Now showing 1 - 10 of 66
  • Publication
    Alcohol-Attributable Death and Burden of Illness among Aboriginal and Non-Aboriginal Populations in Remote Australia, 2014-2018.
    Harmful use of alcohol is a problem in the Northern Territory (NT), Australia. The aim of this study was to assess and compare alcohol-attributable deaths and the contribution of alcohol to the burden of disease and injury (BOD) among the Aboriginal and non-Aboriginal populations in the NT between 2014 and 2018. The alcohol-use data for adults aged 15+ years old in the NT population was taken from the 2016 National Drug Strategy Household Survey. BOD was measured in disability-adjusted life years (DALY) as part of the NT BOD study. Population-attributable fractions were derived to analyse deaths and BOD. Between 2014 and 2018, 673 Aboriginal and 392 non-Aboriginal people died of harmful use of alcohol, accounting for 26.3% and 12.9% of the total deaths in the Aboriginal and non-Aboriginal population, respectively. Alcohol caused 38,596 and 15,433 DALY (19.9% and 10.2% of the total), respectively, in the NT Aboriginal and non-Aboriginal population for the same period. The alcohol-attributable DALY rate in the Aboriginal population was 10,444.6 per 100,000 persons, six times the non-Aboriginal rate. This study highlights the urgent need to reduce harmful alcohol use in the NT, which disproportionately affects Aboriginal peoples in rural and remote areas.
  • Publication
    All-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study.
    (2020-01-02) ;
    Jeyaraman K
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    ; ;
    Guthridge S
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    ;
    Falhammar H
    To evaluate the benefit and risk of low-dose acetylsalicylic acid (aspirin) in patients from remote Aboriginal communities in the Northern Territory, Australia. Retrospective cohort study using primary care and hospital data routinely used for healthcare. Aspirin users and non-users were compared before and after controlling confounders by matching. Marginal structural models (MSM) were applied to ascertain the benefit and risk. The benefit and harm of aspirin were investigated in patients aged ≥18 years from 54 remote Aboriginal communities. None had a previous cardiovascular event or major bleeds. Patients on anticoagulants or other antiplatelets were excluded. Aspirin at a dose of 75-162 mg/day. Endpoints were all-cause, cardiovascular mortality and incidences of cardiovascular events and major bleeds. 8167 predominantly Aboriginal adults were included and followed between July 2009 and June 2017 (aspirin users n=1865, non-users n=6302, mean follow-up 4 years with hospitalisations 6.4 per person). Univariate analysis found material differences in demographics, prevalence of chronic diseases and outcome measures between aspirin users and non-users before matching. After matching, aspirin was significantly associated with reduced all-cause mortality (HR=0.45: 95% CI 0.34 to 0.60; p<0.001), but not bleeding (HR=1.13: 95% CI 0.39 to 3.26; p=0.820). After using MSMs to eliminate the effects of confounders, loss of follow-up and time dependency of treatment, aspirin was associated with reduced all-cause mortality (HR=0.60: 95% CI 0.47 to 0.76; p<0.001), independent of age (HR=1.06; p<0.001), presence of diabetes (HR=1.42; p<0.001), hypertension (HR=1.61; p<0.001) and alcohol abuse (HR=1.81; p<0.001). No association between aspirin and major bleeding was found (HR=1.14: 95% CI 0.48 to 2.73; p=0.765). Sensitivity analysis suggested these findings were unlikely to have been the result of unmeasured confounding. Aspirin was associated with reduced all-cause mortality. Bleeding risk was less compared with survival benefits. Aspirin should be considered for primary prevention in Aboriginal people with high cardiovascular risk.
  • Publication
    Potentially preventable hospitalisations in the Northern Territory 2005-06 to 2017-18
    (Department of Health, 2021-02) ; ;
    Innovation and Research
    ;
    Population and Digital Health, Department of Health
    This report presents the results of a departmental project which analysed the PPHs in the NT during the 2017-18 financial year and of a time trend since 2005-06.
  • Publication
    Northern Territory Cancer Register data quality, 1981-2001
    (NT Cancer Registry, the Cooperative Research Centre for Aboriginal Health, Charles Darwin University and the Menzies School of Health Research, 2004-08)
    Condon J
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    ;
    Armstrong B
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    Barnes T
    ;
    Health Gains Planning
    Indicators of completeness of case ascertainment and of data accuracy were assessed for the NTCR for cases diagnosed from 1981 (when the Registry commenced operation) to 2001. Data quality indicators were compared to indicators for other Australian cancer registries. Where possible, data quality was assessed separately for cancer registrations for indigenous and non-indigenous people. Several notification sources were re-screened to identify cases that had not been previously notified.
  • Publication
    External validation of the Health Care Homes hospital admission risk stratification tool in the Aboriginal Australian population of the Northern Territory.
