bluuebunny/crossref_metadata_2025 huggingface dataset:
The Natural History of Health and Symptoms in Narcolepsy: A to-year Longitudinal Study
Authors: Bruck Dorothy , Costa Andrea
Published: August 2009

This longitudinal study investigated, over a 10-year period, reported changes in people with narcolepsy (a disorder of excessive daytime sleepiness). The issues of the functional impact of symptoms; stimulant medication status; body mass index, and concomitant illnesses were examined. The study also documented, using retrospective report, environmental factors influencing narcolepsy severity, and reported time of worst symptom severity following narcolepsy onset. In 1991, 127 people with diagnosed narcolepsy and cataplexy completed a wide-ranging questionnaire. In 2001, attempts were made to recontact these participants and 67 were traceable. Of these, 47 people, (18 males, 29 females; mean age 61.76 years, age range 31-86 years) returned a revised questionnaire. The reported impact of excessive daytime sleepiness (EDS) on the ability to carry out day-to-day activities showed minor increases in severity over the 10-year period in this older narcolepsy sample, and this could not be attributed to major changes in medication status. It is argued that the underlying severity of EDS does not increase with time, but rather that the interaction of EDS with the ageing process increases its detrimental impact. Improvements in the functional impact of sleep paralysis, hallucinations and automatic behaviour were reported. There was no evidence that any narcolepsy symptom became substantially worse with time for most people with the disorder. The influence of environmental factors on symptoms was inconsistent within the group. The elevated body mass index, stable over time, suggested that excess weight may be a trait often associated with narcolepsy, possibly linked to hypocretin deficiency.
From Policy to Practice: The Development of an Integrated Health Promotion Plan for Children's Services at Plenty Valley Community Health Inc.
Authors: Andrews Fiona
Published: August 2009

Current changes in the funding of health promotion in community health in Victoria require community health agencies to integrate health promotion with service delivery. This provides both opportunities and challenges for community health staff. Members of the Children's Service Team at Plenty Valley Community Health Inc. addressed these changes by developing an integrated health promotion plan. The approach used involved identifying client pathways and then integrating opportunities for health promotion interventions into these pathways. Staff perceptions of the process involved in developing the plan were examined. The use of client pathways to integrate health promotion into everyday practice proved a successful approach for members of the Children's Services Team, and provides a useful model for health promotion planning in community health that helps staff to see the relevance of health promotion to their practice, and engages staff in the planning process. Members of the Children's Services Team reported that the process involved in developing their integrated health promotion plan was a very worthwhile experience that allowed them a strong sense of ownership of the plan.
Developing a Consistent Approach to Determining Priority for HACC Services
Authors: J. Black Kirsten , L. Buckley Patricia
Published: August 2009

This paper reports on the development of a Priority of Access tool for Home and Community Care services provided by local governments in the Western Metropolitan Region of Victoria. Managing the demand for these services requires an equitable approach to service allocation decisions. The Priority of Access tool was developed with input from Western Metropolitan Region local government HACC representatives and the Department of Human Services. A literature review identified indicators of need that predicted use of community services; however, no substantial contributions were identified relating to prioritising access to health services in the home. The tool developed relies on cross-referencing responses from the Service Coordination tools developed through the Victorian Primary Care Partnership initiative. A pilot was conducted with assessment staff and their feedback led to modification of the tool. Staff found the tool a useful method of increasing objectivity in assessments and providing a framework to consistently determine priority. The importance of training in the use of the tool was reinforced during piloting of the tool. The Priority of Access tool provides a simple and consistent, yet comprehensive, approach for Western Metropolitan Region local government HACC services to equitably determine priority of access for clients.
Compulsory Treatment: The Voices of Young Heroin Dependent Offenders
Authors: Wile Cheryl , M. Hood Bernadette
Published: August 2009

This study is a qualitative evaluation of the experiences of 12 young heroin dependent persons who failed to comply with court mandated treatment orders. Based on a phenomenological method of inquiry, the paper explores their perceptions of both compulsory treatment and an outreach intervention. Reasons reported by participants for non-compliance with court directives included (i) their belief that treatment cannot be mandated but must be driven by personal motivation for change, (ii) a lack of confidence in the efficacy of some treatment services, and (iii) lifestyle issues which create barriers to compliance. Outreach interventions were viewed positively by all participants due to (i) convenience and accessibility, (ii) capacity to engender a sense of achievement, and (iii) humanistic orientation. In addition to providing a voice for these young offenders, the paper identifies the potential for their attitudes and behaviours to be explored within a framework characterised by the struggle that some young people experience in an attempt to retain integrity and experience personal power within a context of systemic powerlessness.
Racism and Injustice: Urban Aboriginal Women's Experiences when Patronising Licensed Premises in South Australia
Authors: de Crespigny Charlotte , Groenkjaer Mette , Casey Wendy , Murray Helen , Parfoot Warren
Published: August 2009

