Objective Chronic opioid use can develop in previously opioid-naïve patients following an emergency department (ED) or hospital admission; however, most evidence is from North America. This study aims to assess the prevalence of persistent opioid use after an ED presentation in an Australian setting. Methods This was a population-based, retrospective cohort study using state-based linked data. Persistent opioid use was defined as continued use after 12 months, among previously opioid-naïve patients who filled an opioid prescription following discharge from any Queensland public hospital ED between 1 January 2011 and 31 December 2017. Descriptive statistics were used to summarise demographic characteristics of the study population and to outline primary outcome measures. Results There were 3,082,681 ED presentations during the study period, and 11,281,039 opioid prescriptions within 12 months of the ED presentations included in the study. A total of 186,545 opioid-naïve patients had an opioid prescription associated with their ED presentation, with more prescriptions in 2017 (34,273) compared with 2011 (14,896), driven predominantly by oxycodone prescription increases. However, of the total cohort, only 3539 (1.9%) were classified as persistent opioid users, with similar annual proportions seen throughout the study period. Conclusion The proportion of patients progressing to persistent opioid use after ED presentation was low and remained relatively stable, despite a substantial increase in the number of patients receiving at least one opioid prescription after an ED presentation. These results highlight the need for continued focus on appropriate prescribing and patient safety.
OBJECTIVES:This study characterises the use of type 1 diabetes (T1D) guidelines and protocols in Australian T1D clinics working with paediatric patients, and determines if management practices align with T1D-specific guidelines. METHODS:T1D clinic service leaders responded to an online survey on guidelines (e.g. glycated haemoglobin target levels, time in range targets, and technology uptake and management) and protocols (e.g. surgery) used. Responses were compared with T1D guidelines or protocols. RESULTS:A representative healthcare professional from 32 T1D services (16 metropolitan; 16 regional) from all Australian states and territories completed the survey. Most services (90%) reported glycated haemoglobin targets of <7% and a time in range of ≥70% (95%). Twenty-one services (72%) developed shared care plans, giving access to schools (91%), patients/families (81%) and general practitioners (71%), and with referrals to other health professionals (52%). Most (79%) clinics provided patients with International Society for Pediatric and Adolescent Diabetes/National Institute of Clinical Excellence guideline-aligned responses on managing out-of-range blood glucose level readings from T1D-related technologies. Regional clinics (68%) provided guideline-aligned responses less frequently than metropolitan clinics (91%). Services used combinations of state-based, national and locally developed protocols for patient management. CONCLUSIONS:This is the first Australia-wide study examining the protocols and guidelines followed for paediatric T1D management by T1D clinics. Most services reported management practices aligned with T1D guidelines. Greater sharing of care plans when referring patients to other services could improve care continuity. Increasing regional clinics' delivery of guideline-aligned information to patients on using T1D technology could support patient self-management. This survey provides a benchmark of diabetes guideline awareness and protocol usage in Australia.
OBJECTIVE:This desktop/scoping document review aimed to determine differences in availability, content, definitions, and terminology used in NSW Health policy documents that pertained to end-of-life planning. METHODS:A desktop/scoping comparative analysis of identified documents from the 15 NSW Local Health District (LHD) intranet sites was conducted to identify policy documents that describe elements of or were relevant to end-of-life planning. Of those that pertained to end-of-life planning, data were extracted and analysed using the READ approach. RESULTS:A total of 105 documents were obtained, with 49 (46%) being identified as discussing or mentioning resuscitation plans, advance care plans, or advance care directives (36 LHD, 9 facility-level, and 5 state-level). The frequency of definitions identified in the 49 documents included 26 (53%) using advance care plan, 24 (48%) using advance care directive, and 16 (32%) using resuscitation plan. The greater proportion of these did not align with the state policy PD_2014_030. Significant variation was observed in terminology and abbreviations among all documents. Using the Australian Statistical Geography Standard Remoteness Structure of geographical remoteness, there are differences in the availability and accessibility between major cities (61% of documents) versus inner-regional/outer-regional/remote/very-remote-areas (11.4 /15.9/2.3/9.1%). CONCLUSION:This review highlights variations in the number and type of documents available to clinicians across LHDs. There were evident disparities in the number of documents available on LHD intranets as well as between regional-remote NSW when compared to major cities. When viewed in conjunction with document-to-document inconsistencies in terminology and definitions, these findings highlight the possibility that current state policies are not meeting the needs of LHDs and hospitals at the local level. This underscores the importance of accepted, uniform definitions within the context of statewide policymaking.
