Australian Health Practitioner Regulation Agency

BACKGROUND: Fundamentally, the goal of health professional regulatory regimes is to ensure the highest quality of care to the public. Part of that task is to control what health professionals do, or their scope of practice. Ideally, this involves the application of evidence-based professional standards of practice to the tasks for which health professional have received training. There are different jurisdictional approaches to achieving these goals. METHODS: Using a comparative case study approach and similar systems policy analysis design, we present and discuss four different regulatory approaches from the US, Canada, Australia and the UK. For each case, we highlight the jurisdictional differences in how these countries regulate health professional scopes of practice in the interest of the public. Our comparative Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis is based on archival research carried out by the authors wherein we describe the evolution of the institutional arrangements for form of regulatory approach, with specific reference to scope of practice. RESULTS/CONCLUSIONS: Our comparative examination finds that the different regulatory approaches in these countries have emerged in response to similar challenges. In some cases, 'tasks' or 'activities' are the basis of regulation, whereas in other contexts protected 'titles' are regulated, and in some cases both. From our results and the jurisdiction-specific SWOT analyses, we have conceptualized a synthesized table of leading practices related to regulating scopes of practice mapped to specific regulatory principles. We discuss the implications for how these different approaches achieve positive outcomes for the public, but also for health professionals and the system more broadly in terms of workforce optimization.

BACKGROUND: Health practitioner regulators throughout the world use continuing professional development (CPD) standards to ensure that registrants maintain, improve and broaden their knowledge, expertise and competence. As the CPD standard for most regulated health professions in Australia are currently under review, it is timely that an appraisal of the evidence be undertaken. METHODS: A systematic review was conducted using major databases (including MEDLINE, EMBASE, PsycInfo, and CINAHL), search engines and grey literature for evidence published between 2015 and April 2022. Publications included in the review were assessed against the relevant CASP checklist for quantitative studies and the McMaster University checklist for qualitative studies. RESULTS: The search yielded 87 abstracts of which 37 full-text articles met the inclusion criteria. The evidence showed that mandatory CPD requirements are a strong motivational factor for their completion and improves practitioners' knowledge and behaviour. CPD that is more interactive is most effective and e-learning is as effective as face-to-face CPD. There is no direct evidence to suggest the optimal quantity of CPD, although there was some evidence that complex or infrequently used skills deteriorate between 4 months to a year after training, depending on the task. CONCLUSIONS: CPD is most effective when it is interactive, uses a variety of methods and is delivered in a sequence involving multiple exposures over a period of time that is focused on outcomes considered important by practitioners. Although there is no optimal quantity of CPD, there is evidence that complex skills may require more frequent CPD.

BACKGROUND: Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES: 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS: We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA: We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS: Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS: We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS: Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.

Economic evaluation (EE) studies have been undertaken in dentistry since the late 20th century because economic data provide additional information to policy makers to develop guidelines and set future direction for oral health services. The objectives of this study were to assess the methodological quality of EEs in oral health. Electronic searching of Ovid MEDLINE, the Cochrane Library, and the NHS Economic Evaluation Database from 1975 to 2013 were undertaken to identify publications that include costs and outcomes in dentistry. Relevant reference lists were also searched for additional studies. Studies were retrieved and reviewed independently for inclusion by 3 authors. Furthermore, to appraise the EE methods, 1 author applied the Drummond 10-item (13-criteria) checklist tool to each study. Of the 114 publications identified, 79 studies were considered full EE and 35 partial. Twenty-eight studies (30%) were published between the years 2011 and 2013. Sixty-four (53%) studies focused on dental caries prevention or treatment. Median appraisal scores calculated for full and partial EE studies were 11 and 9 out of 13, respectively. Quality assessment scores showed that the quality of partial EE studies published after 2000 significantly improved (P = 0.02) compared to those published before 2000. Significant quality improvement was not found in full EE studies. Common methodological limitations were identified: absence of sensitivity analysis, discounting, and insufficient information on how costs and outcomes were measured and valued. EE studies in dentistry increased over the last 40 y in both quantity and quality, but a number of publications failed to satisfy some components of standard EE research methods, such as sensitivity analysis and discounting.

