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Статті в журналах з теми "Public health Australia Evaluation":
1
Patrick, Rebecca, and Jonathan Kingsley. "Health promotion and sustainability programmes in Australia: barriers and enablers to evaluation." Global Health Promotion 26, no. 2 (August 23, 2017): 82–92. http://dx.doi.org/10.1177/1757975917715038.
Анотація:
In an era characterised by the adverse impacts of climate change and environmental degradation, health promotion programmes are beginning to actively link human health with environmental sustainability imperatives. This paper draws on a study of health promotion and sustainability programmes in Australia, providing insights to evaluation approaches being used and barriers and enablers to these evaluations. The study was based on a multi-strategy research involving both quantitative and qualitative methods. Health promotion practitioners explained through surveys and semi-structured interviews that they focused on five overarching health and sustainability programme types (healthy and sustainable food, active transport, energy efficiency, contact with nature, and capacity building). Various evaluation methods and indicators (health, social, environmental, economic and demographic) were identified as being valuable for monitoring and evaluating health and sustainability programmes. Findings identified several evaluation enablers such as successful community engagement, knowledge of health and sustainability issues and programme champions, whereas barriers included resource constraints and competing interests. This paper highlights the need for ecological models and evaluation tools to support the design and monitoring of health promotion and sustainability programmes.
2
Baum, Frances, and Valerie A. Brown. "HEALTHY CITIES (AUSTRALIA) PROJECT: ISSUES OF EVALUATION FOR THE NEW PUBLIC HEALTH." Community Health Studies 13, no. 2 (February 12, 2010): 140–49. http://dx.doi.org/10.1111/j.1753-6405.1989.tb00190.x.
3
Lambert, Robyn, Naomi Burgess, Nadine Hillock, Joy Gailer, Pravin Hissaria, Tracy Merlin, Chris Pearson, Benjamin Reddi, Michael Ward, and Catherine Hill. "South Australian Medicines Evaluation Panel in review: providing evidence-based guidance on the use of high-cost medicines in the South Australian public health system." Australian Health Review 45, no. 2 (2021): 207. http://dx.doi.org/10.1071/ah20018.
Анотація:
ObjectiveThe South Australian Medicines Evaluation Panel (SAMEP) was established in 2011 to make evidence-based recommendations on the funding of high-cost medicines in South Australian public hospitals via a high-cost medicines formulary. SAMEP represents one component of South Australia’s process for state-based health technology assessment (HTA). The aim of this study was to describe the experience of SAMEP in the context of Australia’s complex governance model for hospital-based care. MethodsA retrospective review was conducted of the SAMEP process and outcomes of medicine evaluations. Decision summaries and meeting minutes were reviewed and reflected upon by the authors to explore the views of the SAMEP membership regarding the function of the committee and state-based HTA more broadly. ResultsSAMEP has reviewed 29 applications, with 14 (48%) listed on the high-cost medicines formulary. Three applications have been the subject of outcome review and confirm expectations of patient benefit. ConclusionRetrospective review of the committee experience suggests that state-based HTA as operationalised by SAMEP is feasible, provides greater equity of access to high-cost medicines in the South Australian public hospital system and allows for access with evidence development. What is known about the topic?State-based hospital funders often need to make decisions on the provision of high-cost medicines for which there is no national guidance or subsidy. Little published information exists about state-based approaches to medicines evaluation and reimbursement within public hospitals in Australia. What does this paper add?The South Australian experience demonstrates a method for states and territories to tackle the challenges of providing evidence-based access to high-cost medicines in Australian public hospitals. What are the implications for practitioners?This paper provides information for other jurisdictions considering state-based approaches to medicines evaluation and contributes to the broader literature about state-based HTA in Australia.
4
Hughes, Emma, Chris King, and Sharon Kitt. "Using the Australian and New Zealand Telehealth Committee framework to evaluate telehealth: Identifying conceptual gaps." Journal of Telemedicine and Telecare 8, no. 3_suppl (December 2002): 36–38. http://dx.doi.org/10.1258/13576330260440790.
Анотація:
summary Telehealth is strongly supported in policy rhetoric as being economically significant to Australia, but evaluation standards have been insufficiently developed to ensure that this is the case. The use of one such evaluation standard, the Australian and New Zealand Telehealth Committee (ANZTC) framework, for telehealth evaluation in Australia makes good sense. However, that framework emphasizes economic and technical considerations at the expense of social contexts. Furthermore, there must be questions about the utility of a framework which, it appears, has been used to evaluate only a single telehealth project in Australia. The combination of the economic rationalism of health-care policy and the technological determinism of a tool model of information and communication technologies (ICTs) can result in evaluations that fail to match the complexities of the intersection of health-care and ICTs. Using the ANZTC framework while at the same time focusing on explaining, rather than just describing, the links between interventions and outcomes seems a reasonable compromise. This involves understanding complex socio-technical networks and relationships, and requires investigators to engage with the gulf between private opinions, public statements and actual behaviour.
5
Luu, Xuan, Kate Dundas, and Erica L. James. "Opportunities and Challenges for Undergraduate Public Health Education in Australia and New Zealand." Pedagogy in Health Promotion 5, no. 3 (August 27, 2019): 199–207. http://dx.doi.org/10.1177/2373379919861399.
Анотація:
The international emergence of undergraduate education in public health has transformed the public health education landscape. While this shift is clearest and most widely evaluated in the United States, efforts in other parts of the world—such as Australasia—have not kept pace. This article aims to redress the evidence gap by identifying and discussing the different approaches through which Australian and New Zealand universities deliver public health education at the undergraduate level. A content analysis was conducted of online handbook information published by 47 universities across Australia and New Zealand, to gauge the various ways in which these universities implement undergraduate public health education. Each offering identified was assigned to one of four predetermined categories. Of the 47 universities, 45 were found to offer some form of undergraduate coursework in public health. Offerings took primarily the form of single subjects. Less commonly implemented were specializations ( n = 20), stand-alone undergraduate degrees ( n = 11), and double degree combinations ( n = 6). This breadth of activity highlights the need for renewed efforts in evaluating undergraduate public health education across the region. Further research is recommended into three areas: (1) emerging best practices in curriculum development and implementation, (2) explorations of public health accreditation in the region, and (3) the outcomes achieved by students and graduates of undergraduate public health degrees across Australia and New Zealand. These efforts will ultimately strengthen the operationalization and contribution of this education in helping shape the future public health workforce in Australasia.
