bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing palliative care delivery in a regional community in Australia
Authors: Phillips Jane L , Davidson Patricia M , Jackson Debra , Kristjanson Linda , Bennett Margaret L , Daly John
Published: February 2010

Although access to palliative care is a fundamental
right for people in Australia and is endorsed by
government policy, there is often limited access to
specialist palliative care services in regional, rural
and remote areas. This article appraises the evidence
pertaining to palliative care service delivery
to inform a sustainable model of palliative care
that meets the needs of a regional population on
the mid-north coast of New South Wales.
Expert consultation and an eclectic literature
review were undertaken to develop a model of
palliative care service delivery appropriate to the
needs of the target population and resources of
the local community. On the basis of this review, a
local palliative care system that is based on a
population-based approach to service planning
and delivery, with formalised integrated network
agreements and role delineation between specialist
and generalist providers, has the greatest
potential to meet the palliative care needs of this
regional coastal community.
Australian Health Review call for papers
Authors: Leggat Sandra
Published: February 2010

The Editor of Australian Health Review invites
contributions for an upcoming issue on health
professional education.
Submission deadline: 6 February 2007
It is expected that tertiary education and
research for health professionals will be the focus
of substantial change over the next couple of
years. The health professional workforce has been
the subject of recent studies in Australia and New
Zealand. The New Zealand Health Workforce
Advisory Committee has focused on ensuring an
effective strategic framework and outlined seven
principles comprising equity and appropriateness,
strategic and sustainable supply, healthy
workplaces, collaborative practice, effective education,
stakeholder involvement and information
and monitoring.1 In Australia, the Productivity
Commission made strong recommendations
directed at improving health professional education
to enhance coordination, reduce practice
barriers and address shortages of health professionals.
2
To help inform policy and practice, Australian
Health Review is looking to publish feature articles,
research papers, case studies and commentaries
related to health professional education.
Potential topic areas include:
� Addressing health workforce challenges
� Multidisciplinary professional practice and
interdisciplinary education
� Management education and clinician managers
� Evidence-based education
� Sector-based approaches to education and
training
� Partnerships and social change
� Impact of national education and research policy
on health professional education.
Submissions related to international programs
with lessons for Australia and New Zealand will
also be welcomed.
Submissions can be short commentaries of
1000 to 2000 words, or more comprehensive
reviews of 2000 to 4000 words. Please consult the
AHR Guidelines for Authors for information on
formatting and submission.
Editorial Acknowledgement of Reviewers 1/10/2005 – 26/9/2006
Authors: Leggat Sandra G
Published: February 2010

We called on many professionals around the world to assist us in our peer review of papers for Australian
Health Review.
Traversing the bridge from health care management practice to research
Authors: Dwyer Judith
Published: February 2010

IF THERE IS A BRIDGE from research to practice, I?ve
been crossing against the traffic. In 2000, I moved
from the increasingly tough world of health care
management practice (thinking I?d done my share
and it was someone else?s turn) and took up
teaching and research (hoping I?d have time to
reflect on and learn more about the intractable
problems I?d been battling). Unfortunately I failed
to consider, even though I ?knew?, that universities
are also operating in an increasingly tough world,
and academic work has also been intensified.
But my crossing did coincide with an emerging
focus on health services research, which ?examines
how a variety of factors ? from financing systems
to medical technologies to personal behaviors ?
affect health care costs, quality, and access?.1 It is a
broad field, spanning research on the macro policy
settings (how to fund health care, who gets access)
through to the micro level of health care practice
(for example, how clinicians might work with
patients who have chronic conditions as partners
in the management of their care).
Striving for excellence in abortion services
Authors: Mulligan Ea C
Published: February 2010

The legalisation of abortion allowed the publication
of surgical outcome data demonstrating low
complication rates. South Australian data from the
outcomes of surgery conducted at the Pregnancy
Advisory Centre illustrate the monitoring of complication
rates such as uterine perforation, continuing
pregnancy and incomplete abortion to
improve surgical outcomes. While quality improvement
systems produce positive results, there are
many barriers to their uptake in Australia. Hostility
towards abortion has the potential effect of retarding the adoption of improved techniques.
The National Health Survey 2001: usefulness to inform a discussion on access to and use of quality primary health care using type 2 diabetes mellitus as an example
Authors: Comino Elizabeth J , Harris Mark F , Harris Elizabeth , Powell Davies Gawaine , Chey Tien , Lillioja Stephen
Published: February 2010

