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Issue 46 April 2016
The Hospital Alliance for Research Collaboration
In the news
Variations in Care
Safe prescribing
Understanding patient behaviour

Scholarships open door to wide-ranging research

2016 HARC scholars: Bernadette Aliprandi-Costa, Kim Sutherland, Vladimir Williams and Malcolm Green

HARC's four newest scholars are set to embark on wide-ranging research projects aimed at improving future healthcare delivery.

read more

Addressing variations in care

In this month’s Bulletin, we meet the four new recipients of the 2016 HARC scholarships, who will now have the opportunity to travel abroad to investigate areas ranging from ways to represent Aboriginal voices in health system design and delivery, to ensuring electronic health records keep patients safe.

In our research section, we look at the latest findings on the common problem of variations in care, including one study that shows patient management varies across Australia’s specialised burns units, and another that reveals half of patients at risk of venous thromboembolism (VTE) do not receive appropriate preventive care in Australian hospitals.

In our profile, we meet Anita Dessaix, who has been instrumental in many of the Cancer Institute NSW’s influential cancer prevention campaigns.

Please forward this edition of the Bulletin to colleagues who might be interested in joining the HARC network and, as always, get in touch with your feedback or suggestions at

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Megan Howe
Editor, HARC e-Bulletin

Scholarships open door to wide-ranging research

Four future healthcare leaders are set to embark on research in areas ranging from exploring ways to ensure authentic Aboriginal voices are represented in the health system to the use of electronic health records alerts to keep patients safe, after being awarded HARC scholarships.

Ms Bernadette Aliprandi-Costa, Program Manager Clinical Trials, with the Cancer Institute NSW, aims to develop a statewide operational and reporting framework for cancer clinical trials. She said the scholarship would enable her to review international frameworks that may be suitable to address statewide variation in clinical trial operational performance across NSW.

Research into best practice design of the electronic health record (EHR) to ensure that the right clinician has the right information at the right time to keep patients safe will be the focus of the research project to be undertaken by Mr Malcom Green, Clinical Excellence Commission (CEC) Manager, Deteriorating Patient Programs. Mr Green said the electronic health record had the potential to identify deteriorating patients earlier using complex algorithms that prompted clinicians when a risk was identified. However, there was an inherent risk that constant EHR alerts could lead to “alert fatigue”, and he said the project would also explore innovative solutions to overcome that problem.

Mr Vladimir Williams, an analyst with the Office of Kids and Families, NSW Health, will be testing a pilot methodology to ensure authentic Aboriginal community voices are represented within healthcare design and delivery in NSW to improve Aboriginal health outcomes. He said researching community engagement approaches within the Maori community in New Zealand might identify other ways of working that could translate into the NSW Health context.

Dr Kim Sutherland will focus on the issue of measuring and reporting of unwarranted clinical variation in order to support system improvement. Dr Sutherland, Director of Systems and Thematic Reports with the Bureau of Health Information (BHI), said she would be exploring how European countries’ experience could be applied to the NSW context.

The scholarships, which give researchers the opportunity to travel abroad to investigate areas of future health policy, were first awarded in 2010, and are available to employees of the HARC partner organisations: the CEC, ACI, BHI, Cancer Institute NSW, Office of Kids and Families, NSW Health and the Sax Institute.

They aim to support future healthcare leaders to develop advanced skills in using research in policy making, as well as helping them develop connections to national and international experts in health services research.

• Read more about the HARC scholarship program

HARC forum places still available: Using accreditation to drive health service change

Places are still avalable to attend next week's HARC forum exploring the important role that accreditation can play in driving health service change.

Leading Canadian health systems thinker Ms Leslee Thompson, President and CEO of Accreditation Canada, will be the keynote speaker. Ms Thompson has 25 years of experience from the bedside to the boardroom of some of Canada’s largest and most innovative public and private sector organisations, and has led numerous large-scale complex changes within healthcare organisations.

Ms Margaret Banks, Senior Program Director at the Australian Commission on Quality and Safety in Health Care will give a local perspective on how accreditation could be used as a lever for change, and will give an update on the newest iteration of the National Safety and Quality Health Service (NSQH) standards.

