bluuebunny/crossref_metadata_2025 huggingface dataset:
Brief Research Note: A Comparison of the Provision of Counselling and Advice to Primary Care Patients in Emergency Departments and a General Practice Casualty Department
Authors: Bolton Patrick , Mira Michael
Published: August 2009

Data were collected from clinicians at the time of consultation about the care that they provided in 12,813 encounters in a general practitioner (GP) staffed casualty department and 719 primary care encounters in two emergency departments (Bolton, 1999). Data were collected by the GPs themselves in general practice, and by a research officer located in the emergency departments. Patients seen in the emergency department were ambulatory patients whom the triage nurse assessed would not suffer an adverse outcome if they had to wait an hour or longer for care. Comparison of these two patient populations established that they were similar in terms of age, gender, ethnicity, and reason for encounter.
Editorial
Authors: Gardner Heather
Published: August 2009

Editing the Australian Journal of Primary Health from its inception in 1995 has been a most engaging and enjoyable experience. As this is "my" last issue as editor, I would like to move beyond the academic constraints and formality of editing to recognise some of this experience.
A Public Health Initiative for Steroid Users in Victoria
Authors: Aitken Campbell , Delalande Cheryl
Published: August 2009

Anabolic steroid injectors are at risk of infection with blood-borne viruses (BBVs), but have received little attention from researchers, practitioners or agencies working in public health. In recognition of this gap, in early 1996 the Steroid Peer Education Project (SPEP) began providing part-time mobile needle and syringe distribution and health information and referral services to steroid injectors in north-eastern Melbourne. Demand repeatedly caused the project to expand, and its sole peer worker now operates Victoria-wide, five days per week. Basic information on injecting practices collected from SPEP clients showed that many were at risk of BBV infection. This led to the initiation of a collaborative research project, in which SPEP clients were tested for BBV antibodies and provided detailed information about their risk behaviours. Of 29 steroid injectors tested between May and August 1999, three (10%) had antibodies to the hepatitis C virus, and they described behaviour which could spread the virus to other steroid users. These results show that blood-borne viruses are present in the Victorian steroid injecting community, and reinforce the SPEP's commitment to reducing harm in this group.
Neonates' Birth Weight and Attitudinal Status of Primiparous Women in Hefei, China
Authors: Bi Peng , Tong Shilu , Parton Kevin
Published: August 2009

To examine the maternal attitudinal status among primiparous women, to explore the potential risk factors of their neonates' birth weight and to provide suggestions to improve the quality of perinatal health care, a survey was conducted in a medium city of China. Using a cluster sampling method, four hospitals were selected from Hefei City, China. Social and biomedical information was collected on 394 primiparous women and their neonates over the period of 10 May to 9 June, 1995 both from their medical records and from the mothers' responses to a questionnaire. Data analyses including univariate analysis, F test and multiple linear regression analysis were conducted. It was found that the primiparous women who had a high educational level, an occupation with a stable income and an optimal delivery age (23-29 years old) had a more stable maternal attitudinal status, and their neonates tended to have a higher birth weight. The parents' height, mother's weight, maternal nutritional status, neonate's gender, vagina bleeding history, location of the family home, whether the mother had regular check-ups and mother's negative feeling during pregnancy were also significantly correlated with the neonates' birth weight. The results suggested that the improvement of educational levels, raising economic status, particularly maternal nutrition status during pregnancy and the choice of an optimal delivery age among primiparous women might be helpful in reduction lower birth weight incidence.
Documentation and Discussion of the Process of a Successful Partnership Using an Intersectoral Action Framework: Marrickville Walk Wise Project
Authors: Bindon Jeni
Published: August 2009

Working in partnership has been recommended as a way to achieve health promotion outcomes. This paper uses an intersectoral action framework to document and discuss the partnership process of a local government walking program. Implementation of the Marrickville Walk Wise Project (MWWP) used a partnership strategy between health promotion and a local Council, drawing from diverse campaigns, programs and funding bodies. Results include an audit, modification and signage of walking routes, and establishment of walking groups among resident migrant populations. An inter-sectoral action framework provided a useful method for documentation and would be an effective planning tool. The concept of 'Capacity Building' is a framework for the development of sustainable organisational structures, resources and commitment to health improvement. Partnerships are a key element of this. An intersectoral action framework of necessity, opportunity, capacity, relationship, action and sustainable outcomes facilitated the effective documentation and discussion of the partnership process. This framework could be equally useful as a planning and evaluation tool. An intersectoral action framework provided an effective means to document the process of implementing partnership work of the MWWP. In retrospect, it was recognised that the intersectoral action framework could have been applied to the planning and evaluation process as well. The intersectoral action framework is an effective tool to plan, document and evaluate and can act as a guide for working in partnership with other sectors on health promotion programs. It is particularly useful in further understanding the processes behind such programs.
Patient Satisfaction with Sex Re-assignment Surgery in New South Wales, Australia
Authors: Collyer Fran , Heal Catherine
Published: August 2009