This paper presents the findings regarding urban, predominantly young, Aboriginal women's experiences of patronising licensed premises in South Australia. This research aimed to tap new information directly from the experiences of participants who lived in the southern metropolitan region of South Australia. It focused on their experiences of socialising at licensed premises such as pubs and clubs, locally, and in the city of Adelaide. A qualitative research design within the critical social Scientific paradigm was applied using semi-structured interviews and thematic analysis. The recommendations developed from the findings, and the final community report, were developed collaboratively with participants and other Aboriginal women from their local community. Consistent with the experiences of other young non-Aboriginal women in South Australia, as reported by the chief investigator of this study, the findings of this research show that Aboriginal women try to enjoy socialising with friends and family in licensed premises such as pubs and clubs. However, the Aboriginal women were constrained by frequently experiencing racism and injustices when they tried to enter, or when inside, pubs and clubs. Being accused of stealing, prevented from entering or being expelled from venues, racist comments and being subjected to physical violence, conflict with bar and security staff and non-Aboriginal patrons, as well as lack of safety, were some of the issues these Aboriginal women have experienced in licensed premises in urban and suburban South Australia. This research now offers recommendations from the women that call for important changes in policy and service provision that can improve the conditions of Aboriginal women when they are visiting licensed premises.
Can I trust thee? Self-management, trust and evaluation in chronic disease
Authors: Walker Rae
Published: August 2009

In this paper trust is viewed as a major issue in the relationship between consumers and providers of health care to people living with chronic diseases. The qualities of trust-based relationships are identified and their relevance to chronic disease self-management discussed. Finally, it is argued that an appropriately conceptualised approach to trust should be included in service evaluations as a means of improving the quality of the relationship between consumers and health care providers.
The role of self-help groups in chronic illness management: A qualitative study
Authors: Coppa Kay , M Boyle Frances
Published: August 2009

Self-help groups offer a unique form of support based on mutual understanding and the experiential knowledge of members. They constitute a potentially valuable resource for assisting people to manage chronic illness and its impacts. We conducted in-depth interviews with 15 members and the leaders of five chronic illness-related self-help groups in Newcastle, New South Wales. The focus was on small, voluntary groups with little or no external funding; agencies that are often overlooked in terms of their contribution to the health care system. Those interviewed readily identified benefits relating to quality of life, illness management, and interactions with health care professionals. Increased emotional and social support, access to an expanded information base, a better understanding of their illness, and a greater sense of confidence and control in relation to it seemed to enhance the capacity of members to engage in active self-management of their conditions. Along with such benefits, group leaders also highlighted some of the challenges faced by volunteers who run these agencies. Self-help groups are effective structures that can serve as an adjunct to clinical care and provide tangible benefits to their members. Further investigation and better recognition of these groups is warranted given their potential to assist those with chronic illness and to contribute to national policy objectives for chronic disease management such as those identified in the Sharing Health Care Initiative.
Self-help organisations: A qualitative study of successful collaboration with general practice
Authors: M Boyle Frances , Posner T. Natasha , B Del Mar Christopher , McLean Jill , A Bush Robert
Published: August 2009

Thousands of self-help organisations (SHOs) exist in Australia but little is known about how they relate to the mainstream health care system. This qualitative study, based in south-east Queensland, aimed to identify examples of collaboration between general practitioners (GPs) and SHOs in order to examine the attributes of successful partnerships. Representatives of six SHOs, identified by key informants as having good collaborative links with GPs, and seven GPs with whom they collaborated, completed semi-structured interviews. The interviews focused on evidence of collaboration and perceptions of benefits and barriers experienced. Maximum variation sampling enabled a cross-section of SHOs in terms of size, funding, and health issue. Although GPs readily identified SHO benefits, they referred patients to them only rarely. SHO credibility, evidence of tangible benefits for patients, ease of contacting the SHO, and correspondence between the SHO?s focus and the GP?s personal and professional interests appear to contribute to the success of partnerships. We conclude that mutually beneficial partnerships between GPs and SHOs exist but are under-utilised. A more coordinated effort is needed to strengthen links between the two sectors.
The science of the COAG coordinated care trials
Authors: W Harvey Peter , J McDonald Peter
Published: August 2009

