Teaching health promotion competencies in undergraduate dentistry training: A unique pedagogical approach.

ISSUE ADDRESSED: Using appropriate pedagogical approaches in undergraduate dentistry training is important to develop student's health promotion knowledge, and to shape their attitude towards using these competencies in future dentistry practice. This brief report documents the signature pedagogical approach developed for an undergraduate health science subject at James Cook University, to teach dentistry students health promotion competencies. PEDAGOGICAL APPROACH: The signature pedagogy involves three key approaches - experiential learning, cooperative learning and inquiry-based learning. Experiential learning "beyond the classroom" enables students to develop and deliver a school-based oral health promotion program. "Inside the classroom," role-plays encourage students to apply their health promotion skills to real-world dentistry scenarios. Cooperative learning techniques such as "think, pair, share" create a supportive environment for students to confidently exchange ideas; and inquiry-based learning engages students in thinking critically about health promotion strategies to address contemporary oral health challenges. These pedagogical approaches have developed student's understanding of the health promotion competencies required of a newly qualified dentist. CONCLUSION: Pedagogical approaches that engage dentistry students in experiential, cooperative and inquiry-based learning are important considerations for undergraduate teaching, to strengthen understanding of health promotion and to help shape student's attitude towards using these competencies in future dentistry practice.

Review of patient-reported experience within Patient-Centered Medical Homes: insights for Australian Health Care Homes.

Understanding patient experience is necessary to advance the patient-centred approach to health service delivery. Australia's primary healthcare model, the 'Health Care Home', is based on the 'Patient-Centered Medical Home' (PCMH) model developed in the United States. Both these models aim to improve patient experience; however, the majority of existing PCMH model evaluations have focussed on funding, management and quality assurance measures. This review investigated the scope of evidence reported by adult patients using a PCMH. Using a systematic framework, the review identified 39 studies, sourced from 33 individual datasets, which used both quantitative and qualitative approaches. Patient experience was reported for model attributes, including the patient-physician and patient-practice relationships; care-coordination; access to care; and, patient engagement, goal setting and shared decision-making. Results were mixed, with the patient experience improving under the PCMH model for some attributes, and some studies indicating no difference in patient experience following PCMH implementation. The scope and quality of existing evidence does not demonstrate improvement in adult patient experience when using the PCMH. Better measures to evaluate patient experience in the Australian Health Care Home model are required.

Medical homes and chronic care: consumer lessons for regional Australia.

Medical home models of care, including Australia's Health Care Homes, have the potential to improve health service delivery. This qualitative study explored the primary healthcare experience of people living with chronic conditions in a regional community. The study aim was to use consumer perspectives to inform the further development of a medical home-type model for regional Australia. Participants were recruited from the emergency department of a north Queensland hospital. Twenty-one adults (aged ≥18 years) participated in interviews, using a semi-structured schedule. Inductive, deductive and abductive analyses were guided by grounded theory methods. Participants were committed to an individual GP, rather than a practice organisation. This finding has implications for medical homes, as individuals may choose not to access team-based practice care. Most participants perceived they currently received high-quality GP care, although challenges were identified. These challenges included disconnected after-hours care and uncertainty around the cost of care. Those living with complex, uncommon, chronic conditions felt the most disenfranchised from existing care models, and could benefit from increased engagement with a medical home-type model. Strengthening the continuity of care between GPs both within and outside the practice may enhance service delivery. Involving consumers in the design of care models supports health services that are fit-for-purpose.

Exploring the measure of potentially avoidable general practitioner-type presentations to the emergency department in regional Queensland using linked, patient-perspective data.