Introduction: This paper explores the usefulness
of the 2001 Australian Bureau of Statistics
National Health Survey (2001 NHS) for examining
access to and use of quality primary health care
(PHC) in Australia, using diabetes as an example.
Methods: Potential indicators of access to and
use of quality diabetes care were investigated
(diagnosis, preventive pharmacotherapy, complication
screening, multidisciplinary care and hospitalisation),
and their association with various
factors including socioeconomic and diabetesrelated
health status was assessed.
Results: Older Australian-born females were
more likely to receive preventive pharmacotherapy,
whereas complication screening was associated
with duration of disease. Multidisciplinary care was
associated with recent hospitalisation and not
health need assessed by presence of comorbidity.
Conclusions: This novel use of the 2001 NHS
provided information on patterns of access to and
use of diabetes-related PHC that were consistent
with previous research. It suggests a new role for
survey data in monitoring access to and use of
PHC over time and complementing other population health data collections in this area.
Cooperate, coordinate, communicate or collaborate?
Authors: Leggat Sandra G
Published: February 2010

IN HEALTH CARE we use these ?C? words regularly
? describing what health professionals, patients,
consumers, politicians and managers need to do
to improve health care systems. A snapshot of
each of these is provided below.
The Institute of Medicine?s Crossing the Quality
Chasm report suggested that cooperation among
clinicians was a priority.1 Yet game theorists have
long shown that cooperation results in better
individual outcomes than competitive behaviour.
2 Driven to achieve the best outcomes, people
will choose to cooperate more often than they
choose to compete. Most recently, game theory
analysis has even been applied to the evolution of
cancer, with the resulting conclusion of ?malignancy
from cooperation?3 ? tumours grow
because it is the nature of cells to cooperate.
Given this tremendous innate ?force? for cooperation,
why is there the appearance of less cooperation
among health system components than we
would like?
Implications of conflicting definitions of probability to health risk communication: a case study of familial cancer and genetic counselling
Authors: O'Doherty Kieran C
Published: February 2010

The question of what probability actually is has
long been debated in philosophy and statistics.
Although the concept of probability is fundamental
to many applications in the health sciences, these
debates are generally not well known to health
professionals. This paper begins with an outline of
some of the different interpretations of probability.
Examples are provided of how each interpretation
manifests in clinical practice. The discipline of
genetic counselling (familial cancer) is used to
ground the discussion. In the second part of the
paper, some of the implications that different
interpretations of probability may have in practice
are examined. The main purpose of the paper is to
draw attention to the fact that there is much
contention as to the nature of the concept of
probability. In practice, this creates the potential
for ambiguity and confusion. This paper constitutes
a call for deeper engagement with the ways
in which probability and risk are understood in
health research and practice.
Forecasting emergency department presentations
Authors: Champion Robert , Kinsman Leigh D , Lee Geraldine A , Masman Kevin A , May Elizabeth A , Mills Terence M , Taylor Michael D , Thomas Paulett R , Williams Ruth J
Published: February 2010

Objective: To forecast the number of patients
who will present each month at the emergency
department of a hospital in regional Victoria.
Methods: The data on which the forecasts are
based are the number of presentations in the
emergency department for each month from 2000
to 2005. The statistical forecasting methods used
are exponential smoothing and Box?Jenkins
methods as implemented in the software package
SPSS version 14.0 (SPSS Inc, Chicago, Ill, USA).
Results: For the particular time series, of the
available models, a simple seasonal exponential
smoothing model provides optimal forecasting
performance. Forecasts for the first five months in
2006 compare well with the observed attendance
data.
Conclusions: Time series analysis is shown to
provide a useful, readily available tool for predicting
emergency department demand. The approach
and lessons from this experience may assist other
hospitals and emergency departments to conduct
their own analysis to aid planning.
The place for children's centres for New Zealand children
Authors: Hoare Karen J , Wilson Denise L
Published: February 2010

This paper examines the experience of poverty
and child maltreatment among New Zealand?s
children as compared with international statistics.
New Zealand was a signatory to the United
Nations Convention on the Rights of the Child in
1993, yet indicators suggest that implementation
of the Articles of the Convention is limited. In the
league of Organisation for Economic Co-operation
and Development countries it ranks 23rd out of 26
for child poverty and 24th out of 27 for the child
maltreatment death rate. A case will be made for
coordination of existing and new services for
children and families through a dedicated children?s
centre, modelled on the United Kingdom?s
Sure Start and Children?s Centre program that
was modelled in part on the Head Start program
of the United States. The paper reports on Wellsford,
a rural community north of Auckland, which
has embraced the children?s centre concept and is
investigating ways to obtain funding to implement
the idea.
Editorial
Authors: Yarmo-Roberts Deborah
Published: February 2010

THE INTENT OF the ?Models of Care? section is to
provide quality articles relating to a range of models
of care. It is also a forum for presenting original
research findings, debate and discussion in this area.
As this issue of Australian Health Review features
the theme of meeting needs for ongoing care, there
are a plethora of care models claiming to be the
panacea to effectively treat clients with chronic
illnesses and conditions. Many articles conclude that
care models (such as case management, disease
management, chronic condition self-management
and others) assist clients in receiving the level of care
they need, when they need it, and where they want
it. Yet there is mixed evidence on the impact of
?models of care?, and searching available peerreviewed
literature is not straightforward. For example,
some recent studies evaluating case management
have found reduction in the risk of
institutionalisation1 while others have found that
case management makes no difference and costs
more for the system.2
The invisible contract: shifting care from the hospital to the home
Authors: Dow Briony , McDonald John
Published: February 2010

