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Background Gout has an increasing global prevalence. Underutilization of urate-lowering therapy (ULT) is thought to be common, via both suboptimal dosing and poor medication adherence. The aims of this study were to determine the prevalence of self-reported gout and the key predictors of ULT use in those with gout in a representative population survey in South Australia. Methods Data were obtained from the Spring 2015 South Australian Health Omnibus Survey, a multilevel, systematic, survey in a representative population sample involving face-to-face interviews ( n  = 3005). This study analyzed responses from respondents aged ≥ 25 years ( n  = 2531) about self-reported gout, ULT use, sociodemographic factors, lifestyle factors, and comorbidities, using survey weighting. Univariate and subsequent adjusted logistic regression analyses on self-reported gout were performed. ULT use was divided into three categories (never use, prior use, and current use) and these data were analyzed using a multinomial logistic regression model. Results Self-reported gout prevalence was 6.8% (95% CI 5.8, 7.9). The mean age of respondents with gout was 64 years (standard deviation 16) and 82% were male. As expected, older age, male gender, lower socioeconomic status (SES), and higher body mass index (BMI) were associated with gout, as were high alcohol consumption, current smoking, other forms of arthritis, and hypertension or hypercholesterolemia medication, after adjustment for sociodemographic variables. Two thirds of respondents with gout reported ULT use (36% current; 29% previous) with only 55% continuing treatment. Predictors of ULT use included male gender, low SES, and concomitant cholesterol-lowering therapy. Respondents with gout with a higher BMI were more likely to remain on ULT. Conclusions Despite gout being a common, potentially disabling joint disease, only 55% of respondents with gout in this study adhered to ULT. Identification of key predictors of ULT use will provide guidance on prescribing strategy in clinical practice and on the quality of gout care in the community.

Objective: We aimed to develop and test the feasibility of a nurse-led, telehealth transitional care intervention for people with multimorbidity. Design and methods: A feasibility study, using quantitative and qualitative methods was conducted at an 800-bed acute metropolitan hospital from March 2021 to January 2022. Eligible participants were adult in patients with multimorbidity. The intervention involved three stages: (1) baseline risk of readmission assessment and collaborative development of a Transition Action Plan; (2) transitional care coordination following hospital discharge, and (3) handover to the primary healthcare provider. A Transition Coordinator delivered the intervention with the aim of determining the intervention's feasibility in a practice environment. Acceptability to patients was assessed using a feedback survey. Acceptability to staff was noted through recorded interactions, collaboration, and feedback. Results: Twenty-one adults with a mean age of 78 years participated in the intervention. Participants had 3-10 comorbid chronic conditions, and the most common were hypertension (71%), other cardiovascular (66%), renal (52%), and diabetes (47%). Most patients (52%) were at medium risk of readmission and 38% were at high risk, however, only 24% of patients were readmitted. The study identified there is no routine risk of re-admission screening for patients with multimorbidity, and the intervention was found to be acceptable and feasible to patients, ward staff, and the multidisciplinary team. Conclusion: The results indicated feasibility of a transitional care intervention for people with multimorbidity, and the need for routine risk of readmission screening for people with multimorbidity. Further research is required to determine if the intervention is cost-effective and associated with reduced rates of hospital readmission. Keywords: Care coordination, chronic disease, multimorbidity, nursing, telehealth, transitional care model What is already known about the topic? - People with multimorbidity often receive fragmented health services, which May increase their risk of hospital readmission. - Internationally, Transitional Care Model interventions improve the transition experience from acute hospital care to the community and reduce short-term readmission rates, for people with multimorbidity. - Transitional Care Model interventions have shown improved health and economic benefits for older adults. However, these benefits have not been evaluated in Australia. What this paper adds - This study provides evidence regarding the feasibility and acceptability of a low-cost, nurse- led, transitional care intervention to support people with multimorbidity transitioning from acute hospital care to home/community, in the Australian context. - The study identified high support needs of participants upon transition and provides preliminary evidence in favour of a fundamental shift from discharge planning to stratified transition planning for patients with multimorbidity. - Presently, on hospital admission, there is no systematic risk of readmission assessment or transition care planning and implementation for people with multimorbidity. This is a notable service gap requiring redress across South Australian Local Health Networks.

