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PubMed1999

The frequency of common nonmalignant skin conditions in adults in central Victoria, Australia.

BACKGROUND: Nonmalignant skin conditions are believed to be common in adults, although there are very few community-based studies to determine their exact frequency. OBJECTIVE: To record the prevalence of common, nonmalignant skin conditions in adults in central Victoria, Australia. METHODS: A total of 1457 respondents from a random selection of adults aged 20 years and over from Maryborough, central Victoria, were given a total body examination by a dermatologist or dermatology trainee. People with any nail or skin signs suggestive of tinea had scrapings taken for fungal culture. RESULTS: The age- and sex-adjusted prevalence of warts was 7.1% (95% confidence interval (CI), 5.8-8.4%), acne 12.8% (95% CI, 11.0-14.5%), atopic dermatitis 6.9% (95% CI, 5.6-8.3%), seborrheic dermatitis 9. 7% (95% CI, 8.2-11.2%), asteatotic dermatitis 8.6% (95% CI, 7.1-10. 0%), psoriasis 6.6% (95% CI, 5.7-7.9%), culture-positive tinea 12% (95% CI, 10.3-13.6%), seborrheic keratoses 58.2% (95% CI, 55.6-60. 7%), and Campbell de Morgan spots (cherry angiomas) 54.4% (95% CI, 51.9-57.0%). There was variation in the prevalence of many of these conditions with age. CONCLUSIONS: This study demonstrates that nonmalignant skin conditions are common in adults in Australia. Their diagnosis and management represent a considerable burden not only to those suffering from the conditions, but also to the health system which provides for their care.

Acne Vulgaris↗
PubMed2001

Training and support program for pharmacists in rural Victoria.

The 'Rural Pharmacist Training and Support Program' was a pilot project that was conducted by the Monash University Centre for Rural Health. It examined the implementation of Pharmacy Board of Victoria Guidelines to Residential Care Facilities in the Loddon Mallee region of Victoria. Through a series of workshops, pharmacists were encouraged to discuss and address difficulties that were impeding implementation of the guidelines. These included upskilling in clinical pharmacy and ways to overcome the shortage of pharmacists in rural areas. Furthermore, the project was a catalyst for eight additional outcomes. This project highlighted the challenges facing rural pharmacists as they seek to implement the guidelines and resulted in a number of recommendations that addressed workforce issues, training and continuing education, Pharmacy Board requirements, improved communication with other health professionals and undergraduate training.

Education, Pharmacy, Continuing↗
PubMed2003

Epidemiological analysis of electroconvulsive therapy in Victoria, Australia.

OBJECTIVE: To determine the population-based utilization rate of electroconvulsive therapy (ECT) in Victoria between 1998-1999, to examine the characteristics of the ECT treated group, and to identify patient factors independently associated with differential rates of ECT treatment. METHOD: Electroconvulsive therapy is reported under statute in Victoria, Australia. Crude, age-adjusted and age-sex specific utilization rates were calculated using this statutory data for the 1998-1999 financial year and estimated mid-year populations from the Australian Bureau of Statistics. Descriptive characteristics of those treated with ECT were derived from the statutory data. Patient factors associated with an increased likelihood of ECT in the public sector were explored with logistic regression analysis, using non-ECT treated mental health patients from the Victorian Psychiatric Case Register as the reference population. RESULTS: The crude treated-person and age-adjusted rates for the State (both public and private sectors) were 39.9 and 44.0 persons per 100 000 resident population per annum, respectively. The crude and age-adjusted administration rates were 330.3 and 362.6 ECT administrations per 100 000 resident population per annum, respectively. Age-sex specific rates varied by age and sex, with rates generally increasing with age and female sex. Overall, 62.8% of the treated group were women, 32.9% aged over 64, and 75.2% had depression. Diagnosis, age and sex each independently predicted ECT in the public sector, with diagnosis the most important factor, followed by age then sex. CONCLUSIONS: Despite decades of use, the appropriate rate of ECT utilization is still unclear. Further research should be directed at exploring the factors, including provider variables, determining ECT treatment.

Adolescent↗
PubMed1998

Predictors of length of stay for transurethral prostatectomy in Victoria.

