Queensland Health

Electronic Medical Records (EMRs) aim to improve efficiency, safety, and quality of care. However, the impact of EMR implementation, particularly in outpatient diabetes care, remains underexplored. This study explored clinicians' perspectives on EMR use in diabetes outpatient care. This qualitative study, conducted in line with COREQ guidelines, involved four focus groups with 22 clinicians (doctors, nurses, and allied health) at a metropolitan diabetes service in Queensland, Australia. Data were analysed using deductive content analysis, guided by the Quintuple Aim and Technology Acceptance Model/Unified Theory of Acceptance and Use of Technology frameworks. Clinicians reported mixed outcomes across the Quintuple Aim domains, shaped by technology adoption constructs. Facilitators such as improved efficiency, access to patient information, and prescribing safety reflected perceived usefulness and positive attitudes, contributing to favourable outcomes across multiple Quintuple Aim. Barriers such as navigation complexity, technical issues, alert fatigue, and overwhelming training led to negative outcomes in EMR use. Tensions around documentation practices and patient expectations of system use, resulted in mixed outcomes. Overall, clinicians viewed EMRs as essential, but sustained adoption required improved usability, tailored training, and better system integration. This study concludes that while the EMRs improved safety, efficiency, and access to information, their design and implementation also introduced burdens that negatively affected clinician experience. EMRs significantly shape the healthcare workforce, influencing workflow, wellbeing, and professional engagement. In outpatient diabetes care, specific workflow challenges such as glycaemic data integration highlight that existing EMR designs may not fully support the complexity of chronic disease management. To maximise benefits, EMR initiatives should be approached as quality improvement activities, with role-specific training, reliable infrastructure, and clinician involvement in system optimisation. Future research should address usability challenges, enhance integration, and ensure that both clinician and patient perspectives guide digital health transformation.

Bloodstream infections (BSIs) are an important complication among injured patients, yet existing studies have focused on selected populations or specific settings, limiting the generalisability of the findings. In this study, we conducted a population-based study to examine the incidence, demographic and clinical variation of injury-related BSIs. The study population consisted of all residents of Queensland, Australia, who developed an injury-related BSI identified between 1 January 2000 and 31 December 2019. The linked data used for this study consisted of three statewide databases of all public and private hospital admissions, public pathology data and deaths. ICD-10 AM codes for injuries (S00-T75 and T79) were used to identify hospitalisations for index injuries. Incidence rates were calculated by age, sex, geographic remoteness and socio-economic status using estimated residential population data and aggregated acute injury hospital episodes. Across 20 years, a total of 3205 injury-related BSI episodes occurred among 3188 individuals. The median age of this cohort was 63 years, with males accounting for 65 % of the population. The overall 30-day case-fatality rate was 13 %. During the study period, age-standardised rates increased from 2.47 to 4.62 per 100,000 population, with males experiencing higher rates than females. Patients from remote areas in Queensland had significantly higher rates compared to those from other regions. Additionally, age-specific rates increased with advancing age. Approximately two-thirds of the injury-related BSI episodes were hospital-onset. The most commonly identified pathogens among these patients were Staphylococcus aureus and Escherichia coli. This world-first population-based study on injury-related BSIs provides a comprehensive understanding of the incidence and variation by demographic and clinical characteristics. Injury-related BSIs differed across subgroups: males, remote area residents and older people had higher rates than females, urban/regional area residents and younger individuals. These findings provide a foundation for further work to target treatment and interventions to minimise the burden of injury-related BSIs.

Obstructive sleep apnoea (OSA) is common in Australia but underexamined among First Nations peoples. We conducted a retrospective cross-sectional analysis of 1563 adult sleep studies in South East Queensland (2022-2023). Thirty-eight participants (2.4%) identified as First Nations, of whom 74% had OSA. Comorbidities were more frequent among the First Nations cohort, though small sample size limited certainty. These findings reveal both under-identification of First Nations status and a substantial OSA burden, emphasising the need for culturally informed, community-led approaches to OSA care in Queensland.

