bluuebunny/crossref_metadata_2025 huggingface dataset:
Concerns about being a a Health Consumer Representative: Results of a South Australian Study on Consumer Perspectives
Authors: Johnson Anne E , Beacham Barbara , Moretti Cecilia , Wishart John
Published: August 2009

Community and consumer participation is strongly advocated as a way to help shape health systems and health services to become more inclusive, accountable, responsive to community and consumer needs, and to improve health outcomes. Involving consumer representatives on committees is one partnership-style method of bringing a consumer perspective into health system and health services decision-making processes. Many consumer organisations are invited to provide consumer representatives to be members of committees. A study was conducted to identify the concerns of health consumers when they are required to take on the role of being a consumer representative on committees. Focus group interviews were conducted using a series of scenarios and questions as a discussion guide. Forty-eight participants were involved in eight focus group interviews in metropolitan and regional South Australia. General concerns covering seven key areas emerged, as well as more specific concerns relating to particular roles representatives may be required to undertake. This study highlighted particular areas of concern for consumer representatives that can be utilised in developing supports to increase consumers' effectiveness, capacity and confidence to fulfil the representative role. It also highlighted that the capacity building process for consumer participation needs to be a joint partnership between the health sector and consumer organisations, rather than be seen as solely the responsibility of individual consumer representatives.
Managing the Family's Health: Preferences and Experiences of Women with Different Work and Family Arrangements
Authors: Andrews Fiona J , Swerissen Hal
Published: August 2009

Balancing the needs of work and family is a subject of much debate. The purpose of this research was to explore how families manage their children's health within the context of different work and family arrangements. In-depth interviews were conducted with women who were at home full time (8) or in paid work over 30 hours a week (7). Women had at least one child under five years of age. Findings revealed there was no simple relationship between women's working arrangements and how they managed their children's health. All women, irrespective of their working arrangements, held similar preferences for managing their children's health. However, most women experienced either time or financial constraints that meant they had to compromise their original preferences. In some cases this meant children missed out on receiving health services. Workplace support, extended family support and general satisfaction with work and family arrangements appeared to be important factors for the small number of women who had no problems in managing their children's health. The implications of these findings are discussed.
Guest Editorial: Getting Evidence into Policy - Stimulating Debate and Building the Evidence Base
Authors: Glasgow Nicholas , Naccarella Lucio
Published: August 2009

In this special edition of the Journal, we have brought together papers with the aim of contributing to primary health care reform in Australia. The papers will stimulate further debate and increase the evidence base through which policies can be informed.

Does primary health care in Australia need reform? Are there fundamental problems with the health system demanding a reform response? The challenges confronting Australia's health care system over the next decade are real and well documented (Productivity Commission, 2005; Australian Medical Workforce Advisory Committee [AMWAC], 2005). They include the ageing population and longer life expectancies, the increasing prevalence of chronic illness and co-morbidity, heightened consumer expectations, advances in health technologies and shortages in the health workforce.
What does a Population Health Approach Mean for Nurses Working in Primary Health Care? A Cardiovascular Disease Risk Reduction Programme
Authors: Horsburgh Margaret , Goodyear-Smith Felicity , Yallop Julie
Published: August 2009

Cardiovascular (CVD) disease is the leading cause of death and hospitalisation in New Zealand, with major disparities between ethnic groups. Implementing the New Zealand Guidelines on the assessment and management of cardiovascular (CVD) risk is urgent and requires a range of activities from social marketing, community development and health promotion through to clinical care. Clarification of a population health approach and how primary health care nurses can integrate both personal and public health activities is important to the implementation of the CVD risk guidelines. This paper reports on an innovative project where primary health care nurses have a key role in integration of public and personal health and improving management of chronic conditions.
Reforming Primary Care in Australia: A Narrative Review of the Evidence from Five Comparator Countries
Authors: Naccarella Lucio , Southern Donna , Furler John , Scott Anthony , Prosser Lauren , Young Doris , Swerissen Hal , Waters Elizabeth
Published: August 2009