6
Chapman, Simon, and Melanie Wakefield. "Tobacco Control Advocacy in Australia: Reflections on 30 Years of Progress." Health Education & Behavior 28, no. 3 (June 2001): 274–89. http://dx.doi.org/10.1177/109019810102800303.
Анотація:
Australia has one of the world’s most successful records on tobacco control. The role of public health advocacy in securing public and political support for tobacco control legislation and policy and program support is widely acknowledged and enshrined in World Health Organization policy documents yet is seldom the subject of analysis in the public health policy research literature. Australian public health advocates tend to not work in settings where evaluation and systematic planning are valued. However, their day-to-day strategies reveal considerable method and grounding in framing theory. The nature of media advocacy is explored, with differences between the conceptualization of routine “programmatic” public health interventions and the modus operandi of media advocacy highlighted. Two case studies on securing smoke-free indoor air and banning all tobacco advertising are used to illustrate advocacy strategies that have been used in Australia. Finally, the argument that advocacy should emanate from communities and be driven by them is considered.
7
Sebastian, Andi, Liz Fulop, Ann Dadich, Anneke Fitzgerald, Louise Kippist, and Anne Smyth. "Health LEADS Australia and implications for medical leadership." Leadership in Health Services 27, no. 4 (October 6, 2014): 355–70. http://dx.doi.org/10.1108/lhs-03-2014-0028.
Анотація:
Purpose – The purpose of this paper is to call for strong medical co-leadership in transforming the Australian health system. The paper discusses how Health LEADS Australia, the Australian health leadership framework, offers an opportunity to engage medical clinicians and doctors in the leadership of health services. Design/methodology/approach – The paper first discusses the nature of medical leadership and its associated challenges. The paper argues that medical leaders have a key role in the design, implementation and evaluation of healthcare reforms, and in translating these reforms for their colleagues. Second, this paper describes the origins and nature of Health LEADS Australia. Third, this paper discusses the importance of the goal of Health LEADS Australia and suggests the evidence-base underpinning the five foci in shaping medical leadership education and professional development. This paper concludes with suggestions on how Health LEADS Australia might be evaluated. Findings – For the well-being of the Australian health system, doctors need to play an important role in the kind of leadership that makes measurable differences in the retention of clinical professions; improves organisational cultures; enhances the engagement of consumers and their careers; is associated with better patient and public health outcomes; effectively addresses health inequalities; balances cost effectiveness with improved quality and safety; and is sustainable. Originality/value – This is the first article addressing Health LEADS Australia and medical leadership. Australia is actively engaging in a national approach to health leadership. Discussions about the mechanisms and intentions of this are valuable in both national and global health leadership discourses.
8
M. Wallace, Euan. "Prenatal Screening Strategies for Down Syndrome: Many Options but Few Answers." Australian Journal of Primary Health 4, no. 3 (1998): 229. http://dx.doi.org/10.1071/py98053.
Анотація:
Down syndrome is the single most common cause of severe mental handicap in Australia. Prenatal screening for Down syndrome is therefore an important component of modern antenatal care. However, while effective second trimester serum screening for Down syndrome has been available in Australia for almost a decade it appears that the majority of Australian women, particularly those outside South Australia and New South Wales, are still not offered it. Newer methods of screening have been recently described and are already being offered in routine clinical practice. These methods, including nuchal translucency, will afford results earlier in pregnancy than second trimester serum screening and so are attractive to women. However, available evidence suggests that nuchal translucency may not perform as well as second trimester serum screening and further evaluation of the newer screening strategies in an Australian population is urgently required. Alteration of practice prior to such an evaluation is simply not warranted at this time.
9
Broadley, Karen, and Chris Goddard. "A Public Health Approach to Child Protection: Why Data Matter." Children Australia 40, no. 1 (November 3, 2014): 69–77. http://dx.doi.org/10.1017/cha.2014.37.
Анотація:
In Australia, many researchers and policy makers believe that statutory child protection systems are overburdened and ineffective. The way forward, they suggest, is a public health model of child protection. A public health approach comprises four steps: (1) collecting surveillance data; (2) establishing causes and correlations; (3) developing and evaluating interventions; and (4) disseminating information about the effectiveness of intervention activities to the public health community. However, in Australia there are no reliable surveillance data. There is no information about ‘person’. Information is not collected about the characteristics of children (e.g., ethnicity) and parents (e.g., mental illness) reported to child protection services. Data are not comparable across place. This is because the states and territories have their own child protection legislation, definitions and data recording methods. Data are not comparable over time. This is because many jurisdictions have introduced new data recording systems over recent years. This paper concludes that it is essential to develop an effective child protection surveillance data system. This will ensure that services are located in areas and targeted towards populations in greatest need. It will enable large-scale evaluation of the effectiveness of prevention and intervention activities.
10
Kurti, Linda, Susan Rudland, Rebecca Wilkinson, Dawn DeWitt, and Catherine Zhang. "Physician's assistants: a workforce solution for Australia?" Australian Journal of Primary Health 17, no. 1 (2011): 23. http://dx.doi.org/10.1071/py10055.
Анотація:
Significant medical workforce shortages, particularly in rural and remote locations, have prompted a range of responses in Australia at both state and Commonwealth levels. One such response was a pilot project to test the suitability of the Physician Assistant (PA) role in the Australian context. Five US-trained and accredited PAs were employed by Queensland Health and deployed in urban, rural and remote settings across Queensland. A concurrent mixed-method evaluation was conducted by Urbis, an independent research firm. The evaluation found that the PAs provided quality, safe clinical care under the supervision of local medical officers. The majority of nurses and doctors who worked with the PAs believed that the PAs made a positive contribution to the health care team by increasing capacity to meet patient needs; reducing on-call requirements for doctors; liaising with other clinical team members; streamlining procedures for efficient patient throughput; and providing continuity during periods of doctor changeover. The Pilot demonstrated that a delegated PA role can provide safe, quality health care by augmenting an established healthcare team. The PA role has the potential to benefit the community by increasing the capacity of the health care system, and to improve recruitment and retention by providing an additional professional pathway. The small size of the Pilot limits the ability to generalise regarding the future efficacy of the PA role in Australia. Further research is required to test training and deployment of PAs in a wider range of Australian clinical settings, including general practice and rural health clinics.