    (2023)
    Goddard, Laura
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    Field, Emma
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    Moran, Judy
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    Franzon, Julie
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    ;
    Objective This study aimed to externally validate the Commonwealth's Health Care Homes (HCH) algorithm for Aboriginal Australians living in the Northern Territory (NT). Methods A retrospective cohort study design using linked primary health care (PHC) and hospital data was used to analyse the performance of the HCH algorithm in predicting the risk of hospitalisation for the NT study population. The study population consisted of Aboriginal Australians residing in the NT who have visited a PHC clinic at one of the 54 NT Government clinics at least once between 1 January 2013 and 31 December 2017. Predictors of hospitalisation included demographics, patient observations, medications, diagnoses, pathology results and previous hospitalisation. Results There were a total of 3256 (28.5%) emergency attendances or preventable hospitalisations during the study period. The HCH algorithm had an area under the receiver operating characteristic curve (AUC) of 0.58 for the NT remote Aboriginal population, compared with 0.66 in the Victorian cohort. A refitted model including 'previous hospitalisation' had an AUC of 0.72, demonstrating better discrimination than the HCH algorithm. Calibration was also improved in the refitted model, with an intercept of 0.00 and a slope of 1.00, compared with an intercept of 1.29 and a slope of 0.55 in the HCH algorithm. Conclusion The HCH algorithm performed poorly on the NT cohort compared with the Victorian cohort, due to differences in population demographics and burden of disease. A population-specific hospitalisation risk algorithm is required for the NT.
  • Publication
    Burden of disease and injury in Aboriginal and non-Aboriginal populations in the Northern Territory.
    (2004-05-17) ;
    Guthridge S
    ;
    Magnus A
    ;
    Vos T
    To quantify the burden of disease and injury for the Aboriginal and non-Aboriginal populations in the Northern Territory. Analysis of Northern Territory data for 1 January 1994 to 30 December 1998 from multiple sources. Disability-adjusted life-years (DALYs), by age, sex, cause and Aboriginality. Cardiovascular disease was the leading contributor (14.9%) to the total burden of disease and injury in the NT, followed by mental disorders (14.5%) and malignant neoplasms (11.2%). There was also a substantial contribution from unintentional injury (10.4%) and intentional injury (4.9%). Overall, the NT Aboriginal population had a rate of burden of disease 2.5 times higher than the non-Aboriginal population; in the 35-54-year age group their DALY rate was 4.1 times higher. The leading causes of disease burden were cardiovascular disease for both Aboriginal men (19.1%) and women (15.7%) and mental disorders for both non-Aboriginal men (16.7%) and women (22.3%). A comprehensive assessment of fatal and non-fatal conditions is important in describing differentials in health status of the NT population. Our study provides comparative data to identify health priorities and facilitate a more equitable distribution of health funding.
  • Publication
    Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease: A Data-Linkage and Survival Analysis Approach.
    (2016-07-19)
    He VYF
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    Condon JR
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    ; ;
    Roberts K
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    de Dassel JL
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    ;
    Fittock M
    ;
    Edwards KN
    ;
    Carapetis JR
    We investigated adverse outcomes for people with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) and the effect of comorbidities and demographic factors on these outcomes. Using linked data (RHD register, hospital, and mortality data) for residents of the Northern Territory of Australia, we calculated ARF recurrence rates, rates of progression from ARF to RHD to severe RHD, RHD complication rates (heart failure, endocarditis, stroke, and atrial fibrillation), and mortality rates for 572 individuals diagnosed with ARF and 1248 with RHD in 1997 to 2013 (94.9% Indigenous). ARF recurrence was highest (incidence, 3.7 per 100 person-years) in the first year after the initial ARF episode, but low-level risk persisted for >10 years. Progression to RHD was also highest (incidence, 35.9) in the first year, almost 10 times higher than ARF recurrence. The median age at RHD diagnosis in Indigenous people was young, especially among males (17 years). The development of complications was highest in the first year after RHD diagnosis: heart failure incidence rate per 100 person-years, 9.09; atrial fibrillation, 4.70; endocarditis, 1.00; and stroke, 0.58. Mortality was higher among Indigenous than non-Indigenous RHD patients (hazard ratio, 6.55; 95% confidence interval, 2.45-17.51), of which 28% was explained by comorbid renal failure and hazardous alcohol use. RHD complications and mortality rates were higher for urban than for remote residents. This study provides important new prognostic information for ARF/RHD. The residual Indigenous survival disparity in RHD patients, which persisted after accounting for comorbidities, suggests that other factors contribute to mortality, warranting further research.
  • Publication
    Evaluation of a new medical retrieval and primary health care advice model in Central Australia: Results of pre- and post-implementation surveys.
