bluuebunny/crossref_metadata_2025 huggingface dataset:
Some demographic issues affecting private health insurance
Authors: Hanning Brian
Published: February 2010

There will be significant changes in the demography of persons with Private Health Insurance (PHI). Two methods ofprojecting PHI coverage are discussed in this paper. The first assumes the only factors affecting PHI coverage aredemographic change and mortality, and facilitates comparisons between actual and projected PHI coverage.The second projects the percentage of the population insured in each five year age cohort, and makes allowance forchanges in PHI coverage due to all factors. Demographic change will increase Registered Health Benefit Organization(RHBO) premiums by 1.7% per annum. The role of these projections in analysing the effect of future premiumincreases on PHI retention rates is also discussed.
Promoting the health of older Australians: program options, priorities and research
Authors: Howat Peter , Boldy Duncan , Horner Barbara
Published: February 2010

Relatively little emphasis has been placed on identifying health promotion research and program priorities for the olderage group. A one-day conference culminating in an interactive session was organised to engage health serviceprofessionals in a process to identify such priorities in Western Australia. Physical activity, social isolation, mentalhealth and medications were deemed issues warranting more attention by both health promotion research and healthpromotion intervention programs. Additional consultation with representatives of the target population isrecommended to further refine the priorities.
Using nursing information systems to enhance quality service across multiple service providers
Authors: Dunn Sandra , Willis Eileen , Pal Simone , McMillan Virginia , Gassner Lee-Anne
Published: February 2010

This study explored the key requirements identified by stakeholders for the integration of Nursing Information Systems(NIS) in three public hospitals in the southern suburbs of Adelaide. The study used a qualitative approach of semistructuredinterviews, focus groups, site visits to the hospitals and review of relevant literature to ascertain whatparticipants saw as the necessary ingredients to create regional NIS. Study findings showed that the current NIS arenot sustainable in terms of staffing levels, physical resources or the capacity of the two currently-used computer productsto interface with newer generation products. A critical issue for adopting a regional model is the willingness of localsites to revise their current internal structures and functions. This restructuring towards a regionalised NIS wouldimprove overall communication, education, security, efficiency and sustainability.
Falls are a sensitive and challenging area of health care
Authors: Jones Catherine
Published: February 2010

Letter to the EditorsDear Editor,When 16 year old roofer, Joel Exner, was killed after falling from a roof, his employer was held responsible for failing to provide a safe workplace (Herald Sun 16/02/04). Construction workers stopped work to march on the NSW parliament demanding jail sentences for bosses who were guilty of breaches of safety (Sydney MorningHerald 22/10/03). The Labour Council of NSW pushed for the State Government to implement a criminal charge of industrial manslaughter which would carry a maximum fine of $5 million and up to 25 years in jail (Sydney Morning Herald 19/10/03).Imagine the legal ramifications if an up-and-coming Ian Thorpe or Pat Rafter was to be seriously hurt or disabled in a slip and fall accident in a change room. If it could be proven that falls prevention strategies had not been put in place (for example slip resistant floor surfaces) the potential payout would be in the multiple millions. Why is it then, that an elderly person can fall in hospital and die a week later as a direct result of injuries sustained in the fall, and the public is silent?
The lived experience of men and women with hepatitis C: implications for support needs and health information
Authors: Temple-Smith Meredith , Gifford Sandra , StoovÚ Mark
Published: February 2010

Meredith Temple-Smith is a Senior Research Fellow in the Australian Research Centre in Sex, Health and Society, La Trobe University.Sandra Gifford is Professor of Public Health and Director of the Refugee Health Research Centre, La Trobe University.Mark Stoov� is a Lecturer in the School of Health Sciences, Deakin University.Hepatitis C is Australia's most commonly notified infectious disease. Health education and support strategies that are gender-specific are key components of effective management of chronic illness, yet almost no information exists about gender-specific needs of those with hepatitis C. This paper reports on a qualitative study of the experiences of diagnosis, support and discrimination among men and women living with hepatitis C in Melbourne. Content analysis of indepth interviews conducted with 20 women and 12 men revealed gender related differences in relation to symptom recognition, health seeking attitudes and notions of social support, with men tending to dismiss the impact of their illness and their needs for education and support in comparison to women. Results highlight the need to take gender into account when addressing primary health care issues for people living with hepatitis C.
Hepatitis C-related discrimination in New South Wales
Authors: Day Carolyn , Jayasuriya Rohan , Stone Graham
Published: February 2010

