Selected Topics - Clinical Care

Events

• School of Public Health and Community Medicine, UNSW - Upcoming Events

Global policies and related documents

Reports, guidelines and projects

• Australian general practice and pandemic influenza: models of clinical practice in an established pandemic
  This 2007 article by Christine B Phillips, Mahomed S Patel, Nicholas Glasgow, Christopher Pearce, Paul Dugdale, Alison Davies, Sally Hall and Marjan Kljakovic and published in MJA 2007; 186 (7): 355-358, argues that, "to minimise the health impact of pandemic influenza, general practice will need to provide influenza-related and non-influenza primary health care, as well as contribute to the public health goal of disease control." Furthermore, "effective participation by general practice in a pandemic requires supplementary infrastructure support, changes to financial and staffing patterns, a review of legislation on medicolegal implications during an emergency, and intensive collaboration between general practices."
• Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs [Executive Summary]
  "Cancer care today often provides state-of-the-science biomedical treatment, but fails to address the psychological and social (psychosocial) problems associated with the illness. This failure can compromise the effectiveness of health care and thereby adversely affect the health of cancer patients. Psychological and social problems created or exacerbated by cancer--including depression and other emotional problems; lack of information or skills needed to manage the illness; lack of transportation or other resources; and disruptions in work, school, and family life -- cause additional suffering, weaken adherence to prescribed treatments, and threaten patients' return to health. Today, it is not possible to deliver high-quality cancer care without using existing approaches, tools, and resources to address patients' psychosocial health needs. All patients with cancer and their families should expect and receive cancer care that ensures the provision of appropriate psychosocial health services. [The book] Cancer Care for the Whole Patient recommends actions that oncology providers, health policy makers, educators, health insurers, health planners, researchers and research sponsors, and consumer advocates should undertake to ensure that this standard is met."
• Chronic Disease: An Economic Perspective
  "Chronic diseases account for the greatest share of early death and disability worldwide. Over the next few decades this burden is projected to rise particularly fast in the developing world. The lack of research on the economic implications of chronic disease contrasts with the available knowledge on the sheer epidemiological burden of the problem. This paper assesses and evaluates the current state of knowledge, with a primary focus on low- and middle-income countries, and a secondary focus on high-income countries (where information on the former is lacking). Very few such attempts have been undertaken, especially with an interest in developing countries. Thus a critical review of the available evidence is a necessary first step in exploring the case for governments and donors to invest in chronic disease prevention and in clarifying areas in which further research is required. As the evidence is complex, the report should meet the needs of technical audiences for whom detailed knowledge is central as well as be accessible and useful to those for whom synthesised understandings are sufficient."
• Chronic diseases: A clinical and managerial challenge
  "Chronic conditions represent today one of the most relevant threats and challenges in Europe… WHO data indicates that today between 80% and 90% of deaths are due to chronic diseases. But what is particularly alarming, is the increasing incidence and prevalence among population as well as the increasing rate of population with multiple chronic conditions. In all EU Member States chronic diseases creates new challenges in terms of healthcare organisation, balance between the different levels of care and system financing, in a context of growing expectations of the population and possible decrease in resources available. The issue of chronic diseases requires new paradigms of healthcare supply and changes within the system, which are happening effectively at different paces. The table below illustrates the main challenges linked to the management of chronic conditions, both under the clinical and under the economical and managerial perspective, as identified and illustrated by HOPE Exchange participants. While it is obvious that an ageing population and chronic diseases rapidly spreading are major problems everywhere, it is worth noting that the lack of integration and coordination within the system if considered as one of the main weaknesses in most examined countries. This lack of integration concerns the different levels of the healthcare system: general practitioners, nurses, specialists, primary care institutions and hospitals, as well as community care. Another issue regards actions towards the population and patients to foster cultural change with actions of prevention, awareness and direct information. The most important transversal issue, however, lies in the financial constraints, which have negative effect both on the people’s ability to access the system, and on the quality of care received." [HOPE - European Hospital and Healthcare Federation, October 2010]
• Making Shared Decision-Making a Reality: No decision about me, without me
  Shared decision-making is a process in which clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and a system for recording and implementing patients’ informed preferences. The government wants shared decision-making to become the norm in the NHS, but there is confusion about why it is important, what it involves and what the implications might be for patients, clinicians and the wider health service. This report clarifies the concept and outlines the actions needed to make the aspiration a reality. [publication summary] [The King’s Fund - London UK – July, 2011]
• Managing chronic conditions: Experience in eight countries