Дисертації з теми "Public health Australia Evaluation":
1
McGuiness, Clare Frances. "Client perceptions : a useful measure of coordination of health care." View thesis entry in Australian Digital Theses Program, 2001. http://thesis.anu.edu.au/public/adt-ANU20020124.141250/index.html.
2
Fleming, Brian James. "The social gradient in health : trends in C20th ideas, Australian Health Policy 1970-1998, and a health equity policy evaluation of Australian aged care planning /." Title page, abstract and table of contents only, 2003. http://web4.library.adelaide.edu.au/theses/09PH/09phf5971.pdf.
3
Wang, Wei Chun, and wwang@swin edu au. "A comparison of alternative estimation methods in confirmatory factor analyses of the general health questionnaire across four groups of Australian immigrants." Swinburne University of Technology, 2005. http://adt.lib.swin.edu.au./public/adt-VSWT20051025.122616.
Анотація:
This thesis examines the implications of using different correlation input matrices and estimation techniques in confirmatory factor analyses (CFAs) when analyzing ordinal, nonnormal data derived from responses of recently arrived Australian immigrants to the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 is one of the most widely used instruments for determining wellbeing in populations. The response format of the GHQ-12 comprises four ordinal categories and underlying distributions of data obtained invariably do not approximate univariate or multivariate normality. Owing to these data properties, consideration should be given to the application of appropriate statistical approaches for analyzing this type of data sets. This study also investigates the extent to which the GHQ-12 is invariant across gender and cultural groups.
A three-dimensional measurement model for the GHQ-12 was initially examined for four groups of Australian immigrants who originated from Hong Kong (n = 201), Mainland China (n =213), former Yugoslavia (n = 259), and the United Kingdom (n = 428). A series of CFAs using either a Pearson�s product-moment or a polychoric correlation input matrix and employing either maximum likelihood (ML), weighted least squares (WLS) or diagonally weighted least squares (DWLS) estimation methods was conducted on the data. A comparison of the parameter estimates and goodness-of-fit statistics obtained for the different analyses provided support for using polychoric correlation input matrices and DWLS estimation in CFAs when analyzing ordinal, nonnormal data with smaller sample sizes.
Invariance tests across gender and cultural groups were conducted on a second-order measurement model for the GHQ-12, culminating in significant differences between the two Asian and two European cohorts. The GHQ-12 was invariant for immigrants from Hong Kong and Mainland China, as well as for males and females from the United Kingdom. Partial invariance of the GHQ-12 was found for immigrants from Asia, the United Kingdom, and former Yugoslavia and for Asian males and females.
Findings from the present study suggest that estimating models based on nonnormal ordinal responses using polychoric correlations with DWLS is more likely to result in a solution with higher parameter estimates and better indices of fit than other approaches. Further research should be conducted on real and simulated data to investigate the efficacy of WLS and DWLS estimation in CFAs when using polychoric correlations as the input data for varying categorical response formats, with a range of model and sample sizes.
4
Polimeni, Anne-Maree, and Anne-Maree Polimeni@dhs vic gov au. "Narrative of women's hospital experiences the impact of powerlessness on personal identity." Swinburne University of Technology, 2004. http://adt.lib.swin.edu.au./public/adt-VSWT20050309.143640.
Анотація:
Since women dominate the health care system as consumers, it is important to understand how women want to be treated by medical staff, and the factors that contribute to satisfactory hospital experiences. The present research comprised two separate but integrated studies exploring these issues. The first study adopted an
atheoretical approach. Qualitative and quantitative methods were used to examine the
importance of hospital experiences in the lives of women, and the role of power within those experiences. Closed answer items about hospital experiences were completed by 124 women who had had a hospital stay of at least one night. In addition, ten of the women provided open-ended oral and written comments about their hospital
experiences, which were used as the basis of the qualitative data. The majority of the women were satisfied with their hospital stay, but a small group recalled experiences of powerlessness associated with the non-medical aspects of their treatment, such as behaviours on the part of health professionals that influenced participants� sense of control as hospital inpatients. The qualitative data reflected similar issues to the quantitative data and provided �process� information by demonstrating how health professionals� behaviour could contribute to patients� feelings of powerlessness. The results suggested that hospital experiences were a salient part of these women�s lives. The richness of the qualitative data suggested that qualitative methodology would be a productive way to further study this area.
The second study was an extension of the first via in-depth interviews with 19 women who perceived their hospital experiences as life-altering. The interview content and the analysis were based on a narrative approach that used the theoretical framework of McAdams� (1993) Life Story Model of Identity. Using McAdams� methodology enabled the researcher to evaluate how women constructed meaning from their hospital
experiences, and the main issues they faced. The life story interview also proved a useful way to explore issues of loss and self-growth in the face of traumatic hospital experiences. Transcripts of descriptions of positive and negative experiences were analysed according to McAdams� themes of agency (sense of power and control) and communion (relationships with others), and sequences of redemption and
contamination. Redemption sequences involve the storyline moving from a bad, affectively negative life scene, to a good, affectively positive life scene. In a contamination sequence, the narrator describes a change from a good, affectively
positive life scene, to a subsequently bad, affectively negative life scene (McAdams & Bowman, 2001). Participants also rated their experiences according to Hermans� (Hermans & Oles, 1999) list of affects. There was strong agreement between McAdams� coding of agency and
communion and Hermans� agentic and communal indices: the women�s hospital stories strongly emphasised the negative or opposite of McAdams� agentic theme �Self Mastery through Control�, which indicated powerlessness, and Hermans� affects, which involved low self-enhancement. It may be useful for future studies to conceptualise
McAdams� themes as bipolar by incorporating currently coded themes and their reverse; in particular, by expanding ideas of agency to incorporate powerlessness, as this theme was pervasive in women�s hospital experiences. The rating of affects added to the findings as this showed a latent dimension of communion manifested as isolation. The common agency and communion themes were apparent in the two distinct but related aspects of hospitalisation that affect patients� sense of control: the medical condition and the manner in which patients are treated by medical staff. The findings of the main study built on the pilot study by showing how ideas of control and powerlessness can inform better practice. For example, respectful, dignified and fair treatment by health professionals played a part in determining redemption sequences; women also indicated this was how they wanted to be treated. Due to the vulnerability of the �sick role�, disrespectful or offhand treatment by health professionals had particularly distressing effects evident in contamination sequences, such as negative changes to sense of self and attitudes toward the health care system. In some cases, such treatment led to participants� avoiding subsequent interactions with doctors and to sustained feelings of helplessness. The present thesis demonstrates that doctors, nurses
and other health professionals need to allow time to attend to the affective as well as the medical aspects of the encounter. Health professionals need a good bedside manner, compassion, and communication skills, as these characteristics play a part in maintaining female patients� sense of self and their faith in and satisfaction with the health care system.
