Now showing 1 - 10 of 72
  • Publication
    Journal Article
    Remote health workforce turnover and retention: what are the policy and practice priorities?
    (2019-12-16)
    Wakerman, John
    ;
    Humphreys, John
    ;
    Russell, Deborah
    ;
    Guthridge, Steven
    ;
    Bourke, Lisa
    ;
    Dunbar, Terry
    ;
    ; ;
    Murakami-Gold, Lorna
    ;
    Jones, Michael P
    Residents of remote communities in Australia and other geographically large countries have comparatively poorer access to high-quality primary health care. To inform ongoing policy development and practice in relation to remote area health service delivery, particularly in remote Indigenous communities, this review synthesizes the key findings of (1) a comprehensive study of workforce turnover and retention in remote Northern Territory (NT) of Australia and (2) a narrative review of relevant international literature on remote and rural health workforce retention strategies. This synthesis provides a valuable summary of the current state of international knowledge about improving remote health workforce retention.Annual turnover rates of NT remote area nurses (148%) and Aboriginal health practitioners (80%) are very high and 12-month stability rates low (48% and 76%, respectively). In remote NT, use of agency nurses has increased substantially. Primary care costs are high and proportional to staff turnover and remoteness. Effectiveness of care decreases with higher turnover and use of short-term staff, such that higher staff turnover is always less cost-effective. If staff turnover in remote clinics were halved, the potential savings would be approximately A$32 million per annum. Staff turnover and retention were affected by management style and effectiveness, and employment of Indigenous staff. Review of the international literature reveals three broad themes: Targeted enrolment into training and appropriate education designed to produce a competent, accessible, acceptable and 'fit-for-purpose' workforce; addressing broader health system issues that ensure a safe and supportive work environment; and providing ongoing individual and family support. Key educational initiatives include prioritising remote origin and Indigenous students for university entry; maximising training in remote areas; contextualising curricula; providing financial, pedagogical and pastoral support; and ensuring clear, supported career pathways and continuing professional development. Health system initiatives include ensuring adequate funding; providing adequate infrastructure including fit-for-purpose clinics, housing, transport and information technology; offering flexible employment arrangements whilst ensuring a good 'fit' between individual staff and the community (especially with regard to cultural skills); optimising co-ordination and management of services that empower staff and create positive practice environments; and prioritising community participation and employment of locals. Individual and family supports include offering tailored financial incentives, psychological support and 'time out'.Optimal remote health workforce stability and preventing excessive 'avoidable' turnover mandates alignment of government and health authority policies with both health service requirements and individual health professional and community needs. Supportive underpinning policies include: Strong intersectoral collaboration between the health and education sectors to ensure a fit-for-purpose workforce;A funding policy which mandates the development and implementation of an equitable, needs-based formula for funding remote health services;Policies that facilitate transition to community control, prioritise Indigenous training and employment, and mandate a culturally safe work context; andAn employment policy which provides flexibility of employment conditions in order to be able to offer individually customised retention packages There is considerable extant evidence from around the world about effective retention strategies that contribute to slowing excessive remote health workforce turnover, resulting in significant cost savings and improved continuity of care. The immediate problem comprises an 'implementation gap' in translating empirical research evidence into actions designed to resolve existing problems. If we wish to ameliorate the very high turnover of staff in remote areas, in order to provide an equitable service to populations with arguably the highest health needs, we need political and executive commitment to get the policy settings right and ensure the coordinated implementation of multiple strategies, including better linking existing strategies and 'filling the gaps' where necessary.
  • Publication
    Journal Article
    Differences in the cost of admitted patient care for Indigenous people and people from remote locations.
    (2013-02)
    Malyon R
    ;
    ;
    Oates B
    The introduction of activity-based funding (ABF) means that Australian Refined Diagnosis Related Groups and their relative costs will become the basis for reimbursing public hospitals for admitted patient services. This study sought to investigate the variation in admitted patient costs for Indigenous people and people from remote areas that cannot be explained by variation in the clinical mix of cases, and to interpret this variation within an ABF framework. The study used a dataset of discharges from public hospitals of Northern Territory residents between July 2007 and June 2009. Multivariate regression analysis was used to estimate the variation in average costs, using the logarithm of patient cost as the dependent variable and Major Diagnostic Categories (MDCs), hospitals and population subgroups (Indigenous v. non-Indigenous; urban v. remote) as independent variables. Although much of the additional cost of Indigenous and remote patients was found to be due to differences in severity and complexity between MDCs, there were extra costs for remote Indigenous patients that were not captured by the classification system. Hospitals servicing larger than average proportions of these patients could be systematically underfunded within an ABF framework unless a price adjustment is applied.
  • Publication
    Journal Article
    Attitudes to Short-Term Staffing and Workforce Priorities of Community Users of Remote Aboriginal Community-Controlled Health Services: A Qualitative Study.
