bluuebunny/crossref_metadata_2025 huggingface dataset:
Editorial
Authors: Walker Rae
Published: August 2009

For the editorial team, the Australian Journal of Primary Health has three key stakeholder groups: readers, authors and reviewers. Of these, reviewers are the stakeholders least frequently acknowledged. They are, however, critical to the credibility of the journal as a "purveyor of knowledge" in a world saturated with words.
After-hours service models in Queensland Australia: A framework for sustainability
Authors: Crossland Lisa , Veitch Craig
Published: August 2009

This paper outlines the key features of after-hours primary medical care service sustainability in Queensland. It describes the development of these into a practical framework designed to assist either those in the early stages of service development or the evaluation of existing service models. A representative sample was drawn from over 120 separate formal after-hours services identified across Queensland. Semi-structured interviews were held with staff and key informants from 16 services and other local service providers in Queensland. Reviews of documents relating to operating and management procedures and protocols were also completed. Data were assembled and thematically analysed using the QSR NUD.IST qualitative data analysis package. Five key factors related to sustainability commonly featured in the after-hours primary medical care services studied: business management and promotion; collaborative service arrangements; effective protocols and guidelines; recruitment and retention strategies; and remuneration. These issues can be summarised in a table format that demonstrates the interaction between the identified key factors of sustainability and the various model types. The purpose of the diagram is to illustrate the interplay of factors which impact on the development and sustainability of after-hours primary medical care services currently extant in Queensland. It is the complex interaction of all these factors that ultimately determines the sustainability of an after-hours service model.
Approaches to population health care: The emerging context!
Authors: Harvey Peter
Published: August 2009

This paper provides a review of recent developments in population-based approaches to community health and explores the origins of the population health concept and its implications for the operation of health service management. There is a growing perception among health professionals that the key to improving health outcomes will be the implementation of integrated and preventive population-based resource management rather than investment in systems that respond to crises and health problems at the acute end of the service provision spectrum only. That is, we will need increasingly to skew our community health and welfare investments towards preventive care, education, lifestyle change, self-management and environmental improvement if we are to reduce the rate of growth in the incidence of chronic disease and mitigate the impact of these diseases upon the acute health care system. While resources will still need to be devoted to the treatment and management of physical trauma, infectious diseases, inherited illness and chronic conditions, it is suggested we could reduce the rate at which demand for these services is increasing at present by managing our environment and communities better, and through the implementation of more effective early intervention programs across particular population groups. Such approaches are known generally as population health management, as opposed to individual or illness - based health management' or even public health - and suggest that health systems might productively focus in the future on population level causation and not just upon disease-specific problems or illness management after the fact. Population health approaches attempt to broaden our understanding of causation and manage health through an emphasis on the health of whole populations and by building healthy communities rather than seeing "health care" as predominantly about illness management or responses to health crises. The concept also presupposes the existence of cleaner and healthier environments, clean water and food, and the existence of vibrant social contexts in which individuals are able to work for the overall good of communities and, ultimately, of each other.
The impact of Aboriginal community controlled health service advocacy on Aboriginal health policy
Authors: Bartlett Ben , Boffa John
Published: August 2009

This paper reviews the advocacy role of Aboriginal community controlled health services (ACCHSs) in the development of Aboriginal health policy over the past 30 years, with a specific focus on the recent changes in Commonwealth funding and administrative responsibility - the transfer of Aboriginal health service funding from the Aboriginal and Torres Strait Islander Commission (ATSIC) to the Office of Aboriginal and Torres Strait Islander Health Services (OATSIHS) within the Commonwealth Department of Health and Ageing (DoHA), and the development of policies aimed at Aboriginal health services accessing mainstream (Medical Benefits Scheme [MBS]) funds. The outcomes of this policy change include a significant increase in funding to Aboriginal primary health care (PHC), the inclusion of ACCHSs in collaborative strategic relationships, and the development of new arrangements involving regional planning and access to per capita funds based on MBS equivalents. However, the community sector remains significantly disadvantaged in participating in this collaborative effort, and imposed bureaucratic processes have resulted in serious delays in releasing funds for actual services in communities. Government agencies need to take greater heed of community advocacy, and provide appropriate resourcing to enable community organisations to better direct government effort, especially at the implementation phase. These remain major concerns and should be considered by non-health sectors in the development of new funding and program development mechanisms in the wake of the abolition of ATSIC.
Chronic Condition Self-Management: A primary health care change management problem
Authors: Lambert Susan
Published: August 2009

