bluuebunny/crossref_metadata_2025 huggingface dataset:
Mere Tokenism or Best Practice: The Illawarra Division of General Practice Consumer Consultative Committee
Authors: Perkins David , Senior Kate , Owen Alan
Published: August 2009

Divisions of General Practice were set up to improve links between GPs and consumers, to develop a population health perspective in general practice, and to improve patient care. The Illawarra Division of General Practice established a consumer consultative committee as part of a broader strategy to achieve these objectives. An interview study with committee members indicates the difficulties experienced in this task and the persistence of two cultures. Various options are identified by which consumer participation might be improved as means of fostering better links, improved care and a population health perspective amongst GPs. The first step is a more sophisticated understanding of the strengths and weaknesses of current consultative arrangements.
From Condom to Cabbages: Reflections on Primary Health Care
Authors: Mudaly Bala
Published: August 2009

In November 2002, I undertook an extended visit to Thailand. I toured the urban centres and rural areas of north and north eastern Thailand. From reading the local newspapers, talking to local people, and from personal observations, I gained a sense of the more urgent social issues troubling this country: rural poverty, HIV/AIDS, the low status ofwomen, and corruption.
Community Empowerment: Promoting the Safety and Minimising the Abuse of Older People
Authors: Kingsley Beth
Published: August 2009

Elder abuse is a taboo topic that older people talk about in hushed whispers and community workers are hesitant to raise. Nevertheless the abuse of older people is a social issue and a tragedy of an ageing population. To promote the safety of older citizens health professionals cannot stand by and allow clients to be abused where they experience harm at the hands of someone they know and from whom they should be able to expect safe care. The harmful and damaging nature of elder abuse compels practitioners to work with the community to address and resolve this social problem. Evolving from focus group discussions with older people in Perth, Western Australia, a series of community education and empowerment forums were held under the auspice of The Council on the Ageing (WA) Inc. The forums used an innovative drama format to illustrate the issues of elder abuse and demonstrate potential solutions. Forum evaluation indicated that this format was successful in raising awareness of elder abuse, what it is, why it happens and what resources are available to deal with it. From the forums caregivers and older people learned new strategies on how to minimise their risk of abusing or to resist becoming a victim of abuse.
Promoting Nutrition in Licensed Clubs: A Pilot Project
Authors: Weber Danielle , Dick Mathew , Wen Li Ming , Amanatidis Sue
Published: August 2009

Are licensed clubs a suitable setting to promote nutrition to older (65 years and over) Australians? Licensed clubs are a popular and inexpensive place for older Australians to dine, but meals are often high in fat and low in fibre. Catering staff can also significantly influence customer's choice, but most have a limited knowledge of nutrition. The Health Promotion Unit of Central Sydney Area Health Service (CSAHS) worked with the catering staff of a licensed club to implement changes to serving and cooking practices and to increase awareness of nutrition. An audit tool assessed changes made. Staff members were interviewed regarding the program and changes in nutritional knowledge. Bistro patrons were also surveyed to assess awareness of the promotion. Changes in ingredients and serving practices resulted in a decrease in saturated fat and an increase in fibre in bistro foods. Staff, management and patrons responded positively to the changes. Eighty six percent of patrons thought the bistro should continue to offer healthy choices. This pilot project demonstrates that a licensed club can successfully promote nutrition to older patrons and staff. Although resource intensive, a personal, casual approach worked best. Licensed clubs are a promising setting for nutrition promotion initiatives. Clubs provide access to older people, have a good financial base to fund health promotion programs, and have extensive promotional opportunities to raise awareness of health issues to members and staff.
Editorial
Authors: Swerissen Hal , Walker Rae
Published: August 2009

Following Heather Gardner's retirement, we take on joint editorial responsibility for the Australian Journal oj Primary Health. We plan to maintain the high standards set in the past and to continue the editorial policy of promoting the dialogue between policy, research, and practice in primary health. We could not take on the editorial role without acknowledging Heather's tremendous contribution as the Journal's founding editor. Her creation of its first eight volumes is a truly staggering effort, for which all of us are deeply appreciative.
Secular Change of the Australian All-Cause Mortality, 1907-1998
Authors: Bi Peng , Walker Sue , A Parton Kevin , Whitby Michael
Published: August 2009