Objective To explore measures of potentially avoidable general practitioner (PAGP)-type presentations to the emergency department (ED) of a large regional hospital in northern Queensland. Methods Linkage of an ED administrative dataset to a face-to-face patient survey of local residents (n=1000); calculation of Australian Institute of Health and Welfare (AIHW) and Australasian College of Emergency Medicine (ACEM) measures of PAGP-type presentations to the ED; and exploration of these measures with patient-perspective linked data. Results PAGP-type presenters to the ED were younger in age (median age in years: total cohort: 49; AIHW 38, P<0.001; ACEM 36, P<0.001); with the odds of having a chronic condition being less likely for AIHW PAGP-type presenters than other ED presenters (OR (95% CI) 0.54 (0.38-0.77): P=0.001)) after adjustment for age. PAGP-type presenters nominated reasons of convenience rather than urgency as their rationale for attending the ED, irrespective of measure. The number of PAGP-type presentations to the ED identified by the AIHW measure was more than three-fold higher than the ACEM measure (AIHW: n=227; ACEM: n=67). Influencing factors include the low proportion of ED attendees who had a medical consultation time of <1h at this hospital site (1-month survey period: 17.8%); and differences between the patient self-report and ED administrative record for 'self-referral to the ED' (Self-referred: Survey 71% vs EDIS 93%, P<0.001). Conclusions Identification of PAGP-type presentations to the ED could be enhanced with improvements to the quality of administrative processes when recording patient 'self-referral to the ED', along with further consideration of hospital site variation for the length of medical consultation time. What is known about the topic? PAGP-type presentations to the ED are an Australian National Healthcare Agreement progress indicator. Methods of measuring this indicator have been under review since 2012 and debate remains on how to accurately determine the measure. What does this paper add? By using patient perspective-linked data to explore different measures of PAGP-type presentations to EDs, this paper identifies issues with measure elements and suggests ways to improve these measures. What are the implications for practitioners? Measure elements of patient 'self-referral to the ED' and 'medical consultation time' require further consideration if they are to be used to measure PAGP-type presentations to the ED.

Exploring factors that influence adult presentation to an emergency department in regional Queensland: A linked, cross-sectional, patient perspective study.

OBJECTIVE: Explore factors that influence presentation at a regional hospital ED and identify opportunities to reduce attendance, particularly for adults with chronic conditions. METHODS: Cross-sectional survey of ED attenders, for 1 month period (March to April 2014), with linkage of survey data to administrative data sets. RESULTS: A total of 1000 adults completed the survey of which 549 (54.9%) self-identified as living with a chronic condition. Over half (n = 572, 57.2%) had their presenting problem for less than 24 h prior to attending the ED and 56.8% (n = 568) attended the ED outside working hours. Most ED presentations were recorded in the administrative data set as self-referred (n = 933, 93.3%); however, 29% (n = 290) of survey participants reported being referred to the ED by a medical practitioner. The majority of adults had a regular general practice (n = 863, 86.3%) with 30% (n = 258) visiting their practice in the week prior to presentation at the ED. Awareness of services such as the 13-Health telephone advice line was generally low (n = 370, 37%) and most did not consider alternative health services as suitable for their care. High-quality care, co-location of diagnostic services and extended hours of service were important to patients. CONCLUSION: Despite being connected to a general practice, people focussed their health-seeking behaviour on the ED in the immediate period prior to presentation. Patients reported a limited awareness of alternative health services and opportunities exist to potentially reduce ED attendance, particularly for young and middle-aged adults with chronic conditions.

Corrigendum to: Preventable hospitalisations in regional Queensland: potential for primary health?

Objective The aims of this study were to: (1) use local health data to examine potentially preventable hospitalisations (PPHs) as a proportion of total hospital separations and estimated costs to a large regional hospital in northern Queensland, including differences associated with Indigenous status; and (2) identify priority conditions and discuss issues related to strategic local primary health intervention.Methods A cross-sectional analysis was conducted using Queensland Hospital Admitted Patient Data Collection data (July 2012-June 2014) restricted to 51087 separations generated by 29485 local residents. PPHs were identified from the International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification (ICD-10-AM) and procedure codes using National Healthcare Agreement definitions. Age-standardised separation rates were calculated using Australian 2001 reference population and associated economic costs were estimated using Australian-refined diagnosis related groups.Results Eleven per cent (n=5488) of all hospital separations were classified as PPH, and most were for common chronic (n=2486; 45.3%) and acute (n=2845; 51.8%) conditions. Because many acute presentations reflect chronic underlying disease, chronic conditions account for up to 76.5% of all PPHs. Age-standardised PPH rates were 3.4-fold higher for Indigenous than non-Indigenous people. Associated 2-year costs were AU$32.7million, which was 10.7% of estimated total health care expenditure for hospital separations, and were higher for Indigenous (14.9%) than non-Indigenous (9.7%) people.Conclusions High hospitalisation rates and costs for common preventable chronic conditions represent opportunities for primary healthcare interventions. In particular, community-level health services need to be more responsive to the needs of local Indigenous families.What is known about the topic? PPH rates are used as a measure of timely access to quality primary health care, and are incrementally higher in regional and remote areas than in major cities. Investment in primary healthcare services has been shown to significantly reduce costs associated with avoidable hospitalisations.What does this paper add? This study used local health data to identify the most common PPH conditions presenting to a large regional hospital in northern Queensland, including estimation of costs and differences associated with Indigenous status. Recommendations are made to strengthen primary healthcare and reduce hospital-related costs.What are the implications for practitioners? Interventions to address high PPH rates should be tailored to meet the needs of the local population. Primary health strategies targeting common chronic conditions provide the greatest opportunity to reduce avoidable hospitalisations and costs in this regional area. Investment in collaborative, evidence-based interventions is recommended and justified, especially for Indigenous Australians.