5
Walton, Merrilyn. "A multifactorial study of medical mistakes involving interns and residents." Thesis, School of Public Health, 2004. http://hdl.handle.net/2123/9309.
6
Kelman, Christopher William, and christopher kelman@cmis csiro au. "Monitoring Health Care Using National Administrative Data Collections." The Australian National University. National Centre for Epidemiology and Population Health, 2001. http://thesis.anu.edu.au./public/adt-ANU20020620.151547.
Анотація:
With the inevitable adoption of information technology into all areas of human pursuit, the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation.
¶
Evaluation of health services has become increasingly important to provide indicators of the benefits, risks and cost-effectiveness of treatments. However, if administrative data are to be used for this purpose, several questions must first be addressed: Are the current data collections accessible? What outcome measures can be derived from these data? Can privacy issues be managed? Could the quality of the data be improved? Is the existing infrastructure adequate to supply data for evaluation purposes? Could the existing system provide a basis for the development of an integrated health information system?
¶
The aims of the project were:
· To examine the potential for using administrative data to generate outcome measures and surveillance indicators.
· To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework.
· To compare the Australian health-service data system with the current international state-of-the-art.
· To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity.
¶
The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. The potential to evaluate outcomes was investigated using all national health-service information currently available in electronic form. Record linkage techniques were used to combine and augment the existing data collections. Australias national health databases are to varying degrees, amenable to such linkage and cover doctor visits, pharmaceuticals, hospital admissions and deaths. The study focused on medical devices as an illustrative case but the results are applicable to the routine assessment of all medical and surgical interventions.
¶
For the Australian Medical Devices study, the records of 5,316 patients who had medical device implants in 1993-94 were selected from the archives of a major private health insurer. Five groups of medical implants were studied: heart valves, pacemakers, hips, vascular grafts and intra-optic lenses. Outcomes for these patients, including death, re-operation and health service utilisation, were compared and analysed.
¶
A comparison study was performed using data from the Manitoba Health database in Winnipeg, Canada. Manitoba provides a very similar demographic group to that found in Australia and is an example of a prototype integrated-health-information system. One of the principal advantages for research is that personally identified data about medical and hospital services are collected for all patients. Selection bias is eliminated because individual consent is not required for this type of research and all selected patients could be included in the study.
¶
The two studies revealed many barriers to the use of administrative data for health outcomes research. Service event data for the Australian cohort could be collected but only after long delays and hospital morbidity data were not available for the entire cohort. In contrast to the situation in Australia, the Manitoba data were both accessible and complete, but were lacking in detail in some areas.
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Analysis of the collected data demonstrated that without the addition of clinical data only general indications of trends could be deduced. However, with minimal supplementary clinical data, it was possible to examine differences in performance between brands of medical devices thus indicating one of the uses for this type of data collection.
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In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). The need for the establishment of a systemic quality management system for health care is discussed.
¶
The study shows that linked administrative data can provide information about health outcomes which is not readily available from other sources. If expanded and integrated, the system that is currently used to collect and manage administrative data, could provide the basis for a national health information system. This system would provide many benefits for health care. Benefits would include the monitoring, surveillance and cost-effectiveness analysis of new and existing treatments involving medical devices, drugs and surgical procedures. An integrated health information system could thus provide for both clinical and administrative needs, while in addition providing data for research.
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Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures.
¶
Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.
7
Munns, Ailsa M. "Young families' utilisation, self-perceived requirements, and satisfaction with child health services in the City of Belmont, Western Australia." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/1426.
Анотація:
The expectations of young families regarding care they would like to receive from community nurses working in the child health area is affected by the relationship between those expectations, utilisation and sociocultural factors such as family type, family composition and ethnicity. These factors influence family dynamics, needs, functioning and interactions with the wider community. A descriptive study with both quantitative and qualitative components was used to identify and analyse the self-identified requirements of young families utilising Child Health Services in the Belmont area, Western Australia, and their patterns of utilisation. Twenty five women who had a child or children under 5 years of age were interviewed. The study was guided by a conceptual framework provided by the Ottawa Charter (World Health Organisation-Health and Welfare Canada-Canadian Public Health Organisation, 1996). The three main themes that emerged from the data showed that the young families identified knowledge acquisition, reassurance of normal growth and development and accessibility as their key self-perceived requirements of Child Health Services. Family type, family composition and ethnicity were examined within the contexts of these themes, resulting in a greater understanding of the child health issues relating to all types of family groups. The challenge for the providers of Child Health Services is to provide culturally appropriate Child Health Services based on the principles of primary health care within an environment experiencing fiscal restraint The long term benefits to the families and the health care system are not easily evaluated but have important and wide ranging positive effects on the health and wellbeing of the community.
8
Cardona-Morrell, Magnolia. "Evaluation of a Community-wide Diabetes Prevention Program." Phd thesis, University of Sydney, 2011. http://hdl.handle.net/2123/8349.
