Jody Church

An economic evaluation of community and residential aged care falls prevention strategies in NSW

AIM To evaluate the cost-effectiveness of strategies designed to prevent falls amongst people aged 65 years and over living in the community and in residential aged-care facilities. METHODS A systematic review and meta-analysis of the literature was conducted. The pooled fall rate ratio was used in a decision analytic model that combined a Markov model and decision tree to estimate the costs and outcomes of potential interventions and/or strategies. The resulting cost per quality-adjusted life year was estimated. RESULTS The most cost-effective falls prevention strategy in community-dwelling older people was Tai Chi. Expedited cataract surgery and psychotropic medication withdrawal were also found to be cost-effective; however, the effectiveness of these interventions is less certain due to small numbers of trials and participants. The most cost-effective falls prevention strategies in residential aged-care facilities were medication review and vitamin D supplementation.

Australian health-related quality of life population norms derived from the SF-6D.

Objective : To investigate population health‐related quality of life norms in an Australian general sample by age, gender, BMI, education and socioeconomic status.

The cost-effectiveness of falls prevention interventions for older community-dwelling Australians

Objective: To evaluate the cost‐effectiveness of strategies designed to prevent falls among older people.

Education and obesity in four OECD countries

An epidemic of obesity has been developing in virtually all OECD countries over the last 30 years. Existing evidence provides strong suggestions that such epidemic has affected certain social groups more than others. In particular, education appears to be associated with a lower likelihood of obesity, especially among women. A range of analyses of health survey data from Australia, Canada, England and Korea were undertaken with the aim of exploring the relationship between education and obesity. The findings of these analyses show a broadly linear relationship between the number of years spent in full-time education and the probability of obesity, with most educated individuals displaying lower rates of the condition (the only exception being men in Korea). This suggests that marginal returns to education, in terms of reduction in obesity rates, are approximately constant throughout the education spectrum. The findings obtained confirm that the education gradient in obesity is stronger in women than in men. Differences between genders are minor in Australia and Canada, more pronounced in England and major in Korea. The causal nature of the link between education and obesity has not yet been proven with certainty; however, using data from France we were able to ascertain that the direction of causality appears to run mostly from education to obesity, as the strength of the association is only minimally affected when accounting for reduced educational opportunities for those who are obese in young age. Most of the effect of education on obesity is direct. Small components of the overall effect of education on obesity are mediated by an improved socio-economic status linked to higher levels of education, and by a higher level of education of other family members, associated with an individual’s own level of education. The positive effect of education on obesity is likely to be determined by at least three factors: (a) greater access to health-related information and improved ability to handle such information; (b) clearer perception of the risks associated with lifestyle choices; and, (c) improved self-control and consistency of preferences over time. However, it is not just the absolute level of education achieved by an individual that matters, but also how such level of education compares with that of the individual’s peers. The higher the individual’s education relative to his or her peers’, the lower is the probability of the individual being obese.

Self-Expanding Metallic Stents for the Management of Emergency Malignant Large Bowel Obstruction: a Systematic Review.

ObjectivesThis paper evaluates the safety and effectiveness of self-expanding metallic stents (SEMS) for the management of emergency malignant colorectal obstruction in patients otherwise requiring multi-stage surgery. No systematic review has been conducted comparing SEMS to only multi-stage surgery.MethodsBibliographic databases, including Cochrane, PubMed, EMBASE, and CINAHL, were searched in September 2011 and repeated in November 2013. A pre-determined protocol outlined the study inclusion and appraisal.ResultsForty articles were included, seven compared SEMS to multi-stage surgery. Included studies were of low to moderate quality. Bowel perforation was the most severe stent-related complication, while tumor- and stent-related events occurred most frequently. No significant differences in rates of obstruction relief were reported between treatments, and results regarding relative quality of life were inconclusive. SEMS recipients progressed to elective surgery sooner and required shorter post-procedural hospital stays, but commonly required re-intervention. SEMS provided enduring palliative relief of obstruction, with comparable survival longevity between treatments.ConclusionSEMS placement is a viable alternative to multi-stage surgery, providing patients with benefits as a bridge-to-surgery and relief of obstruction in a palliative context, with minimal differences in clinical success and safety compared to multi-stage surgery.

Effectiveness of a Pedometer-based Telephone Coaching Program on Weight and Physical Activity for People Referred to a Cardiac Rehabilitation Program: a randomised controlled trial.

PURPOSE: To determine the effectiveness of a pedometer-based telephone lifestyle coaching intervention on weight and physical activity. METHODS: A randomized controlled trial was conducted with 313 patients referred to cardiac rehabilitation in rural and urban Australia. Participants were allocated to a healthy weight (HW) (4 telephone coaching sessions on weight and physical activity) or a physical activity (PA) intervention (2 telephone coaching sessions on physical activity). Weight and physical activity were assessed by self-report at baseline, short-term (6-8 weeks), and medium-term (6-8 months). RESULTS: More than 90% of participants completed the trial. Over the medium-term, participants in the HW group decreased their weight compared with participants in the PA group (P = .005). Participants in the HW group with a body mass index of ≥25 kg/m2 had a mean weight loss of 1.6 kg compared with participants in the PA-only group who lost a mean of 0.4 kg (P = .015). Short-term, both groups increased their physical activity time, and the PA group maintained this increase at the medium-term. CONCLUSIONS: Participants in the HW group achieved modest improvements in weight, and those in the PA group demonstrated increased physical activity. Low-contact, telephone-based interventions are a feasible means of delivering lifestyle interventions for underserved rural communities, for those not attending cardiac rehabilitation, or as an adjunct to cardiac rehabilitation.

A Comparison of the Cost-effectiveness of Two Pedometer-based Telephone Coaching Programs for People with Cardiac Disease

INTRODUCTION Following a cardiac event it is recommended that cardiac patients participate in cardiac rehabilitation (CR) programs. However, little is known about the relative cost-effectiveness of lifestyle-related interventions for cardiac patients. This study aimed to compare the cost-effectiveness of a telephone-delivered Healthy Weight intervention to a telephone-delivered Physical Activity intervention for patients referred to CR in urban and rural Australia. METHODS A cost-utility analysis was conducted alongside a randomised controlled trial of the two interventions. Outcomes were measured as Quality Adjusted Life Years (QALYs) gained. RESULTS The estimated cost of delivering the interventions was

Cost-effectiveness of an advance notification letter to increase colorectal cancer screening

201.48 per Healthy Weight participant and

International Mobility of Health Professionals and Health Workforce Management in Canada

138.00 per Physical Activity participant. The average total cost (cost of health care utilisation plus patient costs) was

Factors that drive the gap in diabetes rates between Aboriginal and non‐Aboriginal people in non‐remote NSW

1,260 per Healthy Weight participant and