Carolyn Day is with the National Drug and Alcohol Research Centre, University of New South Wales. Rohan Jayasuriya is at the Graduate School of Public Health, University of Wollongong. Graham Stone is with HIV, Program AIDS, Northern Sydney Health, Manly Hospital.Acknowledgements: The HepCare trial was funded by the Commonwealth Department of Health and Family Welfare and the NSW Health Department.Hepatitis C-related discrimination was examined. Intake interviews with 606 HepCare trial participants from New South Wales were analysed to determine the prevalence and correlates of hepatitis C related discrimination. The sample was a mean age of 37 years, 54% were males, 79% reported a history of drug injecting and 35% were current injectors. Forty percent of the sample reported experiencing hepatitis C-related discrimination. Multivariate analysis revealed that current injectors, 35-44 year olds, females, those who had recently consulted a general practitioner and those who had been referred to a specialist for their hepatitis C were more likely to report discrimination than other groups. More research is required to attain a better understanding of hepatitis C-related discrimination.
Building a culture of research dissemination in primary health care: the South Australian experience of supporting the novice researcher
Authors: Ried Karin , Fuller Jeffrey
Published: February 2010

The Primary Health Care Research Evaluation and Development (PHCRED) program in Australia aims to build research capacity in primary health
care. In South Australia, the program (PHCREDSA)
has addressed skill building in dissemination
of research findings by providing support for peer
reviewed publication. The support included comprehensive
advice and feedback for novice and
inexperienced researchers and writers in the publication
process of the program?s 2003 Conference
Proceedings. This paper describes the South
Australian experience of supporting novice
researchers in research dissemination by applying
the PHCRED-SA capacity building support model.
After hours medical ward duties in a teaching hospital
Authors: Ting Joseph Y S , Humphrey Kevin J
Published: February 2010

In many Australian hospitals a medical officer is
available for urgent review of inpatients outside normal
working hours. Current practice in nurse-initiated
requests for medical officer involvement out of hours
may adversely affect patient outcome as well as
medical and nursing resource use at these times.
Of 10523 nurse-initiated requests for out-of-hours
review recorded by medical officers at our hospital in
2002?2003, the most frequent reasons for the
requests were medication review, IV fluid orders, IV
resite, venesection, and pathology review, none of
which are related to acute changes in clinical condition.
Requests for routine review of medication and
fluid orders were found to be rarely essential and
often inappropriate. Medical officer activity was highest
before midnight and least after midnight, suggesting
most requests are fulfilled in the evening.
Several strategies to reduce inappropriate out-ofhours
requests were identified. Routine tasks could
be completed by primary treating unit staff before
going off duty. IV cannulation and venesection may
be performed by appropriately trained phlebotomists
or skilled advanced practice nursing staff. Meticulous
ordering of ?as required? analgesia and night sedation
would reduce unnecessary requests. Clinical
protocols for nurse-initiated adjustment of drugs with
variable dosing may also decrease inefficiencies.
This would leave the ward cover medical officers
more available for their primary function of urgent
patient review.
An evaluation of the timing between key insulin administration-related processes: the reasons why these processes happen when they do, and how to improve their timing
Authors: H Manning Elizabeth , Jackson Linda
Published: February 2010

We investigated the incidence of timing problems
with insulin-related processes in a subacute
inpatient unit in Melbourne and found that
nursing staff often conduct blood glucose level
(BGL) testing longer than 30 minutes before
insulin administration (between 22% and 41%).
Nurses are better at administering rapid-acting
insulin doses within the recommended time
before food intake (94%) than conventional
insulin analogue doses (43%). BGL testing is
carried out too early due to established ward
practices and busy mornings, as well as poor
guidance from an outdated policy. The timing of
conventional insulin analogue administration is
by nature more complex than that of rapidacting
analogues. Current timing places inpatients
at risk of harm from hypoglycaemia. The
high level of care demand in our subacute unit
contributed to timing problems, and this is likely
to be a problem in other units. Process redesign,
policy revision and staff education could
be used to reduce the risk of hypoglycaemia in
this subacute inpatient unit.
Sink or swim — ageing in Australia
Authors: O'Connell Bev O , Ostaszkiewicz Joan
Published: February 2010

As the number of people under the age of 65
declines, the number over 65 will double in the
next half century. By 2031, it is estimated those
over 65 will account for more than a quarter of the
Australian population. The fastest rate of growth
will be in the over-85-years category, projected to
double over the next 20 years and to triple over 50
years to include 2.3 million people. Health care
providers cannot afford to wait for the inevitable
crises this vast demographic shift will provoke. To
meet these future demands, educational and
health care institutes should consider establishing
interdisciplinary think-tanks for multidisciplinary
research, policy development and innovations in
aged care and health service delivery.
Are Victorian elective surgery cases still converting from overnight to same day cases?
Authors: Hanning Brian W T
Published: February 2010

The conversion rate on a diagnosis related group
(DRG)-standardised basis of Victorian private
overnight (ON) elective surgery cases to same
day (SD) cases declined from 4.7% per annum
over 1996?97 to 1998?996 to 2.5% per annum
over 1998?99 to 2002?03. Similar analysis within
the Victorian public sector shows a decline from
3.8% per annum over 1996?97 to 1998?996 to
1.9% over 1998?99 to 2002?03. Comparison on a
DRG-standardised basis shows while the public
sector continued to show a higher incidence of
elective surgery SD cases than the private sector
in 2002?03 (by 1.6%). The difference has declined
since 1998?99 when it was 2.4%. DRG-based
analysis suggests the conversion rate in both
sectors and the difference in SD surgery cases
between the two sectors will continue to decline.
Future savings in recurrent and capital cost due to
ON surgery cases becoming SD cases are likely
to be much lower than savings in recent years.
Long-stay views from the hospital bed: patient perspectives of organisation of care and impact of hospitalisation
Authors: Johnson Anne , Gaughwin Bev , Moore Natasha , Crane Rita
Published: February 2010