The need for reform of primary care is driven by health system inequity, inefficiency, sub-optimal quality of care and outcomes. In Australia, there has been no systematic analysis of the relevance and applicability of international reforms of differing models of primary care delivery and the implications for addressing these issues in the local context. We used a narrative review and synthesis approach to analyse evidence from four English-speaking comparator countries (New Zealand, Canada, United Kingdom, United States of America) and one European country (Netherlands). In this review the term "primary care" refers to the system of health care workers (predominantly general practice, nursing and allied health professionals) who provide locally-based first contact care in the community setting. The existing international evidence does not support the adoption of any specific model of primary care delivery that is suitable to the Australian context. However, the evidence does suggest four key mechanisms that should form the basis of future reform. This includes the funding of GP services, quality and performance frameworks, stronger regional structures to support primary care, and investment in practice infrastructure. This paper provides an overview of the review methods and findings. A full report and in-depth discussion of findings are available from http://www.anu.edu.au/aphcri/Domain/PHCModels/index.php
Integration, Coordination and Multidisciplinary Care: What can These Approaches Offer to Australian Primary Health Care?
Authors: Tieman J. , Mitchell G. , Shelby-James T. , Currow D. , Fazekas B. , O'Dougherty L. , Hegarty M. , Eriksson L. , Brown R. , Reid-Orr D.
Published: August 2009

Australia's population is ageing and the consequential burden of chronic disease increasingly challenges the health system. This has raised interest in, and awareness of, approaches built on multidisciplinary teams and integrated and coordinated care in managing the complex care needs of patient groups such as the chronically ill or frail aged. A systematic investigation of the literature relating to these approaches provided the opportunity to explore the meaning of these terms and their potential application and relevance to the Australian primary health care setting. Five systematic reviews of a sentinel condition and an exemplar approach to coordinated and multidisciplinary care were completed. Common learnings from the individual reviews were identified. The literature suggests that approaches encouraging a coordinated and multidisciplinary plan of care for individual patients and/or particular populations may improve a variety of outcomes. There are many methodological considerations in conducting reviews of complex interventions and in assessing their applicability to the Australian health system.
A Conceptual Framework for Performance Assessment in Primary Health Care
Authors: Sibthorpe Beverly , Gardner Karen
Published: August 2009

As health systems strive to achieve improvements in quality, equity and efficiency, systems of performance assessment are increasingly being introduced. To function effectively as tools for internal quality improvement, they need to be aligned with staff and organisational objectives, foster insight into practice and provide a focus for learning leading to improvement. Adopting such a "coalface" perspective, we developed a conceptual framework to underpin the potential development of a quality system for a large primary health care program. The Framework for Performance Assessment in Primary Health Care (FPA_PHC) is grounded in evaluation theory and explicitly identifies the processes of primary health care articulated by the World Health Organization (WHO). It is based on Donabedian's (1998) now classic "structure", "process", "outcome" model for assessment of quality of care. The FPA_PHC specifies the development of objectives that are focused on patients/families/communities and has four indicator levels relating to stewardship, organisational structures and processes, processes of care and intermediate outcomes. Equity can be assessed by asking of processes of care and intermediate outcomes: "is it the same for everyone?" The indicators can be mapped to higher order system performance frameworks such as the National Health Performance Framework. The FPA_PHC has been adopted for the National Quality and Performance System for Divisions of General Practice and its application in this and a second setting are described.
Editorial: Reflections on Research Impact in Primary Health Care
Authors: Walker Rae
Published: August 2009

The primary health sector has had a long-standing interest in evidence-based practice. Two decades ago the focus was on a primary health care equivalent of evidence-based medicine described by Hennen (1992, p. ix) as "self-criticism in primary care practice through research" or by Ovretveit (1998, p. 266) as "the use of best evidence in making decisions about the care of individual patients". The focus was on clinical interventions and their effects, or lack thereof. Furthermore, the aspiration to systematically use evidence in the provision of care was a central part of the quality movement in both clinical care and health service management (Ovretveit, 1992). More recently, evidence-based practice has been advancing in health services management and policy (Lin & Gibson, 2003).
It Takes More Than a Practice Visit: Effective General Practice Engagement
Authors: Bensberg Monica , Sutherland Julie , Crosby Christine
Published: August 2009

