General practice coordinated chronic disease management to reduce avoidable hospital admission

Chronic disease accounts for about 80 per cent of the total disease burden in Australia, and its management accounts for 70 per cent of all current health expenditure.1 Effective prevention and management of chronic disease requires a coordinated approach between primary health care, acute care services, and the patients.2 However, what is not clear is whether improvements in primary healthcare management can have a clear benefit in the cost of care of patients with chronic disease. We recently completed a pilot study in rural Western Australia to ascertain the feasibility of a coordinated general practice-based approach to managing chronic respiratory and cardiovascular conditions, and to determine the direct cost savings to the public insurer through reduction in avoidable hospital admission. The aim of this correspondence is to share our preliminary findings and encourage debate on how such a project may be scaled up or adapted to other primary healthcare settings.

The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: Development of an evidence-based global consensus

Foot problems complicating diabetes are a source of major patient suffering and societal costs. Investing in evidence-based, internationally appropriate diabetic foot care guidance is likely among the most cost-effective forms of healthcare expenditure, provided it is goal-focused and properly implemented. The International Working Group on the Diabetic Foot (IWGDF) has been publishing and updating international Practical Guidelines since 1999. The 2015 updates are based on systematic reviews of the literature, and recommendations are formulated using the Grading of Recommendations Assessment Development and Evaluation system. As such, we changed the name from 'Practical Guidelines' to 'Guidance'. In this article we describe the development of the 2015 IWGDF Guidance documents on prevention and management of foot problems in diabetes. This Guidance consists of five documents, prepared by five working groups of international experts. These documents provide guidance related to foot complications in persons with diabetes on: prevention; footwear and offloading; peripheral artery disease; infections; and, wound healing interventions. Based on these five documents, the IWGDF Editorial Board produced a summary guidance for daily practice. The resultant of this process, after reviewed by the Editorial Board and by international IWGDF members of all documents, is an evidence-based global consensus on prevention and management of foot problems in diabetes. Plans are already under way to implement this Guidance. We believe that following the recommendations of the 2015 IWGDF Guidance will almost certainly result in improved management of foot problems in persons with diabetes and a subsequent worldwide reduction in the tragedies caused by these foot problems.

Integrated resources management, integrated agriculture-aquaculture and the African farmer

Despite the expenditure of huge amounts of money and human effort, the Green Revolution has largely failed to benefit the vast majority of the rural poor in Africa: those smallholding farmers who sell little, if any, of what they grow and rely almost entirely upon natural soil fertility, rainfall and traditional broodstock and seed varieties. New approaches on food production and income generation in the rural areas must be found if this sector of agricultural community is to be assisted. Integrated resources management (IRM) in general, and integrated agriculture-aquaculture (IAA) in particular, may offer some solutions in cases where the classical methods of improving farm output have failed and/or been unsustainable.

The effects of new topical treatments on management of glaucoma in Scotland:An examination of ophthalmological health care

Background: The management of glaucoma has been changed in the past decade by the introduction of new drugs. The impact of these changes on clinical care of patients was examined by examining operation and prescribing rates for glaucoma in four geographical areas of Scotland for the years 1994 to 1999. Methods: A retrospective analysis of national health statistics: primary care prescribing data, hospital derived operation rates, consultant numbers, optometrist numbers, and eye test data, expressed by estimated population at risk of glaucoma. The outcome measures were prescribing volume and cost for glaucoma medications, and operation rates, corrected for population estimated to be at risk of glaucoma (PEG), for trabeculectomy, for Scotland as a whole, and for four geographical "regions" (north east, south east, central, and south west Scotland). Results: Prescribed items per 1000 population estimated to have glaucoma (PEG) increased by 24.9% between 1994 and 1999. This was above the general increase in prescribing in Scotland (17.8%). This increase varied in the four health regions evaluated (14.3% to 31.9%). Prescribing of topical ß blockers increased little (6.4%), but there was a large increase in the use of new products (topical prostaglandins, carbonic anhydrase inhibitors, and a agonists), at the expense of miotics (47.7% fall), and older sympathomimetics. This change in prescribing pattern was accompanied by a 61.5% increase in cost (range 42.2% to 73.4% in the four regions). New drugs accounted for more than half of total glaucoma expenditure in 1999. Operation rates (corrected for PEG) fell by 45.9% (range 43.1 to 58.6%) between 1994 and 1999. Other indicators suggested increased activity in ophthalmic areas (for example, cataract operations, eye tests, numbers of optometrists and ophthalmic surgeons all increased). Within north east Scotland operation rates decreased and prescribing increased less than in other regions, both from lowest regional baseline in 1994. Conclusions: The introduction of new drug classes has had dramatic effects on the prescribing of glaucoma treatments. There has been a decline in older treatments and an increase in new agents, which has been associated with a large reduction in operation rates for glaucoma in Scotland over 6 years. Comparison of prescribing and operation data indicates regional differences in healthcare delivery for glaucoma.