An evaluation of the effect of sex re-assignment surgery on a group of patients attending a private clinic in Sydney, Australia. Fifty-seven patients who underwent full male-to-female sex re-assignment surgery between 1987 and 2000 completed a satisfaction survey. Several factors that might influence the extent of satisfaction with surgical outcome were explored, including age, work status, social life, and the appearance and function of the new genitalia. Patients reported significantly improved social and personal satisfaction following surgery, compared with five years previously. The study challenges outcomes from previously reported studies with regard to the age of patients at the time of surgery, and the finding that from the patient's perspective, there is no fundamental association between a successful surgical outcome and a satisfactory post-operative life experience.
A Qualitative Approach to the Mental Health Care Needs of People Living with HIV/AIDS in Victoria
Authors: Teresa Dawson Maria , Grech Paul , Hyland Brendan , Judd Fiona , Lloyd John , M. Mijch Anne , Hoy Jennifer , C Street Alan
Published: August 2009

This article reports on the findings of the qualitative stage of a larger project on the mental care needs of people with HIV/AIDS and mental illness (Tender T1176 Department of Human Services, Mental Health Branch, Victoria - Research on the Mental Health Care Needs of People with HIV/AIDS and Mental Illness). The purpose of the larger research was to evaluate the needs and treatment requirements of persons with HIV/AIDS, who also suffer from mental health problems, with a view to developing proposals for improving existing service delivery in Victoria, Australia. The qualitative stage was designed to complement and elucidate data obtained through the quantitative stages of the project. Thirty in-depth open-ended interviews were carried out with service providers including HIV physicians, general practitioners, psychiatrists, clinical and managerial staff of Area Mental Health Services, Contact Tracers and forensic mental health services staff, as well as representatives of community groups such as People Living with HIV/AIDS and Positive Women and carers. The interviews explored the perspective of both service providers and users of such services with respect to needs for psychiatric care and service delivery, ease of access or barriers to mental health services, and the perceived strengths and weaknesses in current service provision. This paper presents the main findings and recommendations submitted to the funding body.
Predictors of Patient Enablement: The Role of Doctors' Helpgiving Style, Patient and Visit Characteristics
Authors: A. Simmons Tanya , R. Winefield Helen
Published: August 2009

Patient enablement is a possible outcome of primary health care consultations and has been employed as a marker of effective helpgiving. We studied predictors of patient enablement, investigating the relative contribution of patient characteristics (gender, age, occupational status, and perceived health status), visit characteristics (length of consultation, duration of physician-patient relationship, and frequency of consultations), and the physician's reported helpgiving style (level of encouragement of patient participation in the consultation). The Helpgiving Practices Scale and Patient Enablement Instrument were completed by 103 patients from eight metropolitan general practices. Patients with better perceived health status and lower occupational status felt more enabled following their consultations. Frequency of consultations employed as a measure of "knowing a doctor well" was also significantly associated with post-consultation enablement. General practitioners' encouragement of patients to participate in their health care then added significantly to the explained variance in patient enablement. Results of this study indicate that the Patient Enablement Instrument is a useful measure of quality of care with scores being less positively skewed than those of frequent employed satisfaction measures.
Can a Prison Practice Good Public Health?
Authors: Smith Debra , Gibson Jeanette
Published: August 2009

This paper provides a description of the health practices that are provided for prisoners in a large rural prison. It takes a model of health promotion using a settings approach to describe these practices and includes descriptions of the barriers to implementing health promoting practices. This paper is concerned only with the health impact of the prison on prisoners, and does not attempt to explore any health issues related to staff. It is also beyond the scope of this paper to consider the impact of privatisation on attempts to improve health in prisons. This paper provides a description of how one prison delivers, or fails to deliver, good public health to its prisoners.
Theatre and Peer Education: An Innovative Approach to Health Promotion
Authors: Lasic Slavica , Kenny Leonie
Published: August 2009

This paper describes a health promotion project with young people from three secondary schools in the western metropolitan region of Melbourne. The project uses drama as a tool to promote social connectedness with family, peers, schools, and community. It draws on the results of an evaluation based on the production of "At All Costs". Drama facilitators from Footscray Community Arts Centre worked with students to workshop and develop issues and themes relevant to young people, Interviews, focus groups, and surveys were conducted to evaluate the benefits and impact of the project on the performers and audience of one of the secondary schools involved.
Enhancing Supervision Skills for Rural Placements through Video-conferencing in Western Australia
Authors: Lower Tony , Ladyshewsky Rick , Loud Joan , Moore Sally
Published: August 2009