The objective of this study was to identify secular change in Australian all-cause mortality over the period 1907-1998. The authors found that there was a decreasing trend in all-cause mortality, with five phases, over the study period. Phase I: 1907 to 1916, with relatively stable, but high, mortality rates. Phase II: 1917 to 1929, with great variations. Phase III: 1930 to 1943, a more stable period with lower mortality. Phase IV: 1944 to 1970, a slightly decreasing trend, with stagnation over the period 1958-69. Phase V: 1971 to 1998, with continuous decline. The mortality trends for major causes of death including infectious diseases, respiratory diseases, circulatory diseases, cancers, and injury are discussed. Possible reasons for the secular changes are explored.
Coping with Grief and Loss: A Community's Shared Responsibility
Authors: Vardanega Lucia , Johnson Amanda
Published: August 2009

The unexpected loss of a loved one through sudden death is a traumatic experience. Generally, there are few resources in the community specifically tailored to meet the needs of family and friends at such a critical time. This paper describes a Primary Health Care initiative that has been developed in a community, in response to an identified need for a package of written materials to assist the grieving process in the case of a sudden death.
The Challenges of Achieving Community Self-determination and Capacity Building in a Neo-liberal Political Environment
Authors: Haslam McKenzie Fiona
Published: August 2009

In Australia over the last 30 years, there has been a shift in federal and state government regional development policies and their engagement with regional communities and regional development. Previously, regional development tended to be a paternalistic and highly centralized, whereas current development policy emphasises entrepreneurialism and self-determination. It is evident from research that, while government policies have used the rhetoric of community self-determination, capacity building and regionalism, de-regulation has undermined the funding necessary to make good the claims. Insistence on self-reliance and the cutting of funding in the name of community autonomy deplete community resources and the pillars of social capital. At the same time, the capacity to work co-operatively, to collaborate, and build trust and networks in order to maintain social cohesion and social capital, undermines the principles of neo-liberalism. Neo-liberalism fails to value unpaid work, community bonds, local knowledge and leadership, and there is limited real acknowledgment by government of their value, nor concern for the future of smaller communities which are undermined by neo-liberalism. This paper examines the associated ambiguities of attaining economic efficiency in a global, neo-liberal economic environment, while at the same time sustaining the social capital of non-metropolitan regional communities and the physical environment in the Central Wheatbelt of Western Australia. It reviews case studies where the notion of capacity building has had meaningful outcomes for rural communities and compares them to other examples where the reality has not matched the rhetoric.
Motor Racing in Australia: Health Damaging or Health Promoting?
Authors: J. Tranter Paul
Published: August 2009

Motor racing, as it is currently practiced in Australia, may have a range of implications for public health. These effects are not limited to the active participants. The health of spectators and the wider community may also be influenced. Motor racing presents some positive public health messages; for example, some Australian motor racing personalities have promoted safe driving practices, including limiting alcohol consumption while driving. However, motor racing may also impact negatively on public health. The negative health impacts of motor racing relate to road accidents, alcohol and tobacco sponsorship, noise and air pollution, and the disruption of "healthy" modes of transport such as walking and cycling. Motor racing on city street circuits can also have negative impacts on the efficient functioning of hospitals, medical practices and emergency services. Some changes in the way that motor sport is conducted in Australia may provide some high profile opportunities for the promotion of healthier lifestyles.
Diabetes self-management: multiple technologies of self
Authors: H Broom Dorothy
Published: August 2009

Self-management is now positioned as essential to the optimal management of many chronic diseases. Health promoters and service providers often acknowledge that some forms of self-management are difficult and demanding, and that health education must be appropriately tailored in order to enhance ?compliance?. These discourses may recognise that part of a person?s response to diagnosis arises from the individual?s personality and their social circumstances. However, less attention is paid to the social and personal effects of the variety of strategies people deploy in order to manage an ongoing condition. Self-management affects more than symptoms or disease status; it also shapes the subjectivity of the person, so different management strategies may mould different selves. The self-management of diabetes entails numerous daily practices, and produces several distinct ways of constructing an embodied diabetic self. In this article, I describe how a sample of adults living with diabetes type 2 manage their diabetes from day to day, and how those activities both arise from, and contribute to, distinctive subject positions. Appreciating the daily and dynamic character of self-management may also help service providers to facilitate an improved quality of life for people with chronic conditions.
The perceived benefits of the chronic disease self-management program among participants with stroke: A qualitative study
Authors: Catalano Tara , Dickson Paul , Kendall Elizabeth , Kuipers Kim , Posner T. Natasha
Published: August 2009