Australia has one of the highest rates of skin cancer globally, and outdoor workers represent a key high-risk population due to prolonged occupational sun exposure. Despite a robust legislative framework mandating comprehensive workplace sun protection, evidence indicates suboptimal implementation and compliance in Australian workplaces. This perspective critically analyses the documented gap between policy and practice, examining the individual, cultural and organisational barriers to effective sun protection. We argue that current workplace policies are insufficient without rigorous enforcement, adequate penalties and a genuine shift in workplace culture. Furthermore, we highlight the pivotal role of occupational health physicians and general practitioners in bridging this gap through patient identification, targeted education, and early skin cancer detection. Closing the policy-practice gap requires a concerted, multi-pronged effort from policymakers, employers, workers, and clinicians to move beyond mere compliance and foster a culture of sun safety.
Australia's hospital performance framework measures emergency department throughput and elective surgery waiting times, but ignores the inpatient journey where older Australian patients face invisible delays. This Perspective proposes National Medical Measures, simple ward-level flow indicators, to make delay patterns observable throughout the acute episode. The National Health Reform Agreement Addendum 2026-2031 requires Health Ministers to develop performance indicators for long-stay patients and cross-sector interfaces; this policy window should include ward-flow measurement. These measures would deliver national visibility of inpatient delays for the first time, establishing the baseline evidence needed to inform earlier clinical intervention, future target setting, and capacity planning.
OBJECTIVE:Spinal surgery rates in Australia continue to rise despite limited evidence for their effectiveness in managing uncomplicated chronic back pain. This study examined patient-level factors that influence willingness to undergo surgery, to informing future work promoting non-surgical care pathways. METHODS:We conducted a cross-sectional online survey in March 2025 of 152 privately insured Australian adults with chronic low back pain. Participants reported pain characteristics, functional interference, prior imaging and pain-related beliefs (expectations of recovery, self-efficacy and catastrophising). Willingness to undergo spinal surgery within 5 years was assessed on a 5-point scale, and dichotomised into 'willing' (3-4) and 'unwilling' (0-1); respondents answering 'unsure' were excluded. Logistic regression examined predictors of willingness to consider surgery. RESULTS:Of 152 participants (mean age 59.3 years, 64% female), 24% expressed willingness to undergo surgery. Negative pain beliefs, higher pain intensity and younger age significantly predicted willingness, with the strongest effect seen for negative pain beliefs (OR 2.62, 95% CI 1.16-5.92, P = 0.02). Functional interference, imaging history and gender showed positive, but non-significant, associations. CONCLUSION:Negative pain beliefs predict willingness to undergo spinal surgery. This finding has important policy implications, suggesting that addressing belief-driven demand may help reduce the economic burden of surgery by directing patients towards guideline-based, high-value, non-surgical care.
OBJECTIVE:Queensland implemented a centralised voluntary assisted dying (VAD) pharmacy model to promote safety, consistency and equitable access to VAD substances. In a geographically dispersed state, such as Queensland, a potential concern is whether centralisation affects time-to-delivery (TTD) for patients in regional and rural areas. This audit examined whether differences exist in TTD between South East Queensland (SEQ; metropolitan) and non-SEQ (non-metropolitan) patients, and explored reasons for prescription and visit cancellations to determine whether geographic factors, particularly remoteness, influenced service reliability. METHODS:All VAD substance deliveries between 1 January 2023 and 31 January 2024 were analysed. TTD was defined as the difference between the patient's preferred and actual supply dates. Comparisons were made across region (SEQ vs non-SEQ), hospital and health service districts, and Modified Monash Model categories. Reasons for prescription and visit cancellations were also explored, as these cases were not captured in the TTD dataset if a delivery did not proceed, and may reveal potential geographic barriers for timely access. RESULTS:Of 911 patients, 723 (83%) received the VAD substance on their preferred date. No statistically significant differences in TTD were observed across region, hospital and health service districts or Modified Monash Model classifications, demonstrating consistent and reliable statewide delivery - an indicator of safety and standardised practice. Cancellations (prescriptions n = 58, visits n = 56) were geographically uniform and most commonly due to patient death. CONCLUSIONS:Queensland's centralised VAD pharmacy enables equity of access and safe delivery of VAD substances regardless of geography, supporting standardised practice and mitigating operational risks through centralised oversight.