This paper presents a snapshot of job vacancies
in the public health workforce labour market. The
analysis is based on 404 advertised public health
jobs appearing in the press, and on-line job alerts
over a 2-month period in mid 2003. The analysis
reveals who was seeking employees, what formal
qualifications and competencies were required,
what salary and other conditions of employment
were offered and where the vacant jobs were
located. The study demonstrates the heterogeneity
of the public health workforce, which limits
definition of clear practice boundaries and complicates
workforce planning. The findings further
demonstrate the benefit of reviewing both the
demand and the supply side of the labour market,
and point to the value of repeated surveys of
advertised jobs as part of an ongoing public health
workforce monitoring and planning process.
Recasting Australian employment law: implications for the health sector
Authors: Buchanan John
Published: February 2010

IN OCTOBER 2004 the Federal Coalition Government
was re-elected with an increased majority
and, from July 2005, control of the Senate.
Between 1996 and 2004, while significant
changes were implemented, most ?reform? proposals
were blocked in the Senate. Now the
government intends to implement these Bills and,
in many cases, proposes further reforms. These
initiatives come at a time when the health care
system is experiencing profound pressures for
change.1-3 This article discusses the proposed
changes in employment law and the likely impact
on the health care sector.
Future directions for workplace bargaining and aged care under a post 2005 Howard government
Authors: Timo Nils
Published: February 2010

ON THE 1ST OF JULY 2005, the Howard Government
took control of both the House of Representatives
and the Senate and substantial reform
of the nation?s industrial relations framework is
likely to proceed. In order to understand the
implications of the proposed industrial relations
(IR) reform agenda on aged care, it is necessary to
briefly revisit the past. Historically, the ability of
the Commonwealth Parliament to regulate industrial
relations was construed in the context of
Section 51 (xxxv) of the Australian Constitution
Act 1900 (Cwlth) that enabled the Commonwealth
to make laws concerning ?conciliation and
arbitration and the prevention and settlement of
industrial disputes extending beyond the limits of
any one state?.
Since 1904, the Commonwealth, with the
states following shortly thereafter, established a
regime of industrial tribunals responsible for third
party independent conciliation and arbitration,
overseeing a system of legally binding industrial
awards covering wages and employment conditions.
This system, in the words of one of its chief
architects, Justice Higgins, ? . . . would substitute
for the rude and barbarous processes of strike and
lock-out?1 (page 2). By 1991, Australian wages
policy gradually shifted from centralised arbitration,
elevating workplace agreements to the status
of government policy on both sides of politics.2
This process accelerated labour market deregulation,
shifting industrial relations and human
resource issues to the enterprise level.3
The shift towards workplace agreements post
1990?s was underpinned by a bold reinterpretation
of Section 51 (xx) of the Constitution Act
that enabled the Commonwealth to regulate the
affairs of ?trading or financial corporations
formed within the limits of the Commonwealth?,
thus, by definition, including regulating
employee relations of corporations. The use by
the Commonwealth of these powers has extended
the jurisdiction of the Australian Industrial Relations
Commission (AIRC) to include the making
and approving of certified agreements made by
constitutional corporations or in settlement of an
industrial dispute. Other types of employers such
as sole traders, churches and charities, partnerships
and unincorporated associations remained
covered by state industrial jurisdictions. (On
these powers of the Commonwealth, see State of
Wise planning
Authors: Di Donato Josie
Published: February 2010

PLANNING IS AN ESSENTIAL PART of modern organisations
and is integral to the role of a health service
manager. The planning activity emerges as a consequence
of the need to contain costs, manage health
outcomes, and be held accountable for the effective,
efficient and equitable provision of health services.
Amidst the challenge to operate within the current
resource (ie, financial, human and time) capacity
there is an imperative to explore and
develop innovative service delivery
models to meet increased demand and
expectations. Therefore, textbooks on
the subject of planning in health-related
topic areas are a valuable resource in
these very challenging times in health
care.
Change through continuity:a quiet revolution in primary health care in New Zealand
Authors: Ashton Toni
Published: February 2010