    (2022-12-09)
    Green D
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    Russell DJ
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    Mathew S
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    Fitts MS
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    Johnson R
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    Reeve DM
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    ;
    Niclasen P
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    Liddle Z
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    Maguire G
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    Remond M
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    Wakerman J
    INTRODUCTION: In February 2018 the Remote Medical Practitioner (RMP)-led telehealth model for providing both primary care advice and aeromedical retrievals in Central Australia was replaced by the Medical Retrieval and Consultation Centre (MRaCC) and Remote Outreach Consultation Centre (ROCC). In this new model, specialists with advanced critical care skills provide telehealth consultations for emergencies 24/7 and afterhours primary care advice (MRaCC) while RMPs (general practitioners) provide primary care telehealth advice in business hours via the separate ROCC. OBJECTIVE: To evaluate changes in clinicians' perceptions of efficiency and timeliness of the new (MRaCC) and (ROCC) model in Central Australia. DESIGN: There were 103 and 72 respondents, respectively, to pre- and post-implementation surveys of remote clinicians and specialist staff. FINDINGS: Both emergency and primary care aspects of telehealth support were perceived as being significantly more timely and efficient under the newly introduced MRaCC/ROCC model. Importantly, health professionals in remote community were more likely to feel that their access to clinical support during emergencies was consistent and immediately available. DISCUSSION: Respondents consistently perceived the new MRaCC/ROCC model more favourably than the previous RMP-led model, suggesting that there are benefits to having separate referral streams for telehealth advice for primary health care and emergencies, and staffing the emergency stream with specialists with advanced critical care skills. CONCLUSION: Given the paucity of literature about optimal models for providing pre-hospital medical care to remote residents, the findings have substantial local, national and international relevance and implications, particularly in similar geographically large countries, with low population density.
  • Publication
    Rethinking remoteness: a simple and objective approach
    (Wiley-Blackwell, 2008-12) ;
    Guthridge S
    This paper re-examines the characteristics and assumptions of current remoteness/ accessibility classifications in Australia and proposes a simple and easily understandable alternative measure for remoteness. In this study, remoteness is redefined simply as the average distance between two nearest people within an appropriate spatial unit where population distribution is assumed to be homogenous. By definition, the most straightforward remoteness and incapacity index (RII) would be remoteness times a measure of the incapacity for social and commercial interaction, where remoteness is gauged by the square root of the area divided by the population, and incapacity is measured by the reciprocal of population. Australian Bureau of Statistics Statistical Local Area (SLA) level population data and digital boundaries have been utilised for assessment of this index. The utility of the RII is demonstrated with two examples of activity measures for general practitioner services and businesses. At the State/Territory level, RIIs are negatively related to both general practitioner services per person (Pearson correlation coefficient r = − 0.873), and the number of businesses per person ( r = − 0.546). The correlation can be further enhanced by normalising the distributions of the remoteness scores with a simple logarithmic function. The strong correlations confirm that remoteness has a substantial inverse impact on daily activities. Greater distance means longer time and higher costs for travelling, diseconomy of scale, and higher personnel costs. The RII provides an alternative measure of remoteness that is both intuitive and statistically straightforward and, at an SLA level, closely coincides with the commonly used but complex Accessibility/Remoteness Index of Australia Plus (ARIA + ). Significantly, the RII is free of the service specific and policy sensitive adjustments justified by accessibility that have been introduced into existing measures.
  • Publication
    Interventions for health workforce retention in rural and remote areas: a systematic review.
    (2021-08-26)
    Russell D
    ;
    Mathew S
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    Fitts M
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    Liddle Z
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    Murakami-Gold L
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    Campbell N
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    Ramjan M
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    Hines S
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    Humphreys JS
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    Wakerman J
    BACKGROUND: Attracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and workforce retention. METHODS: The review considers studies of rural or remote health workers in HICs where participants have experienced interventions, support measures or incentive programs intended to increase retention. Experimental, quasi-experimental and observational study designs including cohort, case-control, cross-sectional and case series studies published since 2010 were eligible for inclusion. The Joanna Briggs Institute methodology for reviews of risk and aetiology was used. Databases searched included MEDLINE (OVID), CINAHL (EBSCO), Embase, Web of Science and Informit. RESULTS: Of 2649 identified articles, 34 were included, with a total of 58,188 participants. All study designs were observational, limiting certainty of findings. Evidence relating to the retention of non-medical health professionals was scant. There is growing evidence that preferential selection of students who grew up in a rural area is associated with increased rural retention. Undertaking substantial lengths of rural training during basic university training or during post-graduate training were each associated with higher rural retention, as was supporting existing rural health professionals to extend their skills or upgrade their qualifications. Regulatory interventions requiring return-of-service (ROS) in a rural area in exchange for visa waivers, access to professional licenses or provider numbers were associated with comparatively low rural retention, especially once the ROS period was complete. Rural retention was higher if ROS was in exchange for loan repayments. CONCLUSION: Educational interventions such as preferential selection of rural students and distributed training in rural areas are associated with increased rural retention of health professionals. Strongly coercive interventions are associated with comparatively lower rural retention than interventions that involve less coercion. Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.