David Dunt

Suicidal ideation and suicide attempts among Australian adults.

Too little is known about suicidal thoughts and behaviors at a population level to recommend appropriate preventive strategies. Using data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), this study examined rates of, and risk factors for, suicidal ideation and suicide attempts. For 10,641 respondents, the 12-month and lifetime cumulative incidence rates of suicidal ideation were 3.4% and 16.0%, respectively; the 12-month and lifetime cumulative incidence rates of suicide attempts were 0.4% and 3.6%, respectively. 12-month ideation was associated with anxiety disorders (relative risk ratio [RRR] = 3.51; population attributable risk percent [PAR%] = 19.6%), affective disorders (RRR = 11.94; PAR% = 38.8%) and substance abuse disorders (RRR = 1.85; PAR% = 6.1%). Attempts in the past 12 months were also associated with anxiety disorders (RRR = 7.06; PAR% = 37.0%), affective disorders (RRR = 12.24; PAR% = 39.5%), and substance abuse disorders (RRR = 2.09; PAR% = 7.7%). Age, marital status, and disability were associated with ideation; marital status and employment status with attempts. Approximately 12% of ideators in the sample progressed to making an attempt; employment status was the only significant predictor. Reducing suicidal ideation and attempts requires a multi-faceted approach that targets those with mental illness but also adopts population-based strategies that address other factors, such as unemployment.

Strategies for improving patient safety culture in hospitals: a systematic review

Purpose To determine the effectiveness of patient safety culture strategies to improve hospital patient safety climate. Data sources Electronic search of the Cochrane Library, OVID Medline, Embase, CINAHL, proQuest and psychinfo databases, with manual searches of quality and safety websites, bibliographies of included articles and key journals. Study selection English language studies published between January 1996 and April 2011 that measured the effectiveness of patient safety culture strategies using a quantitative measure of patient safety climate in a hospital setting. Studies included were randomised controlled trials (RCTs), non-RCTs, controlled before and after studies, interrupted time series and historically controlled studies. Data extraction Data extraction and critical appraisal were conducted by two independent reviewers. Study design, intervention, level of application, setting, study participants, safety climate outcome measures and implementation lessons were extracted from each article. Results of data synthesis Over 2000 articles were screened, with 21 studies meeting the inclusion criteria, one cluster RCT, seven controlled before and after studies, and 13 historically controlled studies. There was marked methodological heterogeneity amongst studies. Impacts of 11 different strategies were reported. There was some evidence to support that leadership walk rounds (p=0.02) and multi-faceted unit-based programmes (p < 0.05) may have a positive impact on patient safety climate. Conclusions Despite strong face validity for a variety of patient safety culture strategies, there is limited evidence to support definitive impacts on patient safety climate outcomes. Organisations are advised to consider robust evaluation designs when implementing these potentially resource intensive strategies.

Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies

BackgroundCase management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness. This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes.MethodsWe searched Web of Science, Scopus, Medline, CINAHL (EBSCO) and PsycINFO (CSA) from inception to 2011 July. Inclusion criteria were: no restriction on date, English language, community-dwelling older people and/or carers, case management in community aged care, published in refereed journals, randomized control trials (RCTs) or comparative observational studies, examining client or carer outcomes. Quality of studies was assessed by using such indicators as quality control, randomization, comparability, follow-up rate, dropout, blinding assessors, and intention-to-treat analysis. Two reviewers independently screened potentially relevant studies, extracted information and assessed study quality. A narrative summary of findings were presented.ResultsTen RCTs and five comparative observational studies were identified. One RCT was rated high quality. Client outcomes included mortality (7 studies), physical or cognitive functioning (6 studies), medical conditions (2 studies), behavioral problems (2 studies) , unmet service needs (3 studies), psychological health or well-being (7 studies) , and satisfaction with care (4 studies), while carer outcomes included stress or burden (6 studies), satisfaction with care (2 studies), psychological health or well-being (5 studies), and social consequences (such as social support and relationships with clients) (2 studies). Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group, while all the three studies consistently reported fewer unmet service needs among the intervention participants. In contrast, available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden. There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above.ConclusionsAvailable evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs. Future studies should investigate what specific components of case management are crucial in improving clients and their carers’ outcomes.

