bluuebunny/crossref_metadata_2025 huggingface dataset:
Health inequality, social exclusion and neighbourhood renewal: Can place-based renewal improve the health of disadvantaged communities?
Authors: Klein Harald
Published: August 2009

The overall improvement in the health of Australians over the last decade has concealed a widening gap between the health of the rich and the poor. Orthodox responses to health inequality based on improving access to health services and changing the behaviour of high-risk groups have not led to a more equal distribution of health outcomes. This paper assesses the policy and practice implications of the causal nexus between health inequality, socioeconomic status, social exclusion and locational disadvantage. In addition to more traditional redistributive macroeconomic and social policies, the paper identifies the need for targeted responses to spatial concentrations of inequality. The Victorian Neighbourhood Renewal initiative is introduced as a place-based social model of health that ?joins-up? government and builds inter-sectoral and community partnerships to tackle local sources of health inequality. Neighbourhood Renewal intervenes in key material, psychosocial and behavioural pathways to morbidity and mortality by transforming poor housing, creating employment, improving education, rejuvenating local economies, reducing crime and building community resilience.
A participatory action research process with a rural Indigenous men's group: monitoring and reinforcing change
Authors: Tsey Komla , Wenitong Mark , McCalman Janya , Whiteside Mary , Baird Leslie , Patterson David , Baird Bradley , Fagan Ruth , Cadet-James Yvonne , Wilson Andrew
Published: August 2009

Since 2001 a team of academic researchers and medical practitioners have been collaborating with Yarrabah Men?s Health Group leaders to implement a participatory action research (PAR) process designed to support the men to (in their own words) ?take their rightful place? in contemporary Australian society. The formative stages of the PAR process and progress over the first 12 months have been documented in previous papers in order to provide much needed direction for others interested in undertaking similar community action-oriented research (Tsey, Patterson, Whiteside, Baird, & Baird, 2002; Tsey et al., 2004). The present paper addresses the need for innovative evaluation methodologies to enable participants in the PAR process to monitor and reinforce the small improvement they are making towards achieving their goals, and to maintain their vision for the future. Participation in men?s group activities resulted in modest but significant change in the men?s personal development and growth and in their response to family responsibilities. Men had the opportunity to dialogue and reflect on their gender responsibilities such as housework, which constitutes a major source of conflict in the family. Several men also gained the confidence and motivation to stand for local government. The study highlights the value of demystifying and making research more relevant to people?s day-to-day living experiences.
Access to rural general practice and primary care: Time now for more equitable and sustainable solutions?
Authors: Heard Sam
Published: August 2009

Australia has the resources to provide reasonable primary medical and health care to all of its population. It is a particularly worthwhile expense, with positive social and biophysical outcomes (Jarman et al., 1999; Starfield, 1998). In many aspects of health care, primary care provides most of the benefit and almost all of the value. Why, then, don?t we provide this basic service to all Australians?
Developing primary care research teams: A qualitative interview study in UK general practice
Authors: Shaw Sara , Macfarlane Fraser , Carter Yvonne H. , Letley Louise
Published: August 2009

Few studies have explored the development of practices as research organisations. This paper reports the findings of a study exploring the development of UK research practices and the impact of practice roles on research. Twenty-eight qualitative interviews were undertaken with research team members in a maximum variety sample of 11 research practices. All interviews were tape-recorded, transcribed and analysed using an adaptation of Framework, a systematic method for qualitative data analysis. Research practice development was influenced by motivations to participate in research and by team roles and activity. General practitioners (GPs) regarded their "research role" as one of generating new knowledge, whereas nurses were motivated by the potential for improving care for their specific patient populations. "Research hierarchies" were revealed in practices hosting research, with GPs often leading decision-making and nurses undertaking much of the groundwork. Lack of coordination across research team/s appeared to hinder development, with shared decision-making helping to foster activity. Tensions were evident in managing the interface between research and other practice roles. Findings raise important issues in relation to assumed practice roles. Role issues must be fully addressed in order for research capacity building to be effective, particularly where the role of nursing is being extended.
Community health advocacy to prevent social and health problems associated with gambling - a case study
Authors: Howat Peter , Maycock Bruce , Slevin Terry
Published: August 2009