This paper examines the use of video-conferencing technology as a medium to deliver preceptor/supervisor training in a multidisciplinary context in rural Western Australia. A video-conference involvIng three rural sites and a transmission site in Perth was conducted. The one-day training program covered the generic issues involved with student supervision. Based on feedback from participants, results illustrate a wide acceptance of the generic supervision content and a moderate acceptance of the video-conferencing technology as a delivery medium. Although further refinement of the manner in which video-conferences are delivered is required, this study supports the utility of video-conferencing as a means to deliver supervision training in a multidisciplinary manner in rural areas.
Communication and Control in the Co-construction of Depression: Women's Accounts of Their Interactions with Health Practitioners
Authors: Egan Ronnie , Gridley Heather , Hood Bernadette , Brew Christine
Published: August 2009

Issues of communication and control have been implicated in the evolution of mental health problems, the process of seeking help and the outcomes of this process. This paper explores control and communication processes in the course of women's help seeking for depression. Although depression rates are consistently higher for women than for men, there is little information on women's experiences of seeking support or treatment. Feminist theory and research highlight the centrality of power and control for women's health and wellbeing, but examination of mechanisms mediating power and powerlessness within treatment contexts is lacking. This study utilises a predominantly qualitative methodology to explore how 14 women diagnosed with depression describe interactions with health practitioners. Building on previous theoretical positions, we develop a framework to encompass the complexities of the women's accounts, providing insight into processes by which women and health practitioners co-construct healthcare interactions. The findings suggest that for these women, the commonly posited dichotomy between understandings of depression as either a biomedical or sociocultural construct was less salient than, and mediated by, issues of control and communication. Financial and systemic considerations emerged as contextual mediators of both the women's and health practitioners' degree of control in working towards improved health outcomes.
A Comparison of Waiting Times, Patient Choice and Satisfaction in Three Primary Care Settings
Authors: Boltonl Patrick , Mira Michael
Published: August 2009

The objective of this study was to examine the interaction between patients' choice of care, their satisfaction with that care, and waiting time. Patient satisfaction and waiting times were recorded in three primary care settings in Sydney. The results show that patients in Australian primary care services do not like to wait, and those for whom waiting time is a determinant of choice are easier to satisfy than those for whom it is not, irrespective of the wait. Primary care services may be made be made more satisfying for consumers if consumers are better engaged in choosing their health care.
The Impact of a Clinical Audit on GP Detection of Depression
Authors: G. Bolton Patrick , M. Parker Sharon , J. Fergusson Kylie , D. Orman Jannifer
Published: August 2009

Objective: To determine if a clinical audit and linked educational workshop would improve the ability of general practitioners to accurately detect depression. Design: Pre- and post-data collection over a six-month period (two eight-week collection periods), associated educational workshop, and comprehensive treatment guidelines. Setting: General Practice in the Central Sydney Area. Study participants: A total of 1106 patients (592 pre-, 514 post-collection) from six general practices. Patients were required to be 18-65yrs and willing and able to complete a self-administered depression rating scale. Main Outcome Measures: General practitioner rating of consecutive patients using a tick box scale matched to patients' self-report on the Hospital Anxiety and Depression Scale. Comparison of patients' scores on the two sub-scales of the Scale (depression and anxiety) and the reason for presentation rated by the general practitioner. Results: The mean age of participants was 35 years for audit one and 33 years for audit two with substantially more females participating (73.6% and 68.1%) as opposed to males (26.4% and 31.9%). The presence of psychological problems as identified by the HADS was higher than that reported in the literature and actually decreased from 65.9% in audit one to 59.7% in audit two. There were non-significant increases in the rate at which participating general practitioners detected depression with the proportion of "true negatives" increasing between the audits and the proportion of "false negatives" decreasing. No change occurred in either the true or false positive rates. Conclusions: Within this study, the audit, feedback and educational workshop in combination achieved poor results. This, and the prevalence of depression in the population, suggests further research is warranted to determine an effective method of educating general practitioners to detect depression.
"On Your Feet, On Your Back" Development of an Allied Health Outreach Service for Sex Workers
Authors: Hopkins Penny , Slater Colleen , Clark Damien
Published: August 2009

