Melbourne Institute of Applied Economic and Social Research - Research Publications
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ItemAn RCT protocol of varying financial incentive amounts for smoking cessation among pregnant women(BMC, 2012-11-27)BACKGROUND: Smoking during pregnancy is harmful to the unborn child. Few smoking cessation interventions have been successfully incorporated into standard antenatal care. The main aim of this study is to determine the feasibility of a personal financial incentive scheme for encouraging smoking cessation among pregnant women. DESIGN: A pilot randomised control trial will be conducted to assess the feasibility and potential effectiveness of two varying financial incentives that increase incrementally in magnitude ($20 vs. $40AUD), compared to no incentive in reducing smoking in pregnant women attending an Australian public hospital antenatal clinic. METHOD: Ninety (90) pregnant women who self-report smoking in the last 7 days and whose smoking status is biochemically verified, will be block randomised into one of three groups: a. No incentive control group (n=30), b. $20 incremental incentive group (n=30), and c. $40 incremental incentive group (n=30). Smoking status will be assessed via a self-report computer based survey in nine study sessions with saliva cotinine analysis used as biochemical validation. Women in the two incentive groups will be eligible to receive a cash reward at each of eight measurement points during pregnancy if 7-day smoking cessation is achieved. Cash rewards will increase incrementally for each period of smoking abstinence. DISCUSSION: Identifying strategies that are effective in reducing the number of women smoking during pregnancy and are easily adopted into standard antenatal practice is of utmost importance. A personal financial incentive scheme is a potential antenatal smoking cessation strategy that warrants further investigation. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12612000399897.
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ItemSplash!: a prospective birth cohort study of the impact of environmental, social and family-level influences on child oral health and obesity related risk factors and outcomes(BIOMED CENTRAL LTD, 2011-06-27)BACKGROUND: Dental caries (decay) is the most prevalent disease of childhood. It is often left untreated and can impact negatively on general health, and physical, developmental, social and learning outcomes. Similar to other health issues, the greatest burden of dental caries is seen in those of low socio-economic position. In addition, a number of diet-related risk factors for dental caries are shared risk factors for the development of childhood obesity. These include high and frequent consumption of refined carbohydrates (predominately sugars), and soft drinks and other sweetened beverages, and low intake of (fluoridated) water. The prevalence of childhood obesity is also at a concerning level in most countries and there is an opportunity to determine interventions for addressing both of these largely preventable conditions through sustainable and equitable solutions. This study aims to prospectively examine the impact of drink choices on child obesity risk and oral health status. METHODS/DESIGN: This is a two-stage study using a mixed methods research approach. The first stage involves qualitative interviews of a sub-sample of recruited parents to develop an understanding of the processes involved in drink choice, and inform the development of the Discrete Choice Experiment analysis and the measurement instruments to be used in the second stage. The second stage involves the establishment of a prospective birth cohort of 500 children from disadvantaged communities in rural and regional Victoria, Australia (with and without water fluoridation). This longitudinal design allows measurement of changes in the child's diet over time, exposure to fluoride sources including water, dental caries progression, and the risk of childhood obesity. DISCUSSION: This research will provide a unique contribution to integrated health, education and social policy and program directions, by providing clearer policy relevant evidence on strategies to counter social and environmental factors which predispose infants and children to poor health, wellbeing and social outcomes; and evidence-based strategies to promote health and prevent disease through the adoption of healthier lifestyles and diet. Further, given the absence of evidence on the processes and effectiveness of contemporary policy implementation, such as community water fluoridation in rural and regional communities it's approach and findings will be extremely informative.