Find out more or register now

Government reveals new model of care for chronically ill

Patients with multiple complex and chronic illnesses will be able to officially enrol with their GP, who will receive an up-front payment to manage their healthcare needs under a new model of care announced by the Federal Government.

“Health Care Homes” would be established in general practices to design tailored care plans that outline the health services needed by patients with complex chronic conditions and to co-ordinate that care, said Federal Health Minister Sussan Ley.

The Health Care Homes, which are part of a package of reforms badged “Healthier Medicare”, were aimed at keeping chronically ill patients out of hospital, she said.

The model was recommended by the Primary Health Care Advisory Group to ensure better care for the one in five Australians who now have multiple chronic conditions (see reports below).

Ms Ley said 65,000 patients would be enrolled in a trial of the Health Care Homes model in 200 general practices from July 2017.

“This means patients will be supported with access to coordinated medical, allied health and out-of-hospital services, regardless of whether they are provided by Medicare, state and local governments, the community sector or the multitude of other sources currently fragmenting the system,” the Minister’s statement said.

GPs who signed up to become Health Care Homes for those patients would receive an upfront, quarterly bundled payment to reduce the pressure on them to bill every item of service delivered for patients with complex chronic conditions, she said.

The announcement followed a recent HARC symposium that explored the concept of patient-centred medical homes, including insights from US experts and a look what the model could mean for the way primary healthcare is delivered in NSW and Australia.  See more below.

Patient-centred medical home symposium: Watch the videos

If you missed the recent HARC symposium on the patient-centred medical home (PCMH), you can now view the videos of keynote presentations by visiting US experts Professor Kevin Grumbach and Professor Jennifer DeVoe.

Professor Grumbach told the symposium that the US move towards the PCMH, under which patients are enrolled with a primary care practice that co-ordinates their care, was a better way of providng primary care in the 21st century.

Associate Professor Jennifer  DeVoe outlined how networks of patient-centred medical homes could serve as data laboratories, or real-world “community laboratories”, to aggregate data that could be used to improve both practice and population health.

• Watch the videos

• Read more about the symposium, which was co-hosted by the Centre for Primary Health Care and Equity (CPHCE) at the University of NSW.

Flu vaccination urged before winter

The 2016 flu vaccine is now available and will protect against four influenza strains, including the Brisbane strain that contributed to a spike in hospitalisations last year, Federal Health Minister Sussan Ley has announced.

The quadrivalent vaccine covers the B strains of the influenza virus, Brisbane and Phuket, and A strains California and Hong Kong. Last year a record 100,000 people were diagnosed with influenza, with 17,000 hospitalised.

Ms Ley said 4.48 million free doses of the vaccine were available for those at increased risk of severe flu and its complications including: people aged over 65 years, Aboriginal and Torres Strait Islander people aged six months to five years and older than 15 years, pregnant women and people with medical conditions including severe asthma, diabetes and heart disease.


Burns care variations prompt action

New evidence-based clinical guidelines are in development, after a study revealed significant variation in the management and outcomes of patients treated at specialised burn units in Australia and New Zealand.

The researchers studied data from the Burns Registry of Australia and New Zealand (BRANZ) on 7184 adult burns cases treated at 10 acute adult burns units between 2010 and 2014.

While variation is not necessarily in itself a sign of inferior treatments, it does signal the need for further investigation, especially where outcome indicators are also found to vary  
Mortality rates differ among units

The findings, published in the MJA, showed there were significant differences between burns units in both the clinical management of burns injuries and in patient outcomes.

The proportion of patients admitted to intensive care units varied from 4.9% to 24.6% across burns units, and skin grafting rates ranged from 21.7% to 71.2%.  Patients’ length of stay in hospital increased in line with the extent of burns, however the study found the mean, adjusted length of stay differed by more than two days across units.

The adjusted odds of mortality also differed, with three units reporting significantly lower estimated probabilities of death than the two units with the highest estimates.

