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Wong PKK, Ng BCK, Mitchell J, Han J, Lam C, Spencer D, Cai K, Manolios N. The disproportionately large contribution of the Māori and Pacific Islander community to the healthcare burden of gout in Western Sydney. Intern Med J 2023; 53:1450-1457. [PMID: 35670212 DOI: 10.1111/imj.15831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gout is a common chronic inflammatory disorder due to monosodium urate deposition, which results in severe inflammatory arthritis. It is particularly common in those of Māori or Pacific Islander heritage. There is a significant number of this at-risk ethnic group in western Sydney. AIMS To determine the healthcare burden of gout in Western Sydney. METHODS We characterised patients managed in the emergency departments (EDs) of the four Western Sydney Local Health District (WSLHD) hospitals and those admitted for gout as the primary or secondary diagnosis from 1 January 2017 to 31 December 2018. RESULTS There were 472 patients managed in ED on 552 occasions at a direct cost to the LHD of A$367 835. Those of Māori or Pacific Islander ethnicity comprised 25.2% (n = 119/472), while half (n = 39/80) of those managed in ED for gout on two or more occasions were of Māori or Pacific Islander ethnicity. Overall, 310 patients were admitted with gout as the principal diagnosis on 413 occasions at a cost of A$1.73 million. Seventy-five (24.2%) of the 310 patients were of Māori or Pacific Islander heritage. A total of 584 WSLHD inpatients had gout as a secondary diagnosis. This was associated with 714 admissions. CONCLUSIONS The disproportionately large healthcare burden of gout in Western Sydney from the relatively small Māori and Pacific Islander population needs attention. Urgent culturally appropriate interventions to address gout are required to address this inequality.
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Affiliation(s)
- Peter K K Wong
- Department of Rheumatology, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- The University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
| | - Beverly C K Ng
- Department of Rheumatology, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - James Mitchell
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Han
- Clinical Analytics Unit, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Cinda Lam
- Department of Rheumatology, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - David Spencer
- Department of Rheumatology, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Ken Cai
- Department of Rheumatology, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Manolios
- Department of Rheumatology, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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Tedja AM, Shanmugam MS, Stathis S, Middeldorp CM. Short research article: COVID-19 and its impact on child and youth mental health service demand in the community and emergency department. Child Adolesc Ment Health 2023; 28:167-171. [PMID: 35970198 PMCID: PMC9538734 DOI: 10.1111/camh.12593] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND To explore changes in child and youth mental health service (CYMHS) demand in Brisbane, Australia, following the COVID pandemic. METHODS The number of monthly presentations and referrals to respectively the emergency department (ED) and community CYMHS were compared among 2018, 2019 and 2020. RESULTS The study shows a marked increase in referrals to ED starting from July and in the community from May 2020. In the population referred to as community teams, the proportions of Indigenous children and those from lower socio-economic areas decreased. CONCLUSIONS The COVID-19 pandemic has aggravated the supply and demand disparity in CYMHS, with the largest effect on the most vulnerable families.
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Affiliation(s)
- Amy M. Tedja
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
| | - Meenakshi S. Shanmugam
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
| | - Stephen Stathis
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
- Child Health Research CentreUniversity of QueenslandBrisbaneQLDAustralia
| | - Christel M. Middeldorp
- Child and Youth Mental Health ServiceChildren's Health Queensland Hospital and Health ServiceBrisbaneQLDAustralia
- Child Health Research CentreUniversity of QueenslandBrisbaneQLDAustralia
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Casey M, Perera D, Enticott J, Vo H, Cubra S, Gravell A, Waerea M, Habib G. High utilisers of emergency departments: the profile and journey of patients with mental health issues. Int J Psychiatry Clin Pract 2021; 25:316-324. [PMID: 33945750 DOI: 10.1080/13651501.2021.1904998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Frequent presenters to the Emergency Department (ED) are known to have complex physical, behavioural and social needs. The study aimed to analyse the system's behaviour to generate new insights into ED high utilisers with complex mental health issues. METHODS A retrospective cohort study of the ED presentations of 200 high utilisers during a 12-month period was conducted. Analyses included psychiatric diagnoses, re-presentation rates, cost-benefit analysis of services and patient journey maps to illustrate the patient experience. RESULTS The profiled high utilisers represented nearly a quarter of total ED mental health presentations and were more likely to be single and unemployed. Diagnostically, Borderline Personality Disorder and Schizophrenia predominated. The re-presentation rate was high (70% within 28 days) and mental health attributable costs represented nearly three quarters of total health costs. CONCLUSION The study revealed a disintegrated service system for ED high utilisers with mental health issues, resulting in suboptimal clinical outcomes and substantial costs. To deliver value-based mental healthcare our lessons were; (1) stabilise the system's interaction with the patient by ensuring service responses are consistent with their enhanced management plan (2) all the system's parts channel the patient into various support services including psychological treatment with one therapist.KEY POINTSThe top 200 high utilisers presented to emergency 1928 times within 12 monthsThe re-presentation rate amongst the study's cohort was high (70% within 28 days)A high prevalence of BPD and schizophrenia was noted for this cohortThe study reveals a disintegrated service system for ED high utilisers, resulting in suboptimal clinical outcomes and substantial costs for the serviceA need for early identification, consistency in service responses and various support services to be provided by the hospital including psychological treatment.
