PurposeThe compounded disadvantage for individuals with unmet social and health care needs often leads to frequent emergency presentations. In Australia, New South Wales, the Emergency Department to Community (EDC) program was devised to support intensive care coordination for patients with complex care. With a lack of qualitative evidence, the aim of this study was to explore the barriers and facilitators of forming, implementing and sustaining partnerships with EDC stakeholders in four local health districts: Sydney, Central Coast, South Eastern Sydney and Murrumbidgee. Design/methodology/approachData collection (March–July 2025) comprised documentary analyses of EDC documentation and interviews and focus groups with stakeholders, the allied workforce and community providers. Approvals were obtained, all data were de-identified and data saturation was achieved. Thematic analysis was undertaken pragmatically within the School of Strauss and Corbin. An adapted version of Wodchis's policy framework was applied to assess subtheme alignment and sustainability of EDC partnerships. Triangulation between data sources was undertaken, and a roundtable was held to verify findings. Governance was provided by a steering committee with representatives from LHDs. FindingsIn total, 48 documents and 53 interview/focus group data were analysed. Four key themes are described: EDC patients have diverse complex needs and deep mistrust in the system. Multidisciplinary working and collaboration through cross-sectoral meetings, emergency department (ED) management plans and technological systems helped break silos and connect care across settings. Hidden work, which is not captured in data metrics, was often led by program champions and generalists that build rapport and bridge gaps in care coordination with multiple specialists. The impact of EDC was consistently echoed as “great” with staff satisfaction and a perceived reduction in ED presentations. Originality/valueThe EDC program delivers trauma-informed care for people with complex needs who are excluded from standard care models. Hidden labour and generalists are critical in building connections and rapport with specialists across health and social sectors. The program’s policy and social impacts align with equity, supporting the quintuple aim and sustainable development goals by prioritising support for the most disadvantaged groups.

OBJECTIVES:In individuals with schizophrenia receiving either clozapine or olanzapine, this study examined changes in 1) body weight and other cardiometabolic measures and microbiota biodiversity and composition between commencement and completion of 24-week semaglutide intervention; 2) body weight between commencement and 76-week follow-up. METHODS:24-week intervention (16-weeks full-dose (1.0 mg/week) after 8-weeks' titration) of open-label nurse-administered semaglutide in a public mental health setting, with one-year post-intervention follow-up (76-week trial-completion). PARTICIPANTS:people with schizophrenia without diabetes receiving clozapine or olanzapine with BMI > 27 kg/m2. PRIMARY ENDPOINTS:%body weight change at 24-weeks, and 76-weeks. Secondary endpoints: %change in waist circumference, HbA1c at 24-weeks and 76-weeks, body composition at 24-weeks. Gut microbiota changes were compared at baseline, 10-weeks and 24-weeks intervention completion. RESULTS:Mean age: 41.5 years (range 18-61), 65.4% female. Intervention completed by 65.4% (n = 17/26). 24-week intervention: intention-to-treat body weight reduction: -9.8% (95% CI: [-12.7%, -6.8%], p < 0.001) or - 10.1 kg (95% CI [-13.6, -6.6]); waist circumference reduction: -7.3% (95% CI: [-10.1%, -4.4%], p < 0.001); HbA1c non-significant reduction: -5.3% (95% CI [-10.4%, 0.1%], p = 0.055). Microbial alpha diversity decreased as time on semaglutide increased, with enrichment of Parasutterella excrementihominis. Trial completion: 88.2% (n = 15/17). Average body weight change baseline-76-weeks: -5.1% (95% CI: [-8.3%, -1.9%], p = 0.001) or - 5.3 kg (95% CI: [-8.9, -1.7]). DISCUSSION:Semaglutide was associated with significant weight loss in overweight/obese people with schizophrenia. These benefits attenuated following semaglutide discontinuation. Gut microbial compositional differences consistent with improvement in health outcomes may occur in semaglutide-treated people living with schizophrenia.