The Inner South Community Health Service is a multi-sited community health agency situated in inner Melbourne. As part of its commitment to community development, in january 2000 it extended its role to offer a health and education program to the sex industry. In keeping with this philosophy, in October 2001 a pilot project "On Your Feet, On Your Back" was initiated. This project involved allied health workers providing assertive outreach to sex workers on the streets and at a drop-in clinic. This paper discusses the challenges of taking allied health workers out of their traditional clinical setting and placing them in the workplace environment of sex workers in order to provide a meaningful service to this client group. A case presentation will illustrate the importance of utilising a variety of innovative strategies in order to achieve a positive outcome for both the allied health staff and the sex workers. As a conclusion, this study will demonstrate the importance of the availability of adequate support and resourcing at all levels of an organization, and how this enables successful innovation in the provision of primary health services.
Editorial: Chronic illness: policies and paradoxes
Authors: Aroni Rosalie , Swerissen Hal
Published: August 2009

It is almost a truism to state that Australia has experienced a health transition from infectious and acute diseases to chronic disease, impairment and disability in the last century (Murray & Lopez, 1996; Beaglehole & Bonita, 1997; Australian Institute o
Asthma self-management: What do we really mean?
Authors: i RA Aron , r SM Sawye , n MJ Abramso , t K Stewar , n FC Thie , n DP Goema , s JA Douglas
Published: August 2009

The term "self-management" is sometimes perceived by sociologists and consumers as a code word for adherence or compliance with the health care regimen. Their criticisms are often couched in terms of putting the "self" back into self-management, whereas t
The Partners in Health scale: The development and psychometric properties of a generic assessment scale for chronic condition self-management
Authors: W Battersby Malcolm , Ask Alex , M Reece Marion , J Markwick Mignon , P Collins James
Published: August 2009

Despite the vast amount of evidence supporting the effectiveness of chronic condition self-management, no generic instrument exists to assess self-management. In light of this, the Partners in Health (PIH) scale was developed and then piloted for acceptability. Forty-six patients completed the PIH pilot scale, with positive feedback from the patients, GPs, and other health professionals in the pilot program. The PIH scale has demonstrated potential to be a reliable and valid measure of chronic condition self-management. A future study is proposed, however, to confirm the findings presented here. The PIH scale may help health professionals to introduce the concept of self-management to their patients/clients, and provides a rapid checklist of areas of self-management that may lead to interventions targeted to the individual. Out of the many terms used in the literature, self-management is the term decided on here to refer to the active involvement of the patient in the management of their chronic medical condition.
Chronic illness and self-management: A patient's perspection
Authors: Ng Joanna
Published: August 2009

As a person living with epilepsy, my primary care is delivered by my neurologist, my pharmacist, myself, my family and my friends. This paper will document not only the pathology of epilepsy, but also the biopsychosocial issues that affect people living with epilepsy.
Managing health care in Australia: Steps on the health care roundabout?
Authors: Harvey Peter
Published: August 2009

This paper explores some of the lessons of the coordinated care trials in Australia in the context of managed care in America and asks how do we best manage our finite health care dollars for the most equitable and effective outcomes for whole populations?
The COAG trial in Australia tested a more structured process for managing the care of patients with chronic illness and postulated that currently fragmented health system funding could be pooled around individual patient need, and managed for improved economic outcomes and patient wellbeing. There is little doubt, following this initiative and much work in other countries, that as health care costs rise, for a range of reasons, improvements are needed in the management of our resources if we are to control rising health care costs. We also know that chronic illness, much of which is preventable and avoidable, is the major component in the rising health care cost equation and a factor likely to consume around 75% of our health dollars in the future. Much chronic illness can be prevented through social and population health strategies and we know that even if chronic illness can?t be prevented, it can be managed better through community-based chronic illness management programs. These programs rely on information, education, patient lifestyle and behaviour change, and on patients developing improved self-management skills. But, what is the best way to manage population health in Australia and ensure equity and fairness in the health care market as we evolve new approaches, especially to the management of chronic illness?
Small-scale rural pilot programs in chronic illness management - what next?
Authors: y PW Harve , s PD Mill , n G Misa , n K Warre
Published: August 2009