BACKGROUND: Transurethral resection of prostate (TURP) is among the top 10 surgical conditions that account for hospital admission in Victoria. Bed utilization for TURP is an increasing concern in current times. This paper describes trends in length of stay (LOS) and identifies predictors of LOS for TURP in Victoria. METHODS: Trends in TURP were studied using ICD-9-CM coded Victorian hospital morbidity data from public hospitals from 1987/88 to 1994/95. Detailed morbidity data from the same source for the financial year 1995/96 were used to study predictors of LOS by logistic regression. RESULTS: Length of stay decreased significantly between 1987 and 1995 from 10.6 to 6.1 days. The strongest predictor of increased LOS was admission through the emergency room (odds ratio (OR) 14.7; 95% confidence interval (CI) 11.8-18.3). Other significant predictors were older age, lower socio-economic status, presence of comorbid conditions, occurrence of procedural morbidity, and hospital type and location. CONCLUSIONS: The trend in decreasing LOS may be explained by increasingly efficient bed management in hospitals who are faced with an increasing need for cost control. Advances in surgical techniques and peri-operative care have also contributed to the decrease in LOS. Other factors that influence LOS can be divided into three categories: intrinsic patient factors, such as co-morbid conditions; procedure-specific factors such as peri-operative morbidity; and intrinsic hospital factors relating to capacity and resources. Such determinants of LOS may be of value to policy makers when considering the effective application of newer methods for treatment of benign prostatic hyperplasia.

Adult↗
PubMed1999

Waiting times for appointments with orthopaedic surgeons in Victoria: 1995-97.

BACKGROUND: A number of different models have been proposed for determining surgical workforce requirements. METHODS: In 1995 the Workforce Subcommittee of the Victorian Regional Branch of the Australian Orthopaedic Association commenced a prospective evaluation of waiting times for both urgent and nonurgent appointments with orthopaedic surgeons in Victoria. RESULTS: The results for the 3 years, 1995-97, show no significant change in the waiting time for nonurgent appointments and no difference between metropolitan and rural areas. The waiting time for an urgent appointment increased from 1995 to 1997 for the state of Victoria and for metropolitan Melbourne but not for rural areas. However, the median waiting time for an urgent appointment did not change. CONCLUSION: Overall the waiting times were found to be satisfactory by previously reported standards.

Appointments and Schedules↗
PubMed2001

In situ and small invasive breast cancer register in Victoria, 1988 to 1992: tumour characteristics and patient management.

BACKGROUND: All cases of in situ and invasive breast cancer are reported to the Victorian Cancer Registry. In 1988 a special subregister of all cases of carcinoma in situ and small invasive cancers up to 10 mm in size was established--the In situ and Small Invasive Breast Cancer Register (ISSIBCR). This was unique in being a population-based register and only possible because in Victoria, as in some other Australian states, all cancers including in situ disease are reported to the Central Cancer Registry. METHODS: Between 1 January 1988 and 31 December 1992, 517 cases of in situ cancers and 892 invasive cancers of < or =10 mm in diameter were registered. During the study period, mammography screening was progressively introduced in Victoria and the number of cases, in both categories registered annually, doubled. RESULTS: The method of detection, the pathology and treatment of these lesions are described. It is of interest that 46.5% of the in situ cancers and 68.8% of the invasive cancers were detected either by the patient or her doctor on clinical examination. Total mastectomy was the method of treatment in 35.4% of in situ cancers and 42.0% of small invasive tumours. Only 38.0% of patients with small invasive cancers treated by breast-conserving surgery had irradiation of the affected breast. CONCLUSIONS: This register provides a valuable resource for the follow up of the natural history and outcome of treatment of the affected women.

Adult↗
PubMed2000

Sudden unexpected death in epilepsy in Victoria.