    (2024-04-14)
    Liddle, Zania
    ;
    Fitts, Michelle S
    ;
    Bourke, Lisa
    ;
    Murakami-Gold, Lorna
    ;
    Campbell, Narelle
    ;
    Russell, Deborah J
    ;
    Mathew, Supriya
    ;
    Bonson, Jason
    ;
    Mulholland, Edward
    ;
    Humphreys, John S
    ;
    ;
    Boffa, John
    ;
    ;
    Tangey, Annie
    ;
    Schultz, Rosalie
    ;
    Wakerman, John
    In recent years, there has been an increasing trend of short-term staffing in remote health services, including Aboriginal Community-Controlled Health Services (ACCHSs). This paper explores the perceptions of clinic users' experiences at their local clinic and how short-term staffing impacts the quality of service, acceptability, cultural safety, and continuity of care in ACCHSs in remote communities. Using purposeful and convenience sampling, community users (aged 18+) of the eleven partnering ACCHSs were invited to provide feedback about their experiences through an interview or focus group. Between February 2020 and October 2021, 331 participants from the Northern Territory and Western Australia were recruited to participate in the study. Audio recordings were transcribed verbatim, and written notes and transcriptions were analysed deductively. Overall, community users felt that their ACCHS provided comprehensive healthcare that was responsive to their health needs and was delivered by well-trained staff. In general, community users expressed concern over the high turnover of staff. Recognising the challenges of attracting and retaining staff in remote Australia, community users were accepting of rotation and job-sharing arrangements, whereby staff return periodically to the same community, as this facilitated trusting relationships. Increased support for local employment pathways, the use of interpreters to enhance communication with healthcare services, and services for men delivered by men were priorities for clinic users.
  • Publication
    Journal Article
    An investigation of the significance of residual confounding effect.
    (2014)
    Liang W
    ;
    ;
    Lee AH
    Observational studies are commonly conducted in health research. However, due to their lack of randomization, the estimated associations between the outcome and the exposure can be affected by unmeasured confounding factors. It is important to determine how likely a significant association observed between an outcome variable and a noncausally related exposure may be introduced by residual confounding factors. A simulation approach is developed based on the sufficient cause model to test the likelihood of significant associations observed between a noncausally related exposure and the outcome. Based on the estimates from all 500 replicates, the association between the exposure and the outcome is found to be significant in 386 (77%) replicates when all confounders (component causes) are controlled for in the model. However, when a subset of real component causes and some noncausal factors are controlled for in the model, the association between exposure and the outcome becomes significant in 487 (97%) replicates. Even when all confounding factors are known and controlled for using conventional multivariate analysis, the observed association between exposure and outcome can still be dominated by residual confounding effects. Therefore, an observed significant association apparently provides limited evidence for a causal relationship.
      1206
  • Publication
    Journal Article
    Acute myocardial infarction incidence and survival in Aboriginal and non-Aboriginal populations: an observational study in the Northern Territory of Australia, 1992-2014.
    (2020-10-08)
    Coffey C
    ;
    ;
    Condon JR
    ;
    ;
    Guthridge S
    OBJECTIVES: To examine long-term trends in acute myocardial infarction (AMI) incidence and survival among Aboriginal and non-Aboriginal people. DESIGN: Retrospective cohort study. SETTING, PARTICIPANTS: All first AMI hospital cases and deaths due to ischaemic heart disease in the Northern Territory of Australia (NT), 1992-2014. MAIN OUTCOME MEASURES: Age standardised incidence, survival and mortality. RESULTS: The upward trend in Aboriginal AMI incidence plateaued around 2007 for males and 2001 for females. AMI incidence decreased for non-Aboriginal population, consistent with the national trends. AMI incidence was higher and survival lower for males, for Aboriginal people and in older age groups. In 2014, the age standardised incidence was 881 and 579 per 100 000 for Aboriginal males and females, respectively, compared with 290 and 187 per 100 000 for non-Aboriginal counterparts. The incidence disparity between Aboriginal and non-Aboriginal population was much greater in younger than older age groups. Survival after an AMI improved over time, and more so for Aboriginal than non-Aboriginal patients, because of a decrease in prehospital deaths and improved survival of hospitalised cases. CONCLUSIONS: There was an important breakpoint in increasing trends of Aboriginal AMI incidence between 2001 and 2007. The disparity in AMI survival between the NT Aboriginal and non-Aboriginal populations reduced over time as survival improved for both populations.