In recent years, rural SA has been the recipient of significant funding to support a range of new primary health care initiatives. Much of this funding, additional to normal recurrent budgets in our health system, has facilitated effective change and development through demonstration and research projects across the state. The resultant work involves programs such as:
? coordinated care trials (COAG)
? more allied health services (MAHS)
? Commonwealth regional health service initiatives (CRHS)
? quality use of medicines (QUM)
? community packages for aged care services
? Indigenous chronic disease self-management pilot programs (CDSM)
? chronic disease self-management (CDSM) programs - Sharing Health Care SA
? chronic disease self-management (CDSM) programs in Indigenous communities.
In addition to the resources listed above, funding was also provided by the Commonwealth to establish the South Australian Centre for Rural and Remote Health (SACRRH) and develop the University Department of Rural Health in Whyalla. While this new funding has led to substantial developmental work in chronic illness management in particular, one needs to ask whether the time might not be right now for these hitherto small-scale change initiatives to be transformed into ongoing mainstream programs, informed and guided by research outcomes to date. Is it time to move beyond tentative chronic illness programs and into mainstream reform? We have shown that there is much to be gained, both for patients and for the system, from improved coordination of primary care services and initiatives such as self-management programs for patients with chronic conditions. Better management leads to improved patient health outcomes and can reduce demand for unplanned hospital and emergency services. Many admissions to rural hospitals requiring expensive services, in terms of infrastructure and staffing, could be either prevented, or patients could be managed more effectively in the community as part of a wider primary health care program.
Contextualising indicators of socio-economic status: Chronic illness as lived experience of SES
Authors: Walker Christine , Peterson Chris
Published: August 2009

The concept of socio-economic status (SES) has been recognised as playing an important role in the incidence and experience of chronic illness (Taylor, 1983; Najman 1988; Syme, 1998; Marmot, 2000). Yet just how SES interacts with the experience of chronic illness has not been well researched. For example, researchers are unable to categorically state if living conditions and life opportunities associated with low SES lead to a greater propensity for developing a chronic illness, or if the experience and consequences of having a chronic illness lead to developing low SES characteristics, or both. Neither has research provided good data on the mediating roles of factors such as ethnic background and location of residence on the relationship between SES and chronic illness.
Self-management programs for chronic disease require different capacities from participants to produce good outcomes. These capacities are to some degree dependent on level of education, type of job, and general level of socio-economic status. Therefore, the level of SES of people with a chronic disease is important to understanding how they will respond to self-management approaches. For example, people with a chronic disease from lower SES backgrounds can be expected in some instances to have a different set of coping capacities with their disease (partly a function of income, education, and work experience) compared to those from higher SES backgrounds. The socio-economic status of people with a chronic disease is an important area for investigation that has implications for the efficacy of self-management programs. This paper will argue that while SES is a vital concept in understanding the impact of chronic illness on people?s lived experiences for many conditions, current approaches oversimplify it by quarantining it from its context. Researchers tend to treat SES as a stable composite concept whose application illuminates the social basis of the illness experience. More frequently, we arrive at an explanation of simplified relationships rather than an explanation of the relationships between chronic ill health and SES as lived by members of real communities (Frank, 1990; Zola, 1991).
Communicating with consumers: The development of an evidence-based research agenda in chronic illness research
Authors: Hill Sophie , Stoelwinder Judith
Published: August 2009

It is probably not surprising, but when most people talk about the ?getting and using? of evidence in health care, they are usually referring to evidence about treatments - things like pills and procedures. Despite this contemporary focus on health treatments, there is a long history of evaluating social, as well as clinical, interventions. Methods developed to answer evaluation questions of social interventions arose early in the twentieth century, and were applied, for example, to evaluate large-scale social programs in the USA (Oakley, 2001, pp.17-19). The study design of meta-analysis, used to synthesise the evidence from a number of studies of similar interventions, has been picked up and developed within medicine as well (Daly, Kellehear, & Gliksman, 1997, pp.139-53). This has led to the establishment of large-scale enterprises such as the Cochrane Collaboration, an example of an international organisation that is assembling and reviewing the effectiveness of many clinical interventions (Chalmers, 1993; Cochrane Collaboration, 2003).
How counsellors generate process knowledge: A content analysis of commentaries on referrals concerning gambling
Authors: Patford Janet
Published: August 2009

The present study aimed to identify and classify counsellors? cognitive processes, as manifest in transcripts of verbal commentaries on written referrals concerning gamblers. Sampling was purposive to ensure that participants worked in a range of agencies and differed in regard to their personal characteristics, professional qualifications, and employment histories. Cognitive processes were identified by means of a content analysis of all transcripts. They were then ordered in a taxonomy comprising three broad categories with related sub-categories. However, differences between transcripts suggested that counsellors had different analytic capacities. Findings raise questions regarding the training and certification of counsellors and suggest some strategies for improving clinical reasoning and judgments.
A microanalysis of a participatory action research process with a rural Aboriginal men's health group
Authors: Tsey Komla , Patterson David , Whiteside Mary , Baird Leslie , Baird Bradley , Tsey Kwame
Published: August 2009