Federal and state elections provide opportunity for health advocacy. Prior to the elections political parties reformulate their policies, many of which are relevant to public health. The adverse effects of gambling have been minimised in Western Australia (WA) compared to other states and territories in Australia due to strict policies that limit the availability of electronic gaming machines (EGMs). In the lead-up to the 2001 state election, aggressive lobbying of politicians was undertaken in an attempt to allow the expansion of poker machines to hotels and licensed clubs throughout the state. The proponents of this were representatives of the hoteliers and licensed clubs who claimed their continued economic viability was dependent on such a move. Opponents consisted of a coalition of community groups and professional associations. This paper is a summary of the approach taken by health advocates that ultimately contributed to written endorsement of the two main political parties to maintain the moratorium on the expansion of poker machines in WA. Focus of the paper is given to one approach involving direct contact with political candidates. This approach holds promise for effective advocacy for other public health issues.
Primary health care and general practice nurses: What is the nexus?
Authors: Patterson Elizabeth , Price Kay , Hegney Desley
Published: August 2009

This paper presents the findings from three separate qualitative studies that sought to explore the current and potential role of nurses employed in general medical practices in Australia. General practitioners', practice nurses' and consumers' views and perceptions were gathered from individual and group interviews. The data indicate that practice nurses (PNs) are involved in first level or primary care of individuals and engage in some form of preventive health care. Some PNs have a family/community focus in addition to their focus of care on individuals. Engagement in health promotion was found to be opportunistic rather than planned, and focussed on interventions to free individuals from medically defined diseases - the aim being compliance with therapeutic procedures and advice. The broader concept of health promotion, as documented in the Ottawa Charter for Health Promotion, was not pronounced in the PNs' reported practice. Consumers do not articulate confidence in PNs acting autonomously as primary health care practitioners but rather as complementary to general practitioners (GPs), undertaking initial assessment for triage purposes and providing ongoing management, education and support under the GPs' delegation. They would also like them to be family-oriented and holistic in their practice; supporting emotional and social needs in the context of their family lives.
What about the men? General differences in utilisation of arthritis self-management services
Authors: Gibbs Lisa , Reidpath Daniel
Published: August 2009

As self-management programs for chronic illness increasingly become the domain of primary health care providers, it is important to consider gender inequities in access to these services and gender differences in patterns of use to inform the development and delivery of services. This study explores gender differences in levels and patterns of access to arthritis self-management services by analyzing data collected from the Telephone Information Service of Arthritis Victoria. Contingency tables were analyzed and odds-ratios calculated to confirm gender differences in levels and patterns of service utilisation. Men were found to be significantly under-represented as users of the service, even after taking into account gender differences in prevalence of arthritis in the population. Women were more likely than men to contact the service on their own behalf. Men were more likely to have a family member or friend contact the service for them. Women showed more interest in learning about their condition while men focused more on symptom management. These gender differences in rates and patterns of service use indicate that service providers of self-management services for conditions such as arthritis need to take into account the interaction between gender and service utilisation.
Spinal cord injury and family caregivers: A description of care and perception of service need
Authors: Foster Michele , Amsters Delena , Carlson Glenys
Published: August 2009

As survival rates and life expectancies of individuals experiencing acquired disabilities such as spinal cord injury improve, greater demands are placed on health, rehabilitation and long-term care services. Further, family caregivers are assuming much of the caring responsibilities. This paper examines family caregiving in relation to individuals with spinal cord injury (SCI) in an Australian context. The paper is based on a descriptive survey conducted with 206 individuals with SCI, referred to a specialist SCI outreach service in Queensland, and 179 family caregivers. The survey collected social and demographic information and details of the type of care provided by family caregivers. It also explored family caregivers' perceptions of the types of services they require to assist them in their caring roles. Family caregiving typically involved physical, practical, and emotional support, and in many cases this occupied in excess of three hours a day, with no additional source of caregiving provided. The most frequently reported service types required by family caregivers included respite, personal support, information services, and health professional services. Mapping caregiver needs in this area establishes a critical basis for service planning and more importantly provides a guide for the development of a range of services dedicated to maintaining the health and well-being of family caregivers of individuals with SCI.
The role of empowerment through life skills development in building comprehensive primary health care systems in Indigenous Australia
Authors: Tsey Komla , Travers Helen , Gibson Teresa , Whiteside Mary , Cadet-James Yvonne , Haswell-Elkins Melissa , McCalman Janya , Wilson Andrew
Published: August 2009

