial , Doença Crônica , Hospitalização/tendências , Austrália , Humanos , Avaliação de Resultados em Cuidados de Saúde
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