BACKGROUND: There are several different frailty measures available for identifying the frail elderly. However, their predictive performance in an Australian population has not been examined. OBJECTIVE: To examine the predictive performance of four internationally validated frailty measures in an older Australian population. METHODS: A retrospective study in the Australian Longitudinal Study of Ageing (ALSA) with 2,087 participants. Frailty was measured at baseline using frailty phenotype (FP), simplified frailty phenotype (SFP), frailty index (FI) and prognostic frailty score (PFS). Odds ratios (OR) were calculated to measure the association between frailty and outcomes at Wave 3 including mortality, hospitalisation, nursing home admission, fall and a combination of all outcomes. Predictive performance was measured by assessing sensitivity, specificity, positive and negative predictive values (PPV and NPV) and likelihood ratio (LR). Area under the curve (AUC) of dichotomised and the multilevel or continuous model of the measures was examined. RESULTS: Prevalence of frailty varied from 2% up to 49% between the measures. Frailty was significantly associated with an increased risk of any outcome, OR (95% confidence interval) for FP: 1.9 (1.4-2.8), SFP: 3.6 (1.5-8.8), FI: 3.4 (2.7-4.3) and PFS: 2.3 (1.8-2.8). PFS had high sensitivity across all outcomes (sensitivity: 55.2-77.1%). The PPV for any outcome was highest for SFP and FI (70.8 and 69.7%, respectively). Only FI had acceptable accuracy in predicting outcomes, AUC: 0.59-0.70. CONCLUSIONS: Being identified as frail by any of the four measures was associated with an increased risk of outcomes; however, their predictive accuracy varied.

Background Shared decision‐making is important in child and adolescent healthcare because there is growing international recognition of children and young people's rights to be included in decisions that affect them. In order for young people to participate effectively in shared decision‐making they need to develop the skills of engagement with healthcare professionals and confidence in interacting with them. They also need to learn how to manage their condition and treatments on their own when they move into adulthood. Children and young people who participate in shared decision‐making in healthcare are likely to be more informed, feel more prepared, and experience less anxiety about the unknown. Significant improvements in cystic fibrosis (CF) survival over recent decades, due to improved therapies and better management of care, means that young people with CF are routinely transitioning to adult healthcare where increasing emphasis on self‐management brings greater complexity in decision‐making. We need to know what interventions are effective in promoting shared decision‐making for young people with CF. Objectives To assess the effectiveness of interventions that promote participation in shared decision‐making for children and adolescents (aged between four and 18 years) with CF. Search methods We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearches of journals and conference abstract books. We also searched the reference lists of articles and reviews addressing shared decision‐making. Date of most recent search: 12 March 2019. We searched PubMed, CINAHL (EBSCO), Embase (Elsevier), PsycINFO (EBSCO), WHO ICTRP, ASSIA (ProQuest), ERIC (ProQuest), ProQuest Dissertations and Theses, and ClinicalTrials.gov. We contacted study authors with published relevant research in shared decision‐making for adults to ask if they were aware of any published or ongoing studies on the promotion of the intervention for children or adolescents (or both) with CF. Date of most recent search: 19 March 2019. Selection criteria We planned to include randomised controlled trials (RCTs) (but not cross‐over RCTs) of interventions promoting shared decision‐making for children and adolescents with CF aged between four and 18 years, such as information provision, booklets, two‐way interaction, checking understanding (by the participant), preparation to participate in a healthcare decision, decision‐aids, and training interventions or educational programs. We planned to include interventions aimed at children or adolescents (or both), parents or healthcare professionals or any combination of these groups provided that the focus was aimed at promoting shared decision‐making for children and adolescents with CF. Data collection and analysis Two authors independently reviewed papers identified in the searches. Main results No eligible RCTs were identified for inclusion in this systematic review. Authors' conclusions We were unable to identify RCTs with evidence which would support healthcare policy‐making and practice related to implementation of shared decision‐making for children and adolescents (aged between four and 18 years) with CF). We hope that having identified this gap in research, awareness will increase amongst researchers of the need to design high‐quality shared decision‐making interventions for young people with CF, perhaps adapted from existing models for adults, and to test these interventions and children's preferences in RCTs. It is also important to target health professionals with evidence‐based education programmes on shared decision‐making and a need for international consensus on addressing the variability in education programmes.