This paper examines the potential contribution of empowerment through life skills development in building effective primary health Care (PHC) systems in Indigenous Australia. More specifically, it assesses the effectiveness of a Family Wellbeing (FWB) empowerment program as a tool for "engaging" Aboriginal people of Cape York to take greater control and responsibility for their health and wellbeing as part of a broader Cape York Partnerships Initiative. Preliminary findings from the pilot study demonstrated the acceptability of the program to both adults and school children. Challenges and opportunities involved in introducing and sustaining such programs in remote Indigenous settings were also highlighted. This follow-up study presents information which demonstrates the critical role that empowerment programs such as FWB may play in achieving the "hardest parts" of the PHC ideal; namely, enhancing the capacity of people to be their own change agents. The key features of the FWB approach that make it effective are that it starts small and focuses on people, it puts people before structures, and it works from personal empowerment or the micro before broadening out to tackling structural issues. This paper highlights the importance of empowerment through life skills development as critical components of PHC systems. The paper also highlights the need for health professionals to work towards creating comprehensive PHC environments through policies and programs that address crucial parts of the PHC ideal - parts which, until now, have been left in the "too hard basket". They include equity, self-determination, world peace and reductions in spending on armaments in order to increase resources to the PHC sector. The aim is to ensure healthy policy environments that support local Indigenous health development initiatives such as those currently being pursued by Cape York leaders.
Access Health: Providing primary health care to vulnerable and marginalised populations - A practice paper
Authors: Rowe James
Published: August 2009

Following an extensive process, spanning nearly two years, the Salvation Army Crisis Services was funded to establish and operate a primary health service in St Kilda for injecting drug users in accordance with guidelines set out by the Victorian Department of Human Services. On 1 September 2004, Access Health was officially opened in a large building adjacent to Crisis Services and the primary Needle and Syringe Programs Locked in Crisis Services. In this paper, we seek to provide an insight into the initial establishment phase of a primary care facility designed to meet the health needs of a particularly vulnerable population. It outlines early trends in client need and the service response developed to meet these needs. It also touches upon the relationships that service management has pursued, the structure of the service, and the processes that have been put in place to address the (relatively few) teething problems that have arisen in the facility's first months of operation. In doing so, it provides insight of relevance to all practitioners who encounter the issues that marginalised and vulnerable clients with complex needs often bring.
Alternatives to for-profit corporatisation: The view from general practice
Authors: Anderson Rob , Haywood Phil , Usherwood Tim , Haas Marion , Hall Jane
Published: August 2009

The aim of this study was to assess the expressed preferences of general practitioners (GPs) for alternative organisational models to for-profit GP corporatisation. A review of the findings of six feasibility studies that examined alternative organisational models for general practice in Australia was undertaken. Five feasibility studies were conducted within nine Divisions of General Practice, and a feasibility study was conducted by a state-based organisation among all 15 of its member Divisions. Overall, the six projects demonstrated a strong resistance among most GPs to any alternative model that involved giving up autonomy over practice matters. Consequently, the most favoured alternative organisational model was the "service company" - the establishment of a third party to provide a range of practice support services. In general, there was implicit acceptance that the service company could recover the cost of support service provision by charging GPs on a fee-for-service basis, and also that the Division itself would be the most acceptable organisation to take on this role. However, in four Divisional areas GPs revealed very low motivation towards either working together or with the local Division as a service company. Although these feasibility studies were carried out using different methods, and in a small sample of mostly urban Divisions, they suggest that many GPs would support their Divisions - or some other Division-related third party - to become more active providers of a range of practice support services.
Developing evidence-based practice in population health at the local level: Qualitative insights can complement quantitative needs assessment.
Authors: Adily Armita , Peacock Wendell , Ward Jeanette
Published: August 2009

In Australia, momentum has been steadily increasing to strengthen evidence-based policy and practice in population health, yet very little research has been reported that helps managers of population health services to change culture and reward an evidence-based approach. We had previously conducted a quantitative needs assessment with a regional population health workforce in Sydney. We then designed a complementary qualitative study to ensure that we understood underlying dimensions and perceptions. We analysed textual material and also conducted semi-structured interviews with 12 staff who were purposefully sampled. Not only was the value of qualitative enquiry recognised by staff as a complement to the previous quantitative needs assessment, we also discovered positive and negative views about the current promotion of evidence-based practice (EBP) and novel ways to overcome barriers and build capacity, including the development of core competencies, that has subsequently occurred. Furthermore, our contextualised assessment of local constructions of EBP also revealed underpinning tensions that will likely confront others who seek to build greater capacity for EBP in primary care.
Barriers to the provision of home and community care services to culturally and linguistically diverse populations in rural Australia
Authors: Ward Bernadette , Ellis Julie , Anderson Karen
Published: August 2009