Background:Mortality in psychiatric hospitals is both elevated and poorly understood. We aimed to address a knowledge gap about cause-specific mortality among current psychiatric inpatients using a meta-analytic synthesis of primary research reporting on the natural, unnatural, and cause-specific mortalities. Methods:We conducted a systematic review and meta-analysis according to PRISMA and MOOSE guidelines. Searches for peer reviewed English language papers published between 1 January 1960 and 24 July 2025 and indexed in MEDLINE, PsycINFO, EMBASE and PubMed were supplemented using searches of grey literature and hand searches of reference lists. Data were pooled using random effects meta-analysis. Mortalities were assessed by cause-specific estimates of. i) the percentage of deaths, ii) mortality per 10,000 admissions and iii) mortality rates per 100,000 person-years. Temporal trends were examined using mixed effects meta-regression. A mixed effects model was used to examine subgroups within each mortality according to publication date and the national income of the study setting. This study is registered with PROSPERO (CRD42024572461). Findings:Thirty-eight studies published from diverse geographic settings over the last five decades were included in a meta-analysis of the percentage of mortality according to cause. Of these, twenty-eight studies were included in a meta-analysis of the mortality per 10,000 admissions and twenty-five studies were included in a meta-analysis of mortality rates per 100,000 patient-years. Natural causes accounted for 81.6% (95% confidence interval (CI) 75.7-86.3%, I-square = 98.5) of inpatient deaths. Vascular causes accounted for 31.0% (95% CI, 27.0-35.2%) of deaths, and infection accounted for 17.8% (CI 11.8-26.0%), The pooled estimate of natural deaths per 10,000 admissions was 78.9 (95% CI, 43.1-143.9, I-square = 99.8), falling from 246.6 (95% CI, 132.9-453.1) in pre-2000 studies to 35.2 (95% CI, 18.8-65.8) in more recent studies. The pooled estimate of the natural mortality rate per 100,000 patient-years was 2905.0 (95% CI, 2350.8-3459.2, I-square = 99.4), with rates falling from 5445.4 (95% CI, 4460.9-6429.9) in pre-2000 studies to 1374.3 (95% CI, 968.3-1780.2) in more recent studies. Suicides and accidents respectively accounted for 4.8% (95% CI, 3.0-7.7%) and 3.3% (2.3-4.7%) of deaths. Unnatural mortality rates have been stable over time. All mortality measures had high between study heterogeneity that was not well explained by the available moderators of year of publication and national income of the study setting. Interpretation:Mortality rates in psychiatric hospitals are highly heterogeneous but have been falling over time. Most inpatient deaths have a natural cause. Our findings suggest a need for primary research examining the demographic and diagnostic associations with inpatient mortality, while underscoring the opportunities for better integration of medical and mental health care. Funding:None.

Background People with lived experience of severe mental illness (PWLE) live around 20 years less than the general population. Most deaths are due to preventable health conditions. Improved access to high-quality preventive health care could help reduce this health inequity. This study aimed to answer the question: What helps PWLE access preventive care from their GP to prevent long-term physical conditions? Methods Qualitative interviews (n = 10) and a focus group (n = 10 participants) were conducted with PWLE who accessed a community mental health service and their carers (n = 5). An asset-based framework was used to explore what helps participants access and engage with a GP. A conceptual framework of access to care guided data collection and analysis. Member checking was conducted with PWLE, service providers and other stakeholders. A lived experience researcher was involved in all stages of the study. Results PWLE and their carers identified multiple challenges to accessing high-quality preventive care, including the impacts of their mental illness, cognitive capacity, experiences of discrimination and low income. Some GPs facilitated access and communication. Key facilitators to access were support people and affordable preventive care. Conclusion GPs can play an important role in facilitating access and communication with PWLE but need support to do so, particularly in the context of current demands in the Australian health system. Support workers, carers and mental health services are key assets in supporting PWLE and facilitating communication between PWLE and GPs. GP capacity building and system changes are needed to strengthen primary care’s responsiveness to PWLE and ability to engage in collaborative/shared care.