Use of breast cancer screening and treatment services by Australian women aged 25–44 years following Kylie Minogue's breast cancer diagnosis

OBJECTIVE To examine the effects of the publicity surrounding Kylie Minogues diagnosis with breast cancer on doctor-referred breast imaging, image-guided biopsy, and cancer excisions among a low-risk population of women in Australia. Method We examine changes in unilateral and bilateral breast imaging, image-guided breast biopsies, and surgical excisions of breast cancer before and after the announcement of Kylie Minogues diagnosis with breast cancer in May 2005. The study included procedures provided through the Australian public health system to women aged 25-44 years from October 2004 and June 2006. RESULTS The odds of women aged 25-44 years undergoing imaging procedures increased by 20% in the first and second quarters after the Minogue publicity, compared to the preceding two quarters. The volume of biopsies als increased but the biopsy rate, measured as a proportion of imaging procedures, did not change among women aged 25-34 years and decreased among women aged 35-44 years. The volume of operations to excise breast cancers did not change for either age group. Compared to the 6 month period before the publicity, there was a large and significant decrease in the odds that an excision would follow biopsy (25-34 years: OR 95% CI=0.69, 0.48-0.98; 35-44 years: OR 95% CI=0.83, 0.72-0.95). CONCLUSIONS High-publicised illnesses may affect both consumer and provider behaviour. Although they present opportunities to improve public health, they also have the potential to adversely impact the appropriateness and cost-effectiveness of service delivery.

Systematic review of the effectiveness of breathing retraining in asthma management

In asthma management, complementary and alternative medicine is enjoying a growing popularity worldwide. This review synthesizes the literature on complementary and alternative medicine techniques that utilize breathing retraining as their primary component and compares evidence from controlled trials with before-and-after trials. Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library electronic databases were searched. Reference lists of all publications were manually checked to identify studies not found through electronic searching. The selection criteria were met by 41 articles. Most randomized controlled trials (RCTs) of the Buteyko breathing technique demonstrated a significant decrease in β2-agonist use while several found improvement in quality of life or decrease in inhaled corticosteroid use. Although few in number, RCTs of respiratory muscle training found a significant reduction in bronchodilator medication use. Where meta-analyses could be done, they provided evidence of benefit from yoga, Buteyko breathing technique and physiotherapist-led breathing training in improving asthma-related quality of life. However, considerable heterogeneity was noted in some RCTs of yoga. It is reasonable for clinicians to offer qualified support to patients with asthma undertaking these breathing retraining techniques.

The effect of continuing professional education on health care outcomes: lessons for dementia care

BACKGROUND This review presents an overview of the published literature on the effectiveness of continuing professional education (CPE), which includes continuing medical education (CME) of different health care professionals in healthcare settings, for improving patient management and patient outcomes. This review summarizes key articles published on the subject, including those relating to dementia care. METHODS A literature search was carried out using the National Library of Medicines PubMed database, Cochrane database and Eric databases. RESULTS Studies on CPE generally provide conflicting evidence on their effectiveness in bringing about a change in professional practices and healthcare outcomes. However interactive, multifaceted interventions, and interventions with repeated inputs appear more effective in bringing about positive changes than traditional non-interactive techniques. There are relatively few studies specifically concerning CPE and dementia care. CONCLUSION This review shows that CPE in dementia care needs to be targeted carefully. Much can be learnt from examining education approaches in the wider professional and medical education literature.

Can we achieve accountability for long-term outcomes?☆☆☆

OBJECTIVE To explore options for the development of a set of indicators to assess the long-term outcomes achieved by all people with a given disabling condition in a given population. DATA SOURCES The review draws on empirical studies of predictive indicators, theoretical literature on long-term recovery processes, and literature from administrative science on the use of indicators in accountability systems. STUDY SELECTION Studies were selected that explicitly sought to relate short-term and long-term outcomes or that explored the mediating factors in the relationship between impairment, disability, and handicap. DATA EXTRACTION The focus of the review is on (1) empirical evidence of the relationship between short- and long-term outcomes, particularly in causal claims, and (2) theoretical analyses of the factors that mediate this relationship. DATA SYNTHESIS Evidence is presented that certain outcome states can be considered thresholds that make the outcome usable and, hence, sustainable or that create the opportunity for further improvement. Such thresholds could meet the construct validity criteria necessary for measures that are to be used as indicators in an accountability system. The interaction between psychological and physical factors in setting thresholds means that both objective and subjective indicators are required in an indicator system. CONCLUSIONS It may well be possible to develop a parsimonious set of population-based outcome indicators for people with disabilities. The key safeguards required are construct validity and the involvement of people with disabilities in both the development and use of the indicators.