Australian general practitioners are recognising the need to implement some form of chronic condition management program to better service and cope with the ever-increasing number of patients presenting with chronic conditions. Chronic Condition Self-Management (CCSM) is one such program. In this paper it is argued that the basis of CCSM is a multi-disciplinary, care-team approach, and that implementation of such an approach represents a paradigm shift in primary health care service delivery. This equates to a significant innovation in primary health care service that, in economic terms, aims to increase primary health care outputs. Although general practitioners are at the centre of the change they cannot implement the change without the participation and collaboration of the other stakeholders. These stakeholders include other health service providers, the Divisions of General Practice, the Department of Health and Ageing, and the patient. This paper presents a general practice business model to illustrate the relationships between stakeholders in the primary health care sector and to identify the impact of CCSM on these relationships. The organisational and business issues that need to be addressed to promote the uptake of CCSM are also identified.
Primary care patients' views on why they present to Emergency Departments: Inappropriate attendances or inappropriate policy?
Authors: Siminski Peter , Cragg Sue , Middleton Rebekkah , Masso Malcolm , Lago Luise , Green Janette , Edgar Kathy
Published: August 2009

This study investigates why some patients with apparently less urgent conditions present to emergency departments (EDs). We report on a survey of "potential primary-care" ED patients, who were asked about their reasons for choosing the ED over GPs. The sample consisted of 397 patients (with a response rate of 99% = 397/400), recruited in the former Illawarra Health Area. The three main reasons selected were: self-assessed urgency; being able to see the doctor and having tests or X-rays done in the same place; and self-assessed seriousness or complexity. The results do not appear to be sensitive to two potential sources of bias (fixed question ordering and non-random sampling). The results suggest a number of potential policy levers for encouraging some people to present to GPs rather than EDs. However, the main conclusion is that the majority of "potential primary-care" patients appear to be presenting for appropriate reasons. Thus "inappropriate attendances" do not seem to be the cause of EDs being under stress. We also argue that the results are useful for drawing inferences more broadly than just in relation to the Illawarra.
Moving towards meaningful local population health data: The service provider perspective
Authors: Ruth Denise , Hurworth Rosalind , Sulaiman Nabil
Published: August 2009

Increasingly, primary care services are required to use data to assess their local population's health needs and plan services. This paper reports focus group discussions of service providers' perceived current practice, issues and needs related to obtaining and using data for planning services in two local government areas of Melbourne. Six groups were conducted with nominees from two municipal councils, four divisions of general practice, three community health services, three hospital networks and eight community organizations. Two groups were conducted with planners and data providers from the Department of Human Services, Victoria. The 66 participants had a broad range of experience in using data to assess local population health needs. Participants reported that issues limiting the use of data related to: access to data (lack of awareness, contacting the right person, poor communication between data providers and users, resource constraints, lack of central access); gaps in data; quality of data (inconsistent definitions and collection, currency, ties to funding); applicability of data (unfriendly format, problems with aggregated versus small area data, non-matching data sets, lack of contextual information); and support for data use in local population health planning. If local population needs assessment is to lead to better health outcomes, service providers need access to high quality data presented in formats that are applicable to their communities. They also need practicable planning methods, skills training and support in using data for local population needs assessment and service planning.
General practice capacity for behavioural risk factor management: A SNAP-shot of a needs assessment in Australia
Authors: Amoroso Cheryl , Hobbs Coletta , Harris Mark F
Published: August 2009

