Cost of tuberculosis-related aeromedical retrievals in the Torres Strait, Australia

Tuberculosis (TB) remains a disease of public health significance at the Australia / Papua New Guinea (PNG) international border. In the remote Torres Strait Islands, aeromedical evacuation is a necessary but costly component of TB management and patients with critical care needs require support to prevent onward TB transmission. A detailed costing of an exemplar TB patient from PNG who presented to a Queensland Health facility in the Torres Strait and required urgent aeromedical evacuation was performed. Data were drawn from patient charts, financial and clinical information systems used within Queensland Health and the Torres and Cape Hospital and Health Service. The total cost of aeromedical evacuation was AUD 124,280; 54% of the cost was attributed to travel. Between 2016 and 2019, 19 patients diagnosed with TB were medically evacuated from an outer Torres Strait Island with a median length of hospital stay of 57 days. Aeromedical evacuation and medical management costs require adequate budget allocation.

Epidemiology of mumps outbreaks and the impact of an additional dose of MMR vaccine for outbreak control in regional Queensland, Australia, 2017–2018

Background In recent years, there have been ongoing outbreaks of mumps reported in Northern and North-Western Queensland, Western Australia and the Northern Territory, Australia. We aimed to define the epidemiology of mumps outbreaks in Central Queensland, Australia between October 2017 and October 2018 and evaluate the effectiveness of an additional dose of measles, mumps, rubella (MMR) vaccine. Methods A retrospective case control study was conducted, including outbreak investigations with laboratory-confirmed cases of mumps and subsequent comparison with matched controls. We analysed mandatory notifications from the Queensland Health Notifiable Conditions System database and immunisation information from the Queensland Health Vaccination Information and Admin System (VIVAS) and the Australian Immunisation Register. Results Between October 2017 and October 2018, there were 93 cases of mumps reported in Central Queensland with three distinct outbreaks: a discrete Indigenous community; a correctional facility; and a boarding school. Among all cases, 74 (79.6%) were fully vaccinated and 14 (15.1%) were partially vaccinated with MMR vaccine. Eighty-six cases (92.5%) were reported among Aboriginal and Torres Strait Islander people. In all outbreaks, an additional dose of MMR vaccine was offered with 35.4%, 73.6% and 35.8% of the target population being immunised in the discrete Indigenous community, the correctional facility and the boarding school, respectively. Prior to this additional dose of MMR, the mumps attack rate was 31.0 (95% confidence interval [95% CI]: 24.2–39.0) per 1000 population, compared to the post-additional dose MMR attack rate of 10.6 (95% CI: 6.7–15.9) per 1000 population. Conclusion An additional or booster dose of MMR should be included as an effective public health intervention strategy, particularly in communal or high-density living conditions to control mumps outbreaks in highly vaccinated populations.

The Barriers and Enablers of Primary Healthcare Service Transition From Government to Community Control in Yarrabah: A Grounded Theory Study

Introduction: Consistent with the aspirations of First Nations Australians for community control of healthcare services, 123/196 (63%) of Australia's First Nations-specific primary health care services are community-controlled. Yet despite policy commitment over 30 years, the transition of government-run First Nations' primary healthcare services to First Nations community control has been slow. This paper identifies the barriers and enablers to transitioning the delivery of primary healthcare services from Queensland Health to Gurriny Yealamucka community-controlled health service in Yarrabah.Methods: Grounded theory methods were used to select 14 Gurriny and Queensland Health (QH) personnel involved in the transition for interview and to analyse these interview transcripts and 88 Gurriny organisational documents.Results: Barriers and enablers to transition were identified at three levels: those internal factors within Gurriny, external factors directly related to the government handover, and broader structural and policy factors outside the control of either Gurriny or QH. Barriers at the Gurriny organisational level were an internal lack of experience and capacity, and varying levels of community confidence; enablers were leadership stability and capacity, community mandate, relationships with partner organisations, and ability to provide service continuity. Barriers in Gurriny's relationship with QH were a lack of certainty, transparency and prioritisation of the transition process; systemic racism; difficulties obtaining and maintaining the necessary workforce; limited resources including insufficient, unstable and inappropriate funding support; and problems with information sharing; enablers were performance frameworks to keep transition progress on track. Barriers in broad policy environment were an unsupportive Queensland government policy environment; government bureaucracy; and delays, conflicts and divisions; enablers were high-level government support and commitment.Conclusions: The evaluation of Yarrabah's transition process suggests that future such transitions will require planning and commitment to a long-term, multi-faceted and complex process, encompassing the required level of authorisation and resourcing. This case example of a transition from government to community control of PHC highlighted the ongoing power issues that are faced every day by community-controlled organisations that co-exist with mainstream health systems within a colonial power structure.