  "One of the greatest challenges facing health systems in the 21st century is the need to develop effective approaches to address the growing burden of chronic disease. Chronic diseases are complex and require a long-term, multifaceted response that coordinates inputs from a wide range of health professionals, essential medicines and – where appropriate – monitoring equipment, all of which is optimally embedded within a system that promotes patient empowerment. With many health systems still largely built around an acute, episodic model of care, health professionals, policy-makers and patient organizations struggle to respond in ways that meet the needs of people with complex chronic health problems. This book examines the health system response to the rising burden of chronic disease in eight countries. It provides a detailed assessment of the current situation, a description of the policy framework and future scenarios, as well as evaluation and lessons learned. It shows that many different strategies are being implemented, with different models of care at varying degrees of development, and with differing comprehensiveness. Perhaps not surprisingly, the approaches adopted often reflect the characteristics of each health system, each with its own governance mechanisms and relationships between, and responsibilities of, different stakeholders. Nonetheless, there are many lessons for those seeking to develop effective responses to this common challenge." Countyries examined: : Denmark [chapter written by Michaela Schiøtz, Anne Frølich, Allan Krasnik], England [written by Debra de Silva and Daragh Fahey], France [by Isabelle Durand-Zaleski, Olivier Obrecht], Germany [Ulrich Siering], the Netherlands [Eveline Klein Lankhorst and Cor Spreeuwenberg], Sweden [Ingvar Karlberg], Australia [Nicholas Glasgow, Nicholas Zwar, Mark Harris, Iqbal Hasan and Tanisha Jowsey] and Canada [Izzat Jiwani and Carl-Ardy Dubois]. [European Observatory on Health Systems and Policies, Observatory Studies Series No 15, 2008]
• Overview of Evidence Relating to Shifting the Balance of Care: A Contribution to the Knowledge Base
  "This report presents the findings of a short review of evidence. The aim was to provide an overview of evidence to contribute to the debate on, and inform the development of, the policy on shifting the balance of care a key theme within health and community care policy which is intended to bring about improvements in service delivery and health outcomes. 'Shifting the balance of care' is a term used to describe change at a number of levels, for example, shifting the location of care towards more community-based facilities, shifting the focus of care towards long term conditions and changing the roles and responsibilities of patients and professionals."
• Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions
  Background: Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment. Objective: To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD). Design: Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients. Participants: Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states. Measurements: The Patient Health Questionnaire-9 assessed MDD. Probable PTSD was defined as a Primary Care PTSD Screen≥3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics. Results: Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P<.001), lower social support (P<.001), more frequent outpatient health care visits (P<.001), and were more likely to report suicidal ideation (P<.001) than MDD patients. No differences were observed in alcohol consumption, self-reported general health, and physical illness comorbidity. Conclusions: PTSD is more common among depressed primary care patients than previously thought. Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment. Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD. [author abstract] [J Gen Intern Med. 2007 June; 22(6): 711–718]
• The Quality of Death: Ranking end-of-life care across the world
  "'Quality of life' is a common phrase. The majority of human endeavours are ostensibly aimed at improving quality of life, whether for the individual or the community, and the concept ultimately informs most aspects of public policy and private enterprise. Advancements in healthcare have been responsible for the most significant quality-of-life gains in the recent past: that humans are (on average) living longer, and more healthily than ever, is well established. But 'quality of death' is another matter. Death, although inevitable, is distressing to contemplate and in many cultures is taboo. Even where the issue can be openly discussed, the obligations implied by the Hippocratic oath — rightly the starting point for all curative medicine — do not fit easily with the demands of end-of-life palliative care, where the patient’s recovery is unlikely and instead the task falls to the physician (or, more often, caregiver) to minimise suffering as death approaches. Too often such care is simply not available… Few nations, including rich ones with cutting-edge healthcare systems, incorporate palliative care strategies into their overall healthcare policy—despite the fact that in many of these countries, increasing longevity and ageing populations mean demand for end-of-life care is likely to rise sharply. Globally, training for palliative care is rarely included in healthcare education curricula. Institutions that specialise in giving palliative and end-of-life care are often not part of national healthcare systems, and many rely on volunteer or charitable status. Added to this, the availability of painkilling drugs — the most basic issue in the minimisation of suffering—is woefully inadequate across much of the world, often because of concerns about illicit use and trafficking. The result of this state of affairs is an incalculable surfeit of suffering, not just for those about to die, but also for their loved ones. Clearly, the deeper inclusion of palliative care into broader health policy, and the improvement of standards of end-of-life care — raising the 'quality of death' — will also yield significant gains for humanity’s quality of life. With this in mind, the Economist Intelligence Unit was commissioned by the Lien Foundation, a Singaporean philanthropic organisation, to devise a 'Quality of Death' Index to rank countries according to their provision of end-of-life care." [The Economist Intelligence Unit, 2010]
• Understanding and Influencing Blood Prescription
  This December 2007 report states: "The Clinical Excellence Commission (CEC), in collaboration with the National Blood Authority (NBA), commissioned market research consultants- Eureka Strategic Research - to identify the influencing behaviours of clinicians who prescribe blood components: specifically, the prescribing of red cells to haemodynamically stable (i.e. not bleeding) adult patients with normal bone marrow. This timely report gives us some insight into what the current transfusion practice amongst senior surgeons and physicians in NSW."

Educational resources

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Organisations and Networks

UN and multinational

Government

• Clinical Excellence Commission, New South Wales Government, Australia
  "Health is moving from a system where hospital and health services had separate approaches to complaints and clinical errors, to a system where uniform standards and processes have been introduced to make sure that the system learns from its mistakes and solutions are adopted system-wide. The establishment of the Clinical Excellence Commission in August 2004 as part of the NSW Patient Safety and Clinical Quality Program ensures patient safety and excellence in clinical care is a top priority for the NSW Health system."

Non Government

• Wound Care Association of NSW - A non-profit organisation dedicated to the improvement of wound care through education, research and communication.

Academic Institutions with particular focus in this area

Key Conferences, conference and workshop reports

Coming conferences

Conference reports

Journals, Newsletters, Forums

Bibliographies, Libraries

Public health bookshops

• Public Health bookshop