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Objective To examine whether community treatment orders for psychiatric patients reduce subsequent use of health services in comparison with control patients not placed on an order. Design Epidemiological study with a before and after, two stage design of matching and multivariate analysis, controlling for sociodemographic variables, clinical features, and psychiatric history. Setting All community based and inpatient psychiatric services in Western Australia, covering a population of 1.7 million people. Participants 228 subjects placed on a community treatment order, matched with an equal number of controls to give a total of 456 patients. Main outcome measures Inpatient admissions, bed days, and outpatient contacts one year after subjects were placed on a community treatment order or the index date of matched controls. Results Both subjects and their matched controls had reduced inpatient admissions and bed days in hospital. Subjects had significantly more outpatient contacts. Multivariate analysis indicated that being placed on a community treatment order was associated with increased outpatient contacts in the subsequent year compared with the control group. Otherwise, orders did not affect subsequent use of health services. Other factors associated with increased use of health services were age and inpatient admissions, bed days, and outpatient contacts before the order or index date. No covariates were shown to be associated with changes in within pair differences in inpatient admissions or bed days. Conclusions The introduction of compulsory treatment in the community does not lead to reduced use of health services.

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Approximately 1 in 3 patients develop a mental health disorder after stroke, although incidence estimates are relatively low. Post-stroke psychosis is associated with greater 10-year mortality, but the mechanisms underlying such an association are yet to be determined.

Heat waves (HWs) have killed more people in Australia than all other natural hazards combined. Climate change is expected to increase the frequency, duration, and intensity of HWs and leads to a doubling of heat-related deaths over the next 40 years. Despite being a significant public health issue, HWs do not attract the same level of attention from researchers, policy makers, and emergency management agencies compared to other natural hazards. The purpose of the study was to identify risk factors that might lead to population vulnerability to HW in Western Australia (WA). HW vulnerability and resilience among the population of the state of WA were investigated by using time series analysis. The health impacts of HWs were assessed by comparing the associations between hospital emergency department (ED) presentations, hospital admissions and mortality data, and intensities of HW. Risk factors including age, gender, socioeconomic status (SES), remoteness, and geographical locations were examined to determine whether certain population groups were more at risk of adverse health impacts due to extreme heat. We found that hospital admissions due to heat-related conditions and kidney diseases, and overall ED attendances, were sensitive indicators of HW. Children aged 14 years or less and those aged 60 years or over were identified as the most vulnerable populations to HWs as shown in ED attendance data. Females had more ED attendances and hospital admissions due to kidney diseases; while males had more heat-related hospital admissions than females. There were significant dose–response relationships between HW intensity and SES, remoteness, and health service usage. The more disadvantaged and remotely located the population, the higher the health service usage during HWs. Our study also found that some population groups and locations were resilient to extreme heat. We produced a mapping tool, which indicated geographic areas throughout WA with various vulnerability and resilience levels to HW. The findings from this study will allow local government, community service organizations, and agencies in health, housing, and education to better identify and understand the degree of vulnerability to HW throughout the state, better target preparatory strategies, and allocate limited resources to those most in need.

BackgroundGuidelines recommend that older people should receive multi-factorial interventions following an injurious fall however there is limited evidence that this is routine practice. We aimed to improve the delivery of evidence based care to patients presenting to the Emergency Department (ED) following a fall.MethodsA prospective before and after study was undertaken in the ED of a medium-sized hospital in Perth, Western Australia. Participants comprised 313 community-dwelling patients, aged 65 years and older, presenting to ED as a result of a fall. A multi-faceted strategy to change practice was implemented and included a referral pathway, audit and feedback and additional falls specialist staff. Key measures to show improvements comprised the proportion of patients reviewed by allied health, proportion of patients referred for guideline care, quality of care index, all determined by record extraction.ResultsAllied health staff increased the proportion of patients being reviewed from 62.7% in the before period to 89% after the intervention (P < 0.001). Before the intervention a referral for comprehensive guideline care occurred for only 6/177 (3.4%) of patients, afterwards for 28/136 (20.6%) (difference = 17.2%, 95% CI 11-23%). Average quality of care index (max score 100) increased from 18.6 (95% CI: 16.7-20.4) to 32.6 (28.6-36.6).ConclusionsA multi-faceted change strategy was associated with an improvement in allied health in ED prioritizing the review of ED fallers as well as subsequent referral for comprehensive geriatric care. The processes of multi-disciplinary care also improved, indicating improved care received by the patient.

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