The objective of this study is to examine current activities, barriers, and capacity needs for the assessment and management of smoking, nutrition, alcohol and physical activity behavioural risk factors in rural and urban general practices. A cross-sectional survey of 287 general practitioners (GPs) was conducted in a rural and urban Division of General Practice in NSW. A total of 146 GPs responded yielding Divisional response rates of 51% rural and 61% urban. For each of the SNAP risk factors, between 37% and 46% of GPs report using guidelines. Verbal advice is given "very often" for smoking by 68% of GPs, for nutrition and alcohol by 48%, and physical activity by 60%. Guideline use is associated with increased frequency of advising patients. Patient compliance is the most frequently reported barrier to giving advice, especially for smoking and alcohol. GPs report that they "often" or "very often" refer patients due to nutritional risk factors (48%), with lower referral rates reported for physical activity and alcohol risk factors (28% and 27% respectively). Only 10% refer patients "often" or "very often" for smoking management, and referral for smoking management and physical activity increase as a result of training in these areas. There is considerable variability in smoking, nutrition, alcohol and physical activity risk factor intervention and management in the general practice setting. A range of strategies is required to improve the systematic management of risk factors including training, use of guidelines, referral networks, and patient education.
The development of a Health Promotion Community Participation Framework
Authors: Llewellyn-Jones Lorraine , Harvey David
Published: August 2009

This paper reports on research conducted through Monash University located in the state of Victoria, Australia. The outcome of the research was the development of a Health Promotion Community Participation Framework, providing guidelines for health professionals in community health centres and services to assist them with facilitating community participation in health promotion. A literature review was conducted and information collected from health professionals working in metropolitan and rural community health centres and services across the state of Victoria, Australia. The Framework does not emphasise levels of community participation as a hierarchy, but instead proposes using the levels or types of participation across a continuum. This has been done to encourage the use of appropriate transparent strategies that will enable both individual community members and different sections of communities to participate in health promotion activities. This is particularly important where government policies dictate the direction of health promotion, as this "top down" approach can lead to the community being excluded for health promotion processes. The use of a continuum promotes the concept that participation can be effective at different levels, even when the issue to be addressed has already been identified. The Framework also proposes that in order for community participation strategies to take place, there needs to be capacity building at both the organisational level and the community level.
Editorial
Authors: Walker Rae
Published: August 2009

Each year the Australian Journal of Primary Health devotes one issue to a special theme under the auspices of a guest editor. In 2006 the focus of the special issue will be on community-based care. Since the 1960s the aspiration to community-based care has become increasingly important for users of services as well as policy-makers. The evolution of community-based care has been influenced by deep currents of change in Western societies. Technical developments in areas such as dialysis technology and pharmaceuticals have made some kinds of complex care in community settings feasible. The evolution of market-based service frameworks and the "consumer society" have strengthened arguments that services should adapt to consumer aspirations by providing more services in communities familiar to their users. In a similar vein the drive for efficiency in public service provision has motivated policy-makers to explore ways of reducing the cost of services whilst striving to maintain quality. The social justice argument has been fundamental to deinstitutionalising people with complex needs.
What are the Challenges for Evaluating a Palliative Care Service?
Authors: Senior Kate , Perkins David
Published: August 2009

This paper identifies the challenges in researching the impact of a rural palliative care service on its patients, carers and providers in the context of the National Palliative Care Strategy. It describes the use of an anthropological method to overcome problems of acceptability and respondent burden and to enable the elaboration of meaning and valuation by participants. It uses the Griffith Area Palliative Care Service as a case study to illustrate the problems of such research and the value of the anthropological method over more conventional research and evaluation approaches. It makes recommendations about how to assess the outcomes of services such as palliative care where the focus of care is complex, individual and family, and the outcomes go far beyond what can be measured with the medical model.
Improving Diabetes Care in an Urban Aboriginal Medical Centre
Authors: Longstreet Diane A , Griffiths Marlene M , Heath Deanne , Marshall Gauwada Emily G , Morisco Paolo , Geary Nichelle , Larkins Sarah , Panaretto Kathryn
Published: August 2009

The aim of this project was to improve the detection, monitoring, and medical care of Indigenous patients with diabetes in an urban Aboriginal medical centre. The research design and methods entailed the diabetes register being cleaned and updated. A pre- and post-project non-random sample audit of medical records of patients diagnosed with diabetes evaluated the level of care received compared to best practice standard of care. A multi-disciplinary Diabetes Team established procedures to improve the patient care provided. Additional service providers, including a dietitian, podiatrist, ophthalmologist, and endocrinologist, joined the team. A holistic health care approach was implemented with an emphasis on opportunistic care. The percentage of patients having a care plan completed increased from 18% in the 2002 audit to 72% in the 2003 audit. There were significant trends between increased completion of all cycle of care activities and frequency of GP review. Doctors prepared care plans for 50% of patients who attended less than two review visits in 2003, but increased to 89% if receiving six visits or more (p = 0.000). No significant improvement in health outcome was noted. The project showed significantly improved care planning and medical management of urban Aboriginal and Torres Strait Islander patients with diabetes.
Is the Far West Mental Health Integration Project Making a Difference? The General Practitioner Perspective
Authors: Perkins David , Lyle David
Published: August 2009