Report on the Expenditure of the Welland and Burlington Canals, 1830

This copy is signed in the upper left hand corner by Mr. Dickson. Mr. Robert Dickson was one of the directors of the Welland Canal Office. The report covers meetings which were held: January 15-16, and 19 of 1830. The meetings were attended by Messrs. Blacklock, Mackenzie, Woodruff, Longley and Hopkins. Balance sheets are also included within the report. The report of the Welland Canal Company for 1829 is also included within this document, and this is dated December 31, 1829. Names at the end of the 1929 report are members of the Welland Canal Office and they include: John Henry Dunn, president; Henry J. Boulton, vice-president and William Allan, George Keefer, John J. Lefferty and Robert Dickson who were directors The report is dated January 26, 1830, and submitted by Thomas Horner, chairman of the Commons House of Assembly.

Consumption Expenditure Pattern of Scheduled Caste Households of Kerala: a Study of Idukki District

The present study made an attempt to analyze the socio-economic background and the consumption pattern of scheduled caste households in Idukki district. The objectives of the study are to examine consumption pattern among the scheduled cast population, differences in the average consumption expenditure of different decile groups, consumption expenditure elasticity of items, variations in expenditure of SC households on food, non-food and total expenditure and to examine the association between consumption expenditure and variables such as income, education, occupation and area of residence. The study reveals that the Monthly Per Capita Expenditure of scheduled castes population in rural Kerala is lower than that of the general population. Average household size is higher in rural sector for Scheduled Caste in Kerala as well as all-India. The per capita expenditure of Scheduled Castes of rural Kerala is found to be much lower than that of general population. The study has found that the levels of livings of the Scheduled Castes are far the below the expectations. Large percentage of the Scheduled Caste belongs to the lower income groups. This is due their very low economic status and the consequent employment prospects in low paying occupations. The consumption standards of the majority of Scheduled Castes are found much below that of General population. Effective implementation of the Schemes for their economic upliftment is needed for improving their consumption standards, Minimum Wage Act in the case of agricultural labourers etc. are some of recommendations on the basis of this study.

Capital expenditure decision in private and public sector entreprises in India A comparative evaluation

This study is focussed on public and private sector The study is confined to industrial Public companies in the states of Kerala and Orissa along with companies in India. undertakings only. sector and private sector private sector companies in other states were studied. Even though the original plan of 190 companies as the sample size could not be accomplished, as the responses were very poor, but data could be collected frmn 6 public and 5 private sector companies in Kerala, 8 public and 8 private sector companies in Orissa along with 27 private sector companies in other states totalling to 54 companies. The number of years of data collected varies from 2 years to 6 years. Factors which are affecting capital expenditures and hence leading to the performance of private sector compared to public sector companies are studied. After the study and analysis, comparisons are made between public sector and private sector, and suitable recomendations are made so that public sector industries can also perform equally well as the private sector industries in India.

Proactive R&D management and firm growth: a punctuated equilibrium model

The external environment is characterized by periods of relative stability interspersed with periods of extreme change, implying that high performing firms must practice exploration and exploitation in order to survive and thrive. In this paper, we posit that R&D expenditure volatility indicates the presence of proactive R&D management, and is evidence of a firm moving from exploitation to exploration over time. This is consistent with a punctuated equilibrium model of R&D investment where shocks are induced by reactions to external turbulence. Using an unbalanced panel of almost 11,000 firm-years from 1997 to 2006, we show that greater fluctuations in the firm's R&D expenditure over time are associated with higher firm growth. Developing a contextual view of the relationship between R&D expenditure volatility and firm growth, we find that this relationship is weaker among firms with higher levels of corporate diversification and negative among smaller firms and those in slow clockspeed industries.

Technology acceptance and care self-management: consideration in context of chronic care management

With an aging global population, the number of people living with a chronic illness is expected to increase significantly by 2050. If left unmanaged, chronic care leads to serious health complications, resulting in poor patient quality of life and a costly time bomb for care providers. If effectively managed, patients with chronic care tend to live a richer and more healthy life, resulting in a less costly total care solution. This chapter considers literature from the areas of technology acceptance and care self-management, which aims to alleviate symptoms and/or reason for non-acceptance of care, and thus minimise the risk of long-term complications, which in turn reduces the chance of spiralling health expenditure. By bringing together these areas, the chapter highlights areas where self-management is failing so that changes can be made in care in advance of health deterioration.

Using a knowledge management evaluation framework for improving an ERP system - a Hong Kong construction industry case study

Organisations need to rely on leadership, information support and human capital in order to ensure a knowledge advantage over their competitors. Knowledge management (KM) provides organisations with sustainable competitive advantage, because it becomes extremely difficult for an organisation to cut expenditure and increase revenue by simply reengineering its business model. Project delivery and success has been traditionally viewed and measured as management of a three-legged stool, with the legs defined as cost, schedule and quality. However, KM can be linked to success by organisations becoming more effective as well as being more efficient.