The ATHENA COVID-19 Study: Cohort profile and first findings for people diagnosed with COVID-19 in Queensland, 1 January to 31 December 2020

Background: To date, there are limited Australian data on characteristics of people diagnosed with COVID-19 and on how these characteristics relate to outcomes. The ATHENA COVID-19 Study was established to describe health outcomes and investigate predictors of outcomes for all people diagnosed with COVID-19 in Queensland by linking COVID-19 notification, hospital, general practice and death registry data. This paper reports on the establishment and first findings for the ATHENA COVID-19 Study. Methods: Part 1 of the ATHENA COVID-19 Study used Notifiable Conditions System data from 1 January 2020 to 31 December 2020, linked to: Emergency Department Collection data for the same period; Queensland Health Admitted Patient Data Collections (from 1 January 2010 to 30 January 2021); and Deaths Registrations data (from 1 January 2020 to 17 January 2021). Results: To 31 December 2020, a total of 1,254 people had been diagnosed with SARS-CoV-2 infection in Queensland: half were female (49.8%); two-thirds (67.7%) were aged 20–59 years; and there was an over-representation of people living in less-disadvantaged areas. More than half of people diagnosed (57.6%) presented to an ED; 21.2% were admitted to hospital as an inpatient (median length of stay 11 days); 1.4% were admitted to an intensive care unit (82.4% of these required ventilation); and there were six deaths. Analysis of factors associated with these outcomes was limited due to small case numbers: people living in less-disadvantaged areas had a lower risk of being admitted to hospital (test for trend, p < 0.001), while those living in more remote areas were less likely than people living in major cities to present to an ED (test for trend: p=0.007), which may reflect differential health care access rather than health outcomes per se. Increasing age (test for trend, p < 0.001) and being a current/recent smoker (age-sex-adjusted relative risk: 1.61; 95% confidence interval: 1.00, 2.61) were associated with a higher risk of being admitted to hospital. Conclusion: Despite uncertainty in our estimates due to small numbers, our findings are consistent with what is known about COVID-19. Our findings reinforce the value of linking multiple data sources to enhance reporting of outcomes for people diagnosed with COVID-19 and provide a platform for longer term follow-up.

Opening the doors: Critically examining the locked wards policy for public mental health inpatient units in Queensland Australia

The Queensland Government issued a policy directive to lock all acute adult public mental health inpatient wards in 2013. Despite criticism from professional bodies and advocacy for an alternative, the policy has been retained to this day. A blanket directive to treat all psychiatric inpatients in a locked environment without individualised consideration of safety is inconsistent with least restrictive recovery-oriented care. It is against the principles of the United Nations Convention on the Rights of Persons with Disabilities, to which Australia is a signatory. It is also contrary to the main objects of the Mental Health Act 2016 (Qld). Queensland Health has reported a reduction in ‘absences without permission’ from psychiatric inpatient wards after the introduction of the locked wards policy; however, no in-depth analysis of the consequences of this policy has been conducted. It has been argued that patients returning late or not returning from approved leave is a more common event than patients ‘escaping’ from mental health wards, yet all may be counted as ‘absent without permission’ events. A review of the international literature found little evidence of reduced absconding from locked wards. Disadvantages for inpatients of locked wards include lowered self-esteem and autonomy, and a sense of exclusion, confinement and stigma. Locked wards are also associated with lower satisfaction with services and higher rates of medication refusal. On the contrary, there is significant international evidence that models of care like Safewards and having open door policies can improve the environment on inpatient units and may lead to less need for containment and restrictive practices. We recommend a review of the locked wards policy in light of human rights principles and international evidence.

Deprescribing tool for use in older Australians with life-limiting illnesses and limited life expectancy: a modified-Delphi study protocol

BackgroundMaking a meaningful decision on deprescribing of potentially inappropriate medications in older adults with life-limiting illnesses (LLIs) and limited life expectancy (LLE) is often challenging. Therefore, we aimed to elicit opinion and gain consensus on a deprescribing tool for use in this population.Methods and analysisA modified-Delphi method will be used to obtain a consensus from a panel of experts in geriatric therapeutics on a deprescribing tool for use in people aged ≥65 years with LLIs and LLE. Through an online survey, in the initial round, the panel will anonymously elicit their opinion on a series of items related to the conceptual model of the deprescribing tool, its practicality and deprescribing of medications, while on the controlled feedback in subsequent rounds till a consensus is reached or the panellists stop revising their answers. In each round, panel members will be using a 5-point Likert scale to rate their agreement with the statement. Consensus will be considered on ≥75% of agreement on the statements.Ethics and disseminationAll the participants will receive an invitation and participant information but they need to consent for the participation. Ethics approval has been granted from the University of Queensland Health and Behavioural Sciences, Low and Negligible Risk Ethics Sub-Committee (reference: 2020001069). The results of this project will be disseminated through conferences and a peer-reviewed clinical journal.

How to create an interactive dashboard using R: the example of the Queensland COVID-19 tracker

Background Interactive tools like data dashboards enable users both to view and interact with data. In today’s data-driven environment it is a priority for researchers and practitioners alike to be able to develop interactive data visualisation tools easily and where possible at a low cost. Aims Here, we provide a guide on how to develop and create an interactive online data dashboard in R, using the COVID-19 tracker for Health and Hospital Regions in Queensland, Australia as an example. We detail a series of steps and explain choices made to design, develop, and easily maintain the dashboard and publish it online. Data and methods The dashboard visualises publicly available data from the Queensland Health web page. We used the programming language R and its free software environment. The dashboard webpage is hosted publicly on GitHub Pages updated via GitHub Desktop. Results Our interactive dashboard is available at https://qcpr.github.io/. Conclusions Interactive dashboards have many applications such as dissemination of research and other data. This guide and the supplementary material can be adjusted to develop a new dashboard for a different set of data and needs.