The demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a cli... more The demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a clinically meaningful improvement from TKA from others is a key challenge for orthopaedic surgeons. Decision aids can help surgeons select appropriate candidates for surgery, but their uptake has been low. The aim of this study was to explore the barriers and facilitators to decision aid uptake among orthopaedic surgeons. A qualitative study involving face-to-face interviews. Questions were constructed on the Theoretical Domains Framework to systematically explore barriers and facilitators. One tertiary hospital in Australia. Twenty orthopaedic surgeons performing TKA. Beliefs underlying similar interview responses were identified and grouped together as themes describing relevant barriers and facilitators to uptake of decision aids. While prioritising their clinical acumen, surgeons believed a decision aid could enhance communication and patient informed consent. Barriers identified includ...
Non-ST-segment elevation acute coronary syndromes include unstable angina and non-ST-segment elev... more Non-ST-segment elevation acute coronary syndromes include unstable angina and non-ST-segment elevation myocardial infarction. Most randomized controlled trials of routine versus selective invasive coronary angiography have high rates of crossover from control to intervention groups and do not include subgroup analysis for unstable angina. Consequently, no clear, specific recommendations exist regarding the use of angiography in unstable angina. To assess the effect of angiography on mortality in unstable angina, incorporating the results of additional cardiac procedures and events. Longitudinal study using hospital discharge data, discrete-time survival analysis with propensity score adjustment, and sensitivity analysis. Victoria, Australia, 2001 to 2011. All residents, all ages. Routine invasive coronary angiography. 12-month all-cause mortality. Emergently admitted patients with unstable angina (n = 33 901) who did or did not receive angiography during their first hospitalization ...
Medical care research and review : MCRR, Jan 3, 2016
This article reviews the literature on the use of financial incentives to improve the provision o... more This article reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to .5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared with other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone. Paying for performance improvement is less likely to be effective. Allowing payments to be used for specific purposes, such as quality improvement, had a higher likelihood of a positive effect, compared with using funding for physician income. Finally, the size of incentive payments relative to revenue was not associated with the proportion of positive...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2002
Against a background of government calls for a radical change in the way the medical workforce is... more Against a background of government calls for a radical change in the way the medical workforce is planned and trained, the concept of skill mix seeks to match clinical presentation to an intervention based on an appropriate level of skill and training. Health economics is not the only framework within which these changes can be analysed. However unless the economic issues are thought through clearly there is a danger that resources may be used inefficiently. The aims of this paper are to outline the economic issues in the area of doctor/nurse skill mix and the problems of obtaining correct solutions from the perspective of efficiency. It concludes by offering a pragmatic framework which can facilitate decisions in this area. Although this paper is written from the perspective of primary care, it is equally relevant to skill mix in the secondary care sector.
Objective Recent trends in primary care have seen closer working relationships between community ... more Objective Recent trends in primary care have seen closer working relationships between community pharmacists and general practitioners (GPs) in an attempt to improve the effectiveness and efficiency of prescribing. Community pharmacists are appropriate for a role in the management of prescribed medicines because of their detailed training in pharmacology, therapeutics and pharmaceutics. The aim of this project was to quantify the benefit of a general practice-based, community pharmacist-led, note-based medication review of patients with hypertension or angina. Method Trained community pharmacists (20), attached to Grampian general practices (43), reviewed repeat prescriptions of a random sample of patients taking cardiovascular drugs for the treatment of angina or hypertension, and made recommendations to the GP for changes, where appropriate. The effect of the pharmaceutical intervention was measured in terms of prescribing indicators, patient outcomes (quality of life, symptom con...
Remuneration has been cited as a factor influencing the distribution of doctors between generalis... more Remuneration has been cited as a factor influencing the distribution of doctors between generalist and specialist roles. To review the evidence on earnings differentials between specialists and GPs, and suggest possible policy responses. Specialists earn almost twice as much as GPs but only half of this difference can be explained by differences in their characteristics. Evidence suggests that expected future earnings, together with a range of other factors, influence specialty choice. Directly altering relative earnings may be difficult, but greater targeted investment in primary care is more achievable to help shift the balance.
Journal of Health Services Research & Policy, 2014
Objectives To examine nurses’ and midwives’ preferences for the characteristics of their jobs. Me... more Objectives To examine nurses’ and midwives’ preferences for the characteristics of their jobs. Methods A discrete choice experiment of 990 nurses and midwives administered as part of a survey of nurses and midwives in Victoria, Australia. Results Autonomy, working hours, and processes to deal with violence and bullying were valued most highly. Nurses and midwives would be willing to forgo 19% and 16% of their annual income for adequate autonomy and adequate processes to deal with violence and bullying, compared to poor autonomy and poor processes for violence and bullying. They would need to be paid an additional 24% to increase their working hours by 10% ($73 per hour). Job characteristics that were less important were shift work, nurse to patient ratios, and public or private sector work. Conclusions Policies to improve retention and job satisfaction of nurses and midwives should initially focus on autonomy, processes to deal with violence and bullying, and reasonable working hour...