Despite the expense associated with rehabilitation following stroke, dissatisfaction with psychosocial outcomes is common (Thomas & Parry, 1996). The rehabilitation system has been critiqued as lacking a theoretical base for psychosocial interventions (Goldberg, Segal, Berk, Schall, & Gershkoff, 1997). The current paper examines the possible role of the Chronic Disease Self-Management Program ([CDSMP] Lorig, 1996) in contributing to the psychosocial rehabilitation of people with stroke. This paper focuses on the analysis of incidental comments made by participants about a version of the CDSMP, tailored for people with stroke. These comments, collected over an 18-month follow-up period, provide interesting insights into the key aspects of the program. Six informative themes emerged from the more specific comments, namely (1) the importance of social contact and comparison, (2) increased awareness and knowledge about stroke, (3) motivation to pursue goals and activities, (4) a sense of achievement, (5) maintenance of gains, and (6) the paradoxical nature of social support. According to participants, the program was associated with enhanced self-efficacy. Other reported benefits (such as social support and enhanced knowledge) were indirectly associated with the program and appeared to reflect social aspects of the group and its stroke-specific focus. Maintenance of gains made by participants was seen as a crucial issue.
Mental illness and "self"-management in rural Australia: caregivers' perspectives
Authors: Siegloff Shari , Aroni Rosalie
Published: August 2009

Current models of chronic disease self-management incorporate an understanding that people with chronic illnesses, their carers and clinicians need to work together in addressing illness management issues (Von Korff, Gruman, Schaefer, Curry, & Wagner, 1997) and that this process enhances personal control of health (Lorig, Ritter et al., 2000). The question we ask is whether the understandings in these models, both implicit and explicit, apply to those people living with mental illness in rural areas in Australia. In-depth interviews were used to explore and examine the way in which carers of people living with mental illness in rural Victoria experienced and perceived the nature of chronic disease self-management. Our findings indicate that illness management in rural areas occurs predominantly as a partnership between the person with mental illness and the family members who act as caregivers, rather than a partnership with health professionals. This confirms that the lack of resources in the rural mental health care system results in a crisis-oriented service rather than a service that is able to respond to preventative and ongoing mental health care. This is recognised as a considerable burden for many families and requires further examination. In addition, a finding of considerable clinical and policy importance in this arena is the experience of family caregivers as partners in not only the support of the ?management? aspects of self-management of mental illness, but also in supporting the person living with mental illness in the maintenance of the ?self? aspect of self-management.
Guest Editorial: Self-management - A new era dawns...
Authors: Frendin Sue
Published: August 2009

Chronic conditions are one of the greatest health challenges facing Australia in the 21st Century. It is estimated that currently around 2.5 million Australians have a chronic condition and by 2016 this will rise to 3.5 million. Evidence in Australia and overseas suggests that self-management programs can assist those with chronic conditions to improve their quality of life, by equipping them with knowledge, skills, and confidence to better manage disease-related problems.
The process of implementing the Stanford Model Chronic Disease Self-Management Program: The Northern Hospital experience
Authors: y M Murph , s J Saunder , l M Campbel , n B Jackso , z D Berlowit
Published: August 2009

In March 2002, The Northern Clinical Research Centre (NCRC), Epping, implemented the Stanford model Chronic Disease Self-Management Program (CDSMP). The NCRC is the first health facility to implement the CDSMP for all cause chronic conditions in the northern suburbs of Melbourne. This paper outlines the establishment, marketing, co-ordination and personnel for a successful program as identified by the NCRC. Barriers to participation in a program were identified by the NCRC and steps to minimise these were implemented. The evaluation of this program in a scientific manner enables the effect of this adjuvant therapy to be examined in the Australian population. Fifty-two participants have graduated from the CDSMP at The Northern Hospital since the program commenced. This paper reviews the unplanned re-admission rates for people who have participated in the CDSMP as part of an ongoing study.
Chronic disease self-management in patients living in lower socio-economic areas: A WA perspective
Authors: Lishman Marny
Published: August 2009

The WA HealthPartners self-management project involves patients over 50 with Type 2 diabetes and/or cardiovascular disease who live in the lower socio-economic areas of Perth. This paper will explore the challenges and successes in trying to recruit GPs and their patients to the HealthPartners program. The paper also outlines the process and progress of the five HealthPartners interventions and the strategies used to ensure sustainability. HealthPartners now have over 12 general practices on board with over 150 general practice patients enrolled in the project. In addition, over 100 people regularly attend the Live Life Club. The growing number of referrals into the project are indicative of the need for additional support for patients with chronic conditions.
Editorial: Access, affordability and equity
Authors: Swerissen Hal
Published: August 2009

Access and affordability of primary care is currently a major focus of health politics. Bulk-billing rates for GPs have now fallen to around 65%, from a high of about 80% in 1997. A range of factors, including the supply of GPs, changing consumer expectations, shifts in practice patterns, increasing costs and declining relative incomes have probably contributed to the fall in bulk billing. As bulk-billing rates fall, out-of-pocket costs for patients go up and affordability and access to services is reduced, at least for people on lower incomes. Access and affordability are particular problems for people in rural areas where bulk-billing rates are generally 10% to 20% below those in metropolitan areas.
A comparison of patient satisfaction in three primary care settings
Authors: Bolton Patrick , Mira Michael
Published: August 2009