“While variation is not necessarily in itself a sign of inferior treatments, it does signal the need for further investigation, especially where outcome indicators are also found to vary," the authors wrote."For example, it may be that variations in LOS [length of stay] reflect differing rehabilitation protocols rather than delay in treatment.”

The author said the information provided by BRANZ provided a unique opportunity for signficantly improving the quality of care for burns patients in Australia and New Zealand.

In response to the findings, the Australia and New Zealand Burn Association had launched the Burns Quality Improvement Project in 2013 to develop evidence-based standards of care for burns care, and to provide a framework to drive change, they said.

Cleland H, Greenwood JE, Wood FM, Read DJ, Wong She R, et al. The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care. Med J Aust 2015;204(5)195


VTE prevention patchy: study

Half of patients at risk of venous thromboembolism (VTE) do not receive the appropriate preventive care and management in Australian hospitals, according to a study which urges a national, system-wide approach to the problem.

Researchers assessed whether VTE indicators were met in a sample of 481 adults who were enrolled in the Caretrack Australia (CTA) study, and who were admitted to hospital overnight at least once during 2009 and 2010.

The indicators included the use of anticoagulant therapy in patients undergoing certain procedures, as well as appropriate management and investigation of hospitalised patients with suspected pulmonary embolism (PE) or deep vein thrombosis.

The study, published in BMJ Open, showed that overall compliance with the VTE indicators was 51% ‒ despite considerable efforts to promote and facilitate the uptake of clinical practice guidelines (CPG) in Australia.

Compliance with aggregated sets of indicators ranged from 34% to 64%, and compliance ranged from 45% to 70% across the 27 hospitals in the study.

“Despite the prevalence, cost, morbidity and mortality associated with VTE and PE, prophylaxis and treatment are still in line with CPGs only half of the time,” the authors wrote.

They suggested the findings were “consistent with the lack of a system-wide approach”, adding that VTE was not included in national standards and did not have a national healthcare goal.

The researchers called for agreement on national clinical standards and on the development of indicators and tools to guide, document and monitor the appropriateness of care for VTE, perhaps through a national wiki-based process.

“VTE data could then be monitored at hospital level and the data aggregated at national, and potentially at international levels, to track progress and inform policy,” they wrote.

Hibbert PD, Hannaford NA, Hooper TD, Hindmarsh DM, Braithwaite J, et al. Assessing the appropriateness of prevention and management of venous thromboembolism in Australia: a cross sectional study. BMJ Open 2016;6:e08618 [Internet] doi.10.1136/bmjopen-2015-008618


Language barrier may impact ACS outcomes

Patients with acute coronary syndrome (ACS) for whom English is a second language have poorer outcomes than those whose first language is English, a study reveals.

Researchers analysed treatments and mortality among 6304 patients from 41 hospitals enrolled in the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE).

The 16% of patients who reported that English was their second language (ESL) were older, and were more likely to have prior myocardial infarction, heart failure and chronic renal failure than those patients whose first language was English (EFL).

Findings in the MJA showed a higher incidence of heart failure, renal failure, stroke, recurrent myocardial infarction, major bleeding and in-hospital mortality in the ESL group compared with the EFL group.

They had longer stays in hospital, but were less likely to use second-line antiplatelet agents and had lower rates of cardiac catheterisations, percutaneous coronary intervention rates and referral to a cardiac rehabilitation than the EFL group, while rates of coronary bypass grafting (CABG) were similar in the two groups.

At six-months follow-up, all-cause mortality was higher in the ESL group than among those who reported English as their first language (13.8% vs 8.3%).

The authors said previous studies had shown that deficiences in intercultural communication might play a role in adverse outcomes for patients from culturally and linguistically diverse backgrounds.

While the poorer outcomes for ACS patients in whom English was as second language may be explained by a higher prevalence of cardiovascular risk factors leading to more advanced disease, they suggested problems of culturally specific communication may also play an important role.

Juergens CP, Dabin B, French JK, Kritharides L, Hyun K, et al. English as a second language and outcomes of patients presenting with acute coronary syndromes: results from the CONCORDANCE registry. Med J Aust 2016; 204(6):239.