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Affiliation(s)
- Melissa Casey
- Psychology and Specialist Services, Monash Health, Clayton, Australia.,Department of Psychiatry, Monash University, Clayton, Australia
| | - Dinali Perera
- Psychology and Specialist Services, Monash Health, Clayton, Australia.,Department of Psychiatry, Monash University, Clayton, Australia
| | - Joanne Enticott
- Department of Psychiatry, Monash University, Clayton, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Australia
| | - Hung Vo
- Operational Improvement, Ambulance Victoria, Victoria, Australia
| | - Stana Cubra
- Integration and Service Improvement, South Eastern Melbourne Primary Health Network, Heatherton, Australia
| | - Ashlee Gravell
- Psychology and Specialist Services, Monash Health, Clayton, Australia.,Faculty of Education, Monash University, Clayton, Australia
| | - Moana Waerea
- Psychology and Specialist Services, Monash Health, Clayton, Australia.,Faculty of Education, Monash University, Clayton, Australia
| | - George Habib
- Wellbeing Services, Student and Scholarly Services, University of Melbourne, Parkville, Australia
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Girgis A, Durcinoska I, Arnold A, Descallar J, Kaadan N, Koh ES, Miller A, Ng W, Carolan M, Della-Fiorentina SA, Avery S, Delaney GP. Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial. J Med Internet Res 2020; 22:e19685. [PMID: 33118954 PMCID: PMC7661255 DOI: 10.2196/19685] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Conclusions Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000615482; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 International Registered Report Identifier (IRRID) RR2-10.1186/s12885-018-4729-3
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Affiliation(s)
- Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Ivana Durcinoska
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Anthony Arnold
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Nasreen Kaadan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Eng-Siew Koh
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Andrew Miller
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia.,Centre for Oncology Informatics, University of Wollongong, Wollongong, Australia
| | - Weng Ng
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Martin Carolan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Stephen A Della-Fiorentina
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, Australia
| | - Sandra Avery
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Geoff P Delaney
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
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Hardy A, Fuller DG, Forrester M, Anderson KP, Cooper C, Jenner B, Marshall I, Mccloskey K, Sanderson C, Standish J, Vuillermin P. Per capita increase in hospital presentations and admissions among children since the 1990s. J Paediatr Child Health 2016; 52:935-938. [PMID: 27272644 DOI: 10.1111/jpc.13232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/27/2022]
Abstract
AIM Data regarding temporal trends in per capita paediatric hospital presentations and admissions are required to inform health system and workforce planning. METHODS Emergency Department (ED) presentations and admissions to the University Hospital Geelong among patients aged 0 to 16 years over a 12-month period (2012-2013) were determined by review of hospital records and then compared with similar data collected during 1996/1997.1 During each period, the Geelong region was serviced by a single ED, enabling us to estimate per capita presentation and admission rates. RESULTS Since 1996/1997, per capita paediatric presentations to the ED increased from 643 to 1837 per 10 000 (186%; 95% confidence interval 181% to 191%). Moreover, the proportion of paediatric ED presentations resulting in hospital admission increased from 12.3% to 18.3% (49%; 95% confidence interval 39% to 59%). CONCLUSIONS There has been a substantial absolute and per capita increase in paediatric ED presentations and hospital admissions since the 1990s. These trends place an increasing burden on the public hospital system, and strategies are required to promote paediatric acute care in the ambulatory setting.