In 2002, qualitative methods in the form of in-depth interviews and focus groups were used to gather data from culturally and linguistically diverse (CALD) population residents, service providers and key stakeholders across rural Victoria, to identify and describe barriers to the effective delivery of home services to people from CALD populations in rural Australia. Barriers to the provision of Home and Community Care (HACC) services to CALD populations in rural areas were not specific to HACC programs. For CALD residents, barriers included lack of information about the range of available services, cultural factors, and negative past and recent experiences in dealing with both the broader community and service providers. Service providers indicated lack of information about the profile of the local CALD population and lack of experience in working with these groups to be barriers. Communication was also an issue both for CALD residents and service providers, in terms of cultural factors and specific communication strategies such as inadequate printed material and under-utilisation of existing resources such as interpreter services. As one of the world?s most ethno-culturally diverse nations, Australia has a responsibility to provide health services that are culturally responsive and acceptable. Greater attention needs to be given to the needs of rural CALD population groups in accessing home services.
Older Australians' Expectations of their Interactions with their GPs
Authors: Pettigrew Simone , Mizerski Katherine , Donovan Robert
Published: August 2009

This article reports the findings of a study into older Australians' expectations when interacting with their general practitioners (GPs). Six focus groups and a national telephone survey (n=505) were conducted to identify those aspects of interactions with GPs considered to be the most important and relevant to older people. The results indicate that the three most important issues relate to ability of GPs to: (1) provide prompt referrals to specialists and ensure an ongoing information flow between GPs and specialists (2) remain abreast of new developments in geriatric and general medicine, and (3) demonstrate a familiarity with the patient's medical history. These issues were considered important to older patients in general and to be of personal relevance to the large majority of those sampled.
The Physical Activity Patterns of Older Australians
Authors: Brownie Sonya
Published: August 2009

One of the aims of this study was to examine the relationship between gender, health profile and physical activity patterns of older Australians. Using a self-administered postal questionnaire, data were obtained from 1,263 Australians (641 males, 622 females), aged 65-98 years, randomly selected from the 2000 Australian Electoral Commission roll. Participants provided general demographic data in addition to information about key health features and self-reported weekly participation in various physical activities. More than half (55%) of the sample averaged at least 30 minutes' exercise most days, excluding gardening and housework. Men participated in a wider range of physical activities and were more likely to average at least 30 minutes' exercise most days compared to women. Living arrangements, ethnicity, education and income were important sociological determinants of low, medium, or high levels of exercise participation. Perceived poor health, chronic disease, lack of motivation and energy, were barriers to achieving regular exercise. Gym training (4%) and tai chi/yoga (2%) were the least popular forms of exercise, yet weight resistance training and Tai chi are associated with improvements in strength, balance, flexibility and range of motion, and could play an important role in reducing the morbidity associated with ageing. General practitioners are well positioned to help older Australians take the first steps towards achieving the national target of at least 30 minutes' moderate-intensity activity most days.
Primary Health Care and Companion Animals ('Pets')
Authors: McCoppin Brigid
Published: August 2009

Pet ownership has a place in primary health care, and possibly as a minor part of public health policy. A number of researchers have established the benefits of having pets, or more correctly, "companion animals", as part of a household - especially for those who live alone, as do many elderly people. Pet owning is undoubtedly popular in Australia and in many other countries, but before endorsing the benefits of companion animals as part of a client's household, questions arise which go beyond merely agreeing that "pets are good for you". For example, if recommending pet ownership to clients, primary care practitioners need to be aware of possible disadvantages. Some may want to go further and examine the reasons for the benefits, and those who are pet owners themselves may also want to consider the welfare of the animals.
An innovative Multi-disciplinary Diabetes Complications Screening Program in a Rural Community: A Description and Preliminary Results of the Screening
Authors: F Jelinek Herbert , Wilding Clare , Tinely Paul
Published: August 2009

This paper describes an innovative multi-disciplinary pilot project for people living in rural north-east Victoria and southern New South Wales that focused on screening for diabetes complications. Participants enrolled for the diabetes screening through media announcements. A total of 91 participants were screened, 14 with diabetes. Screening tests included 12-lead ECG, ankle-brachial index, monofilament sensitivity, retinal photography as well as blood biochemistry. Twenty-six participants were referred to their general practitioners with cardiovascular anomalies, eight had retinal vasculature changes indicating diabetes, and 26 had foot problems that warranted podiatric assessment. This project illustrates that a university-based screening clinic is feasible, can be operated in conjunction with major research projects and results in significant community benefit. Serious health issues were identified in 31% of the study population. Without involvement in the screening, these people?s medical conditions may have otherwise remained hidden, potentially leading to significant health problems.
Genetic Counselling as a Developing Healthcare Profession: A Case Study in the Queensland Context
Authors: Kromberg JGR , Parkes J , Taylor S
Published: August 2009