This paper reports on the evaluation of an Australian Government and NSW State funded Mental Health Integration Project in remote far western NSW. The project was part of the Mental Health Integration Program, developed from the Second National Mental Health Plan. The project implemented a model of community-based mental health services and used innovative financing arrangements to allow the provision of community-based specialist mental health teams to remote communities and to recruit visiting psychiatrists to support the local primary care providers. The evaluation strategy included a survey of general practitioners (GPs) in the Upper Western Sector and Broken Hill, designed to investigate their level and type of contact with psychiatrists and community-based specialist mental health care teams, their perceptions about the impact of the new services, and their interest in further professional development in mental health care.The project has shown that visiting specialists can be deployed in a primary care setting with a focus on meeting the needs of local GPs, primary health care staff and their patients.
What's Needed to Increase Research Capacity in Rural Primary Health Care?
Authors: Barnett L , Holden L , Donoghue D , Passey M , Birden H
Published: August 2009

The aim of this study is to identify ways to build research capacity within primary health. A consultation was undertaken in late 2004 using a combination of a one-page survey and a guided meeting format, in a primary health setting in rural NSW. Most (81.3%) of the 134 individuals consulted were part of an Area Health Service, with 12.7% from non-government settings. Most (80.6%) were clinicians, with a third (31.5%) nurses, 8.3% in medicine, and the remainder from a range of allied health professions. Eleven organisations were represented. The main outcome measures were identification of support needs, processes to enhance research engagement, and barriers and enablers to clinicians' research involvement. The results showed that popular delivery modes for research training and support were courses and "one-to- one" advice. Writing topics were generally more popular than others. Common barriers were time and technology issues. A key enabler was a discipline-specific focus. This is one of few rural Australian consultations on research needs in primary health conducted with a diverse range of clinicians at the clinician level. It will direct future research capacity building efforts towards maximising face-to-face discipline specific options and minimising technology use.
Development of a Computer Assisted Dietary Assessment Tool for use in Primary Healthcare Practice: Perceptions of Nutrition and Computers in a Sample of Older Adults with Type 2 Diabetes Mellitus
Authors: Probst Yasmine C , Krnavek C , Lockyer L , Tapsell Linda C
Published: August 2009

As part of a larger study developing dietary software, this study aims to evaluate a sample of potential users for their experience and comfort with computers, and assess the preferred program design and navigation features for the development of the automated diet history interview. A telephone-based questionnaire and focus groups were employed to evaluate the perceptions, beliefs and attitudes of 37 older adults with type 2 diabetes mellitus. Participants were also shown a range of existing dietary assessment programs and asked to state their perceptions of each. Data was coded and thematically analysed based on computer use, software features, dietary assessment and nutrition programs using N-Vivo software. Three participants had never used a computer, yet others had used computers, and were comfortable using them. For navigation about the program, a preference toward text was identified whilst photographs were preferred for determining food portion sizes. Reduction in the complexity of screen layouts was important and the time to be spent using the program varied widely with a minimum of 10 minutes reported. Development of the computerised dietary assessment program must ensure simplicity of the interface design and flexibility of the locations of use for the older computer user.
Macedonian Women and Breast Cancer: A Model of Psychosocial Support for Early Detection and Treatment
Authors: Aleksoska Katerina
Published: August 2009

In this paper, key controversies surrounding the early detection, management and prevention of breast cancer are explored as a backdrop to considering the psychosocial support needs of women living with breast cancer. This paper also describes an innovative model that was developed at Women's Health In the North (WHIN) in 2004, for women with the greatest need for support - in this case, Macedonian women in the northern metropolitan region.
Making Ethics Work in Collaborative Projects
Authors: Mauldon Emily
Published: August 2009