Non-pharmaceutical interventions (NPIs) are central to mitigating COVID-19 and influenza, yet comparative economic evaluations remain scarce. This systematic review assessed the cost effectiveness and reporting quality of NPI evaluations across both diseases. The study was registered with PROSPERO (CRD42024552613). Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, we searched five medical (PubMed, Scopus, EMBASE, CINAHL, and EconLit) and four health technology assessment databases (NHS HTA, CRD DARE, NHS EED, and INAHTA) up to December 2025, including only full economic evaluations. The search strategy incorporated four domains-'influenza,' 'COVID-19,' 'NPIs,' and 'economic evaluation'-and was guided by the WHO NPI framework, encompassing five domains: personal protective, environmental, physical distancing, travel-related, and educational measures. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) checklist. Thirty-three studies (13 influenza, 20 COVID-19), predominantly from high-income countries, were included. School closures, the most frequently evaluated NPI, were generally not cost effective except during severe pandemics or bundled with other measures. Workforce and business closures were cost effective only in high-severity influenza, with inconsistent findings for COVID-19. Social distancing was cost effective for COVID-19 but not for H1N1 influenza. Isolation, lockdowns, and travel restrictions were cost effective only when implemented early. Face masks and hand hygiene, assessed solely for COVID-19, were generally cost effective when implemented alongside other measures. The median CHEERS score was 75.0%, with one study rated excellent. Our review highlights heterogeneity in cost effectiveness by pandemic severity, intervention type, bundling of measures, and timing. Strategies that combined low-cost NPIs like masks or hand hygiene demonstrated better value, while socially disruptive measures like school and business closure incurred high costs with inconsistent cost-effectiveness outcomes. Integration with vaccines or antivirals further enhanced cost effectiveness. Evidence gaps include the scarcity of evaluations from low-resource settings and variability in country-specific value thresholds. Addressing these gaps is essential for guiding efficient and cost-effective pandemic preparedness.

In the austral summer of 2021–2022, Australia experienced an unprecedented Japanese encephalitis virus (JEV) outbreak, with detections over 3000 km south of previous occurrences. Given the limited knowledge of JEV transmission ecology in Australia, we developed geospatial models of transmission risk to support the public health response. We created time-varying habitat suitability models for suspected mosquito vectors and ardeid hosts using month-scaled occurrence and covariate data from 2000–2023. Ardeid host presence-absence data were obtained from eBird and BirdLife Australia, with habitat suitability estimated using gradient-boosted regression tree models. A national dataset of Culex occurrences was compiled from mosquito surveillance records, literature, and biodiversity databases. Penalised logistic regression was used to model mosquito vector habitat suitability. Vector and host habitat predictions for the outbreak peak in February 2022 were rescaled using JEV infection locations in the public domain to create a combined habitat suitability surface. Our models aligned with detected JEV infections at the continental scale, highlighting transmission suitability across tropical northern Australia and major inland drainage basins in the East. Unlike existing models, we predicted lower suitability along the eastern seaboard, suggesting a delimiting effect of the Great Dividing Range. Our approach provides the most comprehensive and temporally dynamic models for JEV hosts and vectors in Australia, with a significantly larger vector dataset than previous studies. The novel method of rescaling host and vector outputs into a combined surface offers new insights into JEV transmission risk. Favourable conditions were repeated in 2023 with few detected infections, emphasising that JEV ecology in Australia remains poorly understood. This study’s results can support improvements in arbovirus surveillance systems, promoting earlier detection of circulating viruses. Increased focus on vector ecology and distributions is crucial for better understanding JEV transmission in Australia.