Tall Man lettering falls short

The commonly used typographical system of drug labelling known as “Tall Man lettering” aimed at avoiding mix-ups with medications with similar names has been brought into question by a US study, which shows it does not reduce prescribing errors in paediatric hospitals.

The Tall Man labelling system uses mix-cased labelling to visually emphasise differences in drug names that look or sound alike, for example, cefUROXime and cefOTAXime.

The system has been adopted by many drug safety bodies worldwide, including the US Food and Drug Administration (FDA), and is supported by the Australian Commission on Safety and Quality in Health Care (ACSQHC) as part of a multi-faceted approach to reducing risks associated with confusable, look-alike sound-alike medicine names.

In the study, researchers used nine-years of detailed pharmacy data for paediatric inpatients from 42 children’s hospitals, to assess the effect of the introduction of Tall Man lettering on error rates for 11 look-alike, sound-alike drug names including: clonidine-clonazepam; tramadol-trazodone; metformin-metronizadole; guanfacine-guaifenesin.

Findings in BMJ Quality and Safety showed there was no significant change in potential look-alike sound-alike error rates for the 11 drug pairs before and after the 2007 implementation of Tall Man lettering among US children’s hospitals.

While rates of errors remained extremely low during the study period, they found an increase, rather than decrease, in overall error rates for the drugs.

The researchers said the 11 drug pairs analysed were not representative of all look-alike sound-alike drug pairs and said other factors such as the introduction of computerised physician drug ordering may have impacted on the findings.

“Whether Tall Man lettering is effective in clinical practice warrants further study,” they concluded.

The ACSQHC said it was currently reviewing the National Tall Man Lettering Standard and associated National Tall Man Lettering list, and would consider the international harmonisation of medicine ingredient names being conducted by the Therapeutic Goods Administration.

Zhong W, Feinstein JA, Patel NS, Dai D, Feudtner C. Tall Man lettering and potential prescription errors: a time series analysis of 42 children's hospitals in the USA over 9 years. BMJ Qld Saf 2016;25:233‒40


Antibiotic resistance common in children with UTIs

There is a high level of antibiotic resistance in children treated for urinary tract infections (UTI) that could render some antibiotics ineffective as first-line treatments, a new review warns.

The systematic review and meta-analysis included 58 observational studies in 26 countries and involved more than 77,000 Escherichia coli samples.

The study also showed that children previously treated with antibiotics in primary care were more likely to be resistant, and that increased risk could persist for up to six months  
Call to reconsider UTI management

Among children with UTIs, it revealed high rates of bacterial resistance to some of the most commonly prescribed antibiotics in primary care, such as ampicillin.

Resistance to all reported antibiotics was higher in non-OECD countries than OECD countries, but worldwide, rates of resistance to the antibiotic ampicillin were the highest, and resistance to nitrofurantoin was the lowest, according to findings in the BMJ.

The authors said the availability of antibiotics over-the-counter and weaker regulation of antibiotic use may explain the higher rates of resistance in some non-OECD countries.

US and European guidelines recommended that an antibiotic should only be selected for first line empirical treatment of UTI if the local prevalence of resistance was less than 20%, they said.

“According to these guidelines, our review suggests ampicillin, co-trimoxazole, and trimethoprim are no longer suitable first-line treatment options for urinary tract infection in many OECD countries,” they wrote, adding that guidelines may need updating.

The study also showed that children previously treated with antibiotics in primary care were more likely to be resistant, and that increased risk could persist for up to six months.

In an accompanying editorial, Professor Grant Russell of Monash University said the findings presented “compelling evidence of the need to reconsider current approaches to community-based management of paediatric urinary tract infection”.

Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, et al. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ 2016;352:i939 [Internet] doi:

Russel G. Antibiotic resistance in children with E coli urinary tract infection. BMJ 2016;352 doi:



Cutting high-risk prescribing reduces admissions

A multi-faceted intervention targeting high-risk prescribing in primary care reduces risky prescribing, as well as being associated with a fall in emergency hospital admissions for related conditions, new research shows.