This article discusses problems a research team had managing their ethical obligations during a short project, and considers the implications of these problems for better understanding and carrying out ethical research in the future. Two key points will be proposed. Initially, it will be argued that the culture of ethical research as articulated within the research community may not be universally accepted within the primary health care sector. The nature of "ethical conduct" within clinical practice, service provision and research is not the same. Further, practical difficulties the researchers experienced while trying to gain approval from ethics committees and implement the proposed research plan highlight some ways in which institutional ethical review processes are structurally unsuited to the requirements of small collaborative projects. Understanding the different ways in which the term "ethics" is used will allow for a more expedient translation of concepts between different health professionals. Recognising the practical constraints ethical review places on the research process may help reduce some of the frustration primary health care professionals can experience when faced with the requirements of research ethics committees. Due to the history of, and cultural commitment to, ethical research within the university sector, those with formal academic training in research are well placed to assume responsibility for managing the ethics process when involved in cross-sectoral research. This responsibility may include the need to educate team members and study participants about the importance of research ethics.
Editorial: CoAG and Primary Health Reform
Authors: Swerissen Hal
Published: August 2009

Chronic disease prevention and management, integration and community care continue to be key themes for primary health and community care as the papers in this issue of the Journal attest. Three quarters of Australians have an ongoing chronic illness (Australian Bureau of Statistics, 2006).
The Council of Australian Governments has recently emphasised the importance of health promotion and disease prevention (Council of Australian Governments, 2006), but to date proposals for action have been disappointing. There is now a plethora of research on these issues and innovative policy and practice to deal with them. There is little doubt that primary health and community care programs are important for the effective delivery of chronic disease prevention. Yet, it remains difficult to get concrete progress towards a national policy framework for primary health and community care. Instead we have incremental, piecemeal attempts at reform. Why is this so?
A Primary Health Care Approach to Men's Health in Community Health Settings: It's Just Better Practice
Authors: Bentley Michael
Published: August 2009

Promoting men's health in primary care settings such as general practice is now common, but what might primary health care for men's health look like in community health settings? This paper reports on case studies of diverse community-based health and wellbeing services for men in South Australia. The programs selected as case studies include Aboriginal men, gay men and homosexually active men, men from culturally and linguistically diverse backgrounds, older men, middle-aged men, fathers, young men, as well as services that focus on childhood sexual abuse and violence intervention. The case studies share the following main features - they have a social view of health, use a primary health care approach with an emphasis on prevention, address issues of access and equity, use social justice principles, and work across a number of sectors. These features were integrated into a socially just primary health care framework for men's health in community health settings. Socially just primary health care can address health inequities within men's health that are related to, among other things, class, race, ethnicity and sexuality. Socially just primary health care services can work collaboratively with women's health on common concerns such as violence intervention and childhood sexual abuse. Moreover, socially just primary health care services reflect local concerns, where health professionals work with men rather than acting as outside experts.
Australian Parents' Reasons for Attending a GP when their Child has Upper Respiratory Tract Symptoms: An Exploratory Pilot Study
Authors: Stoddart Hannah , Hansen Emily , Nelson Mark
Published: August 2009

Upper respiratory tract infections (URTIs) in children are a frequent presentation in Australian general practice. However, there is limited Australian evidence about why parents decide to consult a doctor for childhood URTIs. Our objective was to design a qualitative pilot study aiming to explore this issue using semi-structured interviews. Interviews were conducted with nine parents. We found that cough, fever and abnormal behaviour of the child prompted a consultation with the general practitioner (GP). Parents sought an examination of their child (in particular "hidden areas" such as ears and throat) and reassurance, rather than antibiotics. They also wanted the GP to suggest practical ways to help alleviate their child's symptoms. The results provide a greater understanding of the fears, concerns and beliefs of parents of children with URTIs and hence may improve the GP - parent consultation. Health providers may be encouraged to address the specific parental concerns emerging from this study.
Mapping GP Integration in the Health Care System in Difference Locations in Australia
Authors: Dunt David , Souther Donna , Elsworth Gerald , Harris Claire , Potiriadis Maria , Young Doris
Published: August 2009