Objectives: To explicate the organisational change agenda of the COAG coordinated care trials within the Australian health system and to illuminate the role of science in this process.
Methods and Results: This article briefly outlines the COAG coordinated care trial aims and the effect of the trial as a change initiative in rural South Australia. It is proposed that although the formal trial outcomes are still not clear, the trial had significant impact upon health service delivery in some sites. The trial involved standard research methods with control and intervention groups and with key hypotheses being tested to compare the costs and service utilization profile of intervention and control groups. Formal results indicate that costs were not significantly different between intervention and control groups across all sites, but that the trial, nonetheless, had a powerful impact on the attitude and behaviours of service providers in the rural trial on Eyre Peninsula in particular. Some of the key structural changes now in place are outlined. Conclusions: The COAG trial has had many and varied impacts upon those organisations and individual providers involved with it. It is argued here that since successive initiatives had been implemented before final evaluation results were published, other agendas were served by the trial apart from those of standard scientific research and hypothesis testing. That is, the main impact of the coordinated care trial in Eyre Region at least has been change by stealth, and not through scientific research and demonstration.
Implications: The COAG trials have set in train a series of structural and procedural changes in the methods of delivery and management of primary health care systems; changes that are embodied in the Enhanced Primary Care packages (EPC) and other initiatives recently introduced by the Commonwealth Government. These changes have occurred and are occurring across the system without formal evidence as to their efficacy, suggesting that other financial motives are driving these new approaches apart from the goal of improving health outcomes for consumers. Also, if science is to be used in this way to drive policy and procedural change ahead of actual outcome evidence, it is important that we examine the more subtle agendas of such research projects in future if the integrity of the scientific method is to be maintained. The occurrence of such phenomena questions the very foundation of scientific endeavour and weakens the application of scientific principles in the arena of social and political science.
Participation and chronic disease self-management: Are we risking inequitable resource allocation?
Authors: Foster Michele , Kendall Elizabeth , Dickson Paul , Chaboyer Wendy , Hunter Beth , Gee Travis
Published: August 2009

The Ottawa Charter for Health Promotion supported the empowerment of individuals to participate in their health care and have control over their health. For older adults with chronic conditions, the Chronic Disease Self-Management Program has been widely adopted as an adjunct to existing healthcare options. A growing body of literature has supported the positive impact of self-management programs on outcomes for people with a range of chronic conditions. However, evidence also suggests that participation in these programs is biased. This paper draws on pilot data to describe the profile of those people who inquire, enrol, attend, and complete CDSM courses in Queensland, Australia. As expected, there was evidence that males, Indigenous people, people of non-English speaking background, and those with multiple responsibilities were less likely to participate. Most importantly, participation was affected by a self-selection bias associated with health status. Those who were either unwell or well at the time of the course were unlikely to attend, minimising the preventative value of the CDSM program. Further, CDSM evaluation studies are likely to be inherently flawed and the distribution of health resources can become inequitable.
The chronic disease self-management project at Katherine West Health Board Aboriginal Corporation in the Northern Territory: A report of the first year
Authors: Mobbs Robyn , The Nguyen Hung , Bell Andrew
Published: August 2009

Katherine West Health Board Aboriginal Corporation (KWHB) at Katherine in the Northern Territory is an Aboriginal health service delivery organization directed by the Indigenous Board. The Chronic Disease Self-Management Demonstration Project (CDSM) commenced in April, 2002 at KWHB with funding from the Commonwealth Department of Health and Ageing Sharing Health Care initiative, as one of eight demonstration projects across the country. The project is under the direction of the KWHB Board, which is made up of 18 members elected by their own communities that lie within the KWHB service sector. The full Board or the Board Executive meet routinely throughout each year and members are actively involved with the project at both community and Board levels. The project governance structure also includes a Steering Committee and the Project Management Group that meets monthly. The project is well supported by the various management and administrative sections of KWHB. In the communities, the project reports to the local health committees that have been established by KWHB with community support, and to the local CDSM committees made up of members of the target group.
Chronic disease self-management in Aboriginal Communities: Towards a sustainable program of care in rural communities
Authors: Kit J Ah , x C Prideau , y PW Harve , s J Collin , y M Battersb , s PD Mill , e S Dansi
Published: August 2009