General practice engagement (GPE) is an important function, communicating new knowledge, new treatments and new ways of working with GPs and practice staff. It is necessary for health system decision-makers to recognise that GPE takes more than a practice visit. In this case study, the Dandenong District Division of General Practice found that, to be effective, GPE must be practice-appropriate (planned) and targeted within a whole-of-practice approach. Practice visits need to be supported by other complementary strategies and delivered by a trusted representative from institutions that appreciate the business of general practice and the culture in which it operates. Strategies require coordination so that general practice is not overwhelmed by simultaneous requests for change
Community Capacity Building for Health Promotion: Lessons from a Regional Australian Initiative
Authors: Fleming Mary-Louise , Higgins Helen , Owen Neville , Clavarino Alexandra , Brown Wendy , Lloyd Jacqui , Gould Trish
Published: August 2009

This paper discusses a health promotion intervention that sets out to develop local capacity to address chronic disease risk factors in a remote Australian community. Community focus groups, and researcher and community discussions, aimed to determine the community's health concerns and build a partnership for community action. The journey from conception to reality was difficult for a number of reasons that are described here. Despite these difficulties, a range of outcomes included the establishment of an organisational structure that involved a local health promotion committee as the principal decision-maker, the establishment of a grants scheme to support locally determined initiatives and the formal incorporation of a community Health Promotion Committee (HPC) that ensured the sustainability of activities beyond the funded project period. The HPC is still coordinating health promotion activities. The promotion of community ownership of health promotion activities is a complicated process, given that time, resources, expertise and community involvement require a much longer-term commitment than that currently imposed by many funding bodies.
The Use of and Attitude Towards Telehealth in Rural Communities
Authors: Mauldon Emily
Published: August 2009

This paper reports on the attitudes of a sample of health care providers towards the use of telehealth to support rural patients and integrate rural primary health and urban hospital care. Telehealth and other information technologies hold the promise of improving the quality of care for people in rural and remote areas and for supporting rural primary health care providers. While seemingly beneficial for rural patients, study participants believed that telehealth remains underused and poorly integrated into their practice. In general, participants thought that telehealth is potentially beneficial but places constraints on their activities, and few actually used it. Published literature usually reports either on the success of telehealth pilot projects or initiatives that are well resourced and do not reflect the constraints of routine practice, or has an international focus limiting its relevance to the Australian context. Because of the paucity of systematic and generalisable research into the effects of the routine use of telehealth to support rural patients, it is unclear why health care professionals choose to provide such services or the costs and benefits they incur in doing so. Research and policy initiatives continue to be needed to identify the impact of telehealth within the context of Australian primary health care and to develop strategies to support its use.
Intensive Case Management in Suicide Attempters Following Discharge from Psychiatric Care
Authors: De Leo Diego , Heller Travis
Published: August 2009

Suicide risk is high in the first week, month and year following discharge from psychiatric inpatient settings. The decrease in care following discharge has been considered as contributing to the excessive suicide rate in this population. The aim of this research was to evaluate the impact of an intensive case management follow-up of these high-risk people for one year. Sixty males with a history of suicide attempts and psychiatric illness were recruited at discharge from a psychiatric inpatient setting at the Gold Coast Hospital, Queensland. Participants were randomly assigned to one of two conditions: Intensive Case Management (ICM) or Treatment As Usual (TAU). ICM featured weekly face-to-face contact with a community case manager and outreach telephone calls from experienced telephone counsellors. TAU participants were discharged under existing hospital practices. All participants completed assessment interviews at baseline, six and twelve months post-discharge. At the end of the twelve-month treatment phase, there was a dropout rate of 53.3% in the ICM condition, and 73.3% in the TAU condition, leaving a final sample of 22 (ICM=14, TAU=8). People in the ICM condition had significant improvements in depression scores, suicide ideation, and quality of life. ICM participants reported more contacts with mental and allied health services, had better relationships with therapists, and were more satisfied with the services that they did receive. No suicides were recorded in the twelve-month follow-up period. A few participants engaged in self-harming behaviours, though there were no differences between treatment conditions with regard to this aspect. Despite the high attrition rate and subsequent low sample size, initial indications are that intensive case management may be beneficial in assisting the post-discharge phase of high-risk psychiatric patients.
The National Mental Health Strategy: Redefining Promotion and Prevention in Mental Health?
Authors: Henderson Julie
Published: August 2009