IN A RECENTLY PUBLISHED paper entitled Continuity
through change: the rhetoric and reality of health reform
in New Zealand, I and my co-authors Nick Mays and
Nancy Devlin pointed out that, in spite of a series of
major health sector reforms during the 1990s and
early 2000s, some key aspects of the system have
endured.1 Moreover, many incremental changes to
existing processes and systems that occurred during
the reform period have, arguably, been more important
to improving the functioning and performance
of the system than the more high level (and more
visible) structural changes.
Since that paper was written, many further
changes have occurred in the organisation, funding
and management of the New Zealand health system.
However, in contrast to the 1990s, the focus
now is on continuity and stability rather than on
any need for further major change. Indeed, terms
such as ?reform? or ?restructuring? have now all but
vanished from any debate about health policy in
New Zealand. Perhaps the reformers have learned
that health system reform is akin to training for the
Olympics. The whole process takes a fair bit of time
and effort, and results are unlikely to be achieved in
the short term. Further major reform is also not
regarded as politically viable. As noted in an article
in the New Zealand Herald just before the general
election in September, there is ?. . . considerable
public sensitivity over any whiff of restructuring in
health?.2
Commentary: the patient's memory stick may complement electronic health records
Authors: Leslie Heather
Published: February 2010

THE SITUATION DESCRIBED by Stevens1 in the
foregoing article is similar to that navigated by
thousands of individuals in hospitals around Australia
each day. Stevens has been able to identify
gaps in communication, processes and timely
availability of pertinent information which potentially
put her health at risk. There is little doubt
that her call for ?legible and enduring record
systems accessible by appropriate people?
(page 400) would be supported by most of the
general community.
Health information management is hugely
complex, with large numbers of concepts and
high rates of clinical knowledge change. Electronic
health records (EHRs) are definitely not
simple concepts that are solved by storing information
in a relational database for use in a single
organisational silo, but require the capture of the
full breadth of health information in a manner
that can be easily stored, retrieved in varying
contexts, and searched. Then there is the additional
and unique requirement of sharing this
same information with a range of health care
providers with differing foci, requirements, technical
tools and term-sets. When you add in some
of the other more lateral requirements such as
medico-legal accountability, pooling data for public
health research, and privacy, consent and
authorisation for sharing sensitive health information,
it becomes increasingly evident that health
data management has no real equivalent in other
industries.
In order for shareable electronic health records
to become ubiquitous, there are numerous building
blocks that need to be in place ? appropriate
levels of funding, legislative changes, consensus
on a range of standards, stakeholder engagement,
implementation of massive change management
programs and so on, as outlined by Grain.2
Australia?s solution is the HealthConnect program
? a joint Commonwealth and state government
initiative ? which is gradually identifying the
required pieces, and laying them out in a systematic
way to solve the e-health system puzzle.
The first eighteen months of a paediatric ambulatory and community service
Authors: Woolfenden Susan R , Dalkeith Troy , Anderson Teresa
Published: February 2010

Hospital admission is distressing and traumatic
for children as they are separated from their
families and home. Internationally, and in Australia,
alternative models of health care are
being developed to meet the needs of children
and their families. We describe the first eighteen
months of the establishment of a paediatric
ambulatory and community service in a district
health service in New South Wales. Key outcomes
include: increased referral to the service
from acute hospital and primary care services;
parental satisfaction and saved hospital beddays.
Lessons learnt in the setting up of this
service include the need for proactive engagement
of consumers and stakeholders; clear
definition of roles and responsibilities; and
measurable and reasonable performance indicators.
How do rural consumers contribute to quality assurance of health services?
Authors: Humphreys John S , Meehan-Andrews Terri A , Jones Judith A , Griffin Lynn D , Wilson Bethia A , Smith Karly B
Published: February 2010

Objective: To investigate the reasons for complaint
or non-complaint by rural consumers of
health services.
Design: Qualitative study using focus group discussion
of hypothetical scenarios.
Setting: Selected rural communities in the Loddon-
Mallee region of north-western Victoria.
Participants: Sixty volunteer participants in eight
focus groups recruited through advertising.
Main outcome measure: Issues and themes
concerning circumstances leading to, and factors
inhibiting, complaints about a health service and
awareness of complaints mechanisms.
Results: Compared with residents of larger
towns, those of small communities were more
likely to report they would complain to the local
provider, whereas those in larger towns were
more likely to mention Hospital Boards or the
Commissioner. Deterrents to making complaints
included the lack of services, scepticism about the
role of complaints in bringing about change and
an attitude that it was more appropriate to try to fix
the problem than complain about it. Lack of
awareness of appropriate complaint mechanisms
which feed into quality assurance processes was
also identified.
Integrated support for Aboriginal tertiary students in health-related courses: the Pika Wiya Learning Centre
Authors: Adams Maree , Aylward Paul , Heyne Nicholas , Hull Charmaine , Misan Gary , Taylor Judy , Walker-Jeffreys May
Published: February 2010

The barriers to Indigenous people entering tertiary
education, succeeding, and gaining employment
in the health professions are broad and
systemic. While efforts have been made to
address these barriers, the number of Indigenous
health professionals remains extremely low
across Australia. The Pika Wiya Learning Centre
in South Australia provides a range of practical,
social, cultural, and emotional supports for tertiary
students to increase the number of Indigenous
health professionals, especially registered
nurses, in the region. This paper reports on the
Centre?s strengths that may represent best practice
in student support, and the obstacles to
further development.
Reducing aggressive behaviour and staff injuries: a multi-strategy approach
Authors: Meehan Tom , Fjeldsoe Kevin , Stedman Terry , Duraiappah Vasanthi
Published: February 2010