The ageing population and associated burgeoning
health care costs have resulted in a shift of care
from institutional settings to home and communitybased
care. As one example, rehabilitation-in-thehome
(RITH) programs are becoming increasingly
prevalent. These programs either substitute or
supplement in-hospital treatment by providing
multidisciplinary rehabilitation and support services
in the client?s own home. This paper investigates
the impact of RITH programs on informal
carers. Semi-structured interviews carried out with
caregivers and staff revealed a complex and contradictory
interpretation of informal caring. Analysis
of carers? interviews revealed: an assumption
by themselves and others (including RITH staff)
that they would provide care; the intimate, arduous
and relentless work of caring; lack of consultation
about discharge; lack of recognition and
reimbursement; and low levels of program support
for them as carers. Carers are integral to the
successful rehabilitation of the client, but they
occupy a marginal status within the program. An
invisible contract consigns to them substantial
care-work that was previously provided by the
hospital. Informal carers in RITH programs can be
seen as disenfranchised care contractors. This
has implications for policy makers, program managers and researchers.
Measuring quality
Authors: Willis Cameron D , Evans Susan M , Stoelwinder Johannes U , Cameron Peter A
Published: February 2010

It is no longer sufficient for health care professionals
to provide high quality health care, they must
also be able to demonstrate that they are meeting
and often exceeding quality targets. Quality indicators
(QIs) provide a means of measuring and
assessing quality, however there are advantages
and disadvantages of indicator measurement.
Further, the clinical perspective needs to be balanced
against managerial control when developing
valid, reliable, sensitive and specific QIs. While
indicators do not represent a perfect measurement
device, they may provide a useful tool for
improving patient safety and meeting community
expectations.
21st century medical education
Authors: Birden Hudson , Page Sue
Published: February 2010

Australian universities provide good examples of
how to meet the growing challenges to the training
of doctors that have resulted from information
overload in traditional curricula, new models of
care, including multidisciplinary team dynamics,
and the rigours of evidence-based practice.
Making interprofessional education real: a university clinic model
Authors: Copley Jodie A , Allison Heather D , Hill Anne E , Moran Monica C , Tait Judy A , Day Toni
Published: February 2010

Interprofessional education (IPE) is an emerging
focus in the professional training of allied health
students. To date, IPE has occurred in classroom
teaching or case simulations, rather than in the
provision of client services. At the University of
Queensland, students in occupational therapy,
speech pathology and music therapy participate in
both on-campus and community-based IPE clinics
conducted by university staff. These clinics are
planned and implemented to promote interprofessional
learning for students, and to provide integrated
service provision for children and young
people in the community. An adapted version of
Bronstein?s model of interdisciplinary collaboration
is used to guide IPE processes, including team
orientation, joint goal-setting and intervention
planning, and integrated delivery of therapy sessions.
The development and implementation of
these IPE clinics is described, together with challenges to clinical IPE in the university context.
What medical students value from their teachers
Authors: Theresa Ho Maria , Tani Massimiliano
Published: February 2010

As Australian medical educators become more
accustomed to the increasing pressures imposed
upon them, there is a risk that the traditional
educational relationship between a student and
his or her teacher is replaced by a pure transactional
relationship between a customer and his or
her supplier. A large sample of medical students
surveyed revealed that medical students seem to
value directed rather than independent learning.
New approaches to teaching, such as being
innovative or entertaining, as well as facilitating
participation, do not appear to be very important
to medical students. Medical students do not
seem to have strong preferences when it comes
to assessment, contradicting some of the fundamental
suggestions of the recent educational
literature, in which assessment is often viewed
as a key element in the formation and the
direction of learning. The fact that medical students
seem to reject many of the paradigms of
the psychology-based educational literature, at
least based on the large sample surveyed at the
University of New South Wales, suggests that
caution should be used in the development of
training programs for teachers in medical faculties,
and that learning and teaching should
ensure that students? expectations and teachers?
training do not mismatch.
Graduate capabilities for health service managers: reconfiguring health management education @UNSW
Authors: Meyer Lois D , Hodgkinson Alan R , Knight Rosemary , Theresa Ho Maria , di Corpo Sophie K , Bhalla Sonal
Published: February 2010