The aim of this study is to compare the satisfaction of less seriously ill patients presenting to emergency departments (ED), general practice, and a general practice staffed casualty (GPC) in central Sydney. Patient satisfaction was measured using the CSQ8b, an internationally validated patient satisfaction questionnaire. Data were collected from all consenting patients in 4,778 encounters in the GPC, 2,532 encounters in 24 general practices (GP) and 312 encounters in the two EDs. Linear models were used to compare patterns of service provision between the three sites. There was an overall difference between the three sites (p<0.00005). There was no difference between patient satisfaction at the GPC and in general practice, but patient satisfaction was higher with GP staffed services than with care from EDs. Patients experience higher levels of satisfaction with care provided by general practitioners than from EDs. To the extent that patient satisfaction is valued as a health outcome, this has implications for the development of GP staffed casualty services.
Evaluation of a program to assist usage of the Enhanced Primary Care case conferencing and care planning items: The allied health professionals' viewpoint
Authors: Sims Jane , Tacticos Theonie , Patiriadis Maria , Naccarella Lucio
Published: August 2009

The General Practice Education, Support and Community Linkages Program was introduced to formally support implementation and appropriate use of the Enhanced Primary Care Medicare Benefits Schedule items. This paper reports upon the Program?s implementation from the allied health professional?s perspective. Semi-structured interviews were conducted in 2002 with healthcare staff trained under the Program. While interviewees noted achievements in the items? uptake during the Program, allied health involvement in case conferencing and care planning had been impeded by GPs? limited adoption of the items. Allied health professionals were broadly interested in participating in care planning and case conferencing with GPs. The General Practice Education, Support and Community Linkages Program supported implementation and appropriate use of the Enhanced Primary Care Medicare Benefits Schedule items. While allied health professionals are generally interested in participating in care planning and case conferencing with GPs, such activity requires ongoing systems support and relationship building. Ample scope remains for awareness raising, relationship building and joint activities across the sector. Future item usage will need to be supported by resources and continued relationship building.
Medication review by GPs reduces polypharmacy in the elderly: A quality use of medicines program
Authors: GM Bolton Patrick , W Tipper Steven , L Tasker Judith
Published: August 2009

This paper describes a Quality Use of Medicines program, addressing polypharmacy in the elderly through a quality assurance program that assisted GPs to improve their prescribing through medication reviews. Sixty-two GPs from four Divisions of General Practice each enrolled up to 12 of their patients aged over 65 for medication review. Data about the total number of medications, and number and dosage of selected cardiovascular and psychotropic medications taken by these patients, were collected. A statistically significant reduction in the total number of medications (p < 0.00005), and the dose (p = 0.028) and number (p = 0.0077) of benzodiazepines, and an increase in the number of Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants (p = 0.0075) were observed. We conclude that these results suggest that medication review by GPs on patients who have complex care needs can be associated with a reduction in the median number of medications that these patients take.
Rural practitioners as researchers: The Spencer Gulf experience of research development in primary health
Authors: Taylor Judy , Fuller Jeff
Published: August 2009

In a health service environment that is becoming more focussed on primary health care, there is a need to underpin new primary health care models with research evidence. This paper draws on the experience of the Spencer Gulf Rural Health School in developing rural primary health care practitioners and consumers as novice researchers. Through the experience of seed-funding 18 novice researchers, several themes have emerged that underpin the success of the program. These are described as establishing a spirit of inquiry, using a broad definition of primary health care research, supporting inquiry with resources and recognition, and demystifying the research process. The value of this research development program is that it has brought research opportunities and supports to rural practitioners and consumers that were not previously available.
Editorial: Research partnerships for primary health?
Authors: Swerissen Hal , Walker Rae
Published: August 2009

Until recently, basic and clinical discovery-oriented health research funded through schemes like the National Health and Medical Research Council (NHMRC) were unchallenged. Narrowly focused, traditional scientific perspectives and judgments about researcher track records ensured newly emerging research issues and methodologies in public health, primary care and health services research struggled to get funding.
Improving stroke outcomes in NSW: A study of GP perspectives
Authors: Middleton Sandy , P Harris John , M Sharpe David , J Corbett Alastair , J Lusby Robert , E Ward Jeanette
Published: August 2009