Sudden unexpected death in epilepsy (SUDEP) refers to sudden unexpected death in patients with epilepsy in whom autopsy fails to reveal an anatomic or toxicological cause of death. The purpose of this study was to examine associated factors and mechanisms relating to SUDEP in Victoria. The study was a retrospective study based on data from questionnaires completed by treating doctors and coronial files including police reports of death, autopsy and toxicology reports. The deaths were of people with epilepsy in Victoria that were referred to the coroner between 1991 and 1997. There were 15,751 coronial autopsies of which 357 had epilepsy and 50 (14%) were SUDEPs. The SUDEP rate was approximately 1 per 3000 epileptics per year. This study suggested the following associations: young age, tonic-clonic seizures, seizure frequency greater than 10/year, duration of epilepsy greater than 10 years, mental retardation, psychiatric disease and alcohol abuse. Antiepileptic drug (AED) compliance was rated by treating doctors as good in 24 cases. One or more postmortem AED drug levels was subtherapeutic in 30 of 50 cases. Only 5 were receiving psychotropic drugs; only 1 of these was receiving more than one of these drugs. A history of recent unusually stressful life event was present in only 4 cases. At least 11 showed evidence of terminal seizure, and the majority of events occurred in sleep. These observations support the hypothesis that seizures are the mechanism of many cases of SUDEP. The associations observed were largely in agreement with previous studies. However, seizure frequency was greater and duration of epilepsy greater than most previous studies. The role of factors such as AED compliance, psychotropic drug prescription and recent unusually stressful life event is less clear. This highlights the need for case-control studies of risk factors for SUDEP.

Adolescent↗
PubMed1999

Midwives in Victoria, Australia: a survey of current issues and job satisfaction.

OBJECTIVE: To describe demographic and work profiles of registered practising midwives, to assess their job satisfaction and their knowledge of and attitudes to the 1990 Victorian Birthing Services review. DESIGN: A questionnaire posted in 1995 to a population-based random sample of registered midwives. PARTICIPANTS: Two hundred and forty midwives currently using their midwifery skills in their work. SETTING: One thousand names and addresses were randomly selected from a database of midwives registered to practise in Victoria, Australia in 1993. FINDINGS: There was a 72% response rate to the postal questionnaire. Two hundred and forty practising midwives returned completed questionnaires. Seventy-three per cent were in full time employment, 49% lived in rural Victoria, 80% were born in Australia, more than half were aged 40 or more years and 72% had at least one child. Twenty-six per cent worked in postnatal wards, 9% in each the labour ward and the neonatal nursery, 2% in birthing centres and 12% in out of hospital settings. Eighty per cent were satisfied with their work and interactions with women were the most important aspect. Satisfaction was associated with working in a labour ward, feeling adequately prepared by midwifery education and training, nursing for more than 15 years and having continuing education. Neonatal and rotating positions were significantly associated with dissatisfaction. Less than one-half of the midwives had read some of the Birthing Services Review, and of these only one-half had changed their attitudes or practice. One-third knew little of the imminent changes to the Midwifery Regulations. CONCLUSION: Although most midwives enjoyed their work there was little evidence of increasing autonomy or involvement in change.

Adult↗
PubMed2002

Funding Victoria's public hospitals: the casemix policy of 2000-2001.

On 1 July 1993 Victoria became the first Australian state to use casemix information to set budgets for its public hospitals commencing with casemix funding for inpatient services. Victoria's casemix funding approach now embraces inpatient, outpatient and rehabilitation services.

Adolescent↗
PubMed2002

The significant impacts of workplace change on medical scientists in Victoria.

Pathology in Victoria has undergone considerable change in the last decade. The need for productivity gains, the effects of downsizing and budget cuts, alongside the effects of casemix funding, privatisation and the advent of Enterprise Bargaining Agreements (EBAs) have all placed considerable strain on medical scientists. This paper outlines the impacts of workplace change on medical scientists in Victoria, the most significant workplace stressors on medical scientists today, and what medical scientists feel needs to happen to enable them to regain control over their working lives. The findings from key informant interviews and focus groups of medical scientists show that radical changes in service requirements have occurred. The restructuring of laboratories to 'core' business and subsequent changes in client expectations has impacted on the standards of service delivery in pathology. These changes have resulted in considerable stress as the scientists struggle to cope with work intensification, increases in rostered work during 'unsociable' hours, the lack of control over change, and challenges to their professionalism as they feel that quality standards are not being met.