This paper explores policy documents published as part of the National Mental Health Strategy for ideas about mental health promotion and prevention, to determine the extent to which these documents adopt a primary health care approach. Discourse analysis was undertaken of key policy documents to discover the manner in which they discuss mental health promotion and prevention. Three points of departure are identified. The first of these is a focus on social and biological risk factors that manifest at an individual rather than at a social level, effectively drawing attention away from social inequalities. These documents also primarily target a population that is viewed as being "at risk" due to exposure to risk factors, shifting attention from strategies aimed at improving the health of the population as a whole. A final difference is found in the understanding of primary health care. Recent policy documents equate primary health care with the first level of service delivery in the community, primarily by general practitioners, shifting the focus of care from mental health promotion with the community to early intervention with those experiencing mental health problems. This is supported by the incorporation of a biomedical understanding into mental health prevention. While recent mental health policy documents re-assert the need for early intervention and health prevention, the form of mental health prevention espoused in these documents differs from that which informed the Declaration of Alma Alta, Ottawa Charter for Health Promotion and World Health Organization's Health for All strategy.
The Concept and Usefulness of Ambulatory Care Sensitive Conditions as Indicators of Quality and Access to Primary Health Care
Authors: Ansari Zahid
Published: August 2009

The purpose of this review is to introduce health services researchers, especially in the area of primary health care, to the meaning and concept of ambulatory care sensitive conditions (ACSCs). More specifically, this review explores the validity of ACSC admissions as proxy indicators of access to primary health care, provides a description of the factors that cause variations in ACSC admission rates, and presents a discussion of the potential usefulness and policy implications of these indicators for primary health care. Critical Interpretive Synthesis (CIS) methodology was used to review the literature on ACSC admissions indicators. Medline and Australasian Medical Index were searched for English language articles published between 1970 and August 2005. The results were supplemented by an internet search of the World Wide Web, further augmented by manual scans of material from deeper levels within the sites. Main finding from the review indicates that ACSC admissions are valid proxy indicators of access to primary health care. Socioeconomic factors are most important in explaining variations in ACSC admissions. Several uses and policy implications of ACSC admission indicators are discussed, including their potential for identifying gaps in the primary health care system and providing opportunities for targeted public health and health services interventions.
Moving and Thinking Behind Bars: The Effectiveness of an Exercise and Health Education Program on Psychological Distress of Incarcerated People with, or at Risk of Developing, a Chronic Illness
Authors: Cashin Andrew , Potter Emily , Stevens Warren , Davidson Kerri , Muldoon Diane
Published: August 2009

Rates of chronic illness within the New South Wales, Australia, prison population are alarmingly high. Population approaches to health care and community development pose some unique challenges in the context of prisons. These challenges are discussed in the context of the report on the results of a small pilot randomised control trial conducted within one New South Wales prison that investigated the effect of a 12-week exercise and health education program on male inmates? psychological distress. The exercise program targeted individuals with a chronic illness, those who had two or more risk factors for developing a chronic illness and/or inmates over 40 years of age. The psychological distress of the inmate participants was measured weekly using a modified Kessler 10 tool. No statistically significant differences were found between the groups pre- or post- the exercise program. There was also no significant correlation between total psychological distress and participating or not participating in the exercise. A further study, with a larger sample size and different tool, is recommended.
Older Chinese Australians? Understanding of Falls and Falls Prevention: Exploring Their Needs for Information
Authors: Jing Yang Xiao , Haralambous Betty , Angus Jocelyn , Hill Keith
Published: August 2009

Falls-related injuries are common and costly in Australia. They have a considerable impact on an older person?s health and quality of life, yet very little is known about falls-related issues in people from culturally and linguistically diverse (CALD) backgrounds. This research aimed to explore the needs of older Chinese Australians in relation to falls prevention and to help the future design of culturally-appropriate falls prevention programs among this ethnic group. Two focus group discussions were conducted in Cantonese with 15 Chinese older people in Melbourne. Findings highlighted that this group of Chinese older people had a need for further education on falls risk factors and prevention strategies, preferably in their first language. Allied health services were viewed as being unfamiliar to participants. Findings indicated that falls prevention programs need to take into account Chinese older people?s special language needs and service delivery preference.
Ageing Well in the Over 45s: Using a Health Check Log
Authors: Sheriff June N. , Chenoweth Lynn
Published: August 2009