The study involved 33 primary care practices in Scotland taking part in a 48-week intervention targeting high-risk prescribing of nonsteroidal anti-inflammatory drugs (NSAIDs) or selected anti-platelet agents – a common cause of medication-related emergency hospital admissions.

The intervention comprised three components: professional education; financial incentives (an initial payment of £350 ($A655) and a payment of £15 ($A28) for every patient for whom the targeted high-risk prescribing was reviewed) and the use of an informatics tool to identify patients who needed review and to provide weekly updates on rates of high-risk prescribing and review progress.

The findings, published in the New England Journal of Medicine, showed that targeted high-risk prescribing was significantly reduced, from a rate of 3.7% immediately before the intervention, to 2.2% at the end of the intervention.

The rate of hospital admissions for gastrointestinal ulcer or bleeding was also significantly reduced from 55.7 admission per 10,000 person-years before the intervention, to a rate of 27.0 after the intervention.

Similarly, the rate of admissions for heart failure fell  from 707.7 to 513.5 admissions per 10,000 person-years after the intervention. Admissions for acute kidney injury were not significantly reduced.

The authors said the blend of education, financial incentives and informatics was effective, but they could not identify which aspect of the intervention mattered most.

They said the three aspects of the intervention were feasible in any system in which primary care was delivered by physician-owned practices that use electronic medical records, and are under contract with third-party payers.

“However, complex interventions of this type inevitably require tailoring to context,” they wrote.

Breischulte T, Donnan P, Grant A, Hapca A, McCowan C, et al. Safer prescribing – a trial of education, informatics and financial incentives. N Engl J Med 2016;374;1053‒64


“Difficult” patients more likely to be misdiagnosed

Doctors are more likely to get a diagnosis wrong if the patient is regarded as “difficult”, according to a study which suggests the mental effort needed to deal with problematic behaviour distracts from the task at hand.

Dutch researchers asked 63 doctors in their last year of family medicine training to provide a diagnosis for one of two versions of six clinical case scenarios: pneumonia, pulmonary embolism, meningoencephalitis, hyperthyroidism, appendicitis and acute alcoholic pancreatitis. 

One version of the scenario portrayed a “difficult” patient with one of the six conditions, and the other described the same scenario, but with a patient who didn’t have disruptive behaviour.

The difficult behaviours portrayed included a demanding patient, an aggressive patient, a patient who questioned the doctor’s competence, a patient who ignored the doctor’s advice, one who didn't expect the doctor to take them seriously, and one who was utterly helpless.

The findings showed that doctors were 42% more likely to misdiagnose a difficult patient than a “neutral” patient in a complex case, and 6% more likely to do so in a simple case. The findings remained the same, irrespective of the time the doctor spent on diagnosis.

“The fact is that difficult patients trigger reactions that may ... affect judgements and cause errors,” the researchers wrote, adding that it may be beneficial to increase doctors’ awareness of how their emotional responses could affect their clinical reasoning and threaten safety.

In a second study, 74 trainee hospital doctors were asked to diagnose eight clinical case scenarios, half of which involved difficult behaviours (including a patient who threatens the doctor and one who accuses the doctor of discrimination) and half of which involved neutral behaviours.

Diagnostic accuracy was 20% lower for difficult patients, even though similar time was spent on the diagnosis.

The findings also showed that the doctors recalled proportionally fewer clinical findings in the difficult patient, with the researchers suggesting the mental energy need to deal with the difficult behaviour interfered with them processing clinical information correctly.

Schmidt HG, van Gog T, Schuuit S, Van den Berge K, Van Daele PLA et al. Do patient’s disruptive behaviours influence the accuracy of a doctors’ diagnosis. BMJ Qual Saf 2016 [Internet] doi:10.1136/bmjqs-2015-004109

Mamdede S, Van Gog T, Schuit SCE, Van den Berge K, Van Daele P, et al. Why patients’ disruptive behaviours impair diagnostic reasoning: a randomised experiment. BMJ Qual Saf 2016 [Internet} doi:10.1136/bmjqs-2015-005065


Patients unlikely to change behaviour due to genetic risk

Telling patients the results of DNA tests which signal disease risk has little impact on changing their behaviours, such as stopping smoking or altering diet, a review finds.