Given a dearth of empirical and baseline data regarding genetic counselling in Australia, this study examined genetic counselling services in Queensland from January 1998 to December 1999. Secondary analysis was conducted with data from the Queensland Clinical Genetics Service (QCGS). During the study period, 8007 clients were seen in 4817 counselling sessions in urban and regional settings, with general practitioners (GPs) constituting the second largest referral source of clients. Genetic counsellors contributed to 80% of clinical genetic sessions as sole and co-counsellors, and counselled across 79 different disorders. Prenatal diagnosis counselling constituted the greatest workload with demands for cancer counselling increasing. Counsellors also provided educational and information services to individuals, families, general practitioners, health professionals and the community. The ratio of counsellors per head of population was less than national recommendations. Thus, although the existing model of genetic service delivery in Queensland demonstrates accessibility, the service in general is underutilised. As developments in genetic technology continue, this profession is expected to grow further and has the potential to contribute to service delivery at the primary health care level.
Towards a Measure of Function for Home and Community Care Services in Australia: Part 2 - Evaluation of the Screening Tool and Assessment Instruments
Authors: Green Janette , Eagar Kathy , Owen Alan , Gordon Rob , Quinsey Karen
Published: August 2009

The National Home and Community Care (HACC) Dependency Data Items Project was established to recommend, for national use, validated and reliable instruments for measuring the dependency of people eligible for HACC services. In Stage 2 of the project - reported here - a screening tool and assessment instruments selected in Stage 1 of the project were field-tested in a range of HACC agencies. The performance of the screen and the associated assessments was evaluated, as was their acceptability to HACC staff and clients. The results suggest that all of the five instruments are suitable for the target population of HACC services and they can be used effectively across a broad range of service types and by providers of diverse professional backgrounds.
Economic Evaluation of the Good Life Club Intervention for Diabetes Self-Management
Authors: Mortimer Duncan , Kelly Jill
Published: August 2009

This paper reports results from an economic evaluation of the Good Life Club (GLC), a self-management intervention for type II diabetes. Based on intention to treat data at 18-month follow-up, 39% of GLC clients were well-managed compared to just 30% at baseline. This gives a risk difference of 0.09 (95%CI: 0.01, 0.16) and a relative risk of being well-managed equal to 1.28 (95%CI: 1.04, 1.58) for the GLC intervention as compared to usual care. Based on detailed description of the GLC intervention, client-level data as to service utilisation and published unit costs, the incremental cost per client of the GLC intervention as compared to usual care was calculated at $1,457 in the base case analysis. Combining estimates of incremental cost and treatment effect implies an incremental cost-effectiveness ratio of just over $16,000 per additional responder (client with well-managed type II diabetes) in the base-case analysis. Additional cost savings are, however, expected to accrue in future years because well-managed diabetes is less likely than usual care to result in diabetes-related complications.
Understanding Life Transitions
Authors: Price Kay
Published: August 2009

I wanted to share with readers the outcomes of a research project I have been involved with. It was funded by a three-year nationally competitive discovery grant (2003-2005) from the Australian Research Council (ARC [DP 0346092]). This was a collaborative project between the Research Unit, Royal District Nursing Services, South Australia and University of South Australia, School of Nursing and Midwifery.
Austin Health Celebrates Collaboration with Aboriginal People during NAIDOC Week in 2006
Authors: Firebrace Shirley , Nayler Daryl , Bisset Penny
Published: August 2009

Austin Health is one of Victoria's largest health care providers. It is a 950-bed major teaching and research hospital affiliated with the University of Melbourne. Austin Health employs more than 6,500 staff over three sites (the Repatriation Hospital, the Royal Talbot, and the Austin Hospital), and is renowned for providing high quality, comprehensive public health services. These services are provided to a significant number of the Aboriginal and Torres Strait Islander (ATSI) population. Throughout Australia, Aboriginal people are dying at almost three times the rate of other Australians and have a life expectancy 17 years lower than the rest of the population. All State-funded hospitals are required to give special attention to the needs of ATSI people by ensuring services are provided in a culturally appropriate way and meet the needs of ATSI people.
Building Healthy Communities: The Rural Chronic Disease Initiative
Authors: Whyte Sue , Wyatt Di , Faulkner Susan , Chesters Janice , Drysdale Marlene , Kirkbright Steve , Clough Rob , Carr Helen , Whyte Gordon
Published: August 2009