Objective To determine Scottish community pharmacists' present involvement with ‘extended’ se... more Objective To determine Scottish community pharmacists' present involvement with ‘extended’ service provision, as outlined in ‘The right medicine’ policy document, as well as an insight into the attitudes of pharmacists in delivering such services. Setting All community pharmacists working in Scotland. Method A questionnaire was developed, piloted and refined before mailing to all community pharmacists working in Scotland (n = 1621). Two reminders were sent to non-responders. Data on current service provision was analysed using SPSS version 11 for windows. Key findings An overall response rate of 56.4% (914/1621) was achieved for pharmacists. The survey revealed that the majority of respondents either agreed or strongly agreed with the ‘key service areas’ being provided from community pharmacies. Some services were obviously agreed with more than others. In particular repeat dispensing and emergency hormonal contraception (EHC) were rated highly. Least agreement was provided for ...
An Early Discharge Program (EDP) for medically uncomplicated obstetrics patients operates from th... more An Early Discharge Program (EDP) for medically uncomplicated obstetrics patients operates from three hospitals in Sydney's western suburbs, Westmead Hospital, a large teaching hospital, and Auburn and Blacktown, which are smaller district hospitals. The patients are discharged home between 6 and 48 hours after delivery and visited in the home by midwives for up to 7 days after birth. This
Journal of Health Organization and Management, 2003
In the absence of central guidance on the development of integrated primary care organisations, a... more In the absence of central guidance on the development of integrated primary care organisations, a diversity of models is emerging. This paper examines the management arrangements of Scottish local health care co‐operatives (LHCCs). A postal questionnaire survey of all 79 LHCCs was conducted. The response rate was 35 per cent. LHCCs set up management bodies and created workgroups. Stakeholder representation was not socially inclusive: attempts to engage patients and local communities were limited and need to be stepped up to increase responsiveness and accountability to local health care users. LHCCs were also vehicles for local ownership and control of health care provision. To facilitate co‐operation among participating practices, LHCCs need to focus on issues of leadership, organisation, and involvement in decision making. Finally, management expenditure per capita was comparable with that of other types of integrated primary care organisations.
The demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a cli... more The demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a clinically meaningful improvement from TKA from others is a key challenge for orthopaedic surgeons. Decision aids can help surgeons select appropriate candidates for surgery, but their uptake has been low. The aim of this study was to explore the barriers and facilitators to decision aid uptake among orthopaedic surgeons. A qualitative study involving face-to-face interviews. Questions were constructed on the Theoretical Domains Framework to systematically explore barriers and facilitators. One tertiary hospital in Australia. Twenty orthopaedic surgeons performing TKA. Beliefs underlying similar interview responses were identified and grouped together as themes describing relevant barriers and facilitators to uptake of decision aids. While prioritising their clinical acumen, surgeons believed a decision aid could enhance communication and patient informed consent. Barriers identified includ...
Non-ST-segment elevation acute coronary syndromes include unstable angina and non-ST-segment elev... more Non-ST-segment elevation acute coronary syndromes include unstable angina and non-ST-segment elevation myocardial infarction. Most randomized controlled trials of routine versus selective invasive coronary angiography have high rates of crossover from control to intervention groups and do not include subgroup analysis for unstable angina. Consequently, no clear, specific recommendations exist regarding the use of angiography in unstable angina. To assess the effect of angiography on mortality in unstable angina, incorporating the results of additional cardiac procedures and events. Longitudinal study using hospital discharge data, discrete-time survival analysis with propensity score adjustment, and sensitivity analysis. Victoria, Australia, 2001 to 2011. All residents, all ages. Routine invasive coronary angiography. 12-month all-cause mortality. Emergently admitted patients with unstable angina (n = 33 901) who did or did not receive angiography during their first hospitalization ...
Medical care research and review : MCRR, Jan 3, 2016
This article reviews the literature on the use of financial incentives to improve the provision o... more This article reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to .5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared with other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone. Paying for performance improvement is less likely to be effective. Allowing payments to be used for specific purposes, such as quality improvement, had a higher likelihood of a positive effect, compared with using funding for physician income. Finally, the size of incentive payments relative to revenue was not associated with the proportion of positive...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2002
Against a background of government calls for a radical change in the way the medical workforce is... more Against a background of government calls for a radical change in the way the medical workforce is planned and trained, the concept of skill mix seeks to match clinical presentation to an intervention based on an appropriate level of skill and training. Health economics is not the only framework within which these changes can be analysed. However unless the economic issues are thought through clearly there is a danger that resources may be used inefficiently. The aims of this paper are to outline the economic issues in the area of doctor/nurse skill mix and the problems of obtaining correct solutions from the perspective of efficiency. It concludes by offering a pragmatic framework which can facilitate decisions in this area. Although this paper is written from the perspective of primary care, it is equally relevant to skill mix in the secondary care sector.
