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Hadgkiss E.J.,Emergency Practice Innovation Center | Renzaho A.M.N.,Monash University | Renzaho A.M.N.,Burnet Institute
Australian Health Review | Year: 2014

Objective To document physical health problems that asylum seekers experience on settlement in the community and to assess their utilisation of healthcare services and barriers to care, in an international context. Methods A systematic review of quantitative and qualitative studies was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, PsycINFO, Embase and CINAHL databases were searched from 2002 to October 2012, focusing on adult asylum seekers residing in the community in high-income countries. Results The search yielded 1499 articles, of which 32 studies met the inclusion criteria - 23 quantitative and nine qualitative. Asylum seekers had complex health profiles spanning a range of infectious diseases, chronic non-communicable conditions, and reproductive-health issues. They appeared to utilise health services at a higher rate than the host population, yet faced significant barriers to care. Conclusion The findings of this study highlight the health inequities faced by asylum seekers residing in the communities of host countries, internationally. National data on asylum seekers' health profiles, service utilisation and barriers to care, as well as cross-country policy comparisons, are urgently required for the development of effective Australian health programs and evidence-based policy. What is known about the topic? The clinical and political focus of asylum seekers' health has largely been on the higher incidence of mental disorders and the impact of immigration detention. Since policy changes made in late 2011, an increasing number of asylum seekers have been permitted to live in the community while their claims are processed. There is a paucity of research exploring the physical health needs of asylum seekers residing in the community. What does this paper add? The international literature highlights the complexity of asylum seekers' health profiles. Although they appear to utilise health services at a higher rate than the host population, they continue to face many barriers to care. What are the implications for practitioners? Studies that explore policy options, including cross-country comparisons of health policy and guidelines that improve health outcomes, to foster equity of access and reduce health inequalities between asylum seekers and the host population are urgently required. © AHHA 2014.

Howard R.,Hospital Admission Risk Program | Hannaford A.,Hospital Admission Risk Program | Weiland T.,Emergency Practice Innovation Center | Weiland T.,University of Melbourne
Australian Health Review | Year: 2014

Objectives To identify medical, social and demographic factors associated with increased risk of 30-day re-presentation to the emergency department (ED) in elderly people presenting with pain. Methods We undertook a single site, prospective observational study of all patients aged >65 years discharged from the ED with pain. Data were collected on possible medical, social and demographic predictors of ED readmission. Participants were a subset of all elderly patients presenting to the ED with pain, and received follow-up case management as part of the hospital's rapid response, assessment and care planning program for elderly people. Results Over 8 months, 356 people were eligible for inclusion in the study; of these, 189 consented to case management and to participate in the study. Three factors statistically increased odds of re-presentation to ED within 30 days: (1) prescription of opioids (P≤0.003); (2) the presence of Home and Community Care Services (P≤0.03); and (3) the absence of a gait aid (P≤0.019). Nineteen per cent of eligible patients re-presented to ED within 30 days of initial presentation. Conclusion These findings contribute to current debate about opioid prescription and effective pain management in the elderly. The study highlights the need for routine follow-up care of older people discharged from the ED with pain, particularly those discharged home with opioids or with complex care needs. What is known about the topic? Re-presentation rates within 28 days for all-comers to the emergency department (ED) are collected and reported as part of routine service monitoring and evaluation. Presentation rates for elderly people to EDs have been escalating over the past decade; however, the risk factors that lead to re-presentations for elderly people have not been documented. Similarly, increasing concern about the prescription of opioids in elderly people is documented; however, its impact on ED re-presentations has not been reported. Innovative models of care are emerging to stem the rise in ED demand; however, their role and impact on re-presentation rates are not documented for this subgroup of ED presenters. What does this paper add? This research has demonstrated that ED re-presentation rates for elderly people with pain are higher than overall ED re-presentation rates. This article has identified three risk factors that significantly increase the risk of re-presentation in this population, including the prescription of opioid analgesics. Qualitative data have identified that elderly people prescribed opioids require extensive education and support to manage the medication side effects. What are the implications for practitioners? Practitioners should be aware that elderly people with pain are a higher risk group for ED re-presentation, particularly those prescribed opioid analgesics or with complex care needs. Discharge planning and assessment of supports should be routinely instigated to manage medication side effects, and follow-up services put in place where inadequate. Improved provision of written information in multiple languages for patients who cannot read English should also be initiated. © AHHA 2014.

