Community Preferences for the Care of Older People at the End of Life: How Important is the Disease Context?

Background: Population preferences for care at the end of life can inform palliative care policy and direction. Research investigating preferences for care at the end of life has focused predominantly on the context of advanced cancer, with relatively little attention to other life-limiting illnesses that are common causes of death.

Objectives: We aimed to investigate preferences for the care of older people at the end of life in three different disease contexts.

Specialist Palliative Care and Health Care Costs at the End of Life.

Background/aims: The use and costs of health care rise substantially in the months prior to death, and although the use of palliative care services may be expected to lead to less costly care, the evidence is mixed. We analysed the costs of care over the last year of life and the extent to which these are associated with the use and duration of specialist palliative care (SPC) for decedents who died from cancer or another life-limiting illness.

Methods: The decedents were participants in a cohort study of older residents of the state of New South Wales, Australia.

Evaluation of the Victorian Healthy Homes Program: protocol for a randomised controlled trial.

Introduction: The evaluation of the Victorian Healthy Homes Program (VHHP) will generate evidence about the efficacy and cost-effectiveness of home upgrades to improve thermal comfort, reduce energy use and produce health and economic benefits to vulnerable households in Victoria, Australia.

Methods And Analysis: The VHHP evaluation will use a staggered, parallel group clustered randomised controlled trial to test the home energy intervention in 1000 households. All households will receive the intervention either before (intervention group) or after (control group) winter (defined as 22 June to 21 September).

Valuing End-of-Life Care for Older People with Advanced Cancer: Is Dying at Home Important?

Background: Most health care systems are facing the challenge of providing health services to support the increasing numbers of older people with chronic life-limiting conditions at the end of life. Many policies focus primarily on increasing the proportion of deaths at home.

Objectives: This study aims to investigate preferences for care throughout the latter stages of a life-limiting illness, particularly the importance of location of care, location of death, and the use of life-sustaining measures.

Choosing a Doctor: Does Presentation Format Affect the Way Consumers Use Health Care Performance Information?

Background: Choosing a new health service provider can be difficult and is dependent on the type and clarity of the information available. This study examines if the presentation of service quality information affects the decisions of consumers choosing a general medical practice.

Objectives: The aim was to examine the impact of presentation format on attribute level interpretation and relative importance.

Development and testing of two implementation tools to measure components of professional pharmacy service fidelity.

Rationale, Aims And Objectives: There is a need to evaluate both service process and implementation outcomes as professional services are being implemented into pharmacy practice. Fidelity is an implementation outcome, which may be used for service optimization, by associating service components to patient outcomes, as well as use in process evaluation. The objective of this study was to develop tools to measure components of fidelity, specifically, an adherence index (adherence of the service provider to the elements of the service) and a patient responsiveness scale for the professional pharmacy service, medication review with follow-up.

Satisfaction with nursing education, job satisfaction, and work intentions of new graduate nurses.

Background And Objective: In the context of predictions of future shortages of nurses, retaining new graduate nurses in the nursing workforce is essential to ensure sufficient nurses in the future. This paper investigates the links between satisfaction with nursing education and job satisfaction, and job dissatisfaction and intentions to leave a nursing job.

Design And Data Sources: It uses survey data from a cohort study of nursing students recruited through two Australian universities and followed after graduation and workforce entry.

Computer modeling with randomized-controlled trial data informs the development of person-centered aged care homes.

Aim: To answer questions on the essential components (services, operations and resources) of a person-centered aged care home (iHome) using computer simulation.

Materials & Methods: iHome was developed with AnyLogic software using extant study data obtained from 60 Australian aged care homes, 900+ clients and 700+ aged care staff. Bayesian analysis of simulated trial data will determine the influence of different iHome characteristics on care service quality and client outcomes.

Factors affecting general practitioner charges and Medicare bulk-billing: results of a survey of Australians.

Objective: To identify factors affecting bulk-billing by general practitioners in Australia.

Design, Participants And Setting: A community-based survey was administered to Australians aged 16 years or older in July 2013 via an online panel. Survey questions focused on patient characteristics, visit characteristics, practice characteristics.

Community preferences in general practice: important factors for choosing a general practitioner.

Background: Understanding the important factors for choosing a general practitioner (GP) can inform the provision of consumer information and contribute to the design of primary care services.

Objective: To identify the factors considered important when choosing a GP and to explore subgroup differences.

Design: An online survey asked about the respondent's experience of GP care and included 36 questions on characteristics important to the choice of GP.

The physical functioning and mental health of informal carers: evidence of care-giving impacts from an Australian population-based cohort.

Informal carers represent a substantial proportion of the population in many countries and health is an important factor in their capacity to continue care-giving. This study investigated the impact of care-giving on the mental and physical health of informal carers, taking account of contextual factors, including family and work. We examined health changes from before care-giving commenced to 2 and 4 years after, using longitudinal data from the Household Income and Labour Dynamics in Australia survey.

PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia.

Background: There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE.

Methods: 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified, then randomized to one of four intervention groups: (1) PCC; (2) PCE; (3) PCC +PCE; (4) no intervention.

Providing Informal Care in Terminal Illness: An Analysis of Preferences for Support Using a Discrete Choice Experiment.

Background: The trend for terminally ill patients to receive much of their end-of-life care at home necessitates the design of services to facilitate this. Care at home also requires that informal care be provided by family members and friends. This study investigated informal carers' preferences for support services to aid the development of end-of-life health care services.

Educational preparation for clinical nursing: the satisfaction of students and new graduates from two Australian universities.

Background: Attrition rates among young and newly registered nurses are high; the capacity of nurse education programmes to prepare nurses for their professional role and the extent to which they are supported during the transition from student to registered nurse may be important factors.

Objectives: This paper examines nursing student and recent graduate satisfaction with their education, focusing on their preparation for work.

Design: A descriptive cohort design was used, combining qualitative and quantitative methods to measure and interpret satisfaction.

Effect of a pharmacist intervention on asthma control. A cluster randomised trial.

Introduction: Achievement and maintenance of good asthma control is a major objective in asthma management. However, asthma control in many patients is suboptimal, due to improper use of asthma medications and non-adherence. The aim of this study was to evaluate the effect of a pharmacist intervention on asthma control in adult patients.

Preferences for support services among adolescents and young adults with cancer or a blood disorder: a discrete choice experiment.

Background: Life-threatening illnesses in young people are traumatic for patients and their families. Support services can help patients and families deal with various non-medical impacts of diagnosis, disease and treatment. The aim of this study was to determine which types of support are most valued by adolescents and young adults (AYA) with cancer or blood disorders and their families.

Repeatability of the six-minute walk test and relation to physical function in survivors of a critical illness.

Background: The Six-Minute Walk Test (6MWT) is widely used as an outcome measure in exercise rehabilitation. However, the repeatability of the 6MWT performed at home in survivors of a critical illness has not been evaluated.

Objective: The purpose of this study was to evaluate, in survivors of a critical illness: (1) the repeatability of the 6MWT performed at home, (2) the effect on estimates of change in functional exercise capacity if only one 6MWT was performed at follow-up assessments, and (3) the relationship between the physical functioning (PF) score of the 36-Item Short-Form Health Survey questionnaire (SF-36) and the 6MWT.

Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program.

Introduction: Significant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery.

Informal care and home-based palliative care: the health-related quality of life of carers.

Health is an important factor in the capacity of family and friends (informal carers) to continue providing care for palliative care patients at home. This study investigates associations between the health-related quality of life (HRQOL) of current informal carers and characteristics of the carers and their caregiving situation, in a sample of Australian carers of palliative care patients. The cross-sectional study used the Short Form-36 Health Survey to measure HRQOL.

Sources of variation in the costs of health care for asthma patients in Australia.

Objectives: Individuals with chronic conditions, such as asthma, on average incur high health care costs, though good control can reduce costs and improve health outcomes. However, there may be substantial variation between patients in their use of services and therefore costs. Our objective was to investigate the sources of such variation in health system and out-of-pocket costs for people with asthma.

Measures of asthma control and quality of life: longitudinal data provide practical insights into their relative usefulness in different research contexts.

Purpose: To further our understanding of the relationships between asthma control and health-related quality of life (HRQOL) and provide insights into the relative usefulness of various measures in different research contexts. We present a conceptual model and test it with longitudinal survey data.

Methods: Participants recruited via population sampling and hospital Emergency Departments completed questionnaires every 6 months for up to 3 years.

Quality of life and survival in the 2 years after surgery for non small-cell lung cancer.

Purpose: Although surgery for early-stage non-small-cell lung cancer (NSCLC) is known to have a substantial impact on health-related quality of life (HRQOL), there are few published studies about HRQOL in the longer term. This article examines HRQOL and survival in the 2 years after surgery.

Patients And Methods: Patients with clinical stage I or II NSCLC (n = 173) completed HRQOL questionnaires before surgery, at discharge, 1 month after surgery, and then every 4 months for 2 years.

Home-based palliative care in Sydney, Australia: the carer's perspective on the provision of informal care.

The provision of home-based palliative care requires a substantial unpaid contribution from family and friends (i.e. informal care).

Using discrete choice experiments to investigate subject preferences for preventive asthma medication.

Background And Objective: Long-term adherence to inhaled corticosteroids is poor despite the crucial role of preventer medications in achieving good asthma outcomes. This study was undertaken to explore patient preferences in relation to their current inhaled corticosteroid medication, a hypothetical preventer or no medication.

Methods: A discrete choice experiment was conducted in 57 adults with mild-moderate asthma and airway hyper-responsiveness, who were using inhaled corticosteroid View Article and Find Full Text PDF