Preventable hospitalisations in regional Queensland: potential for primary health?

Objective The aims of this study were to: (1) use local health data to examine potentially preventable hospitalisations (PPHs) as a proportion of total hospital separations and estimated costs to a large regional hospital in northern Queensland, including differences associated with Indigenous status; and (2) identify priority conditions and discuss issues related to strategic local primary health intervention. Methods A cross-sectional analysis was conducted using Queensland Hospital Admitted Patient Data Collection data (July 2012-June 2014) restricted to 51087 separations generated by 29485 local residents. PPHs were identified from the International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification (ICD-10-AM) and procedure codes using National Healthcare Agreement definitions. Age-standardised separation rates were calculated using Australian 2001 reference population and associated economic costs were estimated using Australian-refined diagnosis related groups. Results Eleven per cent (n=5488) of all hospital separations were classified as PPH, and most were for common chronic (n=2486; 45.3%) and acute (n=2845; 51.8%) conditions. Because many acute presentations reflect chronic underlying disease, chronic conditions account for up to 76.5% of all PPHs. Age-standardised PPH rates were 3.4-fold higher for Indigenous than non-Indigenous people. Associated 2-year costs were AU$32.7million, which was 10.7% of estimated total health care expenditure for hospital separations, and were higher for Indigenous (14.9%) than non-Indigenous (9.7%) people. Conclusions High hospitalisation rates and costs for common preventable chronic conditions represent opportunities for primary healthcare interventions. In particular, community-level health services need to be more responsive to the needs of local Indigenous families. What is known about the topic? PPH rates are used as a measure of timely access to quality primary health care, and are incrementally higher in regional and remote areas than in major cities. Investment in primary healthcare services has been shown to significantly reduce costs associated with avoidable hospitalisations. What does this paper add? This study used local health data to identify the most common PPH conditions presenting to a large regional hospital in northern Queensland, including estimation of costs and differences associated with Indigenous status. Recommendations are made to strengthen primary healthcare and reduce hospital-related costs. What are the implications for practitioners? Interventions to address high PPH rates should be tailored to meet the needs of the local population. Primary health strategies targeting common chronic conditions provide the greatest opportunity to reduce avoidable hospitalisations and costs in this regional area. Investment in collaborative, evidence-based interventions is recommended and justified, especially for Indigenous Australians.

Conflicting interests in private hospital care.

This article looks at key changes impacting on private hospital care: the increasing corporate ownership of private hospitals; the Commonwealth Government's support for private health; the significant increase in health fund membership; and the contracting arrangements between health funds and private hospitals. The changes highlight the often conflicting interests of hospitals, doctors, Government, health funds and patients in the provision of private hospital care. These conflicts surfaced in the debate around allegations of 'cherry picking' by private hospitals of more profitable patients. This is also a good illustration of the increasing entanglement of the Government in the fortunes of the private health industry.

Tailored adsorption of His6-tagged protein onto nickel(II)-cyclam grafted mesoporous silica.

The specific immobilisation of a histidine-tagged protein, Spi, onto mono-anchored nickel(II)-cyclam functionalised SBA-15 is reported.