The Master of Health Administration program at
UNSW was extensively revised in 2006 to ensure
that it effectively meets the challenging and
dynamic environment of health service managers
in local and global health contexts. This paper
describes the innovative approach to the redesign
of the health management program within the
Faculty of Medicine. It outlines the method and
considerations undertaken, particularly in identifying
and embedding new graduate capabilities
within the program. The paper concludes that
using an outcomes-based approach and engaging
with key stakeholders provides opportunity to
identify and promote critical capabilities needed
by managers to support the challenges confronting
health services, including workforce flexibility.
Further research is required on how such curriculum
initiatives might impact on the performance of
health service managers, but initial indications are
that the health industry recognises the need and
value of this approach.
Views from the executive suite: lessons from the introduction of performance management
Authors: Liang Zhanming , Howard Peter F
Published: February 2010

Performance management introduced to the senior
health executive levels in the New South Wales
public health care system included the senior executive
service in 1989 and, as a key element of that
service, performance agreements in 1990. This is
the first qualitative study examining senior health
executives? personal experiences of these changes.
In consideration of what has been learnt from the
most relevant literature and this study, this paper
concludes that the introduction and implementation
performance management is a continuous process.
This process includes the key steps of planning,
measuring, monitoring and evaluating. It can be
used as a means to achieve overall effective organisation
performance by bringing in a two-way management
process for the organisation and its senior
health executives.
Promoting evidence-based practice in population health at the local level: a case study in workforce capacity development
Authors: Maxwell Michelle L , Adily Armita , Ward Jeanette E
Published: February 2010

This paper describes a service-based initiative
to enhance capacity for evidence-based practice
(EBP) in the South Western Sydney Area
Health Service Division of Population Health. A
working group planned an organisational
response to a customised EBP needs assessment
using the New South Wales Department
of Health?s framework for capacity building
focussing on five key action areas; organisational
development, workforce development,
resource allocation, leadership and partnerships.
Innovative strategies to promote EBP
were developed and implemented and on-site
training programs that targeted specific groups
of staff were conducted. Because there was
commitment and leadership from senior staff for
the initiative, a comprehensive approach to
building capacity for EBP in population health
was possible. Evidence of impact needs to be
collected in the future.
The case for Aboriginal Health Workers in palliative care
Authors: McGrath Pam D , Patton Mary Anne S , Ogilvie Katherine F , Rayner Robert D
Published: February 2010

Objectives: The findings are drawn from a 2-year
research project, funded by the National Health
and Medical Research Council (NHMRC), which
aimed to develop an innovative model for Indigenous
palliative care. The findings presented in this
article explore one important strategy for putting
Aboriginal families and their communities at the
centre of the model: that is, the employment of
Aboriginal Health Workers (AHWs) in relation to
the provision of palliative care in the Northern
Territory.
Methods: The data were collected from 72 qualitative
interviews conducted throughout the
regional, rural and remote areas of the Northern
Territory with Indigenous patients and carers in
the Northern Territory and the health professionals
who care for them.
Results: While highlighting the valuable role of
AHWs, the findings emphasise that the current
lack of availability of such workers for palliative
care provision for Indigenous peoples needs serious consideration.
Integrated care facilitation for older patients with complex health care needs reduces hospital demand
Authors: Bird Stephen R , Kurowski William , Dickman Gillian K , Kronborg Ian
Published: February 2010

Objective: The evaluation of a new model of care
for older people with complex health care needs
that aimed to reduce their use of acute hospital
services.
Method: Older people (over 55 years) with complex
health care needs, who had made three or
more presentations to a hospital emergency
department (ED) in the previous 12 months, or
who were identified by community health care
agencies as being at risk of making frequent ED
presentations, were recruited to the project. The
participants were allocated a ?care facilitator? who
provided assistance in identifying and accessing
required health care services, as well as education
in aspects of self management. Data for the
patients who had been participants on the project
for a minimum of 90 days (n = 231) were analysed
for their use of acute hospital services (ED presentations,
admissions and hospital bed-days) for
the period 12-months pre-recruitment and postrecruitment.
A similar analysis on the use of
hospital services was conducted on the data of
patients who were eligible and who had been
offered participation, but who had declined (comparator
group; n=85).
Results: Post recruitment, the recruited patients
displayed a 20.8% reduction in ED presentations,
a 27.9% reduction in hospital admissions, and a
19.2% reduction in bed-days. By comparison, the
patients who declined recruitment displayed a
5.2% increase in ED presentations, a 4.4 %
reduction in hospital admissions, and a 15.3%
increase in inpatient bed-days over a similar timeframe.
Conclusion: A model of care that facilitates
access to community health services and provides
coordination between existing services
reduces hospital demand.
Construction of the Australian Inpatient Export Database (AIED)
Authors: Neil Amanda L , Gordon Moira T
Published: February 2010