To determine the incidence, multiplicity, geographical variability and service trends of keratinocyte cancers (KC) in South Australia (SA). Medicare Australia data with a unique identifier were used to assess the number of people treated over years 2010–2014. A maximum of one KC service claim per year was used to determine incidence. Age‐standardised rates were estimated as were KC service activity trends. There were 497,581 services to 204,183 SA residents for KC, solar keratoses, locally aggressive skin tumours or suspicious skin lesions. Of these, n=159,137 services were for KC (77,502 people). The five‐year (2010–2014) age‐standardised rate of KC in SA was 1,466.6 (95%CI 1,458.3‐1,474.8) per 100,000. Forty per cent of people had more than one KC removed. Men accounted for more incident cases (59.2%). Age‐specific rates showed least variability over time in the youngest age group (15–44 years). For 26 geographical areas, higher age‐standardised ratios of KC were seen in coastal and agricultural areas. There was a 59% increase in services for KC from 2000 to 2015. Age‐standardised rates for KC are relatively stable in SA, but regional variations are evident. Services for KC continue to rise. This is the first systematic report of KC in SA. We demonstrate the utility of using validated Medicare data for assessing KC incidence and trends.

People with multimorbidity have complex health care needs, resulting in high health service use, hospital readmission rates, and support needs. To prevent unnecessary hospital readmissions, effective coordination during the transition from hospital to primary care is essential; the transitional care model (TCM) is an effective approach to achieve this. This study will adapt the TCM, focusing on a nurse-led telehealth-based follow-up transition coordination service to enhance continuity between hospital and primary care, aiming to reduce unnecessary hospital readmissions and improve patient transitions. This study aims to assess the impact of a TCM on 3-month readmission rates in people with multimorbidity after discharge in an Australian context. Other objectives include evaluating the rate of re-presentation to hospital and overall length of hospital stay within 1, 6, and 12 months of discharge from the index admission; conducting a cost analysis of the transitional service model of care; evaluating the patient experience with the transition service; assessing patients' symptom burden before and after transitional support service intervention; and evaluating patients' quality of life, self-efficacy, and symptom management before and after intervention. The study design is a multicenter, pragmatic randomized controlled trial of patients with multimorbidity; therefore, real-world clinical practices, and operations will be the considerations within the research design elements. A mixed methods approach using quantitative and qualitative data collection methods will be used. The study setting incorporates 2 hospitals, initially commencing at the Queen Elizabeth Hospital (a 355-bed acute and subacute teaching hospital) and then at the Royal Adelaide Hospital (an 880-bed acute care teaching hospital), both located within the Central Adelaide Local Health Network, South Australia. We will include 3 to 6 medical units and wards. The intervention will focus on nurse-led transition assessment and care planning and telehealth transition coordination support for people with multimorbidity for 6 to 10 weeks following hospital discharge. This project received ethics approval (17554) on June 29, 2023, and was registered with the Australian New Zealand Clinical Trials Registry on February 15, 2024 (12624000142538). The study commenced on July 1, 2023; data collection started in February 2024 and was completed on March 31, 2025. Finalized results are expected in March 2026. The Central Adelaide Local Health Network currently lacks a process to assess or manage readmission risks for people with multimorbidity, despite evidence linking transitional care to reduced rehospitalizations. Our feasibility study highlighted the effectiveness of a transition coordinator role in supporting patients' return to home and community. Progressing this work, an adapted TCM, with telehealth-based follow-up and home and health care support, will enhance continuity between hospital and primary care, aiming to reduce unnecessary readmissions and improve patient transitions. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12624000142538; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383721. DERR1-10.2196/71847.