This paper uses a KM framework, the Knowledge Advantage (K-Adv), developed initially for use by construction organisations. It assesses the impact of leadership and its supporting information communication technology infrastructure on the ability of people (by effectively creating, sharing, disseminating and using knowledge) to facilitate sustainable competitive advantage.

A case study that is presented is based upon the experience of a leading construction company using an Enterprise Resources Planning (ERP) system to demonstrate the effectiveness of KM from a cost management business unit perspective. Results are evaluated using a capability maturity model (CMM) - that forms the core of the K-Adv tool - to help improve processes that meet the needs of the organisation operating in a highly dynamic business environment. The case study is part of a broader doctoral research project that uses action learning to facilitate and measure ERP improvement.

Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia

Background. The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model.

Methods. A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented.

Results. Based on 2006 estimates, 263 487 DALYs were attributable to CHD in Australia. The proposed program would add $115 650 000 to the annual national heath expenditure. Using an estimated 15% reduction in death and disability and a 40% estimated program uptake, the program’s ICER is $8081 per DALY prevented. With more conservative estimates of effectiveness and uptake, estimates of up to $38 316 per DALY are observed in sensitivity analysis.

Conclusions. Although innovation in CHD management promises improved future patient outcomes, many therapies and strategies proven to reduce morbidity and mortality are available today. A general practice-based program for the optimal application of current therapies is likely to be cost-effective and provide substantial and sustainable benefits to the Australian community.

What is known about this topic? Chronic disease management programs are known to provide gains with respect to reductions in death and disability among patients with coronary heart disease. The cost effectiveness of such programs in the Australian context is not known.

What does this paper add? This paper suggests that implementing a coronary heart disease program in Australia is highly cost-effective across a broad range of assumptions of uptake and effectiveness.

What are the implications for practitioners? These data provide the economic rationale for the implementation of a chronic disease management program with a disease registry and regular review in Australia.

Sustainability evaluation, life cycle assessment and facilities management for Geelong Retail Development

Value management is a technique used during the design stage to justify cost and worth of a proposal. Designer must never center only to save capital expenditure but consider holistically the whole building life which will be sustainable. Therefore, sustainability evaluation must adopt a long term view and will properly include three crucial elements: economic, social and environmental. Lack of awareness of value management during the design stage of a building project will adversely impact on the life cycle assessment (LCA) and facilities management (FM). This paper provides a review of the sustainable elements that must be considered when designing and costing a new retail development in the Geelong region of Australia and how these factors influence the whole building life. The result of this research helps to create a greater understanding of the different attributes that will affect the LCA and FM decisions made on sustainable development in this and other regional Australian cities that are undergoing major population growth.

Acceleration data reveal the energy management strategy of a marine ectotherm during reproduction

1. Maintaining a high and stable body temperature is often critical for female ectotherms during reproduction. Yet this strategy may be energetically costly, and therefore challenging, during this period of already high-energy demand. 2. Here, the 6-week deployment of tri-axial accelerometers (n = 6) on a marine ectotherm, the loggerhead turtle (Caretta caretta), reproducing at the northern limit of the species’ breeding range (i.e. in a thermally dynamic environment) revealed the behavioural mechanisms underlying its energy management strategy during the breeding season. 3. The estimated activity levels of female loggerheads using overall dynamic body acceleration (ODBA) were high during the breeding season, suggesting that marine turtles may not be able to remain inactive for long periods in the same manner as terrestrial ectotherms, because of the thermally dynamic nature of their environment. 4. However, activity levels were not constant throughout the season, being impacted by both ambient water temperature and female reproductive status. In cold water at the beginning of the nesting season, high levels of activity suggested that females behaviourally thermoregulated by seeking out warm water patches along the shoreline. Interactions with male turtles (courtship and/or avoidance) may also explain this high level of activity. As sea temperatures warmed up and the amount of energy devoted to reproduction probably increased, the turtles spent more time resting during long sequential flat-bottomed dives, and reduced any unnecessary locomotory activity. 5. Turtles may therefore adjust their activity patterns in response to seasonal variations in abiotic (i.e. ambient temperature) and biotic (i.e. reproductive status) factors. This may help minimize activity-linked metabolic rate and maximize reproductive output over a season while breeding in thermally dynamic environments. 6. A mechanistic model gave support to these empirical results. The model revealed that actively maintaining high and stable body temperature is of clear benefit to female turtles at temperate breeding sites. While energetically costly, such active thermoregulatory behaviour may speed up egg maturation, allowing turtles to initiate nesting earlier in the season, and hence maximize reproductive output.

New directions for public management

Includes bibliography