Objective: To establish a database of exports by
Australian acute health care institutions for the
period in which exports were first promoted.
Method: Hospital morbidity data for patients resident
overseas (Group A) and Medicare ineligible
patients resident in Australia (Group B) were
sought for the period 1983?84 to 1995?96 from
each state and territory health department. Private
hospital permission was obtained for the
release of identifiable private hospital data.
Results: Data were coalesced into a relational
database covering the period 1987?88 to 1995?
96. Coding variations between and within jurisdictions
over time necessitated the development of a
consistent coding mechanism. Group A and
Group B patients gave rise to at least 77 568
separations over the period 1987?88 to 1995?96.
Of these separations 58 418 (75.3%) should have
generated export income and another 10 158 separations
(13.1%) were likely to have generated
export income. Definite export separations not for
dialysis number 52 573, and these form the AIED.
Conclusion: An Australian database of inpatient
exports, the AIED, encompassing public and private
hospital data has been established for the
period 1987?88 to 1995?96. The problems
encountered in the course of this study emphasise
the desirability of maintaining an adequately
resourced national repository for health statistics.
From the Book Review Editor
Authors: Day Gary E , Ash Susan
Published: February 2010

THIS REVIEW SECTION covers a diverse collection of recent health reports, web sites and book reviews
from the fields of nutrition and dietetics and social work. I am sure the links and book reviews will
provide you with useful information and add to the understanding of a wide range of contemporary
health policy and management issues.
Teaching, learning and research: essential elements of health care and the next Australian Health Care Agreements
Authors: Carmichael Allan
Published: February 2010

Australian Health Care Agreements must set out
the roles and responsibilities of the Australian,
state and territory governments in ensuring the
provision of appropriate clinical placements for the
additional medical student allocation. The roles of
universities and public and private health agencies must also be specified.
Quality junior doctor training, improved workforce outcomes and patient safety
Authors: Landau Louis I
Published: February 2010

The intern year is a critical part of medical education
and pivotal in provision of health services,
especially in tertiary facilities. Training must be
integrated with health service needs, as our health
service is not well served if junior doctor training
creates confidence without competence.
Changing the face of mental health care through needs-based planning
Authors: Andrews Gavin , Titov Nickolai
Published: February 2010

Mental disorders contribute to the burden of
human disease. The National Survey of Mental
Health and Wellbeing revealed low participation in
treatment. The Tolkien II report provided evidence
that a mental health service that utilised needsbased
stepped care was likely to be effective and
affordable to the point that a 30% increase in
budget would treat 60% more people and produce
a 90% increase in health gain.
Five priorities were identified:
� Solve the crisis in psychosis by providing more
step-down beds for people with schizophrenia
who need long-term accommodation.
� Educate the workforce by providing a
nationwide web-based basic curriculum.
� Use clinician guided, step-down web-based
therapy for patients who are mild or moderate,
and web-based education to enhance clinical
treatment for patients who are more severe.
� Educate patients and their families about
treatments that work and about lifestyle
changes that facilitate these treatments.
� Reduce the onset of common mental disorders
by using proven web-based prevention
programs in schools.
With resources such as these in place, changing
the face of mental health care might just be within
our reach.
Managing the interface between acute care and rehabilitation — can utilisation review assist?
Authors: Poulos Christopher J , Eagar Kathy , Poulos Roslyn G
Published: February 2010

Aims and methods: We piloted the InterQual
Criteria tool in a large regional acute hospital in
NSW to determine the utility of this tool in the
Australian context. In particular to compare the
current ?gold standard? of physician assessment
for the selection of patients for rehabilitation and
the timing of transfer, with the guidance provided
by the tool. Consecutive acute care patients with a
diagnosis of stroke, hip fracture or amputation,
and patients referred for rehabilitation assessment,
were followed using the InterQual Criteria.
Results: Results on 242 acute episodes, representing
2698 days in acute care, were analysed.
In accordance with overseas studies, we found
that high levels of inappropriate days of stay in
acute care were suggested by the tool. Using the
InterQual Criteria almost all patients were deemed
appropriate for transfer to rehabilitation much earlier
than current practice.
Conclusion: We conclude that the InterQual
Criteria may have a useful role in patient selection
for rehabilitation, in facilitating the transfer of
patients from acute to subacute care, and in
improving patient flow within acute care. The
reasons for the variation between the results
obtained from the tool and current clinical practice
requires further investigation, and may indicate a
lack of validity of the tool in the Australian setting,
inefficiencies in processes of acute care, or the
lack of suitable alternative care settings or level of
support available in these settings.
Australian Health Review call for papers
Authors: Leggat Sandra G
Published: February 2010

Models of care:
do they make the difference?
Australian Health Review invites contributions for the
Models of Care section of the journal. This is a regular
section and we welcome ongoing article submissions.
Health care is delivered in countless ways for
those who have debilitating illnesses or conditions.
Stakeholders boast that it is the particular
?model of care? that makes the positive difference
to patients and clients ? but, it has been difficult
to ascertain the true impact of models of care on
patient/client or system outcomes. To assist in
clarifying this important area for health service
management and policy decision making, we are
looking for articles on case studies or research
projects that suggest either positive or negative
outcomes for specific models of care.
Australian Health Review is looking to publish
feature articles, research papers, case studies and
commentaries related to your experience with
specific models of care. We are particularly interested
in papers that measure the model's effectiveness
at a system, organisation and/or client
level. Australian and New Zealand submissions
are welcome, as well as international initiatives
with lessons for Australia and New Zealand.
Submissions can be short commentaries of
1000 to 2000 words, or more comprehensive
reviews of 2000 to 4000 words. Please consult
the AHR Guidelines for Authors for information
on formatting and submission.
Clinical school partnerships: the way forward in nursing education, research and clinical practice
Authors: Fetherstonhaugh Deirdre , Nay Rhonda , Heather Mandy
Published: February 2010