Our recent paper (Tsey, Patterson, Whiteside, Baird, & Baird, 2002) analysed the early stages of a participatory action research process (PAR) designed to support members of a rural Aboriginal men?s group to take greater control and responsibility for the factors influencing their health and wellbeing. This follow-up paper focusses on key challenges and opportunities associated with the PAR process. Among other things, the paper highlights: a need for training providers and policy-makers to give more attention to the issue of community development skills and how to promote the uptake of such skills more widely in Indigenous settings; the importance of taking a ?solution-focussed approach? in line with the principles of PAR when doing community development work; a need for relevant training and creation of real employment opportunities to be central to strategies designed to support rural Aboriginal men to take their rightful place; a need for the men?s group to promote the broad spectrum of its activities more widely so as to minimise an image problem that the men?s group is only for men having problems; and, above all, an urgent need for the men?s group organisers to play leadership roles through, for example, dialogue with local gay men so as to jointly come up with ideas to make the men?s group more accessible for all men, including gay men.
From theory to practice: Issues arising for a novice home visitor
Authors: M Bowes Jennifer
Published: August 2009

Home visiting has been widely viewed as an effective part of prevention and early intervention programs for children in their first few years of life. The actual practice of home visiting involves skills and decision-making that may be new or challenging to the novice home visitor. These reflections follow two years of home visiting as part of the Parents as Teachers program, and of teaching in professional development courses about home visiting. The paper presents examples of issues arising in my own experience as well as the experiences of others reported in professional development sessions. Issues include negotiating boundaries, dealing with expectations of expertise, learning to see from other perspectives, dealing with developmental issues for children and for parents, and maintaining flexibility of approach in a highly structured program. Implications for the training and support of home visitors and for the place of home visiting in family support are discussed.
Access and attitudes to health care of Torres Strait Islanders living in mainland Australia
Authors: Ban Paul
Published: August 2009

Ninety-two mainland Torres Strait Islanders, across five communities on mainland Australia, were consulted in relation to their access to health service providers. Similar numbers were interviewed in different-sized locations encompassing urban, rural, and remote areas. This exploratory study was the first to consider the health access issues of mainland Torres Strait Islanders. Overall, community controlled health services were the most commonly used exclusive health service providers, followed by private medical services and hospital outpatient services. The two most common reasons for the choice of health service provider in each community were convenience of access and the quality of relationship and trust with the medical staff. In general, the Torres Strait Islanders interviewed stated they are not comfortable seeking medical treatment, and delay accessing any health services. There was a high level of satisfaction in all communities with private medical services. Concerns were raised regarding long waiting periods at community controlled health services and hospital outpatient services, along with lack of confidentiality at community controlled health services. People wanted to see Torres Strait Islander staff at community controlled health services and hospital outpatient services to help facilitate greater access.
Too many surveys! Eliciting the views of general practitioners for not participating in postal surveys
Authors: Khan Asaduzzaman , Hussain Rafat , Plummer David , Minichiello Victor
Published: August 2009

This study explored the reasons general practitioners (GPs) are reluctant to participate in a postal survey. A cross-sectional postal survey was conducted among currently practising GPs in New South Wales, Australia, in 2002, who were asked to complete a questionnaire on the management of sexually transmitted infections (STIs). The overall response rate for the main STI survey was 45.4%. The GPs who did not respond to the STI questionnaire were sent a one-page non-response questionnaire asking them to report their reasons for not participating in the STI survey. Of the 491 non-responding GPs, 116 (23.6%) completed the non-response questionnaire and form the basis of the present paper. The key reasons reported by GPs for not participating in postal surveys were acute time constraints imposed by increasing workload including substantially increased paperwork, receiving too many survey requests, low STI caseload, and few incentives or returns on their time spent on completing surveys. While researchers need to be cognisant of constraints in general practice, it is also important to develop strategies for increasing GP involvement in research activities. To help improve participation of GPs in postal surveys, we recommend involvement of GPs in the design and conduct of research on issues relevant to general practice along with provision of feedback of survey results.
A rural perspective of telephone counselling and referral
Authors: J Watson Robert , McDonald John
Published: August 2009

A telephone survey was used to examine rural residents? (n=102) perceptions and knowledge of a well-established national telephone counselling and referral service - Lifeline. Residents in rural Australia experience generally poorer access and availability to health-related services than their metropolitan counterparts. They may also have problems with confidentiality and stigmatisation in using what services are available in their area. Although this was a noncomparative study, it was reasoned that these barriers to help-seeking in rural areas would mean their population would know and value a service such as Lifeline, which provides equitable and anonymous support and referrals to all Australians. The results showed that the service was known, valued, and supported strongly by the respondents. The findings supported the belief that telephone counselling and referral has an important and unique place in rural health support and referral.
Improving social connections for caravan park communities on the Mornington Peninsula
Authors: Llewellyn-Jones Lorraine , Occhiuto Shay , Palermo Claire
Published: August 2009