The study's objective was to map general practitioner (GP) integration in urban and rural locations as well as areas defined by Divisions of General Practice (DGP) in Australia. A cross-sectional mail survey of a stratified random, national sample of 2029 GP members of DGPs was conducted to estimate their GP integration index scores. Data on other measures of GP integration-related behaviour were also collected. Rural GPs had higher levels of GP integration than urban GPs, judged by their GP higher-order factor scores, their integration factor scores and integration enabling factor scores. This applied to their patient care management roles but, more substantially, their wider role in community health. Rural GPs had higher levels of involvement in Enhanced Primary Care within their practice and with other health practitioners, hospitals and DGPs outside their practice. A small number of DGP areas showed consistently higher or lower levels of GP integration compared to all other DGP areas in the same urban/rural locations. It was concluded that levels of GP integration varied in geographic location across Australia. Urban DGPs, particularly poorly-performing ones, should be closely monitored in terms of their response to recent initiatives to promote GP integration, and should be the focus of future initiatives.
The Importance of the 'Family Meeting' in Health Care Communication with Indigenous People: Findings from an Australian study
Authors: McGrath Pam , Anne Patton Mary , Holewa Hamish , Rayne Robert
Published: August 2009

The following discussion presents findings from a National Health and Medical Research Council (NHMRC) study that documents the importance to Indigenous people of including the network of extended family and community in health care communication. In particular the discussion explores the data relating to the importance of communicating through family meetings with Aboriginal people during end-of-life care. The data was collected through a series of open-ended, qualitative interviews (n=72) conducted with a cross-section of members of the Aboriginal community and health professionals within the Northern Territory, Australia. Acknowledging Aboriginal peoples' relationship rules and communicating through family meetings are practices that demonstrate respect for Indigenous cultural processes of information sharing. Anger on the part of Aboriginal people about lack of information can be the outcome when such processes are ignored or not understood. Respecting the need to "share the story" broadly with appropriate people in the extended family and community network through family meetings is noted as vitally important in health care, especially during the dying trajectory. The discussion explores the practical issues associated with, the different reasons for, and the positive outcomes from, incorporating family meetings for Indigenous people along the illness trajectory.
Responding to the Health and Disability Service Needs of People Ageing with Spinal Cord Injury: Implications from an Australian Study
Authors: Pershouse Kiley , Kuipers Pim , Amsters Delena , Price Glenda
Published: August 2009

In the course of a large retrospective research study exploring implications of ageing with a spinal cord injury (SCI), 84 participants were asked to provide responses to a brief telephone questionnaire regarding the nature and quality of their utilisation of various health and disability services. The aim of this study was to explore service utilisation, level of satisfaction with the services utilised, and the nature of the support received from these services for a sample of people ageing with spinal cord injury (SCI). Findings highlighted that people ageing with SCI have need of a range of health and disability services predominantly focusing on achieving instrumental assistance. Satisfaction with service was generally high and demonstrated the importance of interpersonal communication skills, technical competence and responsiveness in the delivery of outcomes.
Guest Editorial: Recognising the Scope of Community Health
Authors: Kralik Debbie , Taylor Bill
Published: August 2009

Welcome to this special edition of the Australian Journal of Primary Health that focuses on the broad context of community health. Communities are complex social systems bound together by interactive connecting links between organisations, neighbourhoods, families and friends. Authors of the papers in this special issue have contributed to a developing body of knowledge that will begin to provide some of the answers to the complex health issues confronting our communities.
Dung Hop: Psychiatric Disability Rehabilitation Support Service for the Vietnamese Community
Authors: Nguyen Jean-Louis
Published: August 2009

The Western Region Outreach Service (WROS), a service of the Western Region Health Centre (WRHC), has developed an innovative program and model for service delivery for Vietnamese people with a mental illness, their carers and family members. This model is known as Dung Hop, a family- and community-based model that reflects Vietnamese values and culture. Dung Hop is an eclectic merging of the Psychiatric Disability and Rehabilitation Support Service (PDRSS) principles and the Vietnamese Collectivist Philosophical principles, suggesting a harmonious and balanced way to provide support for clients and their support systems. The written text of this model and some of its applications to the success of the Vietnamese Program can be found at www.wrhc.com.au
An Integrated Model for Community COPD Care
Authors: Taylor Rachel , Marley Annette
Published: August 2009