      1071
  • Publication
    Report
    Investment Analysis of the Aboriginal and Torres Strait Islander Primary Health Care Program in the Northern Territory
    (Department of Communications, Information, 2004)
    Beaver, Carol
    ;
    ;
    Health Gains Planning Unit, Department of Health and Community Services, Centre for Chronic Disease, University of Queensland
    This report was commissioned by the Australian Government Department of Health and Ageing on behalf of the Aboriginal and Torres Strait Islander Primary Health Care Review to assess the cost-effectiveness of current services provided for Aboriginal and Torres Strait Islander Australians. The work presented here relates to the Northern Territory of Australia only. The authors believe that the approach taken in the study (strategic investment analysis utilising the Health Benefit Group/Healthcare Resource Group (HBG/HRG) classification as the base information model) has much to offer other population groups as do the results of the modelling. Determination of the actual impact of investments as modelled to sub-population groups in the Northern Territory and other jurisdictions, as well as at specific points in time, will need to be tested.
      8559
  • Publication
    Journal Article
    Remote health workforce turnover and retention: what are the policy and practice priorities?
    (2019-12-16)
    Wakerman J
    ;
    Humphreys J
    ;
    Russell D
    ;
    Guthridge S
    ;
    Bourke L
    ;
    Dunbar T
    ;
    ;
    Ramjan M
    ;
    Murakami-Gold L
    ;
    Jones MP
    Residents of remote communities in Australia and other geographically large countries have comparatively poorer access to high-quality primary health care. To inform ongoing policy development and practice in relation to remote area health service delivery, particularly in remote Indigenous communities, this review synthesizes the key findings of (1) a comprehensive study of workforce turnover and retention in remote Northern Territory (NT) of Australia and (2) a narrative review of relevant international literature on remote and rural health workforce retention strategies. This synthesis provides a valuable summary of the current state of international knowledge about improving remote health workforce retention. Annual turnover rates of NT remote area nurses (148%) and Aboriginal health practitioners (80%) are very high and 12-month stability rates low (48% and 76%, respectively). In remote NT, use of agency nurses has increased substantially. Primary care costs are high and proportional to staff turnover and remoteness. Effectiveness of care decreases with higher turnover and use of short-term staff, such that higher staff turnover is always less cost-effective. If staff turnover in remote clinics were halved, the potential savings would be approximately A$32 million per annum. Staff turnover and retention were affected by management style and effectiveness, and employment of Indigenous staff. Review of the international literature reveals three broad themes: Targeted enrolment into training and appropriate education designed to produce a competent, accessible, acceptable and 'fit-for-purpose' workforce; addressing broader health system issues that ensure a safe and supportive work environment; and providing ongoing individual and family support. Key educational initiatives include prioritising remote origin and Indigenous students for university entry; maximising training in remote areas; contextualising curricula; providing financial, pedagogical and pastoral support; and ensuring clear, supported career pathways and continuing professional development. Health system initiatives include ensuring adequate funding; providing adequate infrastructure including fit-for-purpose clinics, housing, transport and information technology; offering flexible employment arrangements whilst ensuring a good 'fit' between individual staff and the community (especially with regard to cultural skills); optimising co-ordination and management of services that empower staff and create positive practice environments; and prioritising community participation and employment of locals. Individual and family supports include offering tailored financial incentives, psychological support and 'time out'. Optimal remote health workforce stability and preventing excessive 'avoidable' turnover mandates alignment of government and health authority policies with both health service requirements and individual health professional and community needs. Supportive underpinning policies include: Strong intersectoral collaboration between the health and education sectors to ensure a fit-for-purpose workforce;A funding policy which mandates the development and implementation of an equitable, needs-based formula for funding remote health services;Policies that facilitate transition to community control, prioritise Indigenous training and employment, and mandate a culturally safe work context; andAn employment policy which provides flexibility of employment conditions in order to be able to offer individually customised retention packages There is considerable extant evidence from around the world about effective retention strategies that contribute to slowing excessive remote health workforce turnover, resulting in significant cost savings and improved continuity of care. The immediate problem comprises an 'implementation gap' in translating empirical research evidence into actions designed to resolve existing problems. If we wish to ameliorate the very high turnover of staff in remote areas, in order to provide an equitable service to populations with arguably the highest health needs, we need political and executive commitment to get the policy settings right and ensure the coordinated implementation of multiple strategies, including better linking existing strategies and 'filling the gaps' where necessary.
      1383
  • Publication
    Journal Article
    Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease: A Data-Linkage and Survival Analysis Approach.
    (2016-07-19)
    He VYF
    ;
    Condon JR
    ;
    ; ;
    Roberts K
    ;
    de Dassel JL
    ;
    ;
    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.
      1418
  • Publication
    Journal Article
    Burden of disease and injury in Aboriginal and non-Aboriginal populations in the Northern Territory.
    (Medical Journal of Australia, 2004-05-17) ;
    Guthridge S
    ;
    Magnus A
    ;
    Vos T
    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.
      1542  187
  • Publication
    Journal Article
    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.
      474