This paper describes the development of a partnership
between a university clinical school and a
sub-acute health care facility in Melbourne, Australia.
A brief history of nursing education is given
to provide a background for the development of
this collaborative model. The paper explores the
partnership, what it has achieved and continues to
achieve, as well as the challenges that have been
faced along the way.
What Can We Expect of Our Health Care System? : Introduction
Authors: Leet Martin , Lilley Kathleen
Published: February 2010

IN NOVEMBER 2006 the Queensland Centre for
Public Health and the Brisbane Institute cohosted
a public forum titled ?What can we
expect of our health care system??
The intention of the forum was to promote
public discussion on serious questions about the
long-term sustainability of the health care system.
Even as health care expenditure has grown,
demand for service remains unmet and appears
inexhaustible. Expensive new technologies and
drugs, a population living longer with more
chronic disease, and declining workforce capacity
indicate a worsening of the current situation.
The gap between our demand for health care
and the capacity of the system appears likely to
increase.
In light of such a scenario, this forum considered
what citizens can reasonably expect of their
health system. Consumer expectations are a
large part of the health care equation. In Australia,
a wealthy society with egalitarian traditions,
the great majority of people expect to be
provided with the most advanced medical treatment
available. In contrast with an earlier historical
period in which life was viewed as far more
contingent and unpredictable, we now routinely
expect to live long and fulfilled lives, with the
aid of sophisticated health care.
Are contemporary expectations realistic? Are
we entitled to believe that expensive technology
and drugs should be available to everyone,
irrespective of time, place, or stage of life? Have
we arrived at a situation in which life has been
valued too highly? Do current trends risk creating
an inequitable and dysfunctional health care
system? Is it possible to constrain expectations
without compromising standards of care?
The forum featured presentations and a panel
discussion involving a range of expert speakers,
decision makers, analysts and stakeholders. The
following two papers by Dr Stephen Begg and
Professor Peter Brooks have been submitted as
an outcome of the forum.
Dr Martin Leet
Senior Research Officer, The Brisbane Institute
Kathleen Lilley
Manager, Queensland Centre for Public Health
Predicting absenteeism and turnover intentions in the health professions
Authors: Albion Majella J , Fogarty Gerard J , Machin Michael A , Patrick Jeff
Published: February 2010

Objectives: The study examined the mediating
influence of individual psychological reactions to
work on the relationship between organisational
climate and job withdrawal behaviours (viz, intention
to leave and absenteeism).
Methods: 1097 hospital employees were surveyed
using the Queensland Public Agency Staff
Survey (QPASS) to obtain measures of organisational
climate, psychological reactions to work, job
satisfaction, and self-reported levels of intention to
leave. Group-level absenteeism data were provided
from the Health Service District files.
Results: Two psychological states, quality of
work life and job satisfaction, were found to fully
mediate the relationship between the organisational
climate variable, role clarity, and intention to
leave, while individual distress was found to partially
mediate the same relationship. However, the
hypothesised mediation effect of psychological
states on the relationship between organisational
climate and absenteeism did not emerge.
Conclusion: Skills shortages and increasing
demands for health services make retention of
staff in the health service industry vitally important.
As a means of addressing this issue, this
study presents an emergent mediating model
defining relationships among individual psychological
factors, aspects of organisational climate
and intention to leave. Identification of the processes
associated with staff withdrawal behaviours
or intentions will assist in devising
interventions to improve retention.
Barriers to continuing medical education in Australian prevocational doctors
Authors: Neate Sandra L , Dent Andrew W , Weiland Tracey J , Farish Stephen , Jolly Brian , Crotty Brendan C
Published: February 2010

To determine perceived barriers to continuing
education for Australian hospital-based prevocational
doctors, a cross sectional cohort
survey was distributed to medical administrators
for secondary redistribution to 2607
prevocational doctors from August 2003 to
October 2004. Four hundred and seventy valid
questionnaires (18.1%) were returned. Only
seven per cent (33/470) did not identify any
barriers to continuing education. Barriers identified
the most were lack of time (85% [371/
437]), clinical commitment (65% [284/437]),
resistance from registrars (13% [57/437]) and
resistance from consultant staff (10% [44/
437]). Other barriers included workload issues
(27% [27/98]), teaching program inadequacies
(26% [25/98]), lack of protected time for education
(17% [17/98]), motivational issues (11%
[10/98]) and geographic remoteness (10%
[10/98]). Australian graduates (87%) identified
lack of time more frequently than international
medical graduates (77%) (P = 0.036). Perceived
barriers did not differ significantly
between doctors of differing postgraduate
years.
Looking after health care in the bush
Authors: Chater Alan B
Published: February 2010