Objective: To collaboratively develop a model of nurse-led care, within a multidisciplinary team and support continuity of care at the primary- secondary interface for people with multimorbidity. Background: Existing models of care are frequently based on a medical model, designed to manage a single disease condition, and thus pose a significant challenge to provide healthcare for people with multimorbidity. Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated, however, these have not been applied to the development of a nurse-led model of care for people with multimorbidity. Study design and methods: This paper, the first in a series of two, is part of a broader action research study and reports on the development of a model which will subsequently be assessed in terms of feasibility to provide a nurse-led care coordination service for people with multi-morbidity. This paper reports on the first action research cycle and methodology including a literature search, stakeholder engagement forums, validation workshop, team meetings, and professional engagement and validation. Results: Data from two stakeholder forums were sorted into 257 'structure, process and outcome' statements and 86 goal related statements. These were cross referenced with design elements on models of care from the literature and finally aggregated into themes. The aggregated themes were then integrated into a model of care for a nurse-led care coordination service. The model consists of an overarching component, 4 domains and 6 operational areas with underpinning criteria. Conclusion: Through stakeholder consultation, consideration of the strengths of previous models and building blocks, a new nurse-led model of care that provides a pathway for transitional healthcare management at the primary-secondary interface has been developed. Inclusion of governance and culture within the model's domains enables the approach to be pragmatic and adaptable, contributing to the potential for successful change management and model implementation in the clinical workplace. Further evaluation and refinement of the model is planned and will be reported on, in part 2 of this two-part series. Implications for research, policy, and practice: These findings provide direction for model implementation and further research required regarding nurse-led models of care. The supporting documents, systems, and processes reported, positions the model to support change and guide clinical practitioners and nursing management working at the primary-secondary healthcare interface. The future success of model implementation could provide evidence for health workforce policy and coordinated healthcare management. What is already known about this topic: - Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated. - Interventions delivered at the primary-secondary care interface, particularly stepped care and models of shared care are effective for the management of depression. - Established model design elements and interventions to improve continuity of care at the primary-secondary interface have not been applied to nurse-led models of care for chronic conditions and still require development within research settings. What this paper adds: - A new person-centred nurse-led model of care coordination, with healthcare management activities intended to support and enable development of the person's agency in their healthcare optimisation. - A model with specific domains and criteria with the potential for application to nurse-led services across primary and secondary settings, for a range of patients. - Inclusion of governance and culture as domains within the model, to enable the best possibility for change, model implementation and continuity of care between the primary-secondary healthcare interface.

Background: The prevalence of kidney disease continues to increase, as does the acuity of kidney care. Patients with kidney failure are older, sicker and less mobile. Health systems are under more pressure to manage growing care needs and capacity constraints. This is likely to have an impact on nursing workforce experiences. Aims: The aim of this research was to examine nephrology nursing in South Australia to understand the impact of increasing acuity and organisational factors that may support and sustain the workforce. Methods: An exploratory semi-structured qualitative approach, facilitating eight focus groups with 36 nephrology nurses across six public metropolitan renal units was applied. Data were thematically analysed. Findings: Three central themes relating to nursing culture, patient acuity and organisational factors that impact the nursing workforce were identified. Sub-themes identified were pride and passion, teamwork and collegiality, increasing patient acuity and the lack of clinical rationalisation in kidney care, the value of a 'flat' hierarchy, and vulnerability during the COVID-19 pandemic. Consequently, we identified a disconnect between institutional expectations and what the participants considered pragmatic reality. Participants reported sustained workplace pressure, a 'triage' approach to care, and a sense of work left undone. Conclusion: Nephrology nurses experience a gap between 'supply and demand' on their time, resources and workload. These findings highlight the need for further exploration of the root causes and the development of new systems to provide quality, safe and rewarding care for patients and to reduce the risk of workforce moral distress and burnout.