The Chronic Disease Self-Management (CDSM) strategy for Aboriginal patients on Eyre Peninsula, South Australia, was designed to develop and trial new program tools and processes for goal setting, behaviour change and self-management for Aboriginal people with diabetes. The project was established as a one-year demonstration project to test and trial a range of CDSM processes and procedures within Aboriginal communities and not as a formal research project. Over a one-year period, 60 Aboriginal people with type-2 diabetes in two remote regional centres participated in the pilot program. This represents around 25% of the known Aboriginal diabetic population in these sites. The project included training for four Aboriginal Health Workers in goal setting and self-management strategies in preparation for them to run the program. Patients completed a Diabetes Assessment Tool, a Quality of Life Questionnaire (SF12), the Work and Social Adjustment Scale (WASAS) at 0, 6 and 12 months. The evaluation tools were assessed and revised by consumers and health professionals during the trial to determine the most functional and acceptable processes for Aboriginal patients. Some limited biomedical data were also recorded although this was not the principal purpose of the project. Initial results from the COAG coordinated care trial in Eyre suggest that goal setting and monitoring processes, when modified to be culturally inclusive of Aboriginal people, can be effective strategies for improving self-management skills and health-related behaviours of patients with chronic illness. The CDSM pilot study in Aboriginal communities has led to further refinement of the tools and processes used in chronic illness self-management programs for Aboriginal people and to greater acceptance of these processes in the communities involved. Participation in a diabetes self-management program run by Aboriginal Health Workers assists patients to identify and understand their health problems and develop condition management goals and patient-centred solutions that can lead to improved health and wellbeing for participants. While the development of self-management tools and strategies led to some early indications of improvements in patient participation and resultant health outcomes, the pilot program and the refinement of new assessment tools used to assist this process has been the significant outcome of the project.
The CDSM process described here is a valuable strategy for educating and supporting people with chronic conditions and in gaining their participation in programs designed to improve the way they manage their illness. Such work, and the subsequent health outcome research planned for rural regions, will contribute to the development of more comprehensive CDSM programs for Aboriginal communities generally.
Coaching for behaviour change in chronic disease: A review of the literature and the implications for coaching as a self-management intervention
Authors: Lindner Helen , Menzies David , Kelly Jill , Taylor Sonya , Shearer Marianne
Published: August 2009

Self-management is a necessary aim in the treatment of chronic illnesses, such as diabetes, heart disease, arthritis, lupus, and chronic obstructive pulmonary disease. Although effective treatments are available for these serious conditions, the rate of adherence to medication, dietary changes, physical activity, blood monitoring, or attendance to regular medical screenings is reported to be approximately only 50%. The role of health professional support in effective self-management of chronic illness has been recently acknowledged. Furthermore, numerous studies on professional support for self-management of chronic illness have focused on the health professional as a ?coach?. Coaching has been defined as an interactive role undertaken by a peer or professional individual to support a patient to be an active participant in the self-management of a chronic illness. A review of the literature revealed a limited number of empirical studies on coaching, with these focusing on one of three areas: disease-related education; behaviour change strategies; or, psychosocial support. Due to the small number of research investigations, only tentative support can be given to the efficacy of the different coaching approaches. However, it was apparent that education-based interventions have a significant role in self-management, but that these were not sufficient by themselves. The role of behaviour change-focused coaching was also shown to be an important factor. However, not all patients are ready for change, and therefore the need for coach interactions that move a patient to a stage of action were evident, as was the need to consider the emotional state of the patient. The challenges for future research is to investigate the relative strengths of these coaching approaches for the support of patient self-management of chronic illness, and the means to effectively integrate these approaches into routine health care, through a wide range of health professional groups.
The sharing health care initiative: Issues in design of the evaluation of a national program of demonstration projects for self-management of chronic conditions
Authors: Feyer Anne-Marie , Francis Caitlin , Quigley Ray , Jessop Rebecca , Walsh John
Published: August 2009

This paper aims to consider the key issues in defining and measuring elements for evaluation of the national program of the Sharing Health Care Initiative (SHCI), and to describe the design of the national evaluation framework. Key parts of the chronic disease self-management literature and the evaluation literature were reviewed. The implications of the literature for design of the national evaluation are outlined. Three key issues needed to be addressed in the national evaluation of the SHCI - a program of diverse demonstration projects funded to develop generic self-management approaches. First, a guiding principle of the national evaluation was identification of common project features for analysis against some standard impact and outcome measures, to allow aggregated and comparative analysis. Second, strong emphasis on process evaluation was critical in order to allow analysis of which elements were successful and which were not. Third, the national evaluation was focused more broadly than efficacy at the program participant level; it also covered factors that are likely to contribute to development of self-management programs in the Australian context. The focus of the national evaluation of the SHCI was clearly defined in line with its national role, and reflecting its focus on providing information for future policy options to most effectively develop chronic condition self-management approaches in Australia. Comprehensive evaluation of a range of factors beyond efficacy at the individual client level is needed to assist in understanding the potential effectiveness of population-based implementation of interventions with well-demonstrated efficacy.
Access to Local Government HACC services for people speaking a language other than English at home
Authors: J Black Kristen , N Osborne Deborah , A Lindeman Melissa
Published: August 2009