OBJECTIVE:This study aimed to identify how telehealth supports access to Voluntary Assisted Dying (VAD) globally and explore potential risks and benefits of telehealth for VAD consultations. METHODS:A systematic review of peer-reviewed articles on telehealth and VAD examining global use of telehealth to support access to VAD, global restrictions to telehealth-enabled VAD, and practical and clinical implications of using telehealth in supporting VAD was performed. PubMed, Embase (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and Scopus were searched and supplemented by handsearching relevant articles. Study quality was assessed using the SQUIRE (The Standard for Quality Improvement Reporting Excellence) guidelines. RESULTS:Two hundred and thirty articles were identified and then screened by two reviewers. Data were extracted from 26 included articles. Guided by Braun and Clarke's thematic analysis methodology, manual open coding was undertaken, and peer debriefing meetings resulted in the final key themes. Overall, findings indicate that telehealth can facilitate VAD services, enhance patient and provider experiences, and mitigate access inequities. The analysis highlighted that telehealth could further improve VAD access, especially in rural and remote areas. Until then, there are ongoing legal ambiguities for providers in Australia. CONCLUSIONS:Telehealth can improve access to VAD, particularly in remote areas, reducing travel burdens for terminally ill patients. Global evidence from VAD and other sensitive medical fields supports the conclusion that telehealth's benefits outweigh its risks. Legislative clarity in Australia is necessary to resolve conflicts between federal and state laws and to provide clarity for healthcare providers and improve access for eligible patients. Future research should include more robust measures of the efficacy of telehealth.
OBJECTIVE:Directly influenced by hospital-related factors, potentially avoidable unplanned readmissions (PAURs) offer a more actionable indicator of care quality and safety than unplanned readmissions. Direct costs of PAURs are scarcely reported. This study estimates the direct costs of PAURs within 30 days of discharge and identifies factors associated with higher unplanned readmission costs. METHODS:We retrospectively analysed hospitalisation data for all adult general medicine patients discharged alive from a South Australian hospital between 1 July and 30 September 2022 and readmitted to any state public hospital within 30 days. A panel of senior clinicians evaluated PAURs using pre-defined criteria. Costs were estimated using the National Hospital Cost Data Collection and inflated to 2024 Australian dollars. Predictors of cost were identified using a generalised linear model. RESULTS:Of 375 readmitted patients, 78 readmissions were classified as PAURs. The total unadjusted unplanned readmission cost was $4,720,869, with PAURs accounting for $897,932 (19%). Mean costs were $11,512 (s.d. = $14,329) for PAURs and A$12,872 (s.d. = $19,089) for non-PAURs (P = 0.45). Readmission costs were higher among patients with congestive heart failure and chronic kidney disease (both P < 0.05). Adjusted mean cost per unplanned readmission (both PAURs and non-PAURs) was $13,703 (s.e. = $1112). PAURs were associated with a $3982 cost reduction (P = 0.037). Prior emergency department visits reduced costs (P = 0.017), whereas smoking (P = 0.043) and index admission length of stay (P < 0.05) increased costs. CONCLUSION:PAURs imposed substantial costs but were less expensive per admission than non-PAURs. Higher costs were observed among patients with congestive heart failure, chronic kidney disease, smoking, and longer index admissions. System-level transitional care strategies with targeted case management for high-risk, high-cost patients may enhance continuity of care, reduce readmission-related costs, and support more strategic resource allocation across the public healthcare system.
OBJECTIVE:This study aimed to systematically map the scope, focus, and distribution of Queensland's health workforce (HWF) policies and examine their alignment with strategic HWF objectives. METHODS:A descriptive policy review was conducted using documents sourced from the Queensland Health and Health Workforce Queensland websites between January and May 2025. Documents were coded by policy type (system-level, individual-level, employment), document type, strategic domain (supply, distribution, performance), health profession, policy author, and publication year. RESULTS:A total of 275 policy documents were identified. Among 11 major policy groupings, most policies related to 'general HWF' and 'medical doctors and specialists' with minimal policy attention to pharmacists, physician assistants, paramedics, and aged care workers. Employment-focused policies accounted for 52% of all documents, compared with 38% focused on individual career development and only 10% on system-level strategic objectives. Most documents addressed workforce performance (65%), with fewer addressing supply (39%) or distribution (11%). Employment policy documents were largely authored by human resources and industrial relations bodies, reflecting the prominence of these actors in the HWF policy landscape. CONCLUSIONS:Despite a high volume of HWF policy in Queensland, the policy architecture is fragmented. Profession-specific siloes, a strong emphasis on employment and industrial policy, and uneven focus across supply, distribution and performance domains suggest coordination and alignment challenges when it comes to addressing broader workforce goals. Further work is needed to understand whether and how these patterns may constrain the development of integrated, equitable workforce strategies capable of addressing persistent system-wide planning issues such as skills mix, retention and rural maldistribution.