Objective: To evaluate the impact of a multistrategy
approach on the management of patient
aggression and staff injury rates at a stand-alone
mental health facility.
Methods: A multi-strategy aggression management
program was developed and introduced over
a 2-year period. The program had four components;
staff education/training, a staff support program,
risk assessment tools, and a computerised
incident monitoring system. Aggressive incidents
by patients, staff injuries due to patient aggression
and compensation payments to staff for the 2-year
period before implementation of the aggression
management program were compared with the 3-
year period following implementation of the program.
Results: There was a significant decrease in the
number of staff injuries reported in the 3-year
period following the implementation of the aggression
management program. Although the number
of aggressive incidents reported did decrease
over the study period, the decrease was not
statistically significant.
Conclusions: Despite the increasing acuity of
the clients at the study facility, there was a significant
decrease in staff injuries due to aggressive
behaviour. The strategies implemented seem to
offset the potential for violence. It is likely that the
combined impact of the strategies is greater than
the impact of individual strategies implemented
consecutively.
Improving the retirement village to residential aged care transition
Authors: Cheek Julianne , Ballantyne Alison , Byers Loretta , Quan James
Published: February 2010

Older Australians living in retirement villages are
an increasing community segment. These people
make choices both about the place at which they
live and the support needed at that place to
optimise health and wellbeing. However, for some,
unmet support needs in the retirement village may
result in a transition to a residential aged care
facility. This qualitative study explored how and
why this transition occurs; how it might be
avoided; and, when the move is unavoidable, how
the process can be improved. Implications of
these findings for the retirement village and aged
care sectors are discussed.
Use of clinical guidelines for whiplash by insurers
Authors: Rebbeck Trudy J , Refshauge Kathryn M , Maher Christopher G
Published: February 2010

Objective: To describe the opinions of, use of, and
compliance with guidelines for whiplash associated
disorders (whiplash) by insurance staff after an
implementation program.
Design: Observational design using questionnaires.
Setting: Insurance offices in New South Wales,
Australia.
Study participants: 138 insurance staff (60%
response rate) working in compulsory third party
(CTP) claims for the 8 CTP insurers in NSW.
Intervention: Responses were collected after an
implementation program that included education
workshops provided by an insurance regulator and
by insurance staff trained by the regulator.
Results: After implementation, 73% were aware of
the CTP guidelines for whiplash, 85% had access
to them, and compliance with the recommendations
was 71%. Awareness of, and compliance with
the guidelines was not related to attending the
regulator workshop (P= 1.0). Insurance staff found
the guidelines to be helpful, with the mean ratings
for relevance to work and in managing claims being
7.8/10 and 6.9/10, respectively.
Conclusion: Awareness of, and compliance with
guidelines for whiplash among insurance staff was
high after the implementation program, but was not
related to attending the regulator workshop. Compliance
may be improved by addressing the barriers
nominated by the participants. Developing a
specific guideline for the insurer market was considered useful
Developing a policy simulator at the acute–aged care interface
Authors: Gray Leonard C , Broe Gerald A , Duckett Stephen J , Gibson Diane M , Travers Catherine , McDonnell Geoff
Published: February 2010

This paper describes the development of a computer
simulation of the interactions between the
acute and aged care systems in Australia, using
system dynamics modeling enhanced by agentbased
techniques. National and regional simulations
will be developed, enabling the impact of a
variety of policy scenarios to be forecast over the
next 10 years. The paper includes a description of
the relevant policy environment and some of the
associated key policy issues.
Getting evidence into obstetric and midwifery practice: reducing perineal trauma
Authors: Nicholl Michael C , Cattell Miriam A
Published: February 2010

Problem: Frequent obstetric perineal morbidity in
a hospital setting with service providers inexperienced
in getting evidence into practice.
Design: Clinical practice improvement methodology
in a tertiary referral obstetric unit.
Strategies for change: To cease active instruction
to push in the second stage of labour; encourage
the adoption of the left lateral position when
delivering on a bed; use of the vacuum extractor
rather than forceps where instrumental delivery
indicated.
Effects of change: Improved perineal outcomes
with a 21.5% increase in intact perineum rate and
a 100% reduction in fourth degree perineal tears.
Lessons learned: Clinical practice improvement
methodology is a useful tool for getting evidence
into practice, resulting in improved clinical outcomes.
Designing a podiatry service to meet the needs of the population: a service simulation
Authors: Campbell Jackie A
Published: February 2010