The findings throw doubt on the use of genetic testing to motivate patients to change risky behaviour, the researchers suggested.

The systematic review and met-analysis covered 18 studies on the effects of communicating genetic risk estimates of heart disease, cancers, Alzheimer’s disease, for which behaviour change ‒ such as smoking, alcohol consumption, diet and physical activity ‒ could reduce the risk.

The meta-analysis, published in the BMJ, showed that communicating DNA-based risk estimates had no impact on patients quitting smoking, changing their diet or their level of physical activity. There were also no effects on any other behaviours such as alcohol use and medication use and sun protection behaviour, or on patient’s motivation to change behaviour.

Communicating genetic risk had no adverse effects, such as depression or anxiety, the findings showed.

“The available evidence does not provide support for the expectations raised by researchers and proponents of personalised medicine as well as direct-to-consumer testing companies that the receipt of results from DNA based tests for gene variants that confer increased risk of common complex diseases motivates behaviour change,” the authors wrote.

They added that such tests may have a role in population health strategies if supplemented by the offer of effective behaviour change interventions.

Hollands GJ, French DP, Grififn SJ, Prevost AT, Sutton S, et al. The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis. BMJ 2016;352:i1102. Doi:101136/bmj.i1102


Loneliness linked to stroke and heart attacks

Hospitals and clinics should include assessments of patients’ social integration in electronic medical records, experts have suggested, after a study confirmed that loneliness and isolation are linked to a heightened risk of heart disease and stroke. People were about 30% more likley to have a heart attack or stroke if they were lonely or isolated, according to the systematic review and meta-analysis.

Our work suggests that addressing loneliness and social isolation may have an important role in the prevention of two of the leading causes of morbidity in high-income countries  
Importance of social contacts for wellbeing

The researchers analysed 23 papers involving more than 181,000 adults and included 4628 coronary heart disease events (such as heart attacks, angina attacks and death) and 3002 strokes recorded during monitoring periods ranging from three to 21 years.

Loneliness/social isolation was associated with a 29% increased risk of a heart attack or angina attack and a 32% increased risk of having a stroke ‒ effects that the authors said were comparable to other recognised psychosocial risk factors, such as anxiety and a stressful job.

Writing in the journal Heart, the authors said the findings added weight to public health concerns about the importance of social contacts for health and wellbeing.

“Our work suggests that addressing loneliness and social isolation may have an important role in the prevention of two of the leading causes of morbidity in high-income countries,” they wrote.

In an accompanying editorial, psychologists from Brigham Young University, Utah, US, wrote that social factors should be included in medical education, individual risk assessment and in guidelines and policies applied to populations and the delivery of health services.

Hospitals and health services should routinely assess patient’s level of social integration and/or loneliness, and include the data in patients’ health records to help inform treatment, they suggested.

“This important step can identify individuals at risk ‒ which may also have multiple implications for health service delivery,” they wrote, adding that at a broader level, population-wide surveillance would also aid public health efforts.

Valtorta N, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart 2016 [Internet] doi:10.1136/heartjnl-2015-308790.

Holt-Lunstad J, Smith TB. Loneliness and social isolation as risk factors for CVD: implications for evidence-based patient care and scientific inquiry. Heart 2016 [Internet] doi 10.1136/heartjnl-2015-309242


What stops doctors engaging in research?

The UK Royal College of Physicians has published a report called “Research for all” that draws on the findings of a 2015 UK survey exploring barriers to doctors’ engagement in medical research. Many more doctors would like to do more research if they could, but time and funding are the biggest barriers to them doing so, it finds.

Download report

Tackling chronic care gaps

This report from the Federal Government’s Primary Health Care Advisory Group examines opportunities for reform in primary healthcare to improve the management of people with complex health conditions. Primary healthcare services for these patients can be fragmented, and often poorly linked with secondary care services, making it difficult for patients to be confidently engaged in their care, it states. The report recommends the "Health Care Home" model of care detailed in our news story in this issue.