OBJECTIVE:This study aimed to examine peripheral intravenous catheter (PIVC) policies across Queensland public health services, their underpinning evidence, and alignment with the 2021 Australian PIVC Clinical Care Standard. METHODS:A document review and analysis of public state and health service PIVC policies, procedures, and guidelines across Queensland was performed. Data were extracted using standardised forms, collated, reviewed, and compared for each health service and the state overall. Document characteristics and underpinning evidence (e.g. references, supporting resources, alignment with the 10 PIVC Standard Quality Statements) were analysed descriptively. Binary adherence (yes adherent, no not adherent, other) was assessed for the 10 PIVC Standard Quality Statements. RESULTS:Documents included 17 health service procedures, one protocol, and one statewide guideline (total n = 19), released between 2015 and 2024. Most were PIVC-specific (90%), and four had exceeded their planned update timepoint. Three had no references, but had supporting resources described, whereas one document had both. One provided neither references nor supporting resources. All documents had hyperlinks to other internal and/or external resources. Of 15 released after Standard publication (post-2021), 13 (86.7%) referred to the Standard. No individual document adhered to all 10 Standard Quality Statements. None of the Quality Statements were met by all documents (adherence range 0-95%). CONCLUSIONS:Many PIVC policies lacked a strong evidence framework and did not align with the minimum level of care expected in Australia. This likely impacts the quality of clinical care and patient outcomes. There is an urgent need for rationalisation and system-wide standardisation of policies to reduce variation and ensure clinical standards are met.
Objective: Identify factors influencing retention and attrition of physiotherapists in Australia. Methods: Cross-sectional survey and analysis of 10 years of Australian Health Practitioner Regulation Agency (Ahpra) registration data, involving current or previously registered physiotherapists. Results: Among participants, 6,045 (80.2%) intended to stay in the profession, 711 (9.3%) were unsure, and 779 (10.3%) intended to leave. Of those intending to leave 87% wanted to leave within one-year. Reasons for leaving included retirement, unsatisfactory remuneration, lack of career advancement, professional dissatisfaction, and mental burnout. Respondents more likely to leave or be unsure included: older physiotherapists (over 50: OR = 1.6, 95% CI = 1.2–2.0), those with fewer than 15 years of experience (OR ~ 2.0, 95% CI ~ 1.1–2.8), males (OR = 1.2, 95% CI = 1.0–1.4), practitioners with further qualifications (OR = 1.2, 95% CI = 1.1–1.4), those without Australian Physiotherapy Association (APA) membership (OR = 1.7, 95% CI = 1.5–2.0), those with non-practising (OR = 12.2, 95% CI = 9.2–16.1), and unregistered practitioners (OR = 39.5, 95% CI = 28.7–54.4). From 2014 to 2023, physiotherapists per 100,000 population rose by 41.6% and the replacement rate (~2.5) remained stable overall, with higher replacement rates among males. Conclusion: Most physiotherapists intended to stay with registration data indicating strong workforce growth and stable replacement rates over the past decade. However, nearly one in five physiotherapists plan to leave or remain uncertain – most citing retirement, remuneration, career progression, dissatisfaction, or burnout as reasons. Strategies targeting these factors may improve retention.
OBJECTIVE:To establish a dataset of the speech pathology workforce in the Australian Capital Territory, addressing gaps in workforce data caused by the absence of National Registration and Accreditation Scheme regulation. METHODS:A 21-question online survey was adapted and distributed by subject matter and health workforce experts, based on existing workforce survey data for National Registration and Accreditation Scheme regulated allied health professionals, and previous allied health and speech pathology workforce surveys in other Australian health jurisdictions. Descriptive statistics and regression analysis were performed to examine the relationship between demographic and employment characteristics. RESULTS:The survey revealed an emerging speech pathology workforce requiring structured supervision and support, that is inequitably distributed across the Australia Capital Territory. The collected demographic and basic employment characteristics of speech pathologists in the Australian Capital Territory were largely consistent with 2021 Census data and Speech Pathology Australia estimates. The survey provided greater granularity of speech pathology workforce data that aligns more closely with datasets used for other AH professions under the National Registration and Accreditation Scheme. CONCLUSIONS:This research has established a purpose-built dataset of the speech pathology workforce in the Australian Capital Territory. The granularity of this data can better inform workforce planning for speech pathology and other allied health professions not covered by the National Registration and Accreditation Scheme. A public online register based on this framework for speech pathologists and allied health professions would enhance the understanding of critical workforce dynamics over time and allow more robust planning of the allied health workforce.