Home and Community Care (HACC) services are provided to frail older people, other people with disabilities, and their carers, to assist independent living. HACC policy acknowledges that certain groups within the population have greater difficulty accessing HACC services than others. This paper considers the equity of access issue for one of the groups that have difficulty - people from culturally and linguistically diverse (CALD) backgrounds. Language spoken at home is used as an indicator of CALD status. The 2001 Census data and HACC-user data from the Western Metropolitan Region (WMR) of Victoria was analysed. The proportion of the HACC user population that speaks a language other than English (LOTE) was compared with the proportion of the general population that speaks a language other than English for two age groups ?the total population and those 65 years and over. Chi square analyses were conducted to determine odds ratios to give an indication of the magnitude and direction of the association between CALD status and access to HACC services. Analyses indicated that people who spoke a LOTE at home were approximately a third as likely to access Local Government HACC services than those who spoke English (OR=0.35). The findings suggest that policy and service development initiatives to improve access to HACC services for people of CALD backgrounds have not yet effectively reached their targets.
Education and training needs of nurses in general practice
Authors: Meadley Liz , Conway Jane , McMillan Margaret
Published: August 2009

Practice nurses have been identified as key personnel in management of patients either in the prevention of hospitalisation or follow-up post-discharge from acute settings. There is an increase in numbers of practice nurses (PNs) in Australia, but the role of nurses who work in general practice is poorly understood. There is considerable variation in the activities of PNs, which can include functions as diverse as receptionist duties, performing a range of clinical skills at the direction of the medical practitioner, and conducting independent patient assessment and education. This paper reports on an investigation of PNs? perceptions of their ongoing professional development needs, and identifies issues in providing education and training to nurses who work with general practitioners (GPs).
Partnerships in primary care: What we can learn from the experience of Scottish local health care co-operatives
Authors: Simeons Steven
Published: August 2009

A number of countries are introducing partnerships in primary care that promote collaboration within the primary health care sector in order to provide seamless and high-quality care to patients, whilst containing costs. This paper reports on a nationwide survey of Scottish local health care co-operatives to illustrate how partnerships in primary care manage the process of organisational change and start tackling their core functions. During their first year of operation, local health care co-operatives have put an organisational structure in place to start developing primary care services in collaboration with other health care providers. Strong management has been fundamental to the success of local health care co-operatives in stimulating collaboration between health care providers and in developing services. However, a lack of time of general practitioners to participate in the activities of the co-operative, inadequate representation of stakeholders in management bodies, constraints on management budgets, and reluctance by general practitioners to embrace clinical governance may inhibit the further development of local health care co-operatives. Although local health care co-operatives have made considerable progress, they still need to demonstrate whether they are able to deliver tangible benefits to patients.
Needles and syringes to care and counselling: The need for innovative primary health care to meet the needs of street-based injecting drug users
Authors: Rowe James
Published: August 2009

This article addresses the potential role that the Australian Needle and Syringe Program (NSP) could play to assist the delivery of primary health care to ?street-based? injecting drug users (i.e., those who spend the greater part of their lives ?on the street?). Their personal circumstances mean that street-based drug users are particularly vulnerable to health problems. However, they also face obstacles that discourage their use of health care services. Consequently, relatively minor health problems may be allowed to deteriorate until emergency treatment is required. As one of few established services frequented by street-based drug users, NSPs may be in a unique position to intervene at an early stage of need.
This article draws upon research undertaken with street-based drug users at the primary St Kilda NSP. Some 150 drug users were surveyed. A further 32 were interviewed at length. Users described the obstacles that discouraged their use of mainstream health care services. This article argues that these obstacles - primarily issues of accessibility and attitudinal barriers - might be addressed by linking primary health care services with existing NSP services. NSP staff could draw upon their relationships and skills to refer clients to linked health services.
Enhancing interactivity in videoconference sessions: Tips and tools for health promoters
Authors: Ellis Isabelle , James Ray
Published: August 2009