Access to Australian Mental Health Care by People from Non-English-Speaking Backgrounds

Objective: This study aimed to examine access to mental health care for people from non-English-speaking backgrounds relative to that of people from English-speaking backgrounds, in the context of the mental health status of both groups; and to consider whether, if they perceive that they have needs for care, these needs are met. Method: The study used data from the population-based Australian National Survey of Mental Health and Wellbeing, conducted in 1997. Results: People from non-English-speaking backgrounds and English-speaking backgrounds were equally likely to experience anxiety disorders and affective disorders, but the former were less likely to experience substance-use disorders and any mental disorder. When those with each disorder type were considered alone, people from non-Englishspeaking backgrounds and English-speaking backgrounds were equally likely to use services for mental health problems. When those with perceived needs for care were considered in isolation, there was no difference between birthplace groups in terms of their likelihood of reporting that their needs were fully met. Conclusions: The study had several limitations (i.e. lack of detail on specific ethnic groups and exclusion of potential respondents who could not speak English), which mean that these findings should be interpreted with caution. There is a need to build on this populationbased work, by oversampling people from particular non-English speaking communities and ensuring that those who do not speak English are included in population samples. Such work will further clarify the relative ability of people from non-English-speaking backgrounds to access services, and the extent to which their needs are met.

Variations in hospitalizations for chronic obstructive pulmonary disease in rural and urban Victoria, Australia

Background and objective:  Effective and timely management of COPD should reduce the risk of hospitalization. The purpose of this study was to describe variations in COPD hospital admission rates as an indicator of the adequacy of primary care services.

Integration of primary health care services: perceptions of Australian general practitioners, non-general practitioner health service providers and consumers at the general practice-primary care interface

Abstract Introduction. In conjunction with GPs reporting on their own practice experiences, the experiences of non-GP health professionals and consumer representatives working at the primary care–general practice interface provide valuable considerations for exploring concepts for the development of a GP Integration Index relevant to Australian General Practice. Objectives. To identify concepts that GPs, non-GP health service providers and consumer representatives perceive to be important in facilitating a well integrated approach to delivering primary care, and how these are perceived to be occurring in practice. Method. Group discussions about GP integration were elicited using concept mapping with four groups of GPs and seven groups of health professionals and consumer representatives, purposively selected for diversity in demographic location and practice setting from three Australian States. From Victoria, 19 GPs from two different types of practice settings, 12 Consumer Representatives from 10 separate organisations, 17 Hospital Administrators from 16 major public and private hospitals, 18 specialist doctors representing 12 specialist organisations and 13 Community Service Providers. From Queensland, 13 rural GPs and 22 Nurses representing 10 separate nursing groups were selected. From Western Australia, 19 GPs representing a mix of solo practice, group practice and hospital settings, and 40 Allied Health providers representing various private practitioners and hospital and community centre based allied health practitioners. Concept mapping results from the groups were pooled and analysed using a descriptive meta-matrix to identify overarching themes. Results. Eight overarching themes were identified from consolidated concept maps: GP role; quality outcomes; practice management/accessibility; communication and networks; health care system politics; education and knowledge; personal attributes and attitudes; and lifestyle. Within these major themes, clusters of concepts rated as at least ‘important for patient care’ included various non-clinical aspects of primary care delivery. There was emphasis on a patient—centred and holistic care approach. Strongly advocated by all groups was the need for teamwork between GPs and other health care professionals involved in primary care of the patient. Conclusion. The use of concept mapping was successful in ensuring that the breadth of the topic was explored in its entirety among these groups, contributing to the identification of the dimensions of the concept of GP-integration. Findings from these groups will be pooled and subjected to structural equation modelling processes, to develop a general practice integration index relevant to the Australian setting.