In 2010 Australia established a national registration and accreditation scheme, covering more than 620 000 health practitioners. The data held by the Australian Health Practitioner Regulation Agency is a remarkable platform for research aimed at improving health practitioner regulation, health care quality and workforce planning.

The role of health practitioner regulation in ensuring patient safety is well recognized. Less recognized is the role of regulation in addressing broader health system priorities. These goals include managing the costs, capacities and distribution of health professional education institutions; ensuring the competence and equitable distribution of health workers; informing workforce planning and mobilization; enabling the use of digital technologies; and addressing challenges related to the international mobility of health workers. Even where health practitioner regulation is designed to advance these goals, important gaps exist between the potential of regulatory systems and their performance. The response to the coronavirus disease 2019 (COVID-19) pandemic led many countries to introduce regulatory changes to allow more flexibility and innovations in the mobilization of health practitioners. Building on this experience, we need to critically re-examine health practitioner regulatory systems to ensure that these systems support rather than impede progress towards national health goals. We discuss the role of health practitioner regulation in contemporary health systems, highlighting recent regulatory reforms in selected countries, including during the COVID-19 pandemic. We identify the importance of dynamic, effective and flexible health practitioner regulatory systems in progress towards universal health coverage and health security.

This is a protocol for a Cochrane Review (Qualitative). The objectives are as follows:

Objective Studies of Australian health workforce demographics tend to be limited to single professions, a set geographic area, or based on incomplete data. This study aims to comprehensively describe changes to the demographic characteristics of Australia's regulated health professions over 6 years. Methods Data were sourced from the Australian Health Practitioner Regulation Agency (Ahpra) registration database, and a retrospective analysis of 15 of the 16 regulated health professions between 1 July 2015 and 30 June 2021 was conducted. Variables including profession, age, gender and state/territory locations for the practitioners' principal places of practice were analysed descriptively and via appropriate statistical tests. Results Changes in age, gender representation, and place of practice varied significantly and in different ways across the 15 professions. The total number of registered health practitioners increased by 141 161 (22%) from 2016 to 2021. The number of registered health practitioners per 100 000 population increased by 14% from 2016, with considerable variation across the professions. In 2021, women accounted for 76.3% of health practitioners across the 15 health professions, a significant increase of 0.5% points since 2016. Conclusions Changes to demographics, especially in ageing workforces and feminising professions, can have implications for workforce planning and sustainability. Future research could build on this demographic trend data by investigating causes or undertaking workforce supply or demand modelling.

Protection of the public is the paramount aim for health practitioner regulation, yet there has been growing concern globally on the association between regulatory complaints processes and practitioner mental health and wellbeing. The objective was to understand the experience, particularly distress, of health practitioners involved in a regulatory complaints process to identify potential strategies to minimise future risk of distress. Semi-structured qualitative interviews were conducted with health practitioners in Australia who had recently been through a regulatory complaints process, together with a retrospective analysis of documentation relating to all identified cases of self-harm or suicide of health practitioners who were involved in such a process over 4 years. Data from interviews and the serious incident analysis found there were elements of the regulatory complaints process contributing to practitioner distress. These included poor communication, extended time to close the investigation, and the management of health-related concerns. The study found external personal circumstances and pre-existing conditions could put the practitioner at greater risk of distress. There were found to be key moments in the process-triggers-where the practitioner was at particular risk of severe distress. Strong support networks, both personal and professional, were found to be protective against distress. Through process improvements and, where appropriate, additional support for practitioners, we hope to further minimise the risk of practitioner distress and harm when involved in a regulatory complaints process. The findings also point to the need for improved partnerships between regulators and key stakeholders, such as legal defence organisations, indemnity providers, employers, and those with lived experience of complaints processes. Together they can improve the support for practitioners facing a complaint and address the stigma, shame, and fear associated with regulatory complaints processes. This project provides further evidence that a more compassionate approach to regulation has the potential to be better for all parties and, ultimately, the wider healthcare system.