Stroke is the third leading cause of death in western society, imposing a heavy economic burden on communities worldwide. This study investigated NSW general practitioners? (GPs) views on stroke services. A postal survey was conducted of 296 randomly-selected GPs in NSW (60% response fraction). The main outcome measures were: satisfaction with access to specialists and services; GPs? views on the usefulness of quality indicators when referring patients for carotid endarterectomy; GPs? views about services to enhance stroke outcomes. GPs were satisfied with their access to private vascular laboratories (n=199, 67.2%), casualty/ emergency rooms for stroke patients (n=156, 52.7%), and medical beds for acute stroke in their local hospital (n=157, 53.0%). However, rural and remote GPs were significantly less likely than urban GPs to be satisfied with access to neurologists (?2=12.44, P<0.001), vascular surgeons (?2=8.57, P=0.003), public vascular laboratories (?2=9.46, P=0.002), private vascular laboratories (?2=5.19, P=0.02), and multidisciplinary stroke services (?2=6.09, P=0.014). GPs rated discharge planning most highly as a strategy to improve stroke outcomes (n=260, 87.8%). Our results invite particular attention to rural access to diagnostic, preventive and treatment stroke services. Discharge planning to ensure seamless transfer of care from hospital to general practice is also important.
A comparison of patient attitudes towards the use of computerised medical records and unique identifiers in Australia and Sweden
Authors: Bomba David , Svardsudd Kurt , Kristiansson Per
Published: August 2009

This article compares the attitudes of Australian and Swedish patients towards the use of computerised medical records and unique identifiers in medical practices in Australia and Sweden. A Swedish translation of an Australian survey was conducted and results were compared. Surveys were distributed to patients at a medical practice in Sweden in 2003 and compared to the results of an Australian study by Bomba and Land (2003).
Results: Based on the survey samples (Australia N=271 and Sweden N=55), 91% of Swedish respondents and 78% of Australian respondents gave a positive appraisal of the use of computers in health care. Of the Swedish respondents, 93% agreed that the computer-based patient record is an essential technology for health care in the future, while 86% of the Australian respondents agreed. Overwhelmingly, 95% of Swedish respondents and 91% of Australian respondents stated that the use of computers did not interfere with the doctor-patient consultation. Both groups preferred biometric identification as the method for uniquely identifying patients but differed in their preferred method to store medical information - a combination of central database and smart card for Australian respondents and central database for Swedish respondents. This analysis indicates that patient attitudes towards the use of computerised medical records and unique identifiers in Australia and Sweden are positive; however, there are concerns over information privacy and security. These concerns need to be taken into account in any future development of a national computer health network.
Influence of an educational program on mental health professionals' knowledge and perceptions of problematic alcohol and other drug use
Authors: Carta Bill , Happell Brenda , Pinikahana Jaya
Published: August 2009

The issue of co-morbid substance abuse and mental illness is clearly identified in the literature. The adequacy of the knowledge and skills of mental health professionals to deal with the complex problems associated with this co-morbidity has received considerable attention. The effect of an educational program on mental health professionals? knowledge and perceptions of problematic alcohol and substance abuse was measured in a questionnaire survey in Victoria, Australia. The aim was to determine if an educational program could facilitate knowledge and attitudinal change among mental health professionals. In the pre-survey, a questionnaire on knowledge, skills, attitudes and practices was administered to 378 clinicians in Victoria (133 were returned, representing a 46% response rate). In the post-survey, 131 questionnaires were returned (response rate 35%). Significant changes in knowledge were reported following the educational program in the areas of overall knowledge of drug and alcohol, diagnosis of drug and alcohol abuse, and management of drug and alcohol abusers. While positive attitudes towards problematic drug and alcohol issues were expressed, specific educational programs to enhance their knowledge and skills in assessment and management of problematic drug and alcohol users are recommended.
Health promoting hospitals: Gaining an understanding about collaboration
Authors: Johnson Anne , Jo Nolan
Published: August 2009

Collaboration with others is integral to the way hospitals need to work if they are committed to integrating health promotion into policies and practices to improve the health of their ?setting? and the broader community. This article reports on research that aimed (a) to identify the range of stakeholders a large metropolitan teaching hospital had collaborated with in undertaking health promotion work and how effective that relationship was, and (b) explore with these stakeholders how they had collaborated with the teaching hospital, and what had or had not worked well. Key findings were that the hospital had collaborated with at least 16 organisations. The effectiveness of these relationships was variable, with 55% (n=9) rating their relationship with the hospital as being ?good to excellent? and 45% (n=7) as being ?okay to unworkable?. Where collaboration worked well there was good interpersonal relationships and common goals were shared. In two instances more formal mechanisms were in place to support the collaboration. These mechanisms supported involvement of staff from different levels of the hospital and did not totally rely on cooperation between individuals to sustain the collaboration.Where there was decreased effectiveness in the collaborative relationships, differing attitudes and organisational and structural barriers posed the most significant barriers.
Psychsocial issues resulting from the experience of breast cancer among women in northern Victoria
Authors: Bourke Lisa
Published: August 2009