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ItemDeterminants of successful clinical networks: the conceptual framework and study protocol(BIOMED CENTRAL LTD, 2012-03-13)BACKGROUND: Clinical networks are increasingly being viewed as an important strategy for increasing evidence-based practice and improving models of care, but success is variable and characteristics of networks with high impact are uncertain. This study takes advantage of the variability in the functioning and outcomes of networks supported by the Australian New South Wales (NSW) Agency for Clinical Innovation's non-mandatory model of clinical networks to investigate the factors that contribute to the success of clinical networks. METHODS/DESIGN: The objective of this retrospective study is to examine the association between external support, organisational and program factors, and indicators of success among 19 clinical networks over a three-year period (2006-2008). The outcomes (health impact, system impact, programs implemented, engagement, user perception, and financial leverage) and explanatory factors will be collected using a web-based survey, interviews, and record review. An independent expert panel will provide judgements about the impact or extent of each network's initiatives on health and system impacts. The ratings of the expert panel will be the outcome used in multivariable analyses. Following the rating of network success, a qualitative study will be conducted to provide a more in-depth examination of the most successful networks. DISCUSSION: This is the first study to combine quantitative and qualitative methods to examine the factors that contribute to the success of clinical networks and, more generally, is the largest study of clinical networks undertaken. The adaptation of expert panel methods to rate the impacts of networks is the methodological innovation of this study. The proposed project will identify the conditions that should be established or encouraged by agencies developing clinical networks and will be of immediate use in forming strategies and programs to maximise the effectiveness of such networks.
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ItemNo Preview AvailableDesigning payments for GPs to improve the quality of diabetes care(WILEY, 2012-01-16)Three features are essential in designing the flexible funding payments and pay-for-performance elements.
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ItemMedicine in Australia: Balancing Employment and Life (MABEL)(WILEY-BLACKWELL, 2011-03)
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ItemHow do rural GPs' workloads and work activities differ with community size compared with metropolitan practice?(CSIRO PUBLISHING, 2012)Rural communities continue to experience shortages of doctors, placing increased work demands on the existing rural medical workforce. This paper investigates patterns of geographical variation in the workload and work activities of GPs by community size. Our data comes from wave 1 of the Medicine in Australia: Balancing Employment and Life longitudinal study, a national study of Australian doctors. Self-reported hours worked per usual week across eight workplace settings and on-call/ after-hours workload per usual week were analysed against seven community size categories. Our results showed that a GP's total hours worked per week consistently increases as community size decreases, ranging from 38.6 up to 45.6h in small communities, with most differences attributable to work activities of rural GPs in public hospitals. Higher on-call workload is also significantly associated with smaller rural communities, with the likelihood of GPs attending more than one callout per week ranging from 9% for metropolitan GPs up to 48-58% in small rural communities. Our study is the first to separate hours worked into different work activities whilst adjusting for community size and demographics, providing significantly greater insight to the increased hours worked, more diverse activities and significant after-hours demands experienced by current rural GPs.
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ItemInternational medical graduates mandated to practise in rural Australia are highly unsatisfied: Results from a national survey of doctors(ELSEVIER IRELAND LTD, 2012-12)OBJECTIVES: Rural communities worldwide are increasingly reliant on international medical graduates (IMGs) to provide health care access, with many countries utilising health policies which mandate IMGs to practise only in rural designated areas of (medical) workforce shortage for many years. The objective of this study is to analyse the satisfaction of IMGs in their current work location, particularly in relation to the effect of mandating IMGs to small rural communities. METHODS: We used data of 3502 general practitioners (GPs) from Wave 2 of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal study of Australian doctors. The main outcome measures were the level of professional and non-professional satisfaction expressed by GPs with respect to various job and social aspects. RESULTS: We found that non-professional satisfaction of mandated IMGs was significantly lower across all social aspects, whilst professional satisfaction was also significantly lower for most job aspects relating to their professional autonomy. In contrast, non-mandated IMGs were similarly satisfied compared to Australian trained GPs. CONCLUSIONS: Mandated IMGs are currently filling a critical shortage in rural areas of Australia. However, long-term success of this policy is problematic unless outstanding issues affecting their significantly reduced professional and non-professional satisfaction can be addressed.
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ItemJunior doctors' preferences for specialty choice(ELSEVIER, 2012-12)A number of studies suggest that there is an over-supply of specialists and an under-supply of general practitioners in many developed countries. Previous econometric studies of specialty choice from the US suggest that although income plays a role, other non-pecuniary factors may be important. This paper presents a novel application of a choice experiment to identify the effects of expected future earnings and other attributes on specialty choice. We find the implied marginal wage estimated from our discrete choice model is close to the actual wages of senior specialists, but much higher than those of senior GPs. In a policy simulation we find that increasing GPs' earnings by $50,000, or increasing opportunities for procedural or academic work can increase the number of junior doctors choosing general practice by between 8 and 13 percentage points. The simulation implies an earnings elasticity of specialty choice of 0.95.