Chronic obstructive pulmonary disease (COPD) represents one of the main causes of morbidity and mortality in the western world. Acute exacerbations of COPD were a major cause of hospital admissions and emergency department attendances and represented a considerable economic burden on health resources in the Northern Sydney Area Health Service of Sydney, NSW. To redress deficits in access and equity in health care delivery and to align with best practice, the Area Health Service implemented a comprehensive, interagency, multidisciplinary model of care for chronic respiratory disease in the community setting. The BREATHE program provides nursing, physiotherapy, occupational therapy, clinical psychology, pharmacy and community care aid services in a client's home at a flexible level according to their acuity and complexity of health care needs. This program works in collaboration with primary care providers to provide specialty respiratory services not previously available. Since commencement of client intake in 2001, the program has observed reductions in health care utilisation and improvement in health outcomes.
"Dental as Anything" Inner South Community Health Service Dental Outreach to People with a Mental Illness
Authors: Burchell Anna , Fernbacher Sabin , Lewis Robert , Neil Andrew
Published: August 2009

This article provides an overview of a unique way to respond to the complex oral health needs of people with a mental illness. People with a psychiatric disability, especially those of low income and insecure housing, are at high risk of developing oral disease, due to issues associated with mental illness, poverty and the side-effects of psychotropic medication. The 'Dental as Anything' program is a collaborative partnership between the mental health, dental and administration teams of the Inner South Community Health Service (ISCHS) in Melbourne. It provides a flexible program incorporating engagement, clinical care, education and support in response to client needs. Utilising a health promotion framework and an assertive outreach model, it accesses people who traditionally do not approach mainstream services. The program manages to "reach the unreachable".
Community-based Shared Mental Health Care: A Model of Collaboration?
Authors: Keleher Helen
Published: August 2009

Shared mental health care is being developed as a community-based model of service delivery that is described as a collaborative model with the intention to shift cultures of general practice from simple referral models to stronger models of collaboration. This article examines the degree to which community-based shared mental health care can be considered a collaborative model of care, and the implications for policy and practice and for consumers recovering from depression and related disorders. Victorian-based research informs the discussion, together with literature that discusses shared mental health care. Overall, the literature supports the view that there are positive outcomes of shared primary mental health care, including continuity of care for consumers and enhanced skills for general practitioners. However, features of collaborations such as inter-disciplinary trust, working together, shared planning or sharing of resources are weak in shared mental health care, suggesting that current practice models are working at a level of cooperation rather than true collaboration. The conceptualising of shared mental health care practices in terms of the theory of par partnerships and collaborations can only inform and strengthen the foundations of shared mental health care.
The Centre of Clinical Research Excellence in Aboriginal and Torres Strait Islander Health: An Operational Rationale and Some Reflections on Progress so far
Authors: Giles Glenn , Malin Merridy , Harvey Peter
Published: August 2009

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf / Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing.
Supporting Mental Health in the Community: New Systems for General Practice
Authors: Sved Williams Anne , Poulton Jill
Published: August 2009

General practitioners (GPs) manage nearly one-third of Australians seeking help for mental health problems, and frequently express their need for consultant psychiatric support in this work. The introduction of new Medical Benefits Schedule Item Numbers 291 and 293 to provide "one-off" psychiatric assessments on referral from GPs offered the potential for providing this support, and a single point-of-entry scheme was organised to provide ease of access to appointments. The aims were to establish a single point of entry for psychiatrist assessment using Item 291, to evaluate the take-up rates of Item 291 in South Australia (SA) through this service and to evaluate the acceptability to GPs and psychiatrists of a psychiatric primary care consultation-liaison (c-l) model. Results were: 26 psychiatrists joined the project; 64 GPs referred 78 patients for assessment, providing 24% of the Australian take-up rate for Item 291, for 8% of the population; evaluation showed high approval ratings from GPs who particularly appreciated the single contact point; and positive evaluation by psychiatrists of the primary care c-l model. The conclusions were that a single contact point provided ease of access to psychiatrists for GPs; GP and psychiatrist groups evaluated Item 291 very positively; and consumer and carer evaluation are essential for further primary care c-l development.
Barriers to Respite: A Case Study of a Sub-group from an Older Carers Program in Western Australia
Authors: Hancock Peter J , Jarvis Jayne A , L'Veena Tanja
Published: August 2009

