Please use this identifier to cite or link to this item: https://hdl.handle.net/10137/11933
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dc.contributor.authorJones MPen
dc.contributor.authorZhao Yen
dc.contributor.authorGuthridge Sen
dc.contributor.authorRussell DJen
dc.contributor.authorRamjan Men
dc.contributor.authorHumphreys JSen
dc.contributor.authorWakerman Jen
dc.date.accessioned2021-11-02T03:05:29Zen
dc.date.available2021-11-02T03:05:29Zen
dc.date.issued2021-10-19en
dc.identifier.citation© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.en
dc.identifier.citationBMJ Open. 2021 Oct 19;11(10):e055635. doi: 10.1136/bmjopen-2021-055635.en
dc.identifier.other101552874en
dc.identifier.urihttps://hdl.handle.net/10137/11933en
dc.description.abstractOBJECTIVES: To evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors which may counter hypothesised reduced quality of care associated with lower stability, higher turnover or higher use of short-term staff. DESIGN: Retrospective cohort study (Northern Territory (NT) Department of Health Primary Care Information Systems). SETTING: All 48 government primary healthcare clinics in remote communities in NT, Australia (2011-2015). PARTICIPANTS: 25 413 patients drawn from participating clinics during the study period. OUTCOME MEASURES: Associations between independent variables (resident remote area nurse and Aboriginal Health Practitioner turnover rates, stability rates and the proportional use of agency nurses) and indicators of health service quality in child and maternal health, chronic disease management and preventive health activity were tested using linear regression, adjusting for community and clinic size. Latent class modelling was used to investigate between-clinic heterogeneity. RESULTS: The proportion of resident Aboriginal clients receiving high-quality care as measured by various quality indicators varied considerably across indicators and clinics. Higher quality care was more likely to be received for management of chronic diseases such as diabetes and least likely to be received for general/preventive adult health checks. Many indicators had target goals of 0.80 which were mostly not achieved. The evidence for associations between decreased stability measures or increased use of agency nurses and reduced achievement of quality indicators was not supported as hypothesised. For the majority of associations, the overall effect sizes were small (close to zero) and failed to reach statistical significance. Where statistically significant associations were found, they were generally in the hypothesised direction. CONCLUSIONS: Overall, minimal evidence of the hypothesised negative effects of increased turnover, decreased stability and increased reliance on temporary staff on quality of care was found. Substantial variations in clinic-specific estimates of association were evident, suggesting that clinic-specific factors may counter any potential negative effects of decreased staff employment stability. Investigation of clinic-specific factors using latent class analysis failed to yield clinic characteristics that adequately explain between-clinic variation in associations. Understanding the reasons for this variation would significantly aid the provision of clinical care in remote Australia.en
dc.language.isoengen
dc.titleEffects of turnover and stability of health staff on quality of care in remote communities of the Northern Territory, Australia: a retrospective cohort study.en
dc.typeJournal Articleen
dc.publisher.placeEnglanden
dc.identifier.journaltitleBMJ openen
dc.identifier.doi10.1136/bmjopen-2021-055635en
dc.identifier.orcid0000-0002-5775-4503en
dc.identifier.orcid0000-0003-2221-7334en
dc.identifier.pubmedurihttps://www.ezpdhcs.nt.gov.au/login?url=https://www.ncbi.nlm.nih.gov/pubmed/34667018en
dc.format.pagese055635en
dc.description.affiliationSchool of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia mike.jones@mq.edu.au.en
dc.description.affiliationPopulation and Digital Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia.en
dc.description.affiliationMenzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.en
dc.description.affiliationMenzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia.en
dc.description.affiliationClinical Governance, Darwin Region & Strategic Primary Health Care, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia.en
dc.description.affiliationSchool of Rural Health, Monash University, Bendigo, Victoria, Australia.en
dc.source.volume11en
local.issue.number2044-6055 (Electronic)-
local.issue.number2044-6055 (Linking)-
Appears in Collections:(a) NT Health Research Collection

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