The Australian Government Department of Health and Ageing funded an innovative program to improve the health and wellbeing of people living in small rural and remote communities across Australia. The Rural Chronic Disease Initiative (RCDI) was announced in late 2002 as part of the 2000-2001 Federal Budget. Its purpose was to develop more skills in health organisations and in the community, to improve what people know about chronic disease, to encourage community members to change their behaviour and provide better ways to help people with chronic disease. The department funded 29 small projects across Australia. There will be many outcomes and degrees of success from such a wide-ranging group of community projects. There were three main factors that contributed to success: the skills of the people in project teams and employed as project officers; the partnerships and linkages created for the project; and the degree of community ownership of or engagement with the project. Time was the most important challenge for projects, in particular the time needed to consult with and engage the community. Other challenges included the level of skills and capacity within the community and the lack of available training and accreditation. The RCDI projects have shown that rural and remote communities in Australia can initiate, develop and implement a range of successful strategies to prevent and better manage chronic diseases.
The Role of Practice Nurses in an Integrated Model of Cardiovascular Disease Management in Australian General Practice
Authors: Halcomb Elizabeth J , Davidson Patricia M
Published: August 2009

While various models of chronic disease management have been developed and evaluated, minimal data is available relating specifically to Australian general practice and, in particular, the role of the nurse within the multidisciplinary general practice team. This paper presents a multidisciplinary model of cardiovascular disease management, focused on Australian general practice, and identifies barriers and facilitators to its implementation. This model was developed from data arising from a series of investigations that (1) examined the epidemiology and current general practice management of cardiovascular disease (2) explored the demographics and role of the practice nurse, and (3) established strategic recommendations for future practice development. The model proposes an integrated and multidisciplinary cardiovascular disease management framework to inform policy-makers and health planners in the development of primary health services in Australian general practice.
Care, Community Capacity: Rethinking Mental Health Services in Remote Indigenous Settings
Authors: Santhanam Radhika , Hunter Ernest , Wilkinson Yvonne , Whiteford Harvey , McEwan Alexandra
Published: August 2009

In 2002 a project was initiated to evaluate and restructure the Child and Youth Mental Health (CYMH) services in three health Service Districts: Cape York, the Torres Strait and Northern Peninsula Area and remote Cairns. The objective was to develop, establish and evaluate models of best practice for remote area CYMH services for Indigenous families living in far north Queensland. For the purposes of the project, an action research framework was adopted to guide the project design, methodology, implementation and evaluation. The first phase involved mapping of needs, the second phase focused on service restructure and outcomes were measured in the third phase. The planning/implementation/planning cycle was an ongoing part of the project and raised five significant themes: service equity, service quality, service sufficiency, Indigenous workforce, and service structure/ infrastructure. The principal project outcome was the establishment of a defined model of service delivery that incorporates the identified themes and sits within a community development framework. Other significant outcomes include the implementation of regular supervision and professional development activities and improvements in service data collection. This paper is a descriptive account of the process of service restructure and discusses the key project outcomes.
Primary Health Care, Partnership and Polemic: Child and Family Health Nursing Support in Early Parenting
Authors: Kruske Sue , Barclay Lesley , Schmied Virginia
Published: August 2009

This qualitative research utilised a health services research framework and ethnographic methods to explore, describe and analyse contemporary child and family health (C&FH) nursing practice in an area of New South Wales, and identify the major factors that impact on their ability to effectively support families. The research identified the complexity of current C&FH nursing practice and changes in the philosophy that underpinned this at the policy level that were difficult to adopt. Despite a change in policy direction that advocated a partnership approach, nurses predominantly continue to frame their practice within an "expert" model. The nurses also struggled to deliver new service models while maintaining access for all families. Some explanations for the tensions experienced by the nurses relate to their age and educational preparation within the workforce. Other factors relate to the structures and management systems evident within the health service that employs them. To effectively support new families within the community, health systems must adequately resource services and support C&FH nurses in changing from a paradigm of expert to partner, consistent with primary health care practice.
Capacity Building and Complex Communication Needs: A New Approach to Specialist Speech Pathology Services in Rural Victoria
Authors: McLennan Fiona , Vickers Kate , Mason Kylie , Bloomberg Karen , Leadbetter Victoria , Engel Meg
Published: August 2009