The past two decades have seen a growing awareness of the unique challenges faced by carers and recognition of their valuable contribution to society. Accordingly, assumptions about caregiving (and receiving) are changing; researchers and policy-makers alike are beginning to incorporate notions which pay at least lip service to supporting or empowering caregivers and receivers through needs-led rather than service-led support. However, there remains a significant lack of understanding of many of the issues faced by carers and care-recipients. This lack of understanding surfaces in polices and programs that tend to ignore the experiences of significant cohorts of carers, particularly older cares, Indigenous carers and carers from remote regions. The program upon which this paper is based is unique in that it does indeed address many of the identified gaps in service provision vis-�-vis older carers in the community. The Western Australian (WA) Australian Red Cross (ARC) Older Carers Program (OCP) was developed to support the unique needs of carers aged 65 years and older (50 if Indigenous) who care for a person aged 18 years or older and who have a permanent disability. The aim of the program was to provide intensive case planning, management and volunteer support that would assist older carers to more readily access respite and continue their caring role. To achieve this end, ongoing, individualised and holistic assistance involving carers in decision-making was an integral component of the OCP processes and activities. Nevertheless, in the course of our evaluation research of the program we found that, despite the overall success of the program in meeting its objectives, significant barriers to respite existed among a significant group of participants (which we will call a "sub-group"). Our research identified these subgroups as rural carers, single parents/carers, carers of high-need care recipients and "highly stressed" carers. These unique needs in turn formed barriers to access and are an important consideration in further debate around the important issue of older carers in the community and respite care programs in Australia.
Factors to Consider in Smoking Interventions for Indigenous Women
Authors: Heath Deanne L , Panaretto Kathryn , Manessis Vivienne , Larkins Sarah , Malouf Peter , Reilly Erin , Elston Jacinta
Published: August 2009

More than 18,000 Australians die annually from diseases caused by tobacco. Indigenous Australians suffer a greater smoking-related disease burden than the remainder of the general public and have a higher prevalence of tobacco use than other Australians. The overall decline in smoking rates is slowest in women of low educational status between the ages of 25-44. This is of particular concern as these young women may be pregnant or raising young children. During pregnancy, the effects on the foetus from cigarette smoke include respiratory illness, low birthweight and Sudden Infant Death Syndrome. However, if the mother is able to give up smoking by her fourth month of pregnancy, her risk of delivering a low birthweight baby decreases to nearly that of a non-smoker. As part of the planning to develop an effective smoking cessation program for young Indigenous pregnant women, the Townsville Aboriginal and Islanders Health Services (TAIHS) surveyed a group of women to assess smoking habits, attitudes to smoking, nicotine dependence and readiness for change. This paper reports on this survey and the results found can be used to develop a tailored, smoking cessation program for Indigenous women.
Dimensions of Pastoral Care: Student Wellbeing in Rural Catholic Schools
Authors: Ollerenshaw Alison , McDonald John
Published: August 2009

This paper investigates the health and welfare needs of students (n = 15,806) and the current service model in Catholic schools in the Ballarat Diocese of Victoria, Australia. Catholic schools use a service model underpinned by an ethos of pastoral care; there is a strong tradition of self-reliance within the Catholic education system for meeting students' health and welfare needs. The central research questions are: What are the emerging health and welfare needs of students? How does pastoral care shape the service model to meet these needs? What model/s might better meet students? primary health care needs? The research methods involved analysis of (1) extant databases of expressed service needs including referrals (n = 1,248) to Student Services over the last 2.5 years, (2) trends in the additional funding support such as special needs funding for students and the Education Maintenance Allowance for families, and (3) semi-structured individual and group interviews with 98 Diocesan and school staff responsible for meeting students' health and welfare needs. Analysis of expressed service needs revealed a marked increase in service demand, and in the complexity and severity of students' needs. Thematic analysis of qualitative interview data revealed five pressing issues: the health and welfare needs of students; stressors in the school community; rural isolation; role boundaries and individualised interventions; and self-reliant networks of care. Explanations for many of these problems can be located in wider social and economic forces impacting upon the church and rural communities. It was concluded that the pastoral care model - as it is currently configured - is not equipped to meet the escalating primary health care needs of students in rural areas. This paper considers the implications for enhanced primary health care in both rural communities and in schools.