Questions about typical quantities of alcohol consumed can lead to underestimates, as do questions about drinking 'standard drinks' of alcohol. Recent recall methods encourage fuller reporting of volumes plus more accurate estimates of unrecorded consumption and the proportion of total alcohol consumption that places drinkers at risk of harm. However, they do not capture longer-term drinking patterns. It is recommended that both recent recall and measures of longer-term drinking patterns are included in national surveys.
Two key methodological issues underlying different methods for calculating estimates of the number of alcohol‐caused deaths are identified and recommendations suggested for future work. 1. How to adjust alcohol aetiologic fractions across time and place to reflect different levels of risky drinking. A common approach is outlined for both acute and chronic alcohol‐related conditions. In the absence of consistent, reliable and regionally specific measures of the prevalence of risky alcohol consumption from national surveys, the use of per capita consumption data as a means of adjusting alcohol population aetiologic fractions over time and across regions is recommended. 2. Whether abstainers or low‐risk drinkers should be used as the reference group when assessing the impact of alcohol consumption and how the resulting information is best presented. It is recommended that when abstainers are used as the reference group, the costs and benefits for both‘low‐risk’ and ‘risky/high‐risk’ drinking should be identified. Using this approach, it was estimated that for Australia in 1998 there was a net benefit of 5,100 lives saved due to low‐risk drinking, while there was a net loss of 2,737 lives due to risky/high‐risk drinking. On its own, the figure of a net saving of 2,363 lives per year is a simplistic and potentially misleading picture of alcohol as a net benefit to public health and safety. For public health communications, there is still value in providing estimates using the low‐risk drinking contrast, of the number of lives saved if risky/high‐risk drinkers all became low‐risk drinkers (n=3,292 in 1998). The use of the abstinence contrast, however, allows the more complex picture of alcohol's impact on public health to be apparent, e.g. including the estimated 1,505 deaths associated with low‐risk drinking (mostly from cancer).
The comprehensive PIAC database allows research into patterns of use of aged care services that can inform decision-making by clients, carers, providers and funders of the services.
ObjectiveThis paper tests the hypothesis that increases in recorded dependency levels of permanent residential aged care clients are associated with reduced length of stay and higher turnover. A secondary objective is to compare the Aged Care Funding Instrument with its predecessor, the Resident Classification Scale, on a common schema. MethodsAdministrative data for all Commonwealth-subsidised residential aged care services in Australia from 2008–09 to 2018–19 were obtained from the National Aged Care Data Clearinghouse. More than 750 000 episodes of permanent residential aged care were analysed. The categories from the two rating systems were mapped to a six-level schema, primarily based on the dollar value of the categories at the time of transition. ResultsThere was a strong trend towards higher dependency ratings across admissions, residents, and separations. However, contrary to expectation, measures of system activity showed a slowing of the system: length of stay increased and turnover decreased. ConclusionsThe mapping of dependency rating schemes to a common rating enables the analysis of long-term trends in residential care dynamics. There is no evidence that the marked increases in reported dependency ratings led to accelerated system activity, consistent with an earlier study. This analysis forms a solid base for ongoing analysis of care appraisals in the context of a possible new rating scheme. It highlights the interplay between policy changes and provider behaviour, and the need for robust data to monitor care appraisals and system dynamics. What is known about the topic?Residential aged care subsidies are determined by care needs in relation to assessed dependency levels, using the Aged Care Funding Instrument since 2008, and before that, the Resident Classification Scale. Between 2008–09 and 2018–19, there was considerable growth in residents classified at more dependent levels, and this would be expected to result in greater turnover in the system. What does this paper add?This paper maps the rating schemes to a simplified, common rating that enables the analysis of long-term trends in residential care dynamics. It shows that the system is slowing, contrary to the trends expected if residents were more frail as the reported ratings imply. The paper examines possible explanations of these trends, and addresses policy implications. What are the implications for practitioners?In the context of a potential new client-dependency classification, this study shows the importance of robust measures of the dynamics of the system—and the underlying data—vis-à-vis the means by which client dependency is assessed.
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