The aim of this project was to provide assertive outreach to the residents of two caravan parks on the Mornington Peninsula; to identify issues impacting on their health and work with them to address these. A developmental health promotion approach was taken to connect with proprietors and residents, to enable Peninsula Community Health Service (PCHS) staff to work in partnership with them in their own environment. Multiple strategies were identified and utilised by the communities to assist in improving their health. This paper describes this process, which benefited both caravan park residents and PCHS staff.
Guest Editorial: What can we learn from equity research and interventions?
Authors: Starfield Barbara
Published: August 2009

Equity in health has been defined, in terms to facilitate its assessment and achievement, as the absence of systematic and potentially remediable differences in one or more aspects of health across population groups defined socially, geographically, or demographically (International Society for Equity in Health, 2004). Thus, the key to success in equity research and interventions is to understand those factors that influence the distribution of health in populations.
Taking a systematic approach to addressing health inequality in Primary Health Care
Authors: Harris Elizabeth , Furler John
Published: August 2009

The history and philosophy of primary health care (PHC) in Australia is strongly linked to achieving ?Health for All?. As can be seen from the range of papers in this edition of the Australian Journal of Primary Health, considerations of equity, participation and action to address the underlying causes of poor health drive many programs and research endeavours. We have reason to be proud of the energy, enthusiasm and innovation that is demonstrated in the work presented, and heartened that there is an ever-increasing body of work which demonstrates the effectiveness of a comprehensive PHC approach in improving health and quality of life.
Consumer participation: The challenges to achieving influence and equity
Authors: Nathan Sally
Published: August 2009

Consumer participation in the planning and delivery of health services is recommended and promoted to improve access, quality of care and health outcomes despite questions about the evidence of its impact. There are also significant barriers to participation by certain groups in our community in both their own care and in broader decision-making processes. This paper examines the evidence of the impact of consumer and community participation in health services and the difficulties of engaging more marginalised groups. It proposes three challenges to be met in realising the promise of consumer and community participation: 1) building the capacity of consumers and the community to influence 2) building the capacity of the health system to accept and value their views, and 3) providing opportunities for the most marginalised in society to be heard. In meeting these challenges to consumer and community participation, researchers and practitioners also need to work together to find better ways to measure its impact.
Funding Aboriginal primary health care
Authors: Mooney Gavin , Henry Barbara
Published: August 2009

This paper provides an estimate of what should be spent on Aboriginal primary health care (PHC). Beyond that, it examines how such funding might best be allocated between on the one hand, programs, and on the other what might be broadly called ?investment in infrastructure?. The addressing of needs arising from a holistic Aboriginal construct of health is discussed. The paper adopts a definition of equity as equal access for equal need, but with three departures from how this is normally expressed (1) the use of ?capacity to benefit? as the basis of need - as opposed to the more conventional ?sickness-based? need (2) the weighting of capacity to benefit to reflect relative disadvantage and (3) the incorporation of the concept of MESH (Management Economic Social and Human) infrastructure to recognise that not all communities are equally well placed to use funds to allow them to realise their capacity to benefit.
To arrive at a composite figure for the ratios of funding for Aboriginal versus non-Aboriginal PHC, three ratios (2.9 for relative need as capacity to benefit, 1.2 for vertical equity, and 1.5 for cultural security) are multiplied together. This gives an overall factor of over 5 as the minimum ratio of funding per capita for Aboriginal PHC compared to non-Aboriginal PHC. The paper also discusses certain aspects of how to use the funds and what research is needed to allow estimates of funding requirements to be improved.
Ethnic community stakeholders as partners in primary and secondary diabetes prevention
Authors: Karantzas-Savva Eleni , Kirwan Amy
Published: August 2009