LOOKING AFTER health care in rural Australia
involves providing adequate services to meet the
urgent and non-urgent needs of rural patients in a
timely, cost-effective and safe manner. The very
provision of these services requires an appropriate
workforce and facilities in rural areas. This provides
challenges for clinicians, administrators and
medical educators.
While preventive medicine has made some
significant gains globally in reducing the need for
acute care and hospitalisation in some areas of
medicine such as infectious disease and asthma,
these demands have been replaced by an increase
in trauma, chronic disease and mental illness1
which, with an ageing population, eventually
means presentations at an older age which can
require hospitalisation.
Rural patients have always had to deal with a
relative undersupply of health practitioners. Rural
people have coped valiantly with this. The legendary
stoicism of rural people has been shown by
Schrapnel2 and Davies to be a prominent feature of
the rural personality. This both allowed them to
cope with lack of services and to suffer in silence
while their health status fell below the Australian
average.3 Rural Australians use fewer Medicare
services and see the doctor less per annum than the
Australian average.
Going online — experiences with a web survey
Authors: Kalucy Elizabeth , Hordacre Ann-Louise , Patterson Simon
Published: February 2010

This case study details the process and lessons
learnt from converting a compulsory comprehensive
organisational survey from email to online
format. The conversion was undertaken to
improve data quality and reduce respondent
burden. Key considerations in developing the
online survey were ease of use, security and
access. The new intuitive system allowed simultaneous
access for multiple users, and incorporated
dynamic indicators of progress and
validation of numeric data. Reactions to the
survey were mainly positive ? about 75% of user
feedback was positive or neutral, they reported
the survey was ?user friendly? and preferred the
online format. Negative comments focused predominantly
on the feature of expanding and
collapsing questions which these respondents
found difficult to manage. Administration of the
survey was streamlined, with considerable
reduction in time spent in checking and correcting
responses for both respondents and data
collectors. Although substantial improvements
were recognised and appreciated by many users,
it is important to acknowledge that users adapt to
new technology at different speeds, and adequate
support needs to be implemented for all
users.
A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital
Authors: McLean Rick , Mendis Kumara , Canalese Joe
Published: February 2010

Objective: To examine the trend in unplanned
readmissions (URs) to Dubbo Base Hospital
(DBH) over the period 1996-2005 and assess
possible correlations with basic demographic
data.
Results: URs increased over the study period,
both as a total number and as a proportion of total
admissions (from 4.7 to 5.4%), while average
length of stay decreased from 5.3 to 4.4 days and
available hospital beds decreased from 156 to
116. The proportion of URs for people aged 75
years has more than doubled over the same
period. There were clear temporal variations in
URs (greatest number occurring on Fridays and in
late winter/early spring) and variations with age
and gender (greatest number in young males;
peaks for males in 0-10 and 71-80-year deciles
and for females in 0-10, 21-30 and 71-80 year
deciles). Fifty percent of URs occurred within 7
days of discharge. There was a statistically significant
but small correlation between length of prior
admission and time to readmission (Spearman
correlation coefficient, 0.068; P < 0.01) although
the time to readmission did not change over the
study period. Chronic obstructive pulmonary disease
(3.8%), complications of procedures (3.6%),
heart failure and pneumonia (each 2.2%), angina
(2.1%) and acute bronchiolitis (1.8%) were the top
causes of URs.
Conclusion: URs are becoming more frequent in
DBH; analysis of associations and trends over
time are the first step in determining targeted
measures to address the problem.
Improving Aboriginal health
Authors: Leggat Sandra G
Published: February 2010

In recognition of the recent achievements of the
Close the Gap campaign, this issue of AHR contains
a set of papers focusing on Aboriginal health. At the
national Indigenous Health Equality Summit in
Canberra in March 2008, the Close the Gap Statement
of Intent was signed. This Statement of Intent
requires the government, health and social service
agencies and the Aboriginal communities to work
together to achieve equality in health status and life
expectancy between Indigenous and non-Indigenous
Australians by the year 2030. (See http://
www.hreoc.gov.au/Social_Justice/health/statement_
intent.html)
The first three papers present important policy
lessons. Matthews and her colleagues stress the need
to strengthen the link between policy formulation
and implementation (page 613). Their study found
that the lack of progress in improving Aboriginal
health may be the result of lack of Indigenous
involvement in policy formulation at the senior
Australian Government level, limited participation
of Indigenous community controlled health organisations
in the policy making process and insufficient
resources for implementation. Anderson, Anderson
and Smylie outline the achievements of the National
Indigenous Health Performance Measurement System
(page 626), and change management lessons
from Aboriginal community controlled health
organisations are discussed by Leanne Coombe from
the Apunipima Cape York Health Council
(page 639). Other papers with a focus on Aboriginal
health include a review of emergency department
access (page 648), overseas-trained doctors working
in rural and remote Aboriginal health settings
(page 655) and eye health programs within remote
Aboriginal communities (page 664).
Accessibility and quality of care received in emergency departments by Aboriginal and Torres Strait Islander people
Authors: Thomas David P , Anderson Ian P , Kelaher Margaret A
Published: February 2010