Download report

Advice on evaluations

The UK Policy Innovation Research Unit has released this discussion paper to provide guidance to those thinking of initiating policy pilots and commissioning related evaluations. It is designed to raise awareness of a range of issues and questions that have emerged from conducting national-level evaluations of policy pilots in health and social care in England.

Download report

Opioid prescribing update

The Australian Institute of Health and Welfare has released new data on opioid pharmacotherapy showing that on a snapshot day in 2015, more than 48,000 clients received pharmacotherapy treatment for their opioid dependence at 2589 dosing points around Australia. Methadone remained the most common pharmacotherapy drug.

Download report

Measuring healthcare performance

This Evidence Check review published by The Sax Institute examined organisations that have a key role in healthcare performance measurement and reporting across developed economies. A total of 34 organisations from 12 countries were included in the analysis, with the aim of identifying trends in terms of mandates, functions, structure and staffing, stakeholder engagement, analytic frameworks or indicator sets and outputs and publications. Key lessons emerged about indicator frameworks, independence, quality assurance and data availability.

Download report

After hours primary care in focus

This Deeble Institute for Health Policy Research issues brief entitled Review of After-Hours Service Models: Learnings for regional, rural and remote communities, looks at ways to improve after hours primary care in Australia’s remote regions. It identifies a number of innovations and program elements that could be commonly applied by Primary Health Networks (PHNs), based on key principles including the need for services to be flexible, responsive and tailored to regional circumstance and for the broader health workforce to be efficiently and effectively utilised.

Download report

The cost of physical ill health in people with mental illness

The Royal Australian and New Zealand College of Psychiatrists has published a series of reports and papers examining the barriers to healthcare for people with mental illness and other physical illnesses, and what can be done to reduce these barriers. One report estimates that the economic cost of premature death of people with mental illnesses including schizophrenia, bipolar disorder, psychoses and severe anxiety and depression is $15 billion (0.9% of GDP) annually.

Download report

Youth health policy report

This report, published by the Office of Kids and Families, NSW Health, describes the implementation of the NSW Youth Health Policy 2011‒2016, based on survey responses provided by local health districts (LHDs) and Speciality Health Networks (SHNs). It states that support is needed for more consistent youth participation, and there is a gap between organisations seeking input from young people on an ad hoc basis only and those organisations that are starting to employ young people in more formal advisory roles.

Download report

Anita Dessaix  

Anita Dessaix

Manager, Cancer Prevention
Cancer Institute NSW

An important piece of the public health puzzle

Anita Dessaix ‘s face may be familiar ‒ as a longstanding spokesperson for the Cancer Institute NSW she often appears in the media to warn of the risks of behaviours like smoking and over-exposure to the sun.

While being the public face of such campaigns is a role she embraces with passion, her background is on the other side of the camera, in the field of public health.

She spent her early career in public relations roles with Western Sydney Area Health Service and was working as a campaign manager in NSW Health Marketing & Events when she was offered the opportunity to join the newly created Cancer Institute NSW in 2005, as a project officer working solely on anti-tobacco campaigns.

“I thought it sounded like an incredible opportunity,” she says.

It was a move that sparked her drive to be involved in cancer prevention, and saw her career focus shift from marketing communications and public relations, to public health.

Focus on tobacco control

She took on the role at a time when Australia was stepping up tobacco control measures such as graphic warnings on cigarette packets and new legislation in NSW to protect children from tobacco-related harm.

She began studying for her Masters in Public Health and says she became increasingly aware of the important role that effective public education mass media campaigns can play in tackling public health issues like smoking.

“It has such a critical role to play, not only in engaging the community, but also in shifting social norms around a health issue and contributing to improving public health outcomes. Effective public education campaigns are just one important component in comprehensive policy and education measures to tackle public health problems,” she says.

Anita moved from tobacco control onto the broader area of cancer prevention, managing the tobacco control, melanoma awareness and lifestyle cancers portfolios. She has spearheaded highly successful campaigns, such as the well-known sun protection campaign “There's nothing healthy about a tan” and the 'Voice within” anti-tobacco campaign.