This paper outlines ways of creating more interactive videoconference sessions. Videoconference technology is now widely available in the community. Health promoters need to have the ability to conduct interactive sessions using the technology effectively to maximise its potential. The knowledge and skill needed is akin to setting up a live performance: scriptwriting, choreography, preparing sets, lighting and sound. Getting the basics right and understanding the potential gives health promoters the ability to interact effectively with the audience across the sites. Simple strategies can greatly improve a videoconference session, and most of these strategies do not require a high level of technical expertise or a multitude of support staff; they can be harnessed by any health professional with an interest in getting the best out of a videoconference session. The more complex the presentation the more planning and practice time is needed to ensure that all of the information is delivered and feedback received in the time scheduled.
Sexuality information for older people in the technological age
Authors: DG Goldman Juliette , L Bradley Graham
Published: August 2009

In this new millennium, in response to increasing knowledge and technological change, life-long education is becoming important for everyone, including older people. Life-long education also includes sexuality information. Everyone has the right to access sexuality information. In the past, this has been available for older people from sources such as books, magazines, peers, and television. The technological age upon us now provides yet another source. The Internet has a growing number of sites specifically for sexuality information for the older person. Such information is technology-derived, personal, instantaneous, on demand, accessible anytime, individualised, and not controlled by social, institutional, or educational structures. The opportunities this promotes are almost limitless for enhanced personal understanding and improved inter-personal relationships for older people. Here, a selection of relevant sites is identified and presented for their developmental, psychological and sociological appropriateness.
Habit and habitat: Housing, government policy, drugs, and pregnant women
Authors: Bessant Judith
Published: August 2009

In this paper I report on young drug-dependent pregnant women, their housing needs, and the effectiveness of policies and services designed to meet their needs. The research on which this paper is based is part of an Australian Housing Urban Research Institute project. Most of the material used in this article comes from the City of Yarra, where we interviewed poly-drug users to explore how different kinds of accommodation options (from secure private or public housing through to insecure housing to no accommodation options other than squats or ?sleeping out?) impact on interviewees? capacity to participate in various socioeconomic and cultural activities. The primary research question asked is whether or not government policies and programs complement and support each other or whether they work against each other in respect to young homeless pregnant drug users. A series of vignettes are presented to answer this question, and they reveal how housing and related services that pregnant women need to use frequently overlook their multiple needs. This can range from services offering support in the areas of drug and alcohol, to financial and legal issues, to domestic and family violence matters, to health and disability problems. When a pregnant woman decides to manage her drug use better, she usually faces a number of barriers. An exploration of those barriers takes us into discussions about the general shortage of appropriate housing, the constraints she experiences in the private rental market, and how particular administrative requirements cause difficulties for the pregnant women (i.e., housing acceptance deadlines). Long waiting lists for supported accommodation and public housing along with policies like ?zero-tolerance? drug regulations exclude these women from shelters. In the final section of the paper, the issues of stigma and shame are considered along with the way in which drug use, pregnancy and housing shortages lead to child protection interventions and often loss of custody. My finding is that despite officially declared commitments to a ?whole of government approach?, as opposed to ?a silo approach?, departments and agencies frequently work in isolation from each other, and indeed often against each other.
Consuming health: The market for complementary and alternative medicine
Authors: Easthope Gary
Published: August 2009

A brief account of the collapse of PAN pharmaceuticals is used to identify the major interest groups in the market for complementary and alternative medicine (CAM) products - individual consumers, CAM businesses, insurance companies, doctors, and governments. These interest groups are then described. It is argued that CAM use is primarily driven by individual consumers, but the final form of the market is produced by the intersection of interest group pressures. Finally, it is suggested there may be two consumer markets for CAM products: one oriented towards symptom relief and one towards health maintenance. Therapists are foremost in symptom relief and CAM medicaments foremost in health maintenance.
Swollen limbs: The impact on quality of life
Authors: Posner T. Natasha , Momenzadeh Sirous
Published: August 2009