This study aimed to promote health awareness, health monitoring skills, timely consultation with health professionals and health-related quality of life for persons 45 years and over through maintaining a specially-designed Health Check Log (HCL). A pre-/post-test quasi-experimental research design was employed with data triangulation, to compare health-related quality of life for treatments with matched controls. Data were obtained from a convenience sample of 120 community-dwelling participants and 69 health professionals living and/or working in the South Eastern Sydney/Illawarra Area Health Service catchment area, and volunteer members of the Council on the Ageing. Eighty of the treatment group maintained the HCL for 12 months. Outcome measures included the SF-36 health survey, monthly/bi-monthly telephone/electronic mail interviews, feedback survey, and focus group discussions. The majority of treatments reported that keeping the HCL raised levels of awareness (69%), assisted in developing skills (59%) and confidence (57%) in assessing and monitoring health, and in adopting preventative illness approaches (54%). Stratified analyses of the SF-36 health survey revealed significant differences between groups at post-test; in particular, positive health perceptions in those who are retired and living on their own.
Quality initiatives in the alcohol and other drug treatment sector
Authors: Rose David
Published: August 2009

Quality improvement has recently become a key focus of the alcohol and other drug (AOD) treatment sector through initiatives such as accreditation, workforce development and the adoption of an evidence-based practice approach. While this attention on quality improvement is viewed as a much-needed change, a number of barriers to successful implementation of quality initiatives within the AOD sector exist. This paper discusses these issues, drawing from the research evidence and a case example examining accreditation and workforce development in the AOD sector in Victoria, Australia. The paper concludes that the recent focus on quality improvement within the AOD sector is a very desirable direction, but quality initiatives must be supported by an appropriate level of funding if they are to lead to improved outcomes for service users.
"Not for" sector in community mental health care defines itself and strives for quality
Authors: Ronnau Peggy , Papakotsias Arthur , Tobias Glen
Published: August 2009

This paper briefly describes the history and service context of the Psychiatric Disability Rehabilitation and Support sector (PDRSS) in Victoria, and, to a lesser extent, in New South Wales, South Australia and Western Australia. In describing the sector we will call upon the experience of a particular PDRSS - Neami - in operating and developing services, and the challenges it faced in establishing a culture of quality that directly improves consumer outcomes. Elements of this experience may serve as a guide in the development of mental health service policy at state and federal level.
The Victorian Aged Care Assessment Service quality improvement framework
Authors: Teshuva Karen , Russell Heather , Varanelli Laura
Published: August 2009

The purpose of this paper is to describe the development and evaluation of the Victorian Aged Care Assessment Service (ACAS) quality improvement framework. The framework was developed in 2001 by a reference group consisting of ACAS managers and government officers, to enable ACAS to engage in a quality improvement process specific to its core areas of business. The framework comprises seven core business domains which are used by the ACAS for annual quality improvement planning and reporting. Using the qualitative methodology of thematic analysis, the ACAS Evaluation Unit has examined annual quality improvement reports submitted by the 18 Victorian ACAS teams from 2002-03 to 2006-07. The findings were used to revise the framework and the ACAS quality improvement reporting template. The number and range of ACAS-related quality improvement activities carried out in Victoria since the implementation of the framework demonstrates its effectiveness as a mechanism for capturing and centrally recording quality improvement activities in areas of core ACAS business. The paper concludes that the Victorian QI framework could be drawn on to develop a quality improvement framework for the Aged Care Assessment Program nationwide.
The Search for Primary Care: Please Come Home all is Forgiven
Authors: Cleave Karen
Published: August 2009

The Department of Health and Community Services (H&CS) was established in October 1992 following the amalgamation of the Departments of Health, Community Services and the Office of Older Persons. The Primary Care Division was created in June 1993 and is an amalgamation of a number of front line health and welfare services from the Community Services and Health portfolios. However, a number of other Divisions have primary care functions.
Primary Health Care in Queensland
Authors: Rudd Cobie
Published: August 2009