BACKGROUND: Continuing professional development (CPD) and recency of practice (ROP) standards are components of health practitioner regulation in Australia. The CPD and ROP standards are currently under review, and an evidence base to assist the development of consistent standards is required. Preliminary searching was unable to find a recent systematic review of the literature to provide an evidence base to underpin the standards review. OBJECTIVE: This paper presents the protocol for a systematic review that aims to develop a current evidence base that will support the National Boards to develop more consistent, evidence-based, effective standards that are clear and easy to understand and operationalize. METHODS: Research questions were developed to support the planned review of CPD and ROP registration standards. Major databases and relevant journals were searched for articles published in English between 2015 and 2021, using key search terms based on previous unpublished reviews of the CPD and ROP registration standards. The quality of the articles retrieved will be assessed using an instrument suitable for use in the development of public policy. The findings will be published in a peer-reviewed journal. RESULTS: In September 2021, our search strategy identified 18,002 studies for the CPD-related research questions after removal of duplicates. Of these, 509 records were screened based on their title, and 66 full-text articles were assessed for eligibility based on their abstract, of which 31 met the inclusion criteria. A further 291 articles were identified as relevant to the ROP research questions. Of these, 87 records were screened based on their title, and 46 full-text articles were assessed for eligibility based on their abstract, of which 8 studies met our inclusion criteria. CONCLUSIONS: This protocol outlines the scope and methodology that will be used to conduct a systematic review of evidence for CPD and ROP and inform a review of the standards for regulated health professionals in Australia. Previous research has shown that while CPD improves practitioner knowledge, the link to public safety is unclear. While there has been a greater focus on maintenance of certification and other quality assurance activities over the past 10 years, there remains great variability in CPD requirements across both professions and jurisdictions. ROP was found to be a poorly researched area with most research concentrating on medical practitioners, nurses, and midwives and no clear consensus about the optimal time period after which retraining or an assessment of competence should be introduced. As the CPD and ROP standards are currently under review, it is timely that a review of current evidence be undertaken. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28625.

Abstract Background P2Y 12 inhibitor therapy is recommended for 12 months in patients hospitalised for acute myocardial infarction (AMI) unless the bleeding risk is high. Aims To describe real‐world use of P2Y 12 inhibitor therapy following AMI hospitalisation. Methods We used population‐level linked hospital data to identify all patients discharged from a public hospital with a primary diagnosis of AMI between July 2011 and June 2013 in New South Wales and Victoria, Australia. We used dispensing claims to examine dispensing of a P2Y 12 inhibitor (clopidogrel, prasugrel or ticagrelor) within 30 days of discharge and multilevel models to identify predictors of post‐discharge dispensing and persistence of therapy to 1 year. Results We identified 31 848 patients hospitalised for AMI, of whom 56.8% were dispensed a P2Y 12 inhibitor within 30 days of discharge. The proportion of patients with post‐discharge dispensing varied between hospitals (interquartile range: 25.0–56.5%), and significant between‐hospital variation remained after adjusting for patient characteristics. Patient factors associated with the lowest likelihood of post‐discharge dispensing were: having undergone coronary artery bypass grafting (odds ratio (OR): 0.17; 95% confidence intervals (CI): 0.15–0.20); having oral anticoagulants dispensed 180 days before or 30 days after discharge (OR: 0.39, 95% CI: 0.35–0.44); major bleeding (OR: 0.68, 95% CI: 0.61–0.76); or being aged ≥85 years (OR: 0.68, 95% CI: 0.62–0.75). A total of 26.8% of patients who were dispensed a P2Y 12 inhibitor post‐discharge discontinued therapy within 1 year. Conclusion Post‐hospitalisation use of P2Y 12 inhibitor therapy in AMI patients is low and varies substantially by hospital of discharge. Our findings suggest strategies addressing both health system (hospital and physician) and patient factors are needed to close this evidence‐practice gap.

Objectives To determine whether sharing of routinely collected health service performance data could have predicted a critical safety failure at an Australian maternity service. Design Observational quantitative descriptive study. Setting A public hospital maternity service in Victoria, Australia. Data sources A public health service; the Victorian state health quality and safety office—Safer Care Victoria; the Health Complaints Commission; Victorian Managed Insurance Authority; Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Paediatric Infant Perinatal Emergency Retrieval; Australian Health Practitioner Regulation Agency. Main outcome measures Numbers and rates for events (activity, deaths, complaints, litigation, practitioner notifications). Correlation coefficients. Results Between 2000 and 2014 annual birth numbers at the index hospital more than doubled with no change in bed capacity, to be significantly busier than similar services as determined using an independent samples t-test (p<0.001). There were 36 newborn deaths, 11 of which were considered avoidable. Pearson correlations revealed a weak but significant relationship between number of births per birth suite room birth and perinatal mortality ( r 2 =0.18, p=0.003). Independent samples t-tests demonstrated that the rates of emergency neonatal and perinatal transfer were both significantly lower than similar services (both p<0.001). Direct-to-service patient complaints increased ahead of recognised excess perinatal mortality. Conclusion While clinical activity data and direct-to-service patient complaints appear to offer promise as potential predictors of health service stress, complaints to regulators and medicolegal activity are less promising as predictors of system failure. Significant changes to how all data are handled would be required to progress such an approach to predicting health service failure.