Adaptation, Psychological↗
PubMed2002

Report of the mid-term review of Victoria's Maternity Services Program.

Substantial State Government funding has been committed in Victoria for the enhancement of maternity services. The funding is intended to improve the quality of care for women and meet consumer expectations for choice and continuity of care in maternity services. This paper reports on a mid-term review (the 'Review') of the Victorian Maternity Services Program, which was conducted by the authors on behalf of the Victorian Department of Human Services. Documentary analysis was conducted for the review, and workshops and key informant interviews were held throughout Victoria with midwives, medical staff and Department of Human Services staff. The Review found that there had been many gains as a result of the Maternity Services Program and identified directions for further development. Issues of change and facilitators of change processes in maternity services are highlighted in this article.

Continuity of Patient Care↗
PubMed2004

Effects of increased private health insurance on hospital utilisation in Victoria.

The proportion of Victorians and Australians generally with private health insurance (PHI) increased from 31% in 1998 to 45% in 2001. We analysed a dataset containing all hospital separations throughout Victoria to determine whether changes in the level of private health insurance have had any impact on patterns of public and private hospital utilisation in Victoria. Total utilisation of private hospitals grew by 31% from 1998-99 to 2002-03, whereas utilisation of public hospitals increased by 18%. Total bed-days have increased in both private hospitals and public hospitals by 12%. The proportion of all separations at private hospitals has remained relatively stable between these 2 years, with 33% of all separations being private patients in private hospitals in 1998-99, increasing slightly to 35% by 2002-03. Analysis of a number of specific DRGs shows that patients with more severe disease are more likely to be seen at public hospitals; notably this trend has strengthened between 1998-99 and 2002-03. The number of patients treated in Victorian public hospitals has continued to grow, despite a rapid increase in the utilisation of private hospitals. Given the limited extent of the shift in caseload share between the two sectors, the effectiveness of the Commonwealth's subsidy of private health insurance as a mechanism to reduce pressure on the public sector needs to be carefully examined.

Adolescent↗
PubMed1999

Forecasting hospital expenditure in Victoria: lessons from Europe and Canada.

This paper specifies an econometric model to forecast State government expenditure on recognised public hospitals in Victoria. The OECD's recent cross-country econometric work exploring factors affecting health spending was instructive. The model found that Victorian Gross State Product, population aged under 4 years, the mix of public and private patients in public hospitals, introduction of casemix funding and funding cuts, the proportion of public beds to total beds in Victoria and technology significantly impacted on expenditure. The model may have application internationally for forecasting health costs, particularly in short and medium-term budgetary cycles.

Adolescent↗
PubMed2002

Exploration of factors linked with high cervical cancer rates in women from the former Yugoslavia in Victoria, Australia.

OBJECTIVES: The aim of the project was to identify the cervical screening rate and other factors that may be associated with high rates of cervical cancer in women from the former Yugoslavia compared to the general population in Victoria, Australia. DESIGN: A cross-sectional survey was conducted by structured personal interviews of 42 Bosnian, 56 Croatian, 49 Macedonian, and 35 Serbian women, and 39 women who identified as Yugoslav or of mixed background. Self-report data were collected on Pap testing behaviour, estimated screening rate of each community, stage-based barriers to cervical screening, and women's theories about causes of cervical cancer within their community. RESULTS: Women in this study had an acceptable screening rate, but barriers to cervical screening were similar to those of other groups. While Macedonian women believed more of their community had Pap tests than the other cultural groups, just under half were under-screened themselves. Smoking rates were very high for women in this study. The most common causes of cervical cancer suggested by women in the study were: a low screening rate, lifestyle stress, and chemicals. CONCLUSION: It is unlikely that the high cervical cancer rate in women from the former Yugoslavia is a result of under-screening, lifestyle stress, or chemicals. Smoking may well contribute to the cancer rate, however the most likely explanation is that cancers not previously detected in Yugoslavia are now being found, together with cervical abnormalities, within the systematic two yearly screening programme of PapScreen Victoria, in Australia.

Adolescent↗
PubMed2006

Medicine of senescence or managing a hospital system: the resistible rise of geriatric medicine in the State of Victoria.