Анотація:
This thesis is an evaluation of the effectiveness of a community-wide diabetes prevention program conducted in three Divisions of General Practice in Sydney, Australia. The aims were to assess whether translation of diabetes prevention programs was feasible in real-life settings and whether results achieved were comparable with those of randomised trials on which this intervention was based. Its primary goals were to assess whether the lifestyle intervention could increase participation in moderate-to-vigorous physical activity to 210 minutes per week, reduce total fat and saturated fat consumption to 30% and 10% of total daily energy intake, increase fibre consumption to 15 g/1,000 kcal/day, and lead to 5% weight loss over one year. The background section covers the physiopathology of type 2 diabetes, its risk factors, and the available population screening tools to identify people at risk. The growing morbidity and mortality burden, the economic implications of this public health problem, and the importance and feasibility of preventing or delaying the onset by intervening in the precursor stages are then summarised. Evidence for preventability is examined through a literature review of lifestyle interventions in research settings comprising highly structured and closely monitored physical activity and dietary programs under controlled conditions. Examples of the effectiveness of translation of randomised controlled trials (RCTs) into less stringent programs in community settings such as workplaces, churches, indigenous communities and whole-of-country initiatives are presented. A systematic review and meta-analysis of effectiveness of the lifestyle approaches in routine clinical practice supplements the evidence for application of prevention principles in real-life settings. The main chapters of the thesis centre on process and impact evaluation of the semi-structured Sydney-based intervention, which recruited 1,250 participants from the mainstream Australian 29 public using general practitioner services in the study area, who were followed for 12 months. The intervention’s goals aligned with those of the Finnish Diabetes Prevention Program but with less stringent entry criteria and less intensive intervention components delivered by purpose-trained lifestyle officers. The Program included an initial individual assessment and coaching session, three subsequent group sessions in the following three months, then three follow-up coaching calls at three, six and nine months. A final assessment at one year, using the same objective and self-reported measures as in the initial assessment, captured changes in body weight, physical activity and dietary habits. The process evaluation showed that it is feasible and effective to use targeted screening to identify and recruit high-risk individuals into a free-of-charge program in the general practice setting, however a quarter of participants were lost to follow-up by one year. While minor variations in aspects of the Program were required to meet local need, Program fidelity in delivering components, and self-reported adherence to diet and physical activity was high. Using a before-after study design, the impact evaluation measured 1-year changes in key Program parameters in relation to baseline. These comprised: measured weight, waist circumference, BMI, and glycaemia measurements; and self-reported dietary intake and structured physical activity, using a 3-day food record and the Physical Activity Scale for the Elderly (PASE) questionnaire, respectively. The main findings at 12 months for the 586 completers as at December 2010 were: a mean weight loss of 2.1 kg; waist circumference reduction of 2.5 cm; no significant change in glycaemia; 3% reduction of fat and saturated fat intake; 16% increase in fibre intake; and mean increase in moderate-to-vigorous physical activity of 13.7 minutes/week. All these changes were smaller than those achieved by the RCTs in research settings, most likely due to the lower intensity and monitoring of the Sydney intervention. Weight loss and waist circumference reductions were similar for participants in 30 group session and those who received telephone-only coaching. Diabetes incidence was 1% at the end of the first year. An economic appraisal of the Program implementation completes the evaluation. A cost of A$400 per kg lost among people achieving the weight goal was estimated on Program completion, but the cost was double for the overall group that included non weight losers. The cost of achieving the physical activity goal and the dietary goals was not feasible or sustainable with resources available in routine clinical settings. The costs per outcome were similar for participants not attending group sessions, who received only telephone coaching. Hence it is worth exploring this less labour-intensive modality if a general practice based Program were to be delivered as routine preventive care. In sum, the evaluation of this community-wide diabetes prevention program showed that translation of diabetes prevention programs into routine practice, while feasible at less intensive levels than in RCTs, has a somewhat lower effect on diabetes risk reduction and it can still be a financial burden in clinical settings. However, given the potential for population-wide benefit, the effectiveness of alternative delivery modes, number and duration of program components and more targeted patient sub-groups should be investigated.The Sydney Diabetes Prevention Program was funded by New South Wales Health as part of the Australian Better Health Initiative. Financial contribution and other in-kind support were provided by the Sydney South West Area Health Service and the Australian Diabetes Council -NSW.
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Esgin, Tuguy. "Evaluation of acceptance and efficiency of exercise for Indigenous Australians to benefit physiological, anthropometric and metabolic syndrome outcomes." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2017. https://ro.ecu.edu.au/theses/2003.
Анотація:
The proposed study will provide an increased understanding in a much-understudied area of how the Australian Indigenous community perceives physical activity and the beneficial effects for improving health outcomes.
The PhD will be made up of three studies:
1) To design an exercise prescription that is culturally appropriate and specifically addresses the major Indigenous health issues around metabolic syndrome.
The first will be a cross sectional study that surveys the motivators and barriers to physical activity within the Perth Noongar community. The results of this study will be used to enhance the intervention section of the PhD. It will provide a more accurate and the best means of ensuring not only a greater uptake, but also ways of developing positive lifelong physical activity habits.
2) Determining the amount of physical activity taking place within the Noongar community.
Utilising the Global Physical Activity Questionnaire to measure the amount of physical activity and sedentary rates within the Indigenous community.
3) Evaluate the compliance and effectiveness of the developed intervention to inform future exercise therapy programmes for this population.
The second study will be a randomised control trial looking at the physiological responses to a combination of aerobic and anabolic (resistance) exercise. The significance of this aspect of the PhD will be to capture and record physiological and quality of life measures some not previous recorded in the Indigenous community. This will inform policy relation to the most appropriate targets for eliciting successful behaviour change to improve health in Indigenous and non-Indigenous populations
10
Davey, Peter J. "Municipal Public Health Planning and Implementation in Local Government in Queensland." Thesis, Griffith University, 2007. http://hdl.handle.net/10072/365756.