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Affiliation(s)
- Andrew Hardy
- Children's Services, Barwon Health, Geelong, Victoria, Australia
| | - David G Fuller
- Children's Services, Barwon Health, Geelong, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia.,St John of God Hospital, Geelong, Victoria, Australia
| | - Mike Forrester
- Children's Services, Barwon Health, Geelong, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia.,St John of God Hospital, Geelong, Victoria, Australia.,Child Health Research Unit, Barwon Health (CHERUB), Geelong, Victoria, Australia
| | - Kym P Anderson
- Children's Services, Barwon Health, Geelong, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia.,St John of God Hospital, Geelong, Victoria, Australia
| | - Chris Cooper
- Children's Services, Barwon Health, Geelong, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia.,St John of God Hospital, Geelong, Victoria, Australia
| | - Bernard Jenner
- Children's Services, Barwon Health, Geelong, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia.,St John of God Hospital, Geelong, Victoria, Australia
| | - Isaac Marshall
- Children's Services, Barwon Health, Geelong, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia.,St John of God Hospital, Geelong, Victoria, Australia
| | - Kate Mccloskey
- Children's Services, Barwon Health, Geelong, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia.,St John of God Hospital, Geelong, Victoria, Australia.,Child Health Research Unit, Barwon Health (CHERUB), Geelong, Victoria, Australia
| | - Christine Sanderson
- Children's Services, Barwon Health, Geelong, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia.,St John of God Hospital, Geelong, Victoria, Australia
| | - Jane Standish
- Children's Services, Barwon Health, Geelong, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia.,St John of God Hospital, Geelong, Victoria, Australia
| | - Peter Vuillermin
- Children's Services, Barwon Health, Geelong, Victoria, Australia. .,Deakin University, Geelong, Victoria, Australia. .,St John of God Hospital, Geelong, Victoria, Australia. .,Child Health Research Unit, Barwon Health (CHERUB), Geelong, Victoria, Australia. .,Murdoch Children's Research Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Aboagye-Sarfo P, Mai Q, Sanfilippo FM, Fatovich DM. Impact of population ageing on growing demand for emergency transportation to emergency departments in Western Australia, 2005-2020. Emerg Med Australas 2016; 28:551-7. [PMID: 27469467 DOI: 10.1111/1742-6723.12641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/19/2016] [Accepted: 05/25/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the present paper is to quantify the impact of population ageing on demand for emergency transportation (ET) to EDs in Western Australia (WA). METHODS A population-based longitudinal study using the statewide ED presentation data from 2005-2014 was used to predict ET demand in 2020, stratified by age group and sex. RESULTS From 2005 to 2014, 14.9% of all ED presentations arrived by ET. The number rose from 94 369 (13.9%) in 2005 to 153 374 (15.5%) in 2014, a compound annual growth of 5.5%. Of those presentations, 55.2% resulted in hospital admission. The proportion was higher in older age groups (64.5% in 65-74 years, 67.1% in 75-84 years and 68.4% in ≥85 years). Of ED presentations arriving by ET in age group ≥65 years, 70.9% were Australasian Triage Scale category 1, 2 or 3. The rate of ET per 1000 population increased in all age groups and sex. The highest growth was in the older age groups: from 86.6, 187.0 and 512.1 in ages 65-74 years, 75-84 years and ≥85 years, respectively, in 2005 to 102.5, 226.7 and 613.6 in 2014, and are expected to increase to 115.1, 264.3 and 707.7 by 2020. The ET demands in these age groups were projected to increase annually by 5.0%, 3.6% and 4.9%, respectively, in the next 6 years, comparing to less than 4.5% in the younger age groups. CONCLUSION There has been a continuous rise in ET demand in WA, particularly in older people who have a higher urgency and requirement for admission.
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Affiliation(s)
- Patrick Aboagye-Sarfo
- Clinical Modelling, Health System Improvement Unit, System Policy and Planning, Department of Health, Perth, Western Australia, Australia.
| | - Qun Mai
- Clinical Modelling, Health System Improvement Unit, System Policy and Planning, Department of Health, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- Clinical Epidemiology Unit, School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel M Fatovich
- Emergency Medicine, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia
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