One in 12 Australian women will experience breast cancer. While the focus on physical and clinical issues has improved clinical care, less attention has been given to the psychosocial issues associated with a breast cancer diagnosis. The experience of breast cancer is emotional as much as it is a physical illness. This paper is one effort to address the dearth of literature analysing the psychosocial impacts of breast cancer. Questionnaires were distributed by health professionals to women in the Hume Health region in northern Victoria who had been treated for breast cancer between 1996 and 2001. A total of 219 were returned (an estimated third of this population). Women were generally happy with clinical services but indicated that emotional issues were at the fore, and more psychosocial support services are needed in this region. Further, women identified that the social and psychological issues resulting from a breast cancer diagnosis are life-changing and long-term, and that this is not well understood by health care providers or local communities.
Only misunderstood? The effects of Parkinson's Disease on interactions with health professionals
Authors: Mott Sarah , Kenrick Marita , Dixon Miriam , Bird Graham
Published: August 2009

Many people living with Parkinson?s disease (PWP) experience a variety of voice and swallowing difficulties as well as spontaneous movement and facial expression deficiencies. Impaired communication affects the ways in which people engage with others in a variety of settings. This paper reports on a study undertaken in New South Wales to ascertain the support needs of people with Parkinson?s disease. Responses to a 31-item survey were received from 444 people with the disease. Sixty-four per cent (n=243) reported experiencing difficulties with communication. These difficulties were compounded by participants? perceptions of a lack of understanding by health professionals about what it is like to live with this disease. The findings increase our understanding of the potential difficulties encountered by people living with Parkinson?s disease. They provide evidence of the need for health professionals to be especially sensitive to this client group in the provision of adequate time and expertise for the effective identification and management of symptoms.
The Darebin Family Violence Working Group: a partnership approach
Authors: Merkes Monika
Published: August 2009

In 2002, the City of Darebin initiated a partnership involving individuals and organisations that provide services to people in Darebin experiencing family violence. This coincided with the establishment of a Family Violence Coordination Unit for the Darebin Police. Subsequently, the Darebin Family Violence Working Group developed and strengthened the relationship between its members, resulting in improved communication, increased and better informed referrals, and a greater understanding of members? professional roles and limitations. Traditionally, local governments have not considered it their role to address family violence at the policy level, or to improve the local service system for individuals and families experiencing family violence. By taking leadership, and establishing, supporting, and facilitating the Darebin Family Violence Working Group, the City of Darebin has demonstrated that local government can play an important role in this area and achieve positive outcomes for its community. This paper describes the partnership of local services and organisations that came together in the Darebin Family Violence Working Group, the resulting changes to the service system, and the factors that have contributed to the success of the partnership.
General Practice/Primary Care Agencies Systems Integration: A patient-centred approach
Authors: Delaney Lisa , Fuller Catherine
Published: August 2009

The Primary Care Partnership ? General Practice /Primary Care Agencies Integration Framework is the result a body of work undertaken by the Central Victorian Health Alliance, designed to create effective collaborative working relationships between general practice and other sections of the primary care sector. The body of work included collaborative planning and joint projects designed to develop working relationships and information sharing. Underpinning this work was the premise that the goal of each project or task is to improve consumer health outcomes. In the absence of an existing working framework to guide this work we developed a simple concrete tool grounded in practice. Key aspects of the Framework include: recognition that for all health professionals the shared goal is the improvement of patient/consumer health outcomes; a focus on general practice and general practice systems, not on general practitioners alone; and a focus on the development and implementation of systems that support general practice and primary care agencies? service alignment interactions as well as foster interpersonal relationships.
Partnerships, primary health care and health inequalities: problems and possibilities
Authors: M Lewis Jenny
Published: August 2009

Partnerships have become a widespread tool for coordinating the disconnected components of primary health care. They are based on network modes of governing which are seen as less susceptible to power disparities and as being more democratic than hierarchies, and more inclusive and egalitarian than markets. This paper examines whether government mandated partnerships, which mix network characteristics with aspects of hierarchies and markets, can contribute to ameliorating the effects of inequities and their impacts on health. Partnerships have benefits but are complicated and time consuming. They have theoretical appeal in addressing health problems which require solutions that reach beyond traditional health boundaries to be more interconnected and inclusive. Evaluations of partnerships in the UK indicate their substantial coordination benefits. But reducing the impact of inequities also requires shifting to a conception of health that emphasises the social and environmental context. This is the case even where partnerships have political support and health inequalities are on the agenda. Partnerships are not a quick fix, but they are a necessary component of tackling the impacts of inequities on health. They create possibilities for reducing the impacts of inequities on health by providing a platform on which additional measures can be built.
An analysis of the Primary Health Care Access Program in the Northern Territory: A major Aboriginal health policy reform
Authors: Rosewarne Clive , Boffa John
Published: August 2009