Campaigns’ life-saving impact

A recently published review of three skin cancer awareness campaigns run by the Cancer Institute NSW between 2006 and 2013 found that they prevented an estimated 112 deaths and 13,174 skin cancers over that period. For every dollar invested in the campaigns, the return was almost fourfold.

And a paper she co-authored in Public Health Research & Practice looking at factors contributing to a decline in youth smoking, also found that adult-targeted anti-tobacco campaigns had a continued role to play in encouraging cessation, preventing relapse and preventing the uptake of smoking among non-smokers.

Anita says the rapid growth of social media has seen a big shift in the way such public health campaigns are designed.

“When I first started, work on public education campaigns was much easier, as traditional forms of mass media reigned supreme – TV, radio and press,” she says. “Ten or 15 years down the track, digital media in all its forms is playing an increasingly important role, particularly when trying to reach and engage with younger audiences.”

Anita is set to continue leading the design of evidence-based social marketing campaigns that inspire generational change.

“We are constantly aligning evidence with the latest insights on media consumption to make sure we reach the right people, at the right time, with information that will motivate them to make a positive change to their health today,” she says.

How can accreditation drive change in health services?

Leading Canadian health system thinker Ms Leslee Thompson will explor the role of accreditation in driving health service change at this HARC forum. A local perspective on how accreditation can be used as a change lever in Australia will be presented by Ms Margaret Banks, Senior Program Diretor at the Australian Commission on Safety and Quality in Health Care.

3 May, Sydney
Read more
Reaping the benefits: Australian Longitudinal Study on Women’s Health Scientific Meeting
3–6 May, Newcastle
Read more

This meeting hosted by the Hunter Medical Research Institute, Newcastle, is a chance to explore how researchers, governments and the public are ‘reaping the benefits’ of the Australian Longitudinal Study on Women’s Health (ALSWH); the foremost longitudinal study on women’s health in Australia. Keynote speakers include the Sax Institute’s CEO Professor Sally Redman AO and the Scientific Director of the 45 and Up Study, Professor Emily Banks.

2016 Patient Experience Symposium

The Agency for Clinical Innovation and The Clinical Excellence Commission (CEC), in partnership with the Office of Kids and Families, Cancer Institute NSW, Bureau of Health Information (BHI), Health Education and Training Institute, Nursing and Midwifery Office, with support of Health Consumers NSW, are co-hosting this symposium, The event will be an opportunity for clinicians, consumers and managers to hear from experts in the field and to share innovations in improving patient experience and outcomes.

5‒6 May, Sydney
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Healthier law: How rigorous public health law research can strengthen prevention policy
18 May, Sydney
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Pioneer and champion of empirical public health law research, Professor Scott Burris, will describe the potential of public health law to make new inroads into chronic disease prevention at this seminar, co-hosted by The Australian Prevention Partnership Centre and The George Institute for Global Health.

2016 Primary Health Care Research Conference

The 2016 PHC Research Conference is themed “Reform and innovation in PHC policy and practice” and aims to provide an opportunity for national knowledge exchange for people working across the primary health care frontline. Delegates from research as well as practice, policy, management and consumer/community fields are set to debate the latest quality peer-reviewed PHC research.

8‒9 June, Canberra
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45 and Up Collaborator’s Meeting 2016
6 September, Sydney
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Save the date: The Sax Institute is inviting invite research collaborators, partners, supporters and others with an interest in the 45 and Up Study to save the date for this year’s 45 and Up Study Collaborators’ Meeting. A call for abstracts, formal invitation, registration form and provisional program will be sent closer to the date.

APAC Forum

Registrations are now open for the APAC Forum health improvement conference, which is being held in Sydney for the first time and is themed: “Exploring new frontiers ‒ creating your blueprint for a healthy future”. The forum aims to attract health  leaders, policy makers, patients, consumers, carers, doctors, nurses, allied health and quality improvement specialists, providing a platform to improve the health and wellbeing of the population.

12‒14 September, Sydney
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