The aim of this article is to provide a description of the establishment of an innovative approach to improving speech pathology services and community inclusion of people with complex communication needs in rural Victoria. The East Hume Regional Communication Service was established by Ovens and King Community Health Service in partnership with Wodonga Regional Health Service in 2004 as part of a "hub and spoke" network of services across Victoria for people with complex communication needs. Unlike traditional speech pathology services that historically have focused on clinical one-to-one intervention, the Regional Communication Service has a strong focus on community capacity building, enhancing inclusion of people with complex communication needs through improved knowledge, skills and attitudes. This paper will review the relevant literature and outline the Victorian Government policy context within which the service was established. Service highlights and successful initiatives will be described and key factors contributing to the success of the East Hume Regional Communication Service will be explored. Areas for process improvement during the initial two years of operation will also be discussed. This article will provide an insight into establishment of a service delivery model addressing both individual needs and community inclusion that has the potential to be extended across multiple disciplines and areas of practice within rural Australia.
Cost Impact of Improved Primary Level Diabetes Care in Remote Australian Indigenous Communities
Authors: McDermott Robyn , Segal Leonie
Published: August 2009

The objective of this study is to estimate the direct costs and downstream savings of improved quality of diabetes services, compared to usual care, in the primary care setting in a high-risk remote Indigenous Islander population. The study looked at cost impact analysis over six years (2000-2005) comparing costs of quality improvement with actual and projected savings in avoidable diabetes-related hospitalisations. Costs of service provision were derived from district financial reports, costs of diabetes-related complications requiring hospitalisations were estimated from actual admission data and costed using published Diagnosis-Related Group costings in Australian dollars (year 2000). Net present value cost of the quality improvement intervention was estimated using a 5% discount rate. A district health service in remote northern Australia, with 9,600 mainly Indigenous residents, including 1,000 adults with known diabetes served by 21 primary care centres and two hospitals, was the study population and setting. The main outcome measures are the costs of a quality primary level diabetes service and hospitalisations among people with diabetes for infections and other acute complications, lower limb amputations, end-stage renal disease and cardiovascular disease. Over the six years, a net present value cost of $570,000 is estimated for the new service. This is equivalent to A$1,800 for each major event avoided. After four years of initiation, annual cost savings exceed annual program delivery costs. It is concluded that, in this remote Indigenous population with high prevalence of diabetes and associated complications, investment in quality improvement in primary diabetes care using a chronic disease model will achieve cost savings through prevention of expensive diabetes-related hospitalisations.
A Capacity Building Process for Women with a History of Child Sexual Abuse
Authors: van Loon Antonia , Kralik Debbie
Published: August 2009

We report the research process used to promote the capacity of women made homeless by the consequences of addictions to alcohol, drugs or gambling, that are considered the result of being sexually abused as children. We aimed to improve the capacity of service providers working with this client group. We used the participatory action research (PAR) process "Look, Think, Act", employed by Stringer (1999; Stringer & Genet, 2004). "Looking" involved building a picture of the issue based on available information. Participants described what was going on so a clear picture of the context emerged. "Thinking" was the clarification phase where meanings and feelings generated by the experience were explored. It involved sense-making questions such as, "What is happening and why? How am I feeling about this?" The aim was to understand the when, what, where and how of the experience. After describing the issues the women were invited to think about what they could do about the issue. "Acting" (a difficult phase), involved effecting change. Action required involvement with the situation. It was a new skill for many women as they had become disengaged with their lives. They were encouraged to choose actions that moved them towards chosen goals. Many women had become so disempowered they ignored their needs and had few hopes or aspirations. We encouraged them to take the smallest and most easily managed actions likely to have the most benefit for their wellbeing. The process and the outcomes are described in this paper.
Falling Through the Cracks: Supporting Young People with Dual Diagnosis in Rural and Regional Victoria
Authors: Kenny Amanda , Kidd Susan , Tuena Jenni , Jarvis Melanie , Roberston Angela
Published: August 2009

Research has indicated that people with a dual diagnosis of mental illness and substance abuse are more difficult to manage than any other group of mentally ill clients. For young people with a dual diagnosis, particularly in rural and regional areas, there are significant barriers to the provision of optimal care. Currently, a lack of communication between mental health, drug and alcohol services and consumers results in the inadequate provision of treatment for young people, with a resultant significant service gap. Dual diagnosis programs that focus on both substance abuse and mental health issues demonstrate greatly improved client outcomes. Developing a peer education program provides one constructive way of involving dual diagnosis consumers in developing more responsive health services. It provides a highly structured and supported way of involving consumers who ordinarily find mental health services bewildering and inaccessible. By drawing on the knowledge and skills of young people with dual diagnosis, and involving them as peer educators, the notion of expertise in lived experience is captured and harnessed to provide the establishment of a consumer-focused service that better meets the needs of this complex, often neglected, client group.
Evaluating Access to and use of Primary Health Care: Diabetes-related Case Study using the 2002/3 NSW Health Survey
Authors: Comino EJ , Hermiz O , Harris MF , Harris E
Published: August 2009