This paper describes the development of and lessons learned in implementing the Primary Health Care Access Program (PHCAP) in the Northern Territory. The implementation of the PHCAP is a major Aboriginal health policy reform. PHCAP provides an opportunity for Aboriginal people to gain access to properly resourced comprehensive primary health care (PHC) services. PHCAP is described in its unique funding model that attempts to address tensions within the federal governance system. In this paper we argue that access to PHC services is a key determinant of health and that funding of PHC services has been inadequate and inequitable throughout the Northern Territory. The implementation of PHCAP is reforming the existing health system and leading to the establishment of new PHC services. We analyse the barriers encountered in this process. The PHCAP funding model is analysed for its adequacy and design strength to address federal relations. We consider issues of workforce shortage that will limit our capacity to implement the program and the need for effective regional PHC support services. We conclude that the basic funding model within PHCAP - a grant payment plus access to the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme - is the best possible way to fund comprehensive PHC at the present time, and call for bipartisan party commitment to fully realise the potential of this program to address Aboriginal health inequalities.
GPs' views on how low socioeconomic position affects diabetes management: an exploratory study
Authors: Rose Vanessa , Harris Mark , Theresa Ho Maria
Published: August 2009

Little is known about general practitioners? (GP) capacity to effectively manage diabetes among patients of low socioeconomic position (SEP), despite the high burden of type 2 diabetes in this group. Nine GPs involved in a diabetes program and practising in an area of socioeconomic disadvantage participated in a focus group on low-SEP patient barriers to diabetes management, GP problems in managing diabetes among this group, and strategies for improving diabetes management with low-SEP patients. GPs perceived that low health literacy, poverty and psychosocial issues, and negative attitudes towards health were barriers to diabetes management among low-SEP patients. Difficulties in providing care to low-SEP patients were related to the availability of allied health services and GP perceptions of increased stress in providing care to this group. Suggestions for improvements in diabetes management were focussed on providing educational materials to low-SEP patients that matched literacy levels, and initiating patient financial incentive schemes to assist diabetes management and attendance at follow-up consultations.
Matching care to need in general practice: A secondary analysis of Bettering the Evaluation and Care of Health (BEACH) data
Authors: F Harris Mark , Furler John , Valenti Lisa , Harris Elizabeth , Britt Helena
Published: August 2009

Addressing health inequality involves, in part, ensuring access to quality general practice care appropriate to the higher health need in patients from disadvantaged areas. This study compares characteristics of encounters in Australian general practice with patients of high and low socioeconomic disadvantage. The method used was an analysis of data from the study of Australian general practice morbidity - the Bettering the Evaluation and Care of Health, April 1998-March 2001 - comparing patients whose residence was in either the highest or lowest category of socio-economic disadvantage based on the Socio-Economic Indexes for Areas Index of Relative Socio-economic Disadvantage. Multiple regression investigates independent predictors of low and high socio-economic disadvantage. Encounters with patients from areas of highest disadvantage differed markedly in the problems managed from those with patients from areas of least disadvantage. However, psychosocial problems were managed at the same rate in each group. Encounters with patients from areas of highest disadvantage were more likely to be with males, patients from non-English speaking or Indigenous backgrounds, in rural areas, and result in a prescription. They were less likely to be a long consultation, with a female GP, or to result in investigation or referral. The differences in care between the two groups of patient encounters cannot be explained by differences in morbidity. More research is needed to explain why these differences occur, including the possible influence of patient, provider and practice factors. General practitioners working with patients from disadvantaged communities may need greater support to deliver optimal quality of care.
Promoting men's wellbeing: Integrated services for responding to men's depression in community health
Authors: Norton Jonathon , Horan Smith Jacinta
Published: August 2009

Men's health issues and depression have both been identified as key priorities in health policy in Australia. A community health service in Melbourne has developed and delivered an integrated and holistic series of interventions specifically targeting depression in men, in addition to individual counselling services. These include a psycho-educational group program, an ongoing therapeutic and support group, and walking and gym exercise activities. Levels of participation, and outcomes, indicate that this type of package of services can be a highly successful way for community health services to respond to issues relating to men's health and wellbeing.
Improving Indigenous health through better medication management: an overview
Authors: de Crespigny Charlotte , Kowanko Inge , Murray Helen , Emden Carolyn , Wilson Scott
Published: August 2009