To provide a 10-year update on the best available evidence evaluating the impact of nurse practitioner services on cost, waiting times, patient satisfaction, representation rates, and length of stay in emergency and urgent care settings. Systematic review. The search was completed on January 28, 2025, in Embase (Elsevier), Medline (EBSCOhost), CINAHL (EBSCOhost), Cochrane Library (Wiley), Emcare (Ovid), Web of Science Core Collection (Clarivate) and Scopus (Elsevier). The data range (2014-2024) was used to limit the search. The search was conducted with results imported into Covidence. In Covidence, two reviewers conducted screening, data extraction, and quality appraisal of articles, and findings were analysed using a narrative synthesis approach. Eligible studies examined nurse practitioner services in emergency or urgent care settings, reporting outcomes of cost, waiting times, patient satisfaction, representation rates, and length of stay. Title and abstract screening were performed on 2329 records. Of these, 236 full-text articles were reviewed, and 17 underwent critical appraisal and data extraction. Narrative analysis of outcome measures yielded mixed results, with both favourable and unfavourable findings reported regarding nurse practitioner services. Global evaluation of nurse practitioner services in emergency care remains inconsistent. Nevertheless, emerging evidence supports their positive impact, particularly in improving patient outcomes. To effectively inform policy, workforce planning and clinical integration, there is a need for professional benchmarks that provide clear frameworks for the evaluation of patient-centred outcomes and operational impacts in emergency departments. Evidence related to nurse practitioner services in emergency and urgent care clinics highlights the positive impact of nurse practitioner services on patient wait times and satisfaction; however, there is limited and variable evidence of impact on health care costs and outcomes. This paper recommends that evaluating emergency nurse practitioner services requires homogeneous research using consistent professional benchmarks and evaluation frameworks. This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. This study did not include patient or public involvement in its design, conduct, or reporting. PROSPERO 2025 CRD420250645148.

To measure disability and frailty and assess measurement properties of the HIV Disability Questionnaire (HDQ) in outer regional Australian people living with human immunodeficiency virus (HIV). This cross-sectional, validity and reliability study included community-dwelling outer regional Australian adults with HIV. Participants completed the self-reported World Health Organization Disability Assessment Schedule 2.0 (WHODAS; scored 0-100), 5-Question Frail Scale (scored 0-5) and HDQ (scored 0-100). Median scores (Q1, Q3) for disability (WHODAS) and frailty (Frail Scale) were reported. HDQ validity was tested based on 16 a priori hypothesized relationships between WHODAS, Frail Scale and HDQ scores (threshold ≥75% confirmed), and HDQ internal consistency with Cronbach's alpha (acceptability threshold ≥ 0.70). Seven days after the initial completion, the HDQ was re-administered for test-retest reliability (intraclass correlation coefficient, acceptability threshold ≥ 0.75). Fifty participants were recruited, with a median age 55. Eighty-eight percent were male, and 38 participants completed the second HDQ. The median (Q1, Q3) scores were: WHODAS 9 (3,17), with domain scores ranging from 0 to 56. Pre-frailty (score 1-2) and Frailty (score 3-5) were present in 27% and 13% of participants, respectively. The HDQ demonstrated construct validity (81% hypotheses confirmed), internal consistency (Cronbach's alpha ≥ 0.79), except in the Episodic scale-Social inclusion domain (alpha = 0.34), and good test-retest reliability for all Presence and Severity domains (ICC range: 0.77-0.94). Disability, frailty and pre-frailty exist in this sample of outer regional Australians living with HIV. The HDQ showed acceptable construct validity, internal consistency and test-retest reliability to measure disability in this population. Australian New Zealand Clinical Trials Registry (ACTRN12623000090617).

It has long been recognised that the social context, including partner relationships, can impact the chronic pain experience and pain outcomes. The goal of this systematic review is to analyse, appraise and integrate the current evidence regarding the relationships between partner reactions to chronic pain behaviours and pain-related outcomes. A search was conducted using relevant terms across five databases (PubMed, PsycINFO, MEDLINE, CINAHL and EMBASE). To be included, studies had to: (1) be written in English; (2) report on adults (> 18 years) experiencing persistent pain (pain for over 3 months) who are in a relationship; (3) include a measure of partner response or perceived partner response; (4) include a measure of pain-related outcome (i.e., disability, pain severity, quality-of-life, functioning); and (5) report on the relationship between partner response and pain-related outcomes. Sixty-three studies were included in the final review. Findings revealed that solicitous and punishing partner responses were associated with deleterious pain-related outcomes. Only seven studies, which focused on either emphatic responses or partner autonomy support, found associations between partner responses and positive pain-related outcomes. Findings highlight the potential importance of partner responses for pain-related outcomes and suggest the value of improving partner understanding of pain and their capacity to respond constructively within their relationship context. This was the first systematic review to investigate associations between partner reactions and pain-related outcomes for people living with persistent pain. Based on the results of this review, new clinical interventions that consider the relational context and involve partners as active participants are needed in the chronic pain field. Interventions that assist partners to respond with empathy while encouraging autonomy may have promising results and warrant further investigation.