Objective Recent trends in primary care have seen closer working relationships between community ... more Objective Recent trends in primary care have seen closer working relationships between community pharmacists and general practitioners (GPs) in an attempt to improve the effectiveness and efficiency of prescribing. Community pharmacists are appropriate for a role in the management of prescribed medicines because of their detailed training in pharmacology, therapeutics and pharmaceutics. The aim of this project was to quantify the benefit of a general practice-based, community pharmacist-led, note-based medication review of patients with hypertension or angina. Method Trained community pharmacists (20), attached to Grampian general practices (43), reviewed repeat prescriptions of a random sample of patients taking cardiovascular drugs for the treatment of angina or hypertension, and made recommendations to the GP for changes, where appropriate. The effect of the pharmaceutical intervention was measured in terms of prescribing indicators, patient outcomes (quality of life, symptom con...
Remuneration has been cited as a factor influencing the distribution of doctors between generalis... more Remuneration has been cited as a factor influencing the distribution of doctors between generalist and specialist roles. To review the evidence on earnings differentials between specialists and GPs, and suggest possible policy responses. Specialists earn almost twice as much as GPs but only half of this difference can be explained by differences in their characteristics. Evidence suggests that expected future earnings, together with a range of other factors, influence specialty choice. Directly altering relative earnings may be difficult, but greater targeted investment in primary care is more achievable to help shift the balance.
Journal of Health Services Research & Policy, 2014
Objectives To examine nurses’ and midwives’ preferences for the characteristics of their jobs. Me... more Objectives To examine nurses’ and midwives’ preferences for the characteristics of their jobs. Methods A discrete choice experiment of 990 nurses and midwives administered as part of a survey of nurses and midwives in Victoria, Australia. Results Autonomy, working hours, and processes to deal with violence and bullying were valued most highly. Nurses and midwives would be willing to forgo 19% and 16% of their annual income for adequate autonomy and adequate processes to deal with violence and bullying, compared to poor autonomy and poor processes for violence and bullying. They would need to be paid an additional 24% to increase their working hours by 10% ($73 per hour). Job characteristics that were less important were shift work, nurse to patient ratios, and public or private sector work. Conclusions Policies to improve retention and job satisfaction of nurses and midwives should initially focus on autonomy, processes to deal with violence and bullying, and reasonable working hour...
Objective To determine Scottish community pharmacists' present involvement with ‘extended’ se... more Objective To determine Scottish community pharmacists' present involvement with ‘extended’ service provision, as outlined in ‘The right medicine’ policy document, as well as an insight into the attitudes of pharmacists in delivering such services. Setting All community pharmacists working in Scotland. Method A questionnaire was developed, piloted and refined before mailing to all community pharmacists working in Scotland (n = 1621). Two reminders were sent to non-responders. Data on current service provision was analysed using SPSS version 11 for windows. Key findings An overall response rate of 56.4% (914/1621) was achieved for pharmacists. The survey revealed that the majority of respondents either agreed or strongly agreed with the ‘key service areas’ being provided from community pharmacies. Some services were obviously agreed with more than others. In particular repeat dispensing and emergency hormonal contraception (EHC) were rated highly. Least agreement was provided for ...
An Early Discharge Program (EDP) for medically uncomplicated obstetrics patients operates from th... more An Early Discharge Program (EDP) for medically uncomplicated obstetrics patients operates from three hospitals in Sydney's western suburbs, Westmead Hospital, a large teaching hospital, and Auburn and Blacktown, which are smaller district hospitals. The patients are discharged home between 6 and 48 hours after delivery and visited in the home by midwives for up to 7 days after birth. This
Journal of Health Organization and Management, 2003
In the absence of central guidance on the development of integrated primary care organisations, a... more In the absence of central guidance on the development of integrated primary care organisations, a diversity of models is emerging. This paper examines the management arrangements of Scottish local health care co‐operatives (LHCCs). A postal questionnaire survey of all 79 LHCCs was conducted. The response rate was 35 per cent. LHCCs set up management bodies and created workgroups. Stakeholder representation was not socially inclusive: attempts to engage patients and local communities were limited and need to be stepped up to increase responsiveness and accountability to local health care users. LHCCs were also vehicles for local ownership and control of health care provision. To facilitate co‐operation among participating practices, LHCCs need to focus on issues of leadership, organisation, and involvement in decision making. Finally, management expenditure per capita was comparable with that of other types of integrated primary care organisations.
Uploads
Papers by Anthony Scott