A model of a podiatry service has been developed
which takes into consideration the effect of changing
access criteria, skill mix and staffing levels
(among others) given fixed local staffing budgets
and the foot-health characteristics of the local
community. A spreadsheet-based deterministic
model was chosen to allow maximum transparency
of programming.
This work models a podiatry service in England,
but could be adapted for other settings and, with
some modification, for other community-based
services. This model enables individual services
to see the effect on outcome parameters such as
number of patients treated, number discharged
and size of waiting lists of various service configurations,
given their individual local data profile.
The process of designing the model has also had
spin-off benefits for the participants in making
explicit many of the implicit rules used in managing their services.
"Permission to speak": a carer's experience
Authors: Williams Claire
Published: February 2010

BILL, MY LIFE PARTNER of 40 years, was diagnosed
with cardiomyopathy in 2003 when he was 60.
The latter is a quite common severe heart disease,
usually of people older than Bill. Coronary heart
disease saturates publicity about heart disease,
making other heart disease invisible. Coronary
heart disease tends to be a disease of coronary
arteries but Bill?s arteries are very good. Cardiomyopathy
is a disease of the heart muscle. The
damage has led to heart failure, the inability of the
heart to pump sufficient blood to supply his
body?s needs. In heart failure or reduced function,
the heart is unable to pump as effectively, with
symptoms such as shortness of breath, tiredness
and fluid retention.1 Cases are sometimes treated
with a heart transplant.
The role of practice nurses in coordinated care of people with chronic and complex conditions
Authors: Patterson Elizabeth , Muenchberger Heidi , Kendall Elizabeth
Published: February 2010

General practice in Australia must cope with
growing numbers of individuals with chronic and
complex needs. The Australian Government has
recognised the need to reform the primary health
care sector to address this issue, with recent
initiatives, such as coordinated care. The overall
goal of coordinated care at a national level is to
facilitate integrated care for people with chronic
and complex conditions, by enhancing collaborative
partnerships among general practitioners,
primary health care providers, community service
providers and clients. Interestingly, practice
nurses (PNs) have not been identified as key
stakeholders in the coordinated care service
delivery model in Australia. In contrast, an
expanded role for PNs has been in place in the
United Kingdom and New Zealand for some time.
This paper is based on focus group discussions
with Australian PNs who have had a range of
experiences in coordinated care models. The
study identifies an important role for PNs, suggesting
trial of a variety of models of coordinated
care that include PNs in chronic disease management process.
Mutual help groups: an important gateway to wellbeing and mental health
Authors: Finn Lisabeth D , Bishop Brian , Sparrow Neville H
Published: February 2010

Objective: This study investigated the impact of
GROW, an Australia-wide community mental
health organisation, on psychological wellbeing
and mental health.
Design: Triangulation of quantitative and qualitative
research methods was employed. The study
included a cross-sectional and a longitudinal survey
of GROW members together with ethnographic
and phenomenological work.
Research outcomes: The results pointed to
length of membership/extent of involvement in
GROW activities as being associated with
improved wellbeing in the areas of autonomy,
environmental mastery, personal growth, and selfacceptance/
purpose in life, together with a reduction
in medication and hospitalisation. In a longitudinal
study surveying the wellbeing of 28 new
GROW members with 6-month follow-up, there
were statistically significant improvements on all
wellbeing factors. A major theme emerging from
ethnographic and phenomenological research
was that GROW offers a ?real life? mini-community
where people learn social and life management
skills. However, beyond skills acquisition, GROW
offers the potential for identity transformation by
assisting the realisation of core human needs ? a
sense of feeling useful, valuable and belonging.
Reviewing recommendations of root cause analyses
Authors: Middleton Sandy , Chapman Barbara , Griffiths Rhonda , Chester Rosemary
Published: February 2010

Objective: To determine the opinion of medical
and nursing clinicians of recommendations arising
from root cause analyses (RCAs) conducted
between 1 April 2003 and 30 September 2004 in
one Sydney Area Health Service.
Methods: Twelve doctors (response rate 86%)
and 17 nurses (response rate 100%) reviewed
328 recommendations arising from 59 RCAs and
completed a self-administered survey.
Results: Nurses were significantly more likely than
doctors to rate recommendations made by the
original RCA team as ?relevant to the causal statement?,
?understandable?, ?measurable? and ?achievable?.
Doctors and nurses involved in the original
RCA were significantly more likely to state that
recommendations would ?eliminate? or ?control? the
risk of a similar event occurring in the future.
Conclusions: This is one of the first studies to
analyse RCA data at the area health service level.
That nurses reviewed recommendations more
favourably may have implications for successful
adoption of recommendations at the clinical level.
We recommend further detailed analyses of recommendations
arising from RCAs in order to
determine their usefulness to inform strategies for
improved patient safety.
Coming in from the interprofessional cold in Australia
Authors: Stone Nick
Published: February 2010