BACKGROUND: Health practitioner regulators throughout the world use registration standards to define the requirements health practitioners need to meet for registration. These standards commonly include recency of practice (ROP) standards designed to ensure that registrants have sufficient recent practice in the scope in which they intend to work to practise safely. As the ROP registration standards for most National Boards are currently under review, it is timely that an appraisal of current evidence be carried out. METHODS: A systematic review was conducted using databases (including MEDLINE, EMBASE, PsycInfo, and CINAHL), search engines, and a review of grey literature published between 2015 and April 2022. Publications included in the review were assessed against the relevant CASP checklist for quantitative studies and the Joanna Briggs Institute checklist for analytical cross-sectional studies. RESULTS: The search yielded 65 abstracts of which 12 full-text articles met the inclusion criteria. Factors that appear to influence skills retention include the length of time away from practice, level of previous professional experience and age, as well as the complexity of the intervention. The review was unable to find a clear consensus on the period of elapsed time after which a competency assessment should be completed. CONCLUSIONS: Factors that need to be taken into consideration in developing ROP standards include length of time away from practice, previous experience, age and the complexity of the intervention, however, there is a need for further research in this area.

Objective The aim of the study was to describe the sources of notifications of concern (“notifications”) regarding the health, performance, and conduct of health practitioners from 14 registered professions in Australia. Methods This retrospective cohort study analyzed 43,256 notifications lodged with the Australian Health Practitioner Regulation Agency and the Health Professional Councils Authority between 2011 and 2016. We used descriptive statistical analysis to describe the characteristics of these notifications, including their source, issue and domain, and subject. Results Patients and their relatives lodged more than three-quarters (78%) of notifications regarding clinical performance, including diagnosis, treatment, and communication. Fellow practitioners were a common source of notifications about advertising and titles. Self-reports commonly related to health impairments, such as mental illness or substance use. Other agencies played a role in reporting concerns about prescribing or supply of medicines. Conclusions Various actors in the healthcare system play different roles in sketching the picture of healthcare quality and safety that notifications present to regulators. Improved understanding of which sources are most likely to raise which concerns may enhance regulators’ ability to identify and respond to patient safety risks.

CLINICAL RELEVANCE: Understanding workforce retention and attrition trends is needed to inform interventions that mitigate attrition and for planning. BACKGROUND: Retention and attrition are underexplored in optometry. The aim of this study was to identify factors and reasons underpinning decisions made by optometrists to remain in or leave the profession. METHODS: An online survey of optometrists registered with the Australian Health Practitioner Regulation Agency (AHPRA) as of 31 December 2023 and those who had not renewed in the preceding five years was conducted. In addition, a retrospective analysis of AHPRA registration data from 30 June 2014 to 30 June 2023 was undertaken. RESULTS: Out of 7,718 invited, 1,741 optometrists completed the survey (23% response rate). 79% indicated they intended to continue in the profession, 13% indicated they either intended to leave or were uncertain and the remainder were retired. Optometrists with non-practising registration had higher odds of intending to leave or feeling uncertain (OR = 17.65, 95% CI = [9.51, 32.78]), as did those aged over 60 years (OR = 3.13, 95% CI = [1.85, 5.28]). Reasons for intending to leave were: retirement; the work no longer being mentally stimulating, fulfilling or meaningful; unsatisfactory remuneration; and lack of career advancement opportunities. Registration data showed a 22.8% increase in the number of optometrists per 100,000 population, from 19.7 to 24.2. Replacement rate peaked in 2020, before a large decline in 2022 attributable to an increase in the over 60 years and the 35-60 years age groups leaving the profession. CONCLUSION: Although there has been considerable growth in the number of optometrists per population over the past decade, the replacement rate has declined recently due to an increase in optometrists leaving the profession. Strategies to mitigate attrition may include attractive remuneration, flexible work arrangements and a varied workload that offers professional stimulation. Attrition and the reasons for it require ongoing monitoring.

BACKGROUND: Racism arrived in Australia with colonization and its intentionally oppressive policies and actions toward Aboriginal and Torres Strait Islander Peoples. To a large extent, colonial and biomedical agendas are maintained by Australia's health system that underlies much of the racialized health inequities in the country. Dentistry significantly lags behind medicine and other health care areas in the uptake of antiracism, with the dental accreditation body only acknowledging racism as a determinant of oral health in 2022. OBJECTIVE: This project will comprehensively co-design strategies for an antiracist dental health system in Australia through the following objectives: (1) development of an antiracist curriculum for dental students; (2) workforce strategies that support the attraction, retention, and well-being of the Aboriginal and Torres Strait Islander dental workforce; and (3) oral health promotion training for Aboriginal Health Workers/Practitioners. METHODS: This project is grounded in decolonizing and Indigenous methodologies, which guide our ways of working at the knowledge interface. Co-design Yarning sessions will inform the development and implementation associated with each of the objectives through tabulation and narrative synthesis of sessions. Objectives will be evaluated with both quantitative and qualitative measures and analyzed accordingly with inverse probability of treatment weighting, content analysis, or reflexive thematic analysis. RESULTS: The study received ethical review approval in February 2024 and received funding in June 2024. The co-design phase for each objective will run from July 2024 to February 2025. The dental curriculum will be developed in 2025 and delivered to the 2026 student cohort. Evaluation data will be collected from the comparator student cohort in 2025 and the implementation cohort in 2026. Data collection for the development of workforce strategies will be collected from October 2024 to July 2025; the framework will be developed from August to December 2025 and disseminated in 2026. Oral health promotion training will be developed from August to February 2024, implemented from March to June 2025, and qualitative evaluation data will be collected between July and September 2025. CONCLUSIONS: The proposed research will develop an antiracism curriculum for dental students, a tailored Aboriginal and Torres Strait Islander dental workforce framework, and an oral health promotion training program for Aboriginal Health Workers/Practitioners. The processes and final outcomes of this research will be scalable and able to be tailored to different contexts. Together, these strategies will build oral health knowledge at the Community level, in turn supporting Aboriginal and Torres Strait Islander self-determination of oral health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/69012.

This article examines whether Motivational Interviewing (MI) can be truly integrated with Carl Rogers' person-centered approach (PCA) to counselling. While the ‘spirit’ of MI has much in common with PCA, it is argued that the theory and practice of MI indicates several fundamental differences with PCA that distinguishes the ways that each perspective may contribute to rehabilitation counselling. These differences are discussed in relation to the unique aspects of their underlying assumptions, how they define clients' problems, and how they articulate the role of counsellor and successful outcome. Recent meta-analyses have indicated the beneficial aspects of both approaches. Empirical evidence for the efficacy of both MI and PCA is strong across a diverse range of client groups and health care settings. However, the highly variable effectiveness of both MI and PCA suggests that further process-outcome research is needed. Implications for rehabilitation counsellors are discussed.

This review contextualises the role of generative Artificial Intelligence (AI) in healthcare within an Australian healthcare regulatory and ethical framework. Four online databases (PubMed, Scopus, CINAHL and Web of Science) were searched for peer-reviewed publications that addressed at least two of the three topics: (1) the current applications of AI in dentistry and healthcare; (2) data security and privacy in AI-enhanced healthcare; (3) ethical, legal and clinical implications of machine errors, and the delegation of healthcare responsibilities to large technology companies. A total of 31 articles were retrieved for full-text analysis using traditional and AI-assisted software. All studies showed promising use of AI to enhance clinical decision-making, automate administrative tasks and augment personalised care. However, integrating AI into the Australian healthcare context introduces complex ethical, regulatory and legal considerations that include bias, data privacy and ambiguous chains of responsibility. To maximise the benefits of AI technologies while safeguarding patient rights, practitioners and developers must establish regulatory frameworks, mandate practitioner training, foster multidisciplinary collaboration and maintain continuous rigorous oversight.