A swollen limb from lymphoedema is a chronic condition that has not had a high medical profile. Very little research on how it is experienced has been carried out. This paper reports on part of the results of a survey of 137 people with lymphoedema conducted among members of the Lymphoedema Association of Queensland. One of the aims of the study was to assess the degree and nature of the impact of the condition on individual lives. Responses to two open-ended questions were analysed, revealing a considerable variation in the effects of the condition from ?minimal? to ?devastating?, and a range of impacts across functional and emotional dimensions. The condition can substantially reduce mobility and capacity for many activities, cause embarrassment and distress, and make wearing normal clothes difficult, and thus can have a considerable impact on quality of life. For many, the condition is secondary to treatment for cancer, resulting from removal of lymph nodes, and develops with no prior warning or information at a time when recovery from cancer is in prospect. This can make acceptance, participation in treatment and adjustment particularly difficult. Our data map the nature of the impact of a swollen limb (or limbs) on quality of life and body image.
Blacklisted in the city: How stigma affects primary health care for people who inject drugs
Authors: Bennett Gabrielle
Published: August 2009

This paper explores a current issue relating to the delivery of primary health care services for people who inject drugs. It tells the story of Living Room Primary Health Service in Melbourne?s Central Business District, and the problems experienced in trying to find a suitable space in which to operate. Despite adequate funds and a year-long search for a suitable property, the primary health service continues to work from an overcrowded space that presents many health and safety concerns for clients and workers. The issue is discussed from a symbolic interactionist perspective and draws on theories relating to stigma, deviance, and social control. The stigma experienced by people who inject drugs is described and the three forms of stigma described by Erving Goffman (1951) - physical abominations, blemishes of character and tribal stigma - are discussed and applied. Similar stigmas are described that also affect Living Room Primary Health Service, a service for the people who inject drugs. The related concept of ?passing? is also explored in relation to people who inject drugs and to the service designed to provide primary health care to them. Notions of deviance and social control are also discussed and are shown to be pertinent in understanding how people who inject drugs, and services for this group, are blacklisted in the city. This problem raises many issues regarding the public perception of drug use, stigma, social control and the delivery of health services to people who inject drugs. This paper discusses aspects of these important issues and argues that the service?s inability to secure a lease and suitable work space has more to do with the stigma and social control than money and real estate agents.
The role of consumer participation in Victorian Primary Care Partnerships
Authors: Teresa Dawson Maria
Published: August 2009

In April 2000, the Victorian Department of Human Service (DHS) launched the Primary Care Partnerships (PCP) Strategy as a key element of a wider reform of the primary health sector. The PCP Strategy was designed to address perceived fragmentation within the primary health system and to achieve a better integrated system of health service delivery. From the start, consumer, carer and community participation has been integral to the aims, objectives and implementation of the PCP Strategy. This paper argues that the latest developments in the general policy and funding and reporting guidelines for the PCP Strategy have had flow-on effects in policy for consumer participation. The initial in-principle commitment and practical support given by the state government to PCPs to develop and implement consumer participation represented a commitment to consumer participation at the higher levels of the ladder of participation (Brager & Specht, 1969). Most recent policy directions, particularly the funding and reporting guidelines for PCPs - based on outcomes/impact measures - locate consumer participation at the lower levels of the ladder of participation. This paper provides an overview of the key DHS policy and strategic direction documents shaping consumer and community participation in PCPs, and critically analyses these documents against the ladder of participation.
From tearful toddler to strident youth: Tackling health inequalities through primary care
Authors: Catford John
Published: August 2009

Australia, over many decades, has experienced marked differences in health status between population groups as defined by gender, geography, ethnicity and socio-economic status. For example, affluent, privileged people have better health and lower mortality than poor, disadvantaged people. Australia?s health is now one of the best in the world - but the only way for it to improve further is to tackle health inequalities as a central plank of health research, health policy, and health service delivery.
Access to primary health care: three challenges to equity
Authors: Fort Harris Mark , Harris Elizabeth , Roland Martin
Published: August 2009

Access to primary health care is a key policy issue in many countries, and is of particular importance in those countries committed to equitable access to primary health care as a strategy for addressing health inequity. Making sure primary health care systems are equitable and accessible to those who need them most is more complex than equal use by all people or population groups. Access can be defined as the opportunity or ease with which consumers or communities are able to use appropriate services in proportion to their need. This paper explores some of the challenges facing the UK and Australian health systems in relation to improving equity of access, which include providing high quality care for socially disadvantaged groups, ensuring access to primary health care appropriate to needs, and developing universal and targeted policies that reduce inequalities in access to primary health care. Drawing on literature from the two countries, this paper identifies contemporary issues in equity of access and discusses potential measures to address these issues. While the paper focuses on the role of primary health care - and especially those services provided through general practice in reducing health inequity - it is recognised that action must also occur in other sectors to address underlying determinants of health.
Reducing health inequalities: Ethical issues in a Scottish child health home visiting program
Authors: A Rogers Wendy
Published: August 2009