Recently renamed ?Listening to Ethnic Communities about Diabetes?, this project was a winner of the 2003 Innovation and Excellence in Primary Health Care Award, Community and Consumer Participation category. The project is also being promoted as a model of best practice in culturally and linguistically diverse (CALD) community engagement. Listening to Ethnic Communities about Diabetes focused on Type 2 diabetes by developing, piloting and evaluating culturally appropriate primary and secondary prevention health promotion strategies with Maltese, Filipino and Vietnamese communities in the municipality of Brimbank, Victoria. One of the critical success factors for the project was that, while the project was grounded in a health promotion framework, the lead agency did not have a great deal of health expertise. Rather, the focus of its expertise was on relationships with ethnic communities. This allowed for a shift in traditional power structures as the communities were given a real voice and decision-making powers. While the health service providers had the clinical and practical knowledge and expertise in diabetes, it was the involvement of the ethno-specific organisations and ethnic community representatives that enabled the project to develop and pilot models of service provision which had relevance and accessibility to the target community. The project also demonstrated the value in utilising a diverse range of strategies that reflect the cultural practices and preferences of the target communities through being developed and tested in partnership with the communities.
Bringing accessible antenatal care to disadvantaged women in outer western Sydney
Authors: Dwyer Christine , Cooke Helen , Hort Krishna
Published: August 2009

The Parenting and the Community Health (PatCH) project was established in an outer western Sydney primary school to provide a more accessible model of antenatal care to women from the surrounding area who potentially may delay or not access antenatal care in their pregnancy. The risk factor and demographic profile of disadvantaged women who did not access any antenatal care in their pregnancy during 1996-2002 indicates that most women resided in the most disadvantaged decile of collection districts, had several children, were single parents, and smoked; a third of the women were Pacific Islander; some women had drug problems; and some women had an undiagnosed mental disorder. In response, the PatCH project?s ethos includes recognition of psychosocial factors, including chronic poverty, and the social context of the cluster of maternal risk behaviours that potentially impact on maternal and foetal health. Service provision encompasses engaging women early in their pregnancy and continuity in antenatal and postnatal care followed by child and family services for the first five years of the child?s life. Due to the multiplicity of risk factors, the PatCH model includes monitoring the development of infants with a focus on early identification and intervention. Initial accounts from women attending PatCH confirm that continuity of seeing the same midwife encourages them to return as they only have to ?tell their story once?.
Coping with redundancy: A mentorship program for men
Authors: Joy Elyssa , Pond Dimity , Cotter Georgina
Published: August 2009

The idea of a small group mentorship program was developed from the concept that small groups might, in some small degree, replace the companionship that men who had been made redundant had experienced in the workplace and in social activities related to work, and that, as a result, participants? health would improve. It was thought these groups would function better if one or two unemployed peers who could demonstrate some positive approaches to the experience of unemployment were identified. This report documents the use of a small group mentorship intervention among 126 retrenched and unemployed men. The aims of the program were to determine the effectiveness of the mentorship program in improving a range of outcome measures, including improvement in health and wellbeing, increased confidence and skills in job search behaviours, and enhanced social networking/ reduced isolation. The program was evaluated using quantitative and qualitative methodology. The mentorship program was found to be an effective intervention to significantly improve outcome measures for depression and anxiety and social interaction for retrenched men. It is recommended that small group mentoring programs be more generally offered to retrenched men to build skills, to promote social connectivity and to improve men?s health and wellbeing.
The impact of residential socio-economic profile on medical service utilisation and nursing home attendance claims by older Australians
Authors: Gill Gerard , Blackmore Kate , P Geraghty Dominic , FitzGerald Des
Published: August 2009

In other developed countries, older persons in deprived personal circumstances make increased use of primary care and nursing homes compared with those less disadvantaged. The influence of living in a more deprived area on the use of these services by older residents has not been so well studied. This study appraises if older Australians living in more disadvantaged locations have similar increased service usage. Retrospective analyses of fee-for-service data from 1 October 2001 to 30 September 2002 for all Medicare and Department of Veterans? Affairs claimants aged 77 years and over, not admitted to residential aged care, were undertaken. Data were analysed by age, gender and quartile of disadvantage of postcode of residence as categorised by the Australian Bureau of Statistics 1996 Census Index of Relative Socio-economic Disadvantage. The main outcome measures were: mean number of claims for general practitioner primary medical care (GP) services; longer GP consultations; specialist consultations; rate of GP health assessments; and, first claims for GP nursing home attendances. Mean number of claims for GP primary medical care services generally decreased as the disadvantage of postcode increased. Men aged 77-79 years were an exception, with no difference in the mean across quartiles of disadvantage. The mean number of claims for longer primary care consultations and all specialist consultations also decreased as the disadvantage of postcode increased. Claims for GP health assessments were more frequent as the disadvantage of the residential postcode increased. Claim rates for first nursing home attendance items by men did not differ across the range of disadvantage. This lack of difference was also seen for women aged 77-79 years. Claims for first nursing home attendance items by women aged 80 or more years decreased as the disadvantage of postcode increased. This study concluded that there are fewer claims for medical and nursing home services by older Australians living in more disadvantaged postcodes. Whether this represents under-provision of medical care leading to sub-optimal health outcomes needs further examination.