This paper investigates the conditions in which geriatric medicine emerged in the state of Victoria between the late 1950s and the late 1970s. It shows how, in transforming a charity model of care into a medical model of service, nascent geriatricians were caught up in the shifting balance of responsibilities between state and Commonwealth governments in funding health services and care for the aged, and in the efforts of a small segment of the Australian medical profession to establish an organisational setting and professional context for social medicine. In Victoria, the potential for doctors to circumvent bureaucratic and professional limitations on their work lay in their relationship with their institutional committees of management whose members were drawn from the general community. The paper argues that pioneer 'geriatricians' failed to establish a field of practice that met all the needs they discerned in their patient group because they could not change community ideas about appropriate responses to old age infirmity.

Aged↗
PubMed1997

Homicide-suicide in Victoria, Australia.

Thirty-nine incidents of homicide-suicide occurring in Victoria, Australia between 1985 and 1989 were examined. In 33 cases the assailants were men. The victims were spouses or women living in a de facto marriage. The majority of the victims were shot, and this was also the most frequent method of suicide. Breakdown in a relationship was the most frequent reason for killing. Mental illness of the assailant accounted for the killing in approximately 20% of cases. Physical ill health and financial stress were identified as important associative factors, particularly in the elderly. The pattern of homicide-suicide in Victoria is similar to that observed in other jurisdictions and represents an important and distinct subgroup of homicide.

Adolescent↗
PubMedDate not supplied

Identifying participation rates at outpatient cardiac rehabilitation programs in Victoria, Australia.

BACKGROUND: Much has been achieved in implementing structured outpatient cardiac rehabilitation (CR) programs in Victoria, Australia, but little is known about the percentage of eligible patients who participate. This study was undertaken to determine the feasibility of establishing a database of CR participants and comparing it to the Victorian Inpatient Minimum Database (VIMD), a routinely collected hospital morbidity data set documenting all admissions to Victorian public and private hospitals. This would enable program participants and nonparticipants to be identified and program participation rates to be calculated. METHODS: Data on program participants were collected from a sample of eight CR programs. Records from the VIMD were extracted for the concurrent time period for patients discharged home after acute myocardial infarction (AMI), coronary artery bypass graft (CABG) surgery, and percutaneous transluminal coronary angioplasty (PTCA), and therefore considered eligible to participate. Victorian Inpatient Minimum Database data were aggregated according to program catchment areas. Data were compared for program participants and patients eligible to participate. RESULTS: Seven hundred fifty-eight patients were identified as being eligible to attend; 240 (32%) were identified as participating at least once. Discharged CABG patients participated on average at a rate of 53.1%, compared with 27.2% of AMI patients and only 10.3% of PTCA patients. CONCLUSIONS: Despite a comprehensive network of CR programs in Victoria, they are used on average by only a minority of eligible patients. Further work is required to determine barriers to participation to develop strategies to increase participation rates.

Aged↗
PubMed2005

Epidemiology of sepsis in Victoria, Australia.

OBJECTIVE: To determine the clinical and epidemiologic characteristics of patients with sepsis admitted to hospitals in Victoria, Australia, including the incidence of sepsis and severe sepsis, utilization of intensive care unit (ICU) resources, and hospital mortality. DESIGN: A population-based hospital morbidity database generated from hospital discharge coding. SETTING: State of Victoria, Australia (population, 4.5 million), the 4-yr period from July 1, 1999, to June 30, 2003. PATIENTS: A total of 3,122,515 overnight hospitalizations. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The overall hospital incidence of sepsis was 1.1%, with a mortality of 18.4%. Of septic patients, 23.8% received some care in an ICU. For these patients, hospital mortality was 28.9%. Severe sepsis, defined by sepsis and at least one organ dysfunction, occurred in 39% of sepsis patients and was accompanied by a hospital mortality of 31.1%. Fifty percent of patients with severe sepsis received at least some care in an ICU. CONCLUSIONS: Australian state hospital administrative data reveal epidemiologic features of sepsis and severe sepsis that are strikingly similar to those recently reported from comparable populations in North American and Europe. This suggests that lessons learned in this area may be directly applicable internationally.

Adolescent↗