Yuen A.,University of Melbourne | Sugeng Y.,Emergency Practice Innovation Center | Weiland T.J.,University of Melbourne | Jelinek G.A.,University of Melbourne
Australian and New Zealand Journal of Public Health | Year: 2010

Objective: To assess lifestyle and pharmacological interventions aiming to delay type 2 diabetes mellitus (T2DM) in prediabetes. Methods: We searched the Cochrane Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, BIOSIS and LILACS databases, examined reference lists and contacted authors. We included randomised controlled trials (RCTs) on both lifestyle and medication interventions in prediabetes. These studies were at least 12 month duration and aimed to delay T2DM. Results: Four studies investigating lifestyle and medication with a total of 5,196 participants were identified. There was a high risk of bias in the studies and the interventions utilised varied considerably; thus, meta-analysis was not undertaken. The comparison between lifestyle and medication interventions was largely dependent on the intensity of the lifestyle program while we could not adequately assess their effects on cardiovascular morbidity. Adverse events with metformin and acarbose were common. Conclusion: There is substantial evidence that intensive lifestyle programs and medications delay T2DM in impaired glucose tolerance though it remains unclear which is more effective. Implications: Both interventions seem to be able to delay T2DM. However, both have issues with adherence and side effects and more RCTs are required. © 2010 The Authors.

Jelinek G.,Emergency Practice Innovation Center
Journal of law and medicine | Year: 2011

This study aimed to describe the perceived barriers faced by emergency clinicians in utilising mental health legislation in Australian hospital emergency departments. A semi-structured interview methodology was used to assess what barriers emergency department doctors and nurses perceive in the operation of mental health legislation. Key findings from the interview data were drawn in accordance with the most commonly represented themes. A total of 36 interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College for Emergency Nursing Australasia representing the various Australian jurisdictions. Most concerning to clinicians were the effects of access block and overcrowding on the appropriate use of mental health legislation, and the substandard medical care that mental health patients received as a result of long periods in the emergency department. Many respondents were concerned about the lack of applicability of mental health legislation to the emergency department environment, variation in legislation between States and Territories causing problems for clinicians working interstate, and a lack of knowledge and training in mental health legislation. Many felt that clarification of legislative issues around duty of care and intoxicated or violent patients was required. The authors conclude that access block has detrimental effects on emergency mental health care as it does in other areas of emergency medicine. Consideration should be given to uniform national mental health legislation to better serve the needs of people with mental health emergencies.

Lane H.,University of Melbourne | Zordan R.D.,University of Melbourne | Weiland T.J.,Emergency Practice Innovation Center | Philip J.,University of Melbourne
Internal Medicine Journal | Year: 2013

Background: Residents of residential aged care facilities (RACF) are commonly hospitalised towards the end of life. Determining the hospitalisation experiences, including the discussion of goals of treatment, is essential to best plan care including planning for end-of-life care for this population. Aim: To document hospital presentation characteristics, course, outcomes and care planning for high-care residents of RACF. Methods: A retrospective review of medical records was conducted for all high-care residents aged >64 years presenting to a metropolitan hospital over a 6-month period. Results: One hundred and eighty-six high-care residents of RACF presented to hospital 228 times. Transfer paperwork documented resuscitation status for 49 (21%) presentations, and a medical enduring power of attorney or advanced care plan for 85 (37%). Patients had high rates of comorbidities (average Charlson comorbidity index score = 3), polypharmacy (93%), impaired mobility (89%), impaired cognition (81%) and incontinence (76%). Resuscitation status was documented in 50 (55%) and family discussion in 38 (42%) of 91 admissions exceeding 48h. Documented family discussion was significantly associated with complications or new events occurring during admission (odds ratio 1.56, 95% confidence interval 1.07-2.26). Conclusion: There were low rates of documentation of resuscitation status or family discussion for this highly vulnerable population. Neither hospitals nor community providers appear to take responsibility for future care planning. Acute hospitals could play a greater role in care planning because discussion around course of illness and goals of treatment may enhance patient management, satisfaction and reduce hospitalisations. © 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

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