In 1993, the Queensland government responded to the challenges facing the Queensland health system when it released the Queensland Primary Health Care Policy. In the Policy, the public sector involvement in health system reform is outlined, and the vital role played by the non-government and private sectors are supported. The direction for the future delivery of health services clearly entails meeting the needs of local populations through an emphasis on community participation and development, intersectoral collaboration and co-ordination of health services. The Policy supports an improved balance between tertiary, high cost institutional care and community-based primary health care. The development and extension of community health services is recognised in the Plan as an important strategy in achieving a more balanced health system.
The Arts in Health: Implications for Artistic and Health Practice, Policy Development, Education and Training
Authors: Woodhams Libby
Published: August 2009

Although there have been art programs in some Australian health care settings for a number of years they are neither an integral part of health policy or practice, nor of arts policy and practice. A fuller appreciation of what it means to be a person might illustrate why art practices in health settings provide so many, often uncomfortable, challenges to long held assumptions that patients should be passive and accepting, whereas art practices expect them to be active, moral, self defining agents. What is required is collaboration and co-operation at federal, state and local levels between departments and organisations in the arts, health and education, so that the arts might regain their vital role in the care of the sick and in the health of our communities.
ACTing on CHASP: Identifying Barriers to Change
Authors: Murphy Karen , Hazelton Jenny , Aitchison Jenny
Published: August 2009

This paper is a result of participation in the Primary Health Development Program in 1994. As part of this program participants were required to undertake a primary health project. 'ACTing on CHASP�Identifying barriers to change' aimed at identifying key barriers to implementation of the Community Health Accreditation and Standards Program (CHASP) review recommendations in ACT community health centres. The studies involved an analysis of CHASP review reports and discussions with community health staff in three community health centres. Key barriers were identified, but an important outcome appeared to be the positive influence that the CHASP review process had had on community health staff.
Editorial
Authors: Gardner Heather
Published: August 2009

The Australian Journal of Primary Health - Interchange was launched on 11 December 1995 by the Honourable Mr Rob Knowles, Victorian Minister for Aged Care, and Ms Kerry Ferguson, Dean of the Faculty of Health Sciences, and chaired by Ms Shirley Freeman, President of the Victorian Community Health Association and President of the Australian Community Health Association.
Policy Implementation: Monitoring Progress Towards Best Practice in Primary Health Care
Authors: Rudd Cobie
Published: August 2009

Rigorous assessment of strategic policy implementation is difficult and as a result, is relatively rare in Australia. This paper examines the value of, and issues associated with, developing a set of core performance indicators to monitor primary health care policy implementation as part of the quest for best practice. A model to facilitate the use of monitoring information as part of quality improvement practices, including benchmarking towards best practice, is introduced. Because of its practical implications for both formulating and monitoring the implementation of strategic health policy, this paper is believed to be a significant step in the study of policy development. What is sometimes regarded as the final phase in policy development and implementation�the evaluation of policy�should, if best practice is to be achieved, occur as part of policy development itself and be informed integrally by monitoring mechanisms. In this way, assessment of the process, impact and outcomes of a policy can be fed directly and systematically back into the policy development process. The paper concludes with recommendations for future work in this area to support the achievement of best practice in primary health care.
Best Practice and Allied Health
Authors: Thoroughgood Jill
Published: August 2009

In this paper, issues are discussed relating to the provision of quality allied health advice, and the focus of the allied health program in primary health care and community health settings in the Peninsula and Torres Strait Region of Queensland, since Regionalisation in 1991. It was apparent to allied health professionals working in community health, that the change process presented an opportunity to influence not only the Regional Health Authority, but also to act as a united voice for the professions and to be advocates for best practice models of care for the community. Why do allied health professionals need to be utilised in an advisory role in community based health settings? What are the impacts on policy, planning, and on the services provided by community health care workers? How can allied health advisers enhance the quality of outcomes of best practice for the consumers of community health programs? Allied health advisers are important for the whole health sector by ensuring that effective and appropriate allied health services are delivered, that there are increases in allied health resources, that there are improvements in health outcomes for clients, that primary health care models of care are implemented, and, finally, that best practice is implemented by the allied health professional.
Early Identification and Intervention: Primary Health Care in the Nineties
Authors: Hill Helen , Stevens Roslyn
Published: August 2009

Sunbury Community Health Centre's Early Identification and Intervention Program is comprehensive. The Centre has a broad range of