This paper investigates the use of the 2002/3 NSW Health Survey to provide information on access to and use of quality primary health care (PHC) using type 2 diabetes as a case study. The 2002/3 NSW Health Survey is a telephone survey using Computer Assisted Technology to survey a random sample of NSW residents stratified by area health services. We investigated the population characteristics that were associated with access to and use of PHC relating to the diagnosis, proactive management, complication screening and health outcomes of diabetes for participants. Older participants reported increased diabetes, but not diabetes-related risk factors, increased hospitalisation, and increased medication use, but decreased blood pressure screening. Relatively disadvantaged participants reported greater health care needs not reflected in access to and use of health services. While these participants reported increased use of medication to treat diabetes they were less likely to report using three or more accepted management strategies. This work indicates that the NSW Health Survey can provide information on access to and use of health services. Discussion is needed to identify ways in which information on access to and use of PHC can be enhanced.
Sharing Common Principles: Blending the Primary Health Care and Harm Reduction Paradigms to Meet Common Health Goals in HIV/AIDS Prevention
Authors: Pankonin Christopher A
Published: August 2009

HIV/AIDS continues to spread globally and deeply affecting resource-poor settings, with over 90% of cases occurring in developing countries. In these areas, primary health care remains the preferred model of health care delivery; advocating core principles including community involvement, equity, and an emphasis on disease prevention while providing basic medical treatment. The harm reduction paradigm shares key principles with primary health care, and as this paper will argue, a combined comprehensive HIV prevention strategy would provide a holistic and particularly effective approach to HIV prevention. The most important improvement achieved through a combined HIV prevention strategy is by providing the community with an increased number of social services including housing and employment services, financial counselling, mental health counselling, and referrals to additional medical services. In also addressing the social determinants of health, a combined primary health care and harm reduction approach act to provide a holistic disease prevention strategy that also seeks to address the conditions that lead to increased risk-taking behaviours. Additional evidence indicating a successful comprehensive prevention strategy remains closely tied to measures of effectiveness, including improvements in HIV prevalence and incidence rates, needle and syringe coverage, and treatment services for HIV/AIDS patients.
Consumers' Level of Comfort with an Advanced Practice Role for Registered Nurses in General Practice: A Queensland, Australia, Study
Authors: Hegney Desley , Eley Robert , Buikstra Elizabeth , Rees Sharon , Patterson Elizabeth
Published: August 2009

A study was carried out in Queensland, Australia, which aimed to ascertain how comfortable consumers were with both the current and an expanded practice role for nurses employed in general practice. Consumers from metropolitan, rural and remote areas were represented. The self-report questionnaire was completed by 87 females and 19 males. Consumers rated their level of comfort from very comfortable to very uncomfortable on a five-point scale in nurses performing 24 different routine and advanced procedures. They were most comfortable with nurses giving vaccinations and managing treatment of wounds and less comfortable with nurses diagnosing and treating minor illnesses. Overall, consumers were very comfortable with nurses performing what may be considered traditional roles of the practice nurse. They were less comfortable with the more extended roles that are seen more as the traditional role of the general practitioner. However, for no procedure were consumers uncomfortable with nurses performing that task. There were no differences in responses due to consumers' age, sex or previous contact with practice nurses. These results may be used to expand the role of practice nurses to complement the services provided by general practitioners.
Body Dissatisfaction as a Motivator for Weight Loss: Should Assessment of Body Dissatisfaction be Considered in Primary Health Settings for Women Planning to Lose Weight?
Authors: Evans Lynette , Meehan Lisa
Published: August 2009

The objective of this study was to assess whether body dissatisfaction predicted weight loss in terms of an inverted U relationship. It was predicted that women with high and low body dissatisfaction were less likely to lose weight than women with moderate levels of body dissatisfaction. The study also sought to determine if the number of weight loss attempts, success at past weight loss and self-concept predicted percentage of weight loss in women at six months; and to test whether weight loss led to decreased body dissatisfaction and increased self-concept. Women attempting to lose weight (n = 209) were asked to complete a set of questionnaires at two time points. Results show that women with moderate scores on body dissatisfaction lost more weight than women with higher or lower scores, although this association disappeared when Body Mass Index (BMI) was controlled for in the analyses. Low BMI, success of previous weight loss and low personal self-concept predicted weight loss six months later. Women who lost weight reported lower body dissatisfaction and improved self-concept. It was concluded that, assessing for body dissatisfaction, BMI and weight loss history in the context of primary health settings, may aid in identifying women able to motivate themselves to successfully lose weight in a self-directed manner.