Анотація:
The furious pace of global urbanisation has serious impacts on the long-term sustainability and health of the local communities in which we live. The debate about relationships between population size, environmental management and human well-being must now encompass the fundamental concept of sustainability (Rees, 1992; WCED, 1990; McMichael, 2002; Hancock, 1996). Increasingly, the local municipal level is the most influential setting in which to change our relationship with the environment (Chu, 1994; Chu et al., 2000).
In the 1980s, the World Health Organisation (WHO) met this global challenge by advocating healthy public policy and laying foundations for its global Healthy Cities Movement. Significant support developed in the early nineties for participatory health planning action in local government: over 2000 cities world-wide developed municipal public health plans (MPH Plans). The Healthy Cities Movement through regional networks of cities and towns encouraged government partnerships with non-government agencies and industry, to anticipate and mitigate urbanisation’s negative impacts. In Queensland eighteen local governments have developed and implemented MPH Plans using a seven-step process (Chapman and Davey, 1997; WHO (1997b) to improve local planning for health and address the social determinants of health through agency collaboration.
There is however limited understanding and evidence of the success factors for the effective implementation of MPH Plans. Studies of the evaluation of Municipal Public Health Planning (MPHP) approaches have focused predominately on the evaluation of the process of planning, without conducting comprehensive evaluation of its implementation. The organisational barriers that contribute to ineffective health-planning implementation have not been well researched and documented. Here lies the gap in the research: MPHP requires thorough qualitative assessment, not only of the planning process, but also the implementation impacts.
This research explores the achievements, barriers and success factors associated with MPHP implementation in local government organisations by developing a process and impact evaluation framework and applying it to two MPHP projects in Queensland: one, local planning in an expanding tourist city of over 400,000 people; the second, a regional approach involving two provincial cities with a combined population of 100,000 residents. The research examines the degree of collaboration resulting from health planning and assesses if the aims of the MPH Plans have been met. MPHP is both a health promotion tool and a strategic business planning process applied in local communities: this research seeks to understand more about organisational strategic management issues that act as barriers to planning or impact on the success of planning outcomes.
This study design uses qualitative methods with a triangulation approach to analyse and understand the complexities of MPH Plan implementation. Grounded theory provides a methodology for interpreting meanings and discovering themes from the comprehensive process and impact evaluation consisting of preliminary cases studies, key informant interviews, using specific process and impact indicator questions and an analysis of MPHP models compared to other CPHP models and legislative frameworks. The impacts of the intervention are discussed and relate to the implementation effects of MPHP on individuals and organisations including council, government and non-government agencies and on the community.
Achievements and barriers associated with MPHP are identified and discussed. Three main factors emerged. Firstly, MPHP had significantly increased the degree of intersectoral collaboration between the agency project partners, with particular success in clarifying the role of agencies in the management and delivery of public health services. The principles of successful partnerships need to be further articulated in local government settings to successfully implement MPHP. Secondly, positive political and organisational support was found to be a critical factor in the success of the planning implementation. Thirdly, and most importantly, the aims of the MPHP had not been substantially met due to a lack of financial and human resources. The study concluded that, although MPHP has strengths and weaknesses compared to other CPHP models, its features most suit local government.
Success factors recommended for effective MPHP include formalising collaboration and partnerships and improved agency organisational governance in planning; building individual and organisational capacity to strengthen strategic planning; integrating the many layers of regulatory planning in local government and other agencies; sustaining planning structures and processes through regulation and commitment to investment in implementation stages of MPHP. The study’s major recommendation is that, for MPHP local government should facilitate a three-dimensional platform approach: healthy governance – long-term vision, recognising the many layers of planning, supported by state legislation and local industry and with awareness of legislative planning frameworks; a platform mechanism – sustaining agency networking, hosting the stakeholder forum, supporting the advisory committee, enhancing communication; and strategy implementation – in the context of an improved understanding of organisational behaviour, local government and agencies must action priority strategies, formalising agency partners responsibility, articulating desired outcomes, monitoring progress and evaluation.
This recommended Platform Approach to MPHP provides an effective model for managing and implementing future MPH Plans, allocating resources three ways: to build people’s capacity to engage in planning mechanisms, to build organisational capacity to manage planning outcomes and to build more effective Healthy Cities planning approaches. The MPHP evaluation framework developed in this thesis could be used to evaluate other MPHP projects in local governments both in Australia and internationally.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Centre for Environment and Population Health
Faculty of Environmental Sciences
Full Text
Книги з теми "Public health Australia Evaluation":
1
Geddes, Sylvia. Evaluation of the administration of the Local Capital Works Program: A report for the Commonwealth Department of Health, Housing, Local Government, and Community Services. Woden, ACT: S. Geddes and Associates, 1993.
2
Christopher, Reynolds. Public health law in Australia. Sydney: Federation Press, 1995.
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Lawson, James S. Public health Australia: An introduction. 2nd ed. Sydney: McGraw-Hill, 2001.
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Lewis, Milton James. The people's health: Public health in Australia. Westport, Conn: Praeger, 2003.
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Looper, Michael De. International health: How Australia compares. Canberra: Australian Institute of Health and Welfare, 1998.
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Dugdale, Paul. Doing health policy in Australia. Crows Nest, N.S.W: Allen & Unwin, 2008.
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George, Janet. States of health: Health and illness in Australia. 3rd ed. South Melbourne, Vic: Addison Wesley Longman, 1998.
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Davis, Alan G. States of health: Health and illness in Australia. 2nd ed. Pymble, Australia: HarperEducational, 1993.
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Davis, Alan G. States of health: Health and illness in Australia. Sydney: Harper & Row Publishers, 1988.
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Australian Centre For Health Research. Health care in Australia: Prescriptions for improvement. South Melbourne, Vic: Australian Centre for Health Research, 2011.
Частини книг з теми "Public health Australia Evaluation":
1
Cooper, B., H. Dilling, S. Kanowski, and R. Remschmidt. "Die wissenschaftliche Evaluation psychiatrischer Versorgungssysteme: Prinzipien und Forschungsstrategien." In Public health, 497–513. Berlin, Heidelberg: Springer Berlin Heidelberg, 1991. http://dx.doi.org/10.1007/978-3-642-84312-9_32.