In Australia, implementation of interprofessional
education (IPE) has been slow compared with
peer countries. One cause is an apparent uncertainty
about where and how to situate IPE at policy
levels. Without a clear articulation of related
needs, vision and purpose, IPE has largely
remained isolated from the strategic planning and
funding cycles necessary for implementation as
?core business? across various sectors, systems
and levels. This paper draws on international
developments and research to emphasise the
need to complement innovative IPE practice with
supporting policy, specifically to optimise the quality
of future health care delivery. Major forces for
change are identified, as well as some residual
barriers and possible strategies to bring IPE ?in
from the policy cold? in Australia.
Developing metrics for hospital medical workforce allocation
Authors: Shannon Elizabeth A , Anne Brand B , Ratcliffe Kevin M , Tranter Bruce K
Published: February 2010

Public hospitals deliver a broad range of specialist
treatments to patients, with public demand for
hospital services almost always outstripping supply.
Health department and hospital managers
prioritise requests for additional resources, such
as medical staffing, across the full spectrum of
services delivered. Without a clear and equitable
basis of workload comparison across medical
specialties, this decision-making process can be
controversial and internally divisive.
This paper outlines the development of a metric to
guide the allocation of hospital medical staff. It
suggests that a valid comparison of workload can
be gained from the consideration of the number of
inpatients (weighted for case complexity) and the
number of outpatient presentations, as seen by
each full-time hospital medical practitioner per
annum. While this supports a ?common sense?
understanding of hospital medical activity, it also
reflects limitations in the quality and quantity of
data available. The replication and testing of this
methodology in other jurisdictions is encouraged.
Priority rating for community care
Authors: Stevermuer Tara L , Owen Alan , Williams Kathryn , Masso Malcolm
Published: February 2010

This paper, which is an additional nosokinetics
paper to accompany those presented in Aust
Health Rev 31(1), reports on priority rating
through a standardised community care assessment
system, based on screening for functional
abilities and incorporating additional indicators
of need and risk. Routinely collected measures
used to generate a priority rating have proven
useful in clinical decision making and active
demand management at the service entry point.
Priority rating is a step towards a more equitable
and efficient assessment system.
Three examples of priority rating systems are
described. The first is a generalist application
now implemented in routine practice across
multiple service types in the Queensland community
care and community health system. The
second, narrower in scope, was designed for
the NSW Home Care Service, and is also being
routinely collected. The third was pilot tested in
a state-wide program to supply aids and appliances
to disabled people and introduced the
additional concept of ?capacity to benefit?. The
case studies show how a technical and datadriven
approach can be useful in guiding policy
in a complex health care sector.
A partnership model in the development and implementation of a collaborative, cardiovascular education program for Aboriginal Health Workers
Authors: Davidson Patricia M , DiGiacomo Michelle , Abbott Penny , Zecchin Robert , Heal Patricia E , Mieni Lynette , Sheerin Noella , Smith Janice , Mark Andy , Bradbery Brenda , Davison Joyce
Published: February 2010

A partnership model was established among key
education providers, policy makers, non-government
organisations, the local area health service and
Aboriginal community controlled organisations
aimed at increasing collaboration, skill development,
cultural competence and increasing access to mentorship
and expertise for Aboriginal Health Workers
(AHWs). A group of 21 AHWs, within two cohorts,
undertook the program between October 2005 and
June 2006. A mixed-method evaluation using quantitative
and qualitative data collection methods was
undertaken prospectively.
Knowledge and confidence scores significantly
increased for all participants over the course duration.
Student evaluation demonstrated a desire for groupbased
activities and the high value placed on clinical
visits. Feedback on both outcome and process measures will inform course delivery and design.
Rest during shift work in the emergency department
Authors: Mitra Biswadev , Cameron Peter A , Mele Greg , Archer Peter
Published: February 2010

The aim of this study was to pilot a program to
encourage shift breaks for emergency department
doctors and analyse the effects of breaks on
tiredness and fatigue as well as possible effects
on overall departmental performance.
During Phase 1, medical staff were asked to fill
out a survey regarding their working day at the
end of every shift. A 30-minute uninterrupted
break was promoted during Phase 2 by provision
of a cover doctor on the roster as well as educational
sessions and posters.
There were 233 completed surveys received over
the 4-week period. Only 33% of shifts worked
included an uninterrupted break in Phase 1, which
improved significantly to 60% during Phase 2.
Subjective tiredness was significantly lower at the
end of a shift when a break was taken (P < 0.001),
while fatigue levels were also lower, but not significant
(P = 0.060). There were significant improvements in some key performance indicators.
Health, health care and healing: introduction to the Festschrift for Professor Ken Donald
Authors: Ward Michael
Published: February 2010

THE CITATION for Ken Donald?s recent and well
deserved award of an Order of Australia reads
?For service to medicine as an academic and
administrator, particularly as a contributor in the
fields of pathology and community health?. A
true enough statement but hardly sufficient for
such a diverse career and lifetime of contributions
in so many different fields. In this issue of
Australian Health Review we include a collection of
papers to honour Professor Donald.
Aboriginal and Torres Strait Islander Health: today's challenges, tomorrow's opportunities
Authors: Nangala Stanley
Published: February 2010