This paper provides an overview of a major South Australian research project with implications for the health of all Indigenous Australians. The researchers set out to explore the medication needs of Aboriginal people with mental health problems and found that most Aboriginal people have to deal with profound challenges to social and emotional wellbeing with significant medication implications. No previous research had investigated the problem of medication use by Aboriginal people in metropolitan, rural and remote locations to the depth and extent of this project. The research therefore is of widespread relevance and holds interest for many Indigenous and non-Indigenous individuals and groups, consumers, service providers and policy-makers. As a research team comprising Indigenous and non-Indigenous members, we were committed to implementing strategies in the course of the project with immediate benefit to project participants as well as longer-term impact on improved use of medications. The design of the project enabled these strategic interventions and we are pleased to promote this model to other researchers. Recommendations from the project concern services, coordination of care, carers and family members, workforce education, and community development. Readers are advised where the project report and other published papers can be accessed. The project was funded by the Commonwealth Department of Health and Ageing.
Workplace factors: The key to successful and sustained continuation of a general practice-based smoking cessation programme
Authors: Pullon S. , Cornford E. , McLeod D. , Silva K. de , Simpson C.
Published: August 2009

Health promotion activity such as smoking cessation is now expected in primary care settings, including general practice. However, successful implementation and continuation of health promotion programmes is often difficult to achieve in any consistent way across a locality. This study aimed to investigate factors associated with implementation and maintenance difficulties for a smoking cessation programme in primary care, despite the provision of well-received training and support for practice nurses and general practitioners. A descriptive evaluation using numerical data and semi-structured interviews was used for general practices in the Wellington region of New Zealand during 2001-2002. The Can Quit Practice smoking cessation programme was developed and made available to all 114 general practices in the Wellington area. Data were collected and interviews conducted about implementation and ongoing programme delivery. One-third (39/114, 34%) of practices accepted and completed training for at least one staff member, usually a practice nurse. Subsequently, only 44% of practices (17/39) went on to achieve full programme implementation. Key factors precluding implementation included inadequate funding for practice nurse and general practitioner time, high patient workloads, lack of practice nurse autonomy and limited practice-wide commitment to smoking cessation. Unfavourable workplace factors can preclude the successful implementation and maintenance of an effective smoking cessation programme for patients, even when health professionals are aware of the benefits of smoking cessation, recognise the worth of offering such programmes, and receive acceptable training and ongoing support at no cost.
Barriers to the provision of care for people with dementia and their carers in a rural community
Authors: Hansen Emily , Robinson Andrew , Mudge Peter , Crack Geoff
Published: August 2009

This article describes results from a community initiated qualitative research project investigating barriers to the provision of care for people with dementia (PWD) and their carers. The study was conducted in a rural remote Tasmanian community ("Cape Coastal"). Focus group discussions were held with family member carers of PWD, members of the Aged Care Assessment Team (ACAT), nurses employed in the local hospital and a local nursing home, community health nurses and local general practitioners. In addition, two semi-structured interviews were conducted with a dementia support worker allocated to service the region and a single family member carer. Barriers to the effective provision of care for PWD and their carers were identified. These were: distance and isolation; perceptions of geographic and professional boundaries including issues of medical dominance; and gaps in health care provider and carers? knowledge about dementia and dementia services. These results demonstrate that while Cape Coastal has many points in common with other rural and remote communities in Australia and in Canada and the United States (Australian Institute of Health and Welfare [AIHW], 2002), it is important to recognise local context when planning and providing services for PWD and other chronic diseases.
Better medication management for Indigenous Australians: findings from the field
Authors: Emden Carolyn , Kowanko Inge , de Crespigny Charlotte , Murray Helen
Published: August 2009

This paper reports findings from interviews and focus groups conducted within a multi-dimensional action research project concerning medication management among Indigenous Australians. Participants were Aboriginal people with mental health problems, carers and family members, and health and social service workers from different regions in South Australia. A meta-analysis of findings from each regional project component was conducted, and major themes conceptualised and developed into a coherent summary. The findings revealed problems of a magnitude not previously realised - mental health problems (including alcohol and drug problems) and medication management among Aboriginal people clearly are major issues requiring immediate and sustained attention if the health and welfare of the Australian Indigenous population are to be improved. Findings concerned eight major areas: social and emotional wellbeing issues; stressors on Aboriginal health services and providers; training for the Aboriginal health workforce; mainstream health services for Aboriginal people; trust and confidentiality within Aboriginal health services; English language literacy and numeracy skills of Aboriginal clients; remote living arrangements for many Aboriginal people; problems with alcohol use; and institutionalised and individual racism in the community at large.