What is known about the topic? Cost is thought to be a barrier to access to primary care for people with mental illness. What does this paper add? Nearly three-quarters of clients of one mental health services do not report cost to be a barrier to primary care. What are the implications for practitioners? Efforts to help people with mental illness engage in primary care may be best directed towards areas other than the cost of access.

IntroductionMinimal trauma fractures (MTFs) often occur in older patients with osteoporosis and may be precipitated by falls risk-increasing drugs. One category of falls risk-increasing drugs of concern are those with sedative/anticholinergic properties. Collaborative medication management services such as Australia’s Home Medicine Review (HMR) can reduce patients’ intake of sedative/anticholinergics and improve continuity of care. This paper describes a protocol for an randomised controlled trial to determine the efficacy of an HMR service for patients who have sustained MTF.Method and analysisEligible participants are as follows: ≥65 years of age, using ≥5 medicines including at least one falls risk-increasing drug, who have sustained an MTF and under treatment in one of eight Osteoporosis Refracture Prevention clinics in Australia. Consenting participants will be randomised to control (standard care) or intervention groups. For the intervention group, medical specialists will refer to a pharmacist for HMR focused on reducing falls risk predominately through making recommendations to reduce falls risk medicines, and adherence to antiosteoporosis medicines. Twelve months from treatment allocation, comparisons between groups will be made. The main outcome measure is participants’ cumulative exposure to sedative and anticholinergics, using the Drug Burden Index. Secondary outcomes include medication adherence, emergency department visits, hospitalisations, falls and mortality. Economic evaluation will compare the intervention strategy with standard care.Ethics and disseminationApproval was obtained via the New South Wales Research Ethics and Governance Information System (approval number: 2021/ETH12003) with site-specific approvals granted through Human Research Ethics Committees for each research site. Study outcomes will be published in peer-reviewed journals. It will provide robust insight into effectiveness of a pharmacist-based intervention on medicine-related falls risk for patients with osteoporosis. We anticipate that this study will take 2 years to fully accrue including follow-up.Trial registration numberACTRN12622000261718.

The microbiome has been implicated in the development of metabolic conditions which occur at high rates in people with schizophrenia and related psychoses. This exploratory proof-of-concept study aimed to: (i) characterize the gut microbiota in antipsychotic naïve or quasi-naïve people with first-episode psychosis, and people with established schizophrenia receiving clozapine therapy; (ii) test for microbiome changes following a lifestyle intervention which included diet and exercise education and physical activity. Participants were recruited from the Eastern Suburbs Mental Health Service, Sydney, Australia. Anthropometric, lifestyle and gut microbiota data were collected at baseline and following a 12-week lifestyle intervention. Stool samples underwent 16S rRNA sequencing to analyse microbiota diversity and composition. Seventeen people with established schizophrenia and five people with first-episode psychosis were recruited and matched with 22 age-sex, BMI and ethnicity matched controls from a concurrent study for baseline comparisons. There was no difference in α-diversity between groups at baseline, but microbial composition differed by 21 taxa between the established schizophrenia group and controls. In people with established illness pre-post comparison of α-diversity showed significant increases after the 12-week lifestyle intervention. This pilot study adds to the current literature that detail compositional differences in the gut microbiota of people with schizophrenia compared to those without mental illness and suggests that lifestyle interventions may increase gut microbial diversity in patients with established illness. These results show that microbiome studies are feasible in patients with established schizophrenia and larger studies are warranted to validate microbial signatures and understand the relevance of lifestyle change in the development of metabolic conditions in this population.

This paper describes the development and outcomes from 'joint working' between Prince of Wales Hospital and BD (Becton, Dickinson and Company) in Australia. 'Joint working' is a term used within the English National Health Service to describe health system and industry partners working together to create novel service models which benefit patients. The joint working process broadened the perspective of both parties through learning from each other and so enhanced the range of tools they each bring to their work.