2
Thunhurst, Colin. "Policy Formulation, Planning, and Evaluation." In Public Health Intelligence, 147–68. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-28326-5_8.
3
Lewis, Deborah. "Evaluation for Public Health Informatics." In Health Informatics, 239–50. New York, NY: Springer New York, 2003. http://dx.doi.org/10.1007/0-387-22745-8_12.
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Fu, Paul C., Herman Tolentino, and Laura H. Franzke. "Evaluation for Public Health Informatics." In Health Informatics, 233–54. London: Springer London, 2013. http://dx.doi.org/10.1007/978-1-4471-4237-9_13.
5
Asante-Duah, Kofi. "Evaluation of Chemical Toxicity." In Public Health Risk Assessment, 137–72. Dordrecht: Springer Netherlands, 2002. http://dx.doi.org/10.1007/978-94-010-0481-7_7.
6
Raspe, H. H., W. Mau, and A. Wasmus. "Treatment Profiles in Different Groups of Rheumatoid Arthritis Sufferers: Description, Analysis, Evaluation." In Public health, 533–42. Berlin, Heidelberg: Springer Berlin Heidelberg, 1991. http://dx.doi.org/10.1007/978-3-642-84312-9_34.
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Villari, Paolo, Erica Pitini, Elvira D’Andrea, and Annalisa Rosso. "Evaluation of Predictive Genomic Applications." In SpringerBriefs in Public Health, 33–55. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-52399-2_3.
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Dawson, Angela J. "Evaluation Research in Public Health." In Handbook of Research Methods in Health Social Sciences, 333–54. Singapore: Springer Singapore, 2019. http://dx.doi.org/10.1007/978-981-10-5251-4_71.
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Dawson, Angela J. "Evaluation Research in Public Health." In Handbook of Research Methods in Health Social Sciences, 1–23. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-10-2779-6_71-1.
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Jongen, Crystal, Janya McCalman, Roxanne Bainbridge, and Anton Clifford. "Multilevel Cultural Competence Intervention Implementation and Evaluation Framework." In SpringerBriefs in Public Health, 127–33. Singapore: Springer Singapore, 2017. http://dx.doi.org/10.1007/978-981-10-5293-4_9.
Тези доповідей конференцій з теми "Public health Australia Evaluation":
1
Chiu, Vivian, Kaitlyn Harper, and Janni Leung. "Trends and Associates of Non-Medical Prescription Opioid Use in Australia." In The 3rd International Electronic Conference on Environmental Research and Public Health —Public Health Issues in the Context of the COVID-19 Pandemic. Basel, Switzerland: MDPI, 2021. http://dx.doi.org/10.3390/ecerph-3-09071.
2
Putra, Sinar Perdana, Yulia Lanti Retno Dewi, and RB Soemanto RB. Soemanto. "The Effectiveness of Web-Based Health Promotion Intervention on Fruits Consumption in Children in America, Australia, And Europe." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.02.47.
Анотація:
Background: Internet-based interventions for multiple health behavior appear to be promising in changing unhealthy behaviour, such as low fruits consumption in adolescents. In addition, the use of internet technology is particularly relevant to children and adolescents, who are the major users of such technology. This study aimed to examine the effectiveness of web-based health promotion intervention on fruits consumption in children in America, Australia, and Europe. Subjects and Method: This was a meta-analysis and systematic review. The study was conducted by collect the published articles from PubMed, Science Direct, Research Gate, and Google Scholar electronic databases, from 2013 to 2020. The inclusion criteria were full text, randomized controlled trial (RCT), and web-based health promotion intervention. The study subject was children aged 2-6 years. The study outcome was fruits consumption. The articles were analyzed by PRISMA flow chart and Revman 5.3 program. Results: 6 articles had high heterogeneity between experiment groups (I2= 96%; p<0.001). Therefore, this study used random effect model (REM). Web-based health promotion intervention increased fruits consumption behavior 0.64 times in children (Mean Difference= 0.64; 95% CI= 0.07 to 1.20; p= 0.030). Conclusion: Web-based health promotion intervention increases fruits consumption behavior. Keywords: web-based health promotion intervention, fruit intake Correspondence: Sinar Perdana Putra. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: perdanasinarp@gmail.com. Mobile : +6285727777227. DOI: https://doi.org/10.26911/the7thicph.02.47
3
Jagoda, E. T., E. A. K. K. Edirisinghe, and M. K. D. L. Meegoda. "EVALUATION OF SERVICE QUALITY IN NURSING AND PATIENT SATISFACTION: PERCEPTION OF PATIENTS AND STUDENT NURSES." In Global Public Health Conference. The International Institute of Knowledge Management - TIIKM, 2019. http://dx.doi.org/10.17501/26138417.2019.2105.
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Hidajah, Atik Choirul, Arina Mufida Ersanti, and Hari Basuki Notobroto. "EVALUATION OF “SIMPLE WEB” DEVELOPMENT BASED ON THE DeLone AND McLean MODEL." In International Conference on Public Health. The International Institute of Knowledge Management (TIIKM), 2018. http://dx.doi.org/10.17501/icoph.2017.3205.
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Langi, Gaby G., S. Raharto, and Riris A. Ahmad. "EVALUATION OF IRON SUPPLEMENTATION PROGRAM FOR PREGNANT WOMEN IN GUNUNGKIDUL, INDONESIA, 2015." In International Conference on Public Health. The International Institute of Knowledge Management (TIIKM), 2018. http://dx.doi.org/10.17501/icoph.2017.3211.
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Donna Lubis, Lokot. "Histopathologic Evaluation of The Phyllodes Tumor." In 1st Public Health International Conference (PHICo 2016). Paris, France: Atlantis Press, 2017. http://dx.doi.org/10.2991/phico-16.2017.6.
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Cutwardani, Kusuma, Atik Choirul Hidajah, and Sigunawan Sigunawan. "Evaluation of Dengue Hemorrhagic Fever Surveillance System." In The 2nd International Symposium of Public Health. SCITEPRESS - Science and Technology Publications, 2017. http://dx.doi.org/10.5220/0007514803960402.