THIS FESTSCHRIFT PRESENTS a unique opportunity
to pay a warm tribute to Professor Ken Donald
who has built important foundations that will
very much benefit future generations, especially
for those of us who belong to the Aboriginal and
Torres Strait Islander nations of peoples.
Compensation and wellness: a conflict for veterans' health
Authors: Ellis Niki , Mackenzie Alison , Mobbs Robyn
Published: February 2010

In Australia greater attention is being given to
health determinants, and the dominance of treatment
in health policy and budgets is giving away
some ground to prevention, health promotion,
rehabilitation and disability management. This
creates a dilemma for compensation systems:
should the inclusion criteria be broadened to
match the new thinking or should a narrower
definition of ?disease, injury or death? be retained?
This issue is explored in the context of war
syndromes among veterans. While veterans experience
symptoms more frequently and more
severely than military and community controls,
their patterns of symptoms are not unique. Current
compensation and benefit programs can create
iatrogenic effects. It is concluded that
compensation systems should be kept as safety
nets while resources are provided to improve the
capacity of primary health care caregivers, community
organisations and veterans with war syndromes
and their families to better deal with these
problems. Adapting compensation systems to promote
wellness through self-management health
partnerships is one way of directing resources to
individuals and their families. Action research at
the community level with veterans, their families,
their organisations, primary health care organisations,
policy makers and researchers would allow
this sector to work out the best way to apply
existing efficacious tools to these modern health
problems.
From quality assurance to clinical governance
Authors: Balding Cathy
Published: February 2010

Clinical governance is seen as a relatively new
concept; but a long history of health care quality
improvement sits behind it. Over the last 20 years,
a number of approaches have been tried and
discarded, with some inadequately implemented
and others poorly adapted from other industries.
Quality programs have evolved slowly, hampered
by a conservative and complex health care culture
and a lack of focus, data and resources. Despite
the advent of clinical governance, driven by a
patient safety crisis, many of these issues remain
unresolved, and are impacting current clinical
governance implementation. Reflecting on the
quality journey clearly demonstrates that the
potential of clinical governance cannot be realised
without the leadership, commitment and support
of governing bodies and executives.
Reduction in hospitalisation following pulmonary rehabilitation in patients with COPD
Authors: Cecins Nola , Geelhoed Elizabeth , Jenkins Sue C
Published: February 2010

Objectives: Pulmonary rehabilitation (PR)
improves exercise capacity and health-related
quality of life (HRQoL), and reduces health care
utilisation. This study quantified outcomes of a PR
program over a 6-year period and determined the
effects of PR on hospitalisation.
Methods: Patients with chronic obstructive pulmonary
disesae (COPD) who entered an 8-week
outpatient PR program from 1998 to 2003 were
included. Functional exercise capacity (6-minute
walk distance [6MWD]) and HRQoL (Chronic Respiratory
Disease Questionnaire) were measured
before and following PR. The number of hospital
admissions and total bed-days due to a COPD
exacerbation in the 12 months before and following
PR were recorded.
Setting: Physiotherapy Department, Sir Charles
Gairdner Hospital, Western Australia.
Results: 187 (73%) of the 256 patients who
entered PR completed the program. Improvements
in 6MWD (404.2 �114.6 m to
439.6 �115.0m, P < 0.001) and HRQoL
(4.1 �0.9 points per item to 4.9 �0.9 points per
item, P < 0.001) occurred following PR. There was
a 46% reduction in the number of patients admitted
to hospital (71 to 38) with a COPD exacerbation
and a 62% reduction in total bed-days (1131
to 432) following PR.
Conclusion: Pulmonary rehabilitation provided
in an Australian teaching hospital was associated
with a reduction in COPD hospitalisation, and the
resultant savings outweighed the costs of providing the program.
A pilot program of physical activity promotion among clients receiving home and community care
Authors: Cameron Melainie , Chahine Natalie , Selig Steve , Newton Pam
Published: February 2010

Three Victorian local governments cooperated in
a pilot study of physical activity promotion as part
of home and community care (HACC) service
delivery. Thirty-one people receiving HACC volunteered
to participate, including completing the
Transtheoretical Stages of Change Exercise
Questionnaire and the short-form Stanford
Health Assessment Questionnaire (HAQ) just
before and at 3 months and 6 months after
starting regular self-selected physical activity.
Twenty-one participants returned questionnaires
at 3 months, and 17 participants returned questionnaires
at 6 months. Data were analysed
using paired t tests and effect sizes were calculated
as mean differences. At 3 months, mean
improvements were identified on 6 of the 8 HAQDI
(disability index) subscales, and in the overall
HAQ-DI score. Improvement in dressing and
grooming was preserved at 6 months. At either 3
or 6 months, improvements in dressing and
grooming, reach, hygiene, and daily activities,
and overall HAQ-DI score exceeded the minimum
clinically important difference. No improvements
were statistically significant, as is likely in
a pilot study with a small sample, however, these
results suggest that even very small increases in
physical activity may afford clinically meaningful
improvements in some areas of physical function
required for independent living.