Editorial were not found to differ in appropriateness from th whom it recommended go elsewhere. There are th possible explanations for this. First, healthdirect may limited in its capacity to distinguish those who need attend an ED from those who do not. Second, the app priateness construct may be unable to make this disti tion. Third, the patient group that healthdirect referred the ED may be appropriate for either an ED or a gene Telephone advice lines direct resources to improved access without improving the delivery of tangible services

The Internet and computers have brought immense change in how society deals with information. Uptake of these technologies has been disjointed and has occurred in a non-uniform way among general practitioners, compared with other professionals. Information mastery is a key 21st century skill that GPs should acquire. Applying "change management" concepts may help improve uptake of information mastery skills in general practice.

Aim: To assess the combined and independent impact, of two Quality Use of Medicines initiatives‐medication review by general practitioners (GPs) and patient peer education.Method: 27 GPs recruited 185 patients aged < 65 years and taking five or more medications. Patients were randomised to receive a medication review, peer education, both or neither. Peer educators were recruited and trained to educate and empower patients to obtain the information they need from their GPs. GPs attended an educational workshop on medication review for older patients.Results: No significant difference was found for medication review by GPs or patient peer education, or for the interaction between the two, according to the two outcome measures: SF‐36 and medication count.Conclusion: Despite the limitations of the study, particularly limited statistical power, the results raise questions about the value of medication review by GPs for the elderly. Greater engagement between peer educators and patients may be required if peer educators are to have a positive effect on health outcomes.

Data were collected from clinicians at the time of consultation about the care that they provided in 12,813 encounters in a general practitioner (GP) staffed casualty department and 719 primary care encounters in two emergency departments (Bolton, 1999). Data were collected by the GPs themselves in general practice, and by a research officer located in the emergency departments. Patients seen in the emergency department were ambulatory patients whom the triage nurse assessed would not suffer an adverse outcome if they had to wait an hour or longer for care. Comparison of these two patient populations established that they were similar in terms of age, gender, ethnicity, and reason for encounter.

This paper describes HealthConnect, an after-hours telephone triage and advice service which operated for 15 months in 2000 and 2001. We describe the service, discuss utilisation and implementation issues, and conclude with a description of the key lessons learned from the trial. The service received over of 12000 calls, of which over half were for information rather than immediately seeking care.Continuing marketing appears to be required in order to ensure ongoing demand for services of this kind. Qualityassurance is essential to ensure that an optimal service is provided, and staff recruitment and training are critical tothis. A national standardised approach to services of this kind is desirable to provide a consistent service to consumers and realise economies of scale.

DiNCQUMGP (Divisions National Consortium for the Quality Use of Medicines in General Practice) reports on acollaboration between doctors, pharmaceutical companies, government agencies, and medicine users to managepolypharmacy (prescribing multiple medicines to a patient) amongst older people.We have reported the outcomes of our collaboration (improving the Quality Use of Medicines) elsewhere. Here wediscuss how we worked together, opened up new opportunities, and learned from one another. The first part of thisarticle outlines a constructive new way of thinking about collaborating, that we argue is fundamentally different fromcurrent approaches. The second part describes what we did in the words of those involved.

Frequencies, probabilities and sensitivities among symptoms, diagnoses and treatments can be inferred from large databases of health records. We investigate how these "empirical norms" can be leveraged to improve the efficiency and quality assurance capability of online systems in support of general practice medicine. In particular, we assess hotlists (case sensitive menus) of diagnoses to speed data entry. We also explore norm violation as an indicator of poor quality in practice or data recording. Using a survey based database of general practice records, we find: (a) useful hotlists of diagnoses can be generated based on conditional probability and sensitivity with respect to symptoms, and (b) records of hypertension treatments of the most frequent varieties are assessed to be of higher quality than less frequent varieties. The results support the hypothesis that empirical norms have a role to play in future online clinical information systems.