OBJECTIVE:This scoping review aimed to describe current multi-component services and programs with the primary purpose of preventing suicide and self-harming behaviours among adolescents and young adults aged 12-25 years in Australia and summarise evaluations of these initiatives. METHOD:A systematic search of Embase, PsycINFO, PubMed, Scopus, and grey literature was conducted to identify relevant publications from 2014 to 2024. Data on identified services and programs were then analysed using a narrative synthesis approach. A quality assessment of evidence was also employed. RESULTS:The review included six journal articles and six grey literature reports, detailing five different multi-component services and programs. Findings indicated relatively few existing multi-component strategies, with most targeting suicide or suicide and self-harm prevention. No identified multi-component programs focused solely on preventing self-harm. Three programs were delivered in community-based settings, one was web-based, and one was school-based. Common program components included psychoeducational materials/interventions, peer-to-peer support, and professional support/counselling. There was significant variation in how initiatives were evaluated. CONCLUSIONS:The review suggests that there are few multi-component strategies for preventing suicide and self-harm among young Australians. Most of those identified were only introduced within the past 6 years, leaving little opportunity for comprehensive, long-term evaluations. Although available evidence indicates promising results, the scarcity of completed evaluations limits understanding of their overall effectiveness. The absence of multi-component programs specifically addressing self-harm highlights a key gap, emphasising the need for targeted, evidence-based prevention strategies that distinguish between self-harm with suicidal intent and non-suicidal self-harm.
OBJECTIVE:Australia has a critical shortage of general practitioners (GPs). A third of the profession are expected to leave within the next 5 years, and recruitment initiatives have been insufficient to address the gap. Female GPs practice differently to their male colleagues and seem to be reducing their clinical work at higher rates. The aim of this study was to explore the reasons why they are leaving, so that Australian communities are better able to attract and retain their expertise and capacity. METHODS:The study used a narrative methodology with an online survey method. We recruited female GPs who were retiring or reducing their clinical workload by at least 50% and used descriptive, comparative and open-ended questions. The survey explored the way physical, emotional, social, financial and occupational wellbeing influenced their decisions to: become GPs, remain in general practice, choose to leave and consider returning. RESULTS:There was rapid uptake with 770 eligible participants completing the survey within a month. The cohort was broadly representative of the female GP population, in age, experience and geographical distribution. Female GPs expressed a deep commitment to their patients and communities, but described financial, social and occupational barriers to care that were physically, mentally and morally harmful. GPs felt 'targeted' by politicians and policy makers who treated them with 'malignant disregard'. CONCLUSIONS:Female GPs describe unsustainable working conditions that prevent them from working in a profession they love. Rebuilding trust will be a core task if this critical workforce is to be retained.
OBJECTIVES:The Guided Self-Determination (GSD) method is an evidence-based life-skill intervention program that involves self-directed and shared decision-making between people with an ongoing health issue and GSD-trained healthcare practitioners. Type 2 diabetes (T2D) is a significant contributor to disease burden for Aboriginal and Torres Strait Islander peoples. This paper describes the process of developing a co-designed, culturally tailored GSD program to improve diabetes self-management and wellbeing for Aboriginal and Torres Strait Islander peoples. METHODS:Two co-design workshops were held with Aboriginal peoples with lived experience of T2D, in conjunction with healthcare practitioners. RESULTS:The participants' feedback highlighted the need for plain language and pictorials; using respectful Indigenous language terms; the importance of emphasising successful diabetes management; the inclusion of mind mapping; and the use of strengths-based yarning as the foundation of the program. CONCLUSIONS:The importance of tailoring communication methods to fit the cultural and linguistic context for Aboriginal people was integral to participants. Using less medical and technical language and including diagrams, drawings or symbols ensured that the information was accessible. By aligning language and communication styles with that of Aboriginal people, healthcare practitioners can help ensure that their messages are valued and understood. In the next phase of the project, the effectiveness of the co-designed GSD program will be evaluated using diabetes self-management and quality of life measures. In addition, the feasibility and acceptability of the GSD program will be explored.