Childhood inequalities have far-reaching consequences throughout the life cycle. Reducing health inequalities for children is an important goal for health policy, grounded in justice and the desire to prevent avoidable ill health. The purpose of this article is to report and discuss the results of a qualitative study into the ethical issues identified by staff involved in a paediatric home visiting program in Scotland. One of the major aims of the visiting program was to reduce health inequalities. The results presented here relate to two issues identified by study participants: conflicting responsibilities, and ethical tensions inherent in the very task of reducing inequalities. The requirement for evaluation, meeting targets and working with partners led to conflicting responsibilities for some participants. Working to reduce health inequalities led to some paradoxical effects, and a fear that root causes of inequality were not being addressed. These results suggest that programs aimed at reducing inequalities may lead to unexpected ethical tensions. Policy-makers and those implementing such programs need to be aware of possible unintended effects and tensions experienced by staff.
Subsidised Café Meals Program: more than just "a cheap meal"
Authors: Doljanin Katrina , Olaris Kristine
Published: August 2009

This paper describes the Caf� Meals Program that is operating in the City of Yarra. The Program has resulted from a collaboration of North Yarra Community Health (NYCH) and City of Yarra, and aims to improve access to nutritious, affordable and socially acceptable meals for homeless people. The Program forms a part of City of Yarra?s Meals Program; it is managed by NYCH. The Caf� Meals Program is currently feeding 50-60 homeless people in Yarra. It targets those who are homeless (or at risk of becoming homeless), who find it difficult to prepare their own meals, and who have no other prepared meal options that are appropriate for them in the community. It provides a choice of four local caf�s and restaurants for its participants. Each person is provided with a membership card that can be used once per day to purchase a meal (to the value of $8.80) for the price of $2.00. The program empowers clients by giving them control over when, where and what they will eat. It also enables the homeless person to participate in the life of the community by dining in venues where the general community eats and socialises. This improved sense of social connectedness and inclusion can have significant effects on the self-esteem of the program participants, and, subsequently, on their ability to make choices that improve their health and wellbeing. This paper presents this innovative program in detail and provides some insight into its outcomes, the components of the program that make it work, as well as the challenges that the program has had to address.
New Zealand primary health care policy and the role of a non-government organisation
Authors: Glensor Peter
Published: August 2009

I was asked to make the presentation this paper is based on1 following the collaboration between La Trobe University and Health Care Aotearoa over several years. La Trobe is the home of the Quality Improvement Council, of which Health Care Aotearoa is a member. That Council has been one of the international partners who have given validation and inspiration for us in Aotearoa/New Zealand in the field of community-based primary health care. My own background, as a Methodist minister for 20 years, followed a life-transforming year as an 18-year-old volunteer in Sarawak in 1969, and exposure internationally to struggles for social justice. In recent years I have become more directly involved in political engagement, at both the local body and national level, as an expression of my understanding of community development and health. I am Chairman of one of New Zealand?s 21 District Health Boards and am relishing the opportunity to lead a regional health organisation as it builds intersectoral linkages, embraces excellence in the delivery of health services, and addresses issues of disparities in health outcomes. I continue to be involved in national leadership of a number of non-government organisations (NGOs), and am taking a leading role in building a new national entity that can encompass the whole non-government organisation sector in New Zealand. All this work arises directly from the experiences and insights described in this paper.
Tantalus and the Tyranny of Territory: Pursuing the dream of parity in rural and metropolitan population health outcomes through primary health care programs
Authors: Harvey Peter
Published: August 2009

Many health professionals and rural health academics are motivated by the challenge of achieving equitable access to health care in rural communities with the implicit vision that fairer access to services might ultimately lead to more equitable health outcomes for people living in rural and remote settings. The purpose of this paper is to put the issue of rural and urban health outcome parity into perspective and assess recent progress towards achieving the ultimate goal of improving rural health status. I will also explore ways in which rural communities might increase their access to and use of primary health care revenue in the future to improve community health outcomes. While some improvements have been achieved across the rural health system in recent times, the fundamental problem of maintaining infrastructure to service community needs in rural areas remains as daunting as ever. Extensive evidence has now been assembled to show that rural people generally enjoy a much lower standard of health care, health outcomes and life expectancy than their urban cousins. The question underlying all of this evidence, however, is... must this always be so? Is it possible to redress the current inequities between rural and urban populations and could new primary health care initiatives, such as the Enhanced Primary Care (EPC) program, be vehicles for achieving more equitable health care arrangements and health outcomes for people living in rural communities?