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Kamaruzaman, Hanin Farhana, Atikah Shaharudin, Sharifa Ezat Wan Puteh, Zafar Ahmed, and Junainah Sabirin. "BONE TARGETING AGENTS IN PREVENTION OF SKELETAL-RELATED EVENTS IN METASTATIC CANCERS OF SOLID TUMOURS: AN ECONOMIC EVALUATION." In International Conference on Public Health. The International Institute of Knowledge Management (TIIKM), 2019. http://dx.doi.org/10.17501/23246735.2019.5102.
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Nurhidayah, Jumratul, and Ani Margawati. "Evaluation of Public Health Nursing Program: A Systematic Review." In The 5th International Conference on Public Health 2019. Masters Program in Public Health, Universitas Sebelas Maret, 2019. http://dx.doi.org/10.26911/theicph.2019.04.65.
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Avriantini, Vina Sri, and Amal Chalik Sjaaf. "Evaluation of Nurses Need Planning: A Systematic Review." In The 6th International Conference on Public Health 2019. Masters Program in Public Health, Graduate School, Universitas Sebelas Maret, 2019. http://dx.doi.org/10.26911/the6thicph-fp.04.40.
Звіти організацій з теми "Public health Australia Evaluation":
1
Dow, William, Jessica Holmes, Tomas Philipson, and Xavier Sala-i-Martin. Disease Complementarities and the Evaluation of Public Health Interventions. Cambridge, MA: National Bureau of Economic Research, August 1995. http://dx.doi.org/10.3386/w5216.
2
Walsh, D. Illinois department of public health H1N1/A pandemic communications evaluation survey. Office of Scientific and Technical Information (OSTI), September 2010. http://dx.doi.org/10.2172/990518.
3
Codd, Heather, Leslie Fierro, Ann Marie Castleman, Robin Kuwahara, Maureen Wilce, Sarah Gill, Ayana Perkins, et al. Planting the Seeds for High-Quality Program Evaluation in Public Health. National Center for Environmental Health ( U.S.), August 2021. http://dx.doi.org/10.15620/cdc:110639.
Анотація:
Evaluation and evidence-informed decision making are central to public health practice. In recent decades, the professional discipline of evaluation has experienced tremendous growth that can be leveraged for use in public health. To meet the growing need for program evaluation training, the National Asthma Control Program presents the e-textbook Planting the Seeds for High-Quality Program Evaluation in Public Health. This free e-textbook is designed to help public health students and professionals understand evaluation approaches and techniques to improve public health programs.
4
Khan, M. E., Anvita Dixit, Jaleel Ahmad, and G. Pillai. Introduction of DMPA in public health facilities of Uttar Pradesh and Rajasthan: An evaluation. Population Council, 2015. http://dx.doi.org/10.31899/rh9.1076.
5
Wiecha, Jean L., and Mary K. Muth. Agreements Between Public Health Organizations and Food and Beverage Companies: Approaches to Improving Evaluation. RTI Press, January 2021. http://dx.doi.org/10.3768/rtipress.2021.op.0067.2101.
Анотація:
Efforts in the United States and abroad to address the chronic disease epidemic have led to the emergence of voluntary industry agreements as a substitute for regulatory approaches to improve the healthfulness of foods and beverages. Because of the lack of access to data and limited budgets, evaluations of these agreements have often been limited to process evaluation with less focus on outcomes and impact. Increasing scientific scope and rigor in evaluating voluntary food and beverage industry agreements would improve potential public health benefits and understanding of the effects of these agreements. We describe how evaluators can provide formative, process, and outcome assessment and discuss challenges and opportunities for impact assessment. We explain how logic models, industry profiles, quasi-experimental designs, mixed-methods approaches, and third-party data can improve the effectiveness of agreement design and evaluation. These methods could result in more comprehensive and rigorous evaluation of voluntary industry agreements, thus providing data to bolster the public health impacts of future agreements. However, improved access to data and larger evaluation budgets will be needed to support improvements in evaluation.
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S. Abdellatif, Omar, Ali Behbehani, and Mauricio Landin. Australia COVID-19 Governmental Response. UN Compliance Research Group, February 2021. http://dx.doi.org/10.52008/astr0501.
Анотація:
The International Health Regulations (2005) are legally binding on 196 States Parties, Including all WHO Member States. The IHR aims to keep the world informed about public health risks, through committing all signatories to cooperate together in combating any future “illness or medical condition, irrespective of origin or source, that presents or could present significant harm to humans.” Under IHR, countries agreed to strengthen their public health capacities and notify the WHO of any such illness in their populations. The WHO would be the centralized body for all countries facing a health threat, with the power to declare a “public health emergency of international concern,” issue recommendations, and work with countries to tackle a crisis. Although, with the sudden and rapid spread of COVID-19 in the world, many countries varied in implementing the WHO guidelines and health recommendations. While some countries followed the WHO guidelines, others imposed travel restrictions against the WHO’s recommendations. Some refused to share their data with the organization. Others banned the export of medical equipment, even in the face of global shortages. The UN Compliance Research group will focus during the current cycle on analyzing the compliance of the WHO member states to the organizations guidelines during the COVID-19 pandemic.
7
Rhodes, Joy. Exploring collaboration: a program evaluation of a mental health intervention in a public elementary school. Portland State University Library, January 2000. http://dx.doi.org/10.15760/etd.2365.
8
Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.
Анотація:
Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.
9
ROWE, M. D., R. C. KLEIN, and K. W. JONES. PRELIMINARY EVALUATION OF POTENTIAL OCCUPATIONAL AND PUBLIC HEALTH IMPACTS OF SEDIMENT DECONTAMINATION FACILITIES FOR NEW YORK/NEW JERSEY HARBOR. Office of Scientific and Technical Information (OSTI), July 1999. http://dx.doi.org/10.2172/755021.
10
Buck, J. W., G. M. Gelston, and W. T. Farris. Scoring methods and results for qualitative evaluation of public health impacts from the Hanford high-level waste tanks. Integrated Risk Assessment Program. Office of Scientific and Technical Information (OSTI), September 1995. http://dx.doi.org/10.2172/115734.