Objectives: To examine the accessibility and
quality of care received in emergency departments
by Aboriginal and Torres Strait Islander people
compared with other Australians.
Methods: We examined 2004?05 data from the
National Non-admitted Patient Emergency Department
Care database from the Northern Territory
and Western Australia, the only jurisdictions where
Indigenous identification in the database was considered
acceptable.
Results: In the NT, Indigenous people were 1.7
times as likely to present to an emergency department
as non-Indigenous people. Indigenous
patients in the NT and WA do not appear to use
EDs for ?primary care? problems more than non-
Indigenous patients. More NT Indigenous patients
walked out before being seen or before their
treatment was completed. However, Indigenous
patients generally waited a similar time, and often
slightly shorter, to be seen as similar non-Indigenous
patients in WA and the NT.
Conclusions: We recommend the regular monitoring
of equity in the accessibility and quality of
ED care for Indigenous people compared with
other Australians. Indigenous identification in the
database needs to improve so monitoring of ED
performance can extend beyond WA and the NT.
Predictors of readmission after elective coronary artery bypass graft surgery
Authors: Slamowicz Ron , Erbas Bircan , Sundararajan Vijaya , Dharmage Shyamali
Published: February 2010

Objective: We sought to examine potential predictors
of readmission after coronary artery
bypass graft (CABG) surgery.
Design/setting: We analysed routinely collected
data of CABG patients who have used the public
hospital system of Victoria, Australia from July 1998
to June 2003. In total, 6627 patients were selected
by linking records of elective surgery waiting time
data (Elective Surgery Information System), emergency
department data (Victorian Emergency Minimum
Dataset) and hospital discharge data
(Victorian Admitted Episodes Dataset).
Measurements: The outcome measures were 7-
day, 30-day and 6-month readmissions. Possible
predictors included were age, gender, Charlson
comorbidity index, waiting times, length of stay in
the hospital, and frequency of emergency department
(ED) visits before CABG surgery.
Results: 7.1%, 15.2%, and 32.3% of the study
population were readmitted at 7 days, 30 days and 6
months respectively. In a multivariable regression
model Charlson comorbidity index was associated
with 30-day (OR=1.18; 95% CI 1.11-1.24; P<0.01)
and 6-month readmission (OR=1.20; 95% CI 1.15-
1.26; P<0.01). Multiple ED visits were associated
with 7 day (OR=1.75; 95% CI 1.28?2.38; P<0.01),
30 day (OR=1.53; 95% CI 1.22-1.93; P<0.01) and
6 month (OR=1.80; 95% CI 1.49-2.18; P<0.01)
readmission. Waiting time was not a statistically
significant predictor of readmission.
From the Book Review Editor
Authors: Day Gary E
Published: February 2010

THIS REVIEW SECTION covers a diverse collection of recent health reports, web sites and book reviews
from the fields of nutrition and dietetics and social work. I am sure the links and book reviews will
provide you with useful information and add to the understanding of a wide range of contemporary
health policy and management issues. Happy reading!
Transparency in pricing arrangements for medicines listed on the Australian Pharmaceutical Benefits Scheme
Authors: Robertson Jane , Walkom Emily J , Henry David A
Published: February 2010

Australia?s system for assessing the cost-effectiveness
of drugs for listing under the Pharmaceutical
Benefits Scheme (PBS) is recognised internationally.
A variety of mechanisms, such as evidencebased
rules for determining eligibility for initial or
continuing subsidy, price-volume agreements,
rebates, and caps on government expenditure are
used to contain PBS expenditures. In this paper
we assess the extent of use of special pricing
arrangements in Australia and how and where
they are communicated to health professionals
and the community. We searched publicly available
documents published by the Pharmaceutical
Benefits Advisory Committee (PBAC) and the
Pharmaceutical Benefits Pricing Authority (PBPA).
We found 73 medicines where special pricing
arrangements had been applied and where prices
appearing on the Schedule of Pharmaceutical
Benefits might differ from those considered to be
?cost-effective? by the PBAC. Reporting of these
special pricing agreements was inconsistent and
generally non-transparent. In some, the lack of
transparency may have reflected the desire of
manufacturers to disguise the true negotiated
price, lest it weaken their negotiation position in
other jurisdictions.