Background The translation of evidence from clinical trials into practice is complex. One approach to facilitating this translation is to consider the ‘implementability’ of trials as they are designed and conducted. Implementability of trials refers to characteristics of the design, execution and reporting of a late-phase clinical trial that can influence the capacity for the evidence generated by that trial to be implemented. On behalf of the Australian Clinical Trials Alliance (ACTA), the national peak body representing networks of clinician researchers conducting investigator-initiated clinical trials, we conducted a pragmatic literature review to develop a concept map of implementability. Methods Documents were included in the review if they related to the design, conduct and reporting of late-phase clinical trials; described factors that increased or decreased the capacity of trials to be implemented; and were published after 2009 in English. Eligible documents included systematic reviews, guidance documents, tools or primary studies (if other designs were not available). With an expert reference group, we developed a preliminary concept map and conducted a snowballing search based on known relevant papers and websites of key organisations in May 2019. Results Sixty-five resources were included. A final map of 38 concepts was developed covering the domains of validity, relevance and usability across the design, conduct and reporting of a trial. The concepts drew on literature relating to implementation science, consumer engagement, pragmatic trials, reporting, research waste and other fields. No single resource addressed more than ten of the 38 concepts in the map. Conclusions The concept map provides trialists with a tool to think through a range of areas in which practical action could enhance the implementability of their trials. Future work could validate the strength of the associations between the concepts identified and implementability of trials and investigate the effectiveness of steps to address each concept. ACTA will use this concept map to develop guidance for trialists in Australia. Trial registration This review did not include health-related outcomes and was therefore not eligible for registration in the PROSPERO register.

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156 non-Indigenous smokers from South Australia were shown 10 anti-smoking advertisements representing a range of advertisements typically aired in Australia. Participants rated advertisements on a five-point Likert scale assessing factors including message acceptance and personalized effectiveness. On average. Indigenous people rated the mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. Advertisements featuring real people describing the serious health consequences of smoking received mixed responses. Those featuring an ill person were rated higher by Indigenous people than those featuring the family of the person affected by a smoking-related disease. With limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are likely to be highly motivating for Indigenous smokers.

Objective: We aimed to develop and test the feasibility of a nurse-led, telehealth transitional care intervention for people with multimorbidity. Design and methods: A feasibility study, using quantitative and qualitative methods was conducted at an 800-bed acute metropolitan hospital from March 2021 to January 2022. Eligible participants were adult inpatients with multimorbidity. The intervention involved three stages: (1) baseline risk of readmission assessment and collaborative development of a Transition Action Plan; (2) transitional care coordination following hospital discharge, and (3) handover to the primary healthcare provider. A Transition Coordinator delivered the intervention with the aim of determining the intervention’s feasibility in a practice environment. Acceptability to patients was assessed using a feedback survey. Acceptability to staff was noted through recorded interactions, collaboration, and feedback. Results: Twenty-one adults with a mean age of 78 years participated in the intervention. Participants had 3-10 comorbid chronic conditions, and the most common were hypertension (71%), other cardiovascular (66%), renal (52%), and diabetes (47%). Most patients (52%) were at medium risk of readmission and 38% were at high risk, however, only 24% of patients were readmitted. The study identified there is no routine risk of re-admission screening for patients with multimorbidity, and the intervention was found to be acceptable and feasible to patients, ward staff, and the multidisciplinary team. Conclusion: The results indicated feasibility of a transitional care intervention for people with multimorbidity, and the need for routine risk of readmission screening for people with multimorbidity. Further research is required to determine if the intervention is cost-effective and associated with reduced rates of hospital readmission. What is already known about the topic? People with multimorbidity often receive fragmented health services, which may increase their risk of hospital readmission. Internationally, Transitional Care Model interventions improve the transition experience from acute hospital care to the community and reduce short-term readmission rates, for people with multimorbidity. Transitional Care Model interventions have shown improved health and economic benefits for older adults. However, these benefits have not been evaluated in Australia. What this paper adds This study provides evidence regarding the feasibility and acceptability of a low-cost, nurse-led, transitional care intervention to support people with multimorbidity transitioning from acute hospital care to home/community, in the Australian context. The study identified high support needs of participants upon transition and provides preliminary evidence in favour of a fundamental shift from discharge planning to stratified transition planning for patients with multimorbidity. Presently, on hospital admission, there is no systematic risk of readmission assessment or transition care planning and implementation for people with multimorbidity. This is a notable service gap requiring redress across South Australian Local Health Networks.