Simon Eckermann - Academia.edu (original) (raw)

Papers by Simon Eckermann

Healthcare services, delivery, and financing

Context: Relational continuity is a core value of primary care. Little is known as to how it can ... more Context: Relational continuity is a core value of primary care. Little is known as to how it can be promoted. EQuIP-GP was a 12-month cluster RCT in 36 practices exploring whether financial incentives can improve relational continuity in general practice (GP). Objective: We examined a) how financial incentives are perceived and experienced by patients and GP teams and b) how routines related to relational continuity are influenced by financial incentives. Study Design: Mixed methods case study. Setting: Maximum variation sample of 6 (2 per state) of the 18 EQuIP-GP intervention practices from the Australian states of New South Wales, Victoria and Tasmania. Population: Each practice provided quantitative data on 30 patients aged ≥55 and qualitative data from patients, GPs, practice nurses (PN) and practice managers (PM). Intervention: Intervention practices received quality-linked financial incentives for offering longer consultations and early post-hospital review for enrolled patients. Outreach facilitators worked with practices to modify continuity routines. Instruments: Baseline practice attributes survey; Patient Primary Care Assessment Tool (PCAT); semi-structured interviews (13 patients, 10 GPs, 1 PN and 5 PMs). The 3 facilitators collected reflective notes of practice visits and participated in post-study interviews. Outcome Measures: Change in pre-post PCAT relational continuity using paired ttests and one-way ANOVA. Qualitative "practice intervention narratives" helped investigate the response to the intervention and concepts about financial incentives. Results. As with the EQuIP-GP trial, there was no change in relational continuity-PCAT and interview data both suggesting continuity was high at baseline. Participants saw relational continuity as a core component of primary care that should not need incentivising, seeing incentives as a "blunt instrument". Both patients and GPs favoured rewarding, rather than incentivising, quality care. Many felt that Equip-GP's incentive model increased attention to pre-existing routines rather than facilitating new ways of working. Conclusions: While financial incentives can help practices identify how existing routines can influence continuity, incentives for this core component of primary care seem better framed as a reward for good practice rather than an incentive for improvement. Further research could explore these issues in practices with lower baseline continuity of care.

Additional file 2: Table A2. Baseline and post-treatment EORTC QLQ-C15-PAL completion rates.

Additional file 1.Table 1. Trial registration data set.

Preliminary development and validation of a new end-of-life patient-reported outcome measure asse... more Preliminary development and validation of a new end-of-life patient-reported outcome measure assessing the ability of patients to finalise their affairs at the end of life

Health Economics from Theory to Practice, 2017

Chapter 10 shows that the net benefit correspondence theorem methods, introduced and shown to hav... more Chapter 10 shows that the net benefit correspondence theorem methods, introduced and shown to have distinct advantages for multiple strategy comparisons in Chap. 8 and for multiple provider efficiency comparison consistent with maximising net benefit in Chap. 9, naturally extend such advantages to robust multiple domain comparisons under uncertainty. In Chap. 4 we highlighted that robust and generalisable methods to enable jointly considering costs and multiple effects under uncertainty are required to better inform funding decisions in complex clinical areas such as palliative care. While quality-adjusted life years (QALYs) enable integration of patient survival with morbidity, they are either unable, or struggle, to incorporate domains such as carer impacts, family distress, finalising personal and financial affairs and being in community of choice for place of palliative care and place of death. Consequently, without robust multiple domain methods of cost-effectiveness analysis, the use of conventional single outcome evaluation (QALY measures or otherwise) can misrepresent key palliative care preferences. Scarce resources and funds can easily end up supporting interventions, strategies or programmes with overall negative impacts and not supporting options that maximise palliative care outcomes from limited resources. In this chapter we show how cost-effectiveness analysis in cost-disutility (CDU) space enables robust joint consideration of costs and multiple effects under uncertainty facilitating improved societal decision making. We outline and illustrate how the net benefit correspondence theorem (NBCT) and comparison on the CDU plane introduced in Chap. 8 also facilitate robust multiple effect comparison under uncertainty with analogous multiple effect summary measures. New summary measures identify across any set of threshold values for multiple domains of effect the strategies with lowest expected net loss (ENL) or highest expected net benefit with ENL planes and the potential value of undertaking further research for the optimal strategy as the ENL contour as well as the probability of strategies having highest expected net benefit (CEA planes).

Medicine & Science in Sports & Exercise, 2020

Purpose In this study, we tested the effectiveness of a multicomponent sports-based program aimed... more Purpose In this study, we tested the effectiveness of a multicomponent sports-based program aimed at promoting early intervention, help seeking, and resilience among a sample of adolescent male sport participants. Methods The Ahead of the Game program comprised four intervention components and a messaging campaign. Two components targeted mental health literacy, intentions to seek and provide help, and resilience among adolescent boys. A mental health literacy program for parents and a coach education program to assist in the support of athletes’ psychological needs were also included. We evaluated the program using a nonrandomized controlled trial matching two regional communities. In total, 350 sport participants (mean, 14.53 yr) were included in an intervention group, whereas 466 (mean, 14.66 yr) received usual practice in a matched control community. One hundred and eighty parents or caregivers and eight coaches also participated in the intervention components. Between-group mea...

BMC Health Services Research, 2019

Background: There is international interest in whether improved primary care, in particular for p... more Background: There is international interest in whether improved primary care, in particular for patients with chronic or complex conditions, can lead to decreased use of health resources and whether financial incentives help achieve this goal. This trial (EQuIP-GP) will investigate whether a funding model based upon targeted, continuous quality incentive payments for Australian general practices increases relational continuity of care, and lessens health-service utilisation, for high-risk patients and children. Methods: We will use a mixed methods approach incorporating a two-arm pragmatic cluster randomised control trial with nested qualitative case studies. We aim to recruit 36 general practices from Practice-Based Research Networks (PBRN) covering urban and regional areas of Australia, randomised into intervention and control groups. Control practices will provide usual care while intervention practices will be supported to implement a new service model incorporating incentives for relational continuity and timely access to appointments. Patients will comprise three groups: older (over 65 years); 18-65 years with chronic and/or complex conditions; and those aged less than 16 years with increased risk of hospitalisation. The funding model includes financial incentives to general practitioners (GPs) for providing longer consultations, same day access and timely follow-up after hospitalisation to enrolled patients. The payments are proportional to expected health system savings associated with improved quality of GP care. An outreach facilitator will work with practices to help incorporate the incentive model into usual work. The main outcome measure is relational continuity of care (Primary Care Assessment Tool short-form survey), with secondary outcomes including health-related quality of life and health service use (hospitalisations, emergency presentations, GP and specialist services in the community, medicine prescriptions and targeted pathology and imaging ordering). Outcomes will be initially evaluated over a period of 12 months, with ongoing data collection for 5 years.

<p>The end-of-life patient-reported outcome measure.</p

European Journal of Cancer, 2011

controlled release of the encapsulated drug. This investigation focuses on preparation and charac... more controlled release of the encapsulated drug. This investigation focuses on preparation and characterization of nanoparticles of propyl starch, a novel hydrophobic polymer [1], for encapsulating and modulating the release of docetaxel. Docetaxel was selected due to its evident efficacy in numerous cancers limited by its low aqueous solubility and severe toxicity. Material and Methods: Docetaxel nanoparticles were formulated using solvent emulsification-diffusion technique and optimized with respect to relative amounts of docetaxel and propyl starch, influence of various stabilizers and their quantity. Optimum nanoparticles were characterized with regards to particle size, morphology, surface charge, docetaxel encapsulation and it's in vitro release profile. Cytotoxicity assays in cancer cells (Caco-2) were conducted to determine the safety and efficacy of nanoparticles. Cellular internalization of nanoparticles was observed by Confocal laser scanning microscopy. Results in Caco-2 cells were compared with those in non-cancer cells (NHDF-p) to confirm their benignity towards the latter. Results: Nanometric, homogenous and spherical nanoparticles were formulated with a mean particle size of~250 nm and a negative surface charge of −23 mV. Encapsulation efficiency of docetaxel was greater than 80% with a controlled release being observed from the selected polymer indicating probability of increased concentration and duration at the affected area. Cytoxicity tests of unloaded particles in Caco-2 and NHDF-p cells exhibited their safety for cellular evaluations. Cytotoxicity of encapsulated drug was higher than free drug control indicating nanoparticle efficacy attributable to their enhanced internalization. Further, a superior action was observed in cancer versus non-cancer cells. Internalization studies confirmed these results by exhibiting a better uptake of nanoparticles into the cancer cells with a distinct evidence of their peri-nuclear localization. Conclusions: Docetaxel nanoparticles may be regarded as a safe yet efficacious therapeutic with probability of enhanced drug bioavailability as a direct consequence of the 'nano' dimensions of its carrier.

Active Lives South Australia Health Economic Analysis-an evidence base for Active Lives South Aus... more Active Lives South Australia Health Economic Analysis-an evidence base for Active Lives South Australia Health Economic Analysis-an evidence base for potential of health promotion strategies to reduced public health costs with potential of health promotion strategies to reduced public health costs with meeting of adult physical activity guidelines. A report prepared for SA Office of meeting of adult physical activity guidelines. A report prepared for SA Office of Recreation, Sport and Racing and SA Health. Recreation, Sport and Racing and SA Health.

Journal of Pain and Symptom Management, 2015

Context. Does octreotide reduce vomiting in cancer-associated bowel obstruction? Objectives. To e... more Context. Does octreotide reduce vomiting in cancer-associated bowel obstruction? Objectives. To evaluate the net effect of adding octreotide or placebo to standardized therapies on the number of days free of vomiting for populations presenting with vomiting and inoperable bowel obstruction secondary to cancer or its treatment. Methods. Twelve services enrolled people with advanced cancer presenting with vomiting secondary to bowel obstruction where surgery or anti-cancer therapies were not indicated immediately. In a double-blind study, participants were randomized to placebo or octreotide (600 mg/24 hours by infusion). Both arms received standardized supportive therapy (infusion of ranitidine [200 mg/24 hours], dexamethasone [8 mg/24 hours], and parenteral hydration [10e20 mL/kg/24 hours]). The primary outcome was patient-reported days free of vomiting at 72 hours. Results. In a study that recruited to the numbers identified in its power calculation, 87 participants provided data at 72 hours (45, octreotide arm). Seventeen people (octreotide) and 14 (placebo) were free of vomiting for 72 hours (P ¼ 0.67). Mean days free of vomiting were 1.87 (SD 1.10; octreotide) and 1.69 (SD 1.15; placebo; P ¼ 0.47). An adjusted multivariate regression of the incidence of vomiting over the study showed a reduced number of episodes of vomiting in the octreotide group (incidence rate ratio ¼ 0.40; 95% CI: 0.19e0.86; P ¼ 0.019); however, people in the octreotide arm were 2.02 times more likely to be administered hyoscine butylbromide (P ¼ 0.004), potentially reflecting increased colicky pain. Conclusion. Although there was no reduction in the number of days free of vomiting, the multivariate analysis suggests that further study of somatostatin analogues in this setting is warranted.

Supplementary_Information_Frith for Pragmatic randomised controlled trial of a personalised inter... more Supplementary_Information_Frith for Pragmatic randomised controlled trial of a personalised intervention for carers of people requiring home oxygen therapy by Peter Frith, Ruth Sladek, Richard Woodman, Tanja Effing, Sandra Bradley, Suzanne van Asten, Tina Jones, Khin Hnin, Mary Luszcz, Paul Cafarella, Simon Eckermann, Debra Rowett and Paddy A Phillips in Chronic Respiratory Disease

Health Economics Review, 2021

Background This study evaluates the Ahead Of The Game (AOTG) mental health promotion strategy for... more Background This study evaluates the Ahead Of The Game (AOTG) mental health promotion strategy for adolescent males relative to usual practice in team based sporting club community settings, allowing for joint incremental effects across 13 dimensions and 5 domains alongside intervention implementation costs. Methods Analysis is undertaken between matched communities with difference in differences analysis of joint multiple pre-post effect changes alongside implementation costs employing radar plots in cost-disutility space. A robust bootstrapping method allowed including all observed change in effect data from 343 AOTG and 273 control arm participants across 13 effect dimensions. Results Triangulation across joint evidence shows mean incremental effects favoured AOTG in all dimensions (10/13 significantly at 5% level) and in simple aggregation to each of five pre-specified 5 domains (each significant at < 1% level) and global measures (significant at 0.001% level), while mean AOTG...

The Extending the Role of Paramedics (ERP) sub-project built on a model developed by the South Au... more The Extending the Role of Paramedics (ERP) sub-project built on a model developed by the South Australian Ambulance Service (SAAS) which aims to provide a service that is complementary to primary health care, thus reducing emergency department presentations. The core of the model is training Extended Care Paramedics (ECPs) to treat patients in their usual place of residence, with referral to other health professionals if appropriate. ECPs manage patients with a diverse, and often ill-defined, range of signs and symptoms. Although these patients are deemed 'low acuity', these cases can be complex and require the ECP to apply advanced clinical reasoning. In many cases, the patient may have multiple chronic conditions and present as generally unwell. The published evidence to date generally supports an expansion of the role of paramedics to include the assessment and management of patients with minor illnesses and injuries to avoid transport to hospital. However, the evidence i...

BACKGROUND First-line chemotherapeutic treatment of colorectal cancer (CRC) typically comprises o... more BACKGROUND First-line chemotherapeutic treatment of colorectal cancer (CRC) typically comprises oral (capecitabine) or intravenous 5-fluorouracil (5-FU) plus leucovorin (LV), in combination with oxaliplatin (XELOX or FOLFOX, respectively), although debate exists regarding the best course of treatment by modality in clinical practice. Evidence from practice comparisons is important in considering the net benefit of alternative chemotherapy regimens, given expected differences in survival associated with compliance and age of patients treated in real life versus controlled trial settings. PATIENTS AND METHODS Practice variation in 5-FU treatment (i.e. 5-FU/leucovorin, FOLFOX, capecitabine and XELOX) of patients with CRC from an Australian area health service (n=636) was analyzed between modalities by patient age, tumour stage and site using non-parametric tests. Survival analyses (n=434) were conducted over a three-year follow-up period using Cox regression, adjusting for observed con...

of paper presented at PHAA 42nd Annual conference, Melbourne, 16-18 September 2013.

BMC Cancer

Background This analysis aims to evaluate health-related quality of life (HrQoL) (primary outcome... more Background This analysis aims to evaluate health-related quality of life (HrQoL) (primary outcome for this analysis), nausea and vomiting, and pain in patients with inoperable malignant bowel obstruction (IMBO) due to cancer or its treatments randomised to standardised therapies plus octreotide or placebo over a maximum of 72 h in a double-blind clinical trial. Methods Adults with IMBO and vomiting recruited through 12 services spanning inpatient, consultative and community settings in Australia were randomised to subcutaneous octreotide infusion or saline. HrQoL was measured at baseline and treatment cessation (EORTC QLQ-C15-PAL). Mean within-group paired differences between baseline and post-treatment scores were analysed using Wilcoxon Signed Rank test and between group differences estimated using linear mixed models, adjusted for baseline score, sex, age, time, and study arm. Results One hundred six of the 112 randomised participants were included in the analysis (n = 52 octreot...

Journal of Public Health

Aim International comparisons of public health measures relative to observed best practice are in... more Aim International comparisons of public health measures relative to observed best practice are increasingly important for evaluating community health promotion strategies and policies such as meeting or not meeting public health guidelines. This study aimed to identify methods enabling robust evaluation with such binary effect measures at a population level. Subject and methods Conventional efficiency comparisons of binary effect proportions are problematic due to a lack of consistency with alternate framing of resulting relative risks. In this paper, we illustrate such inconsistent efficiency measures comparing the proportion of school age children (9–11 years) meeting or not meeting integrated movement guidelines (IMGs) across the 12 countries from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) study. IMGs jointly consider physical activity, sleep and sedentary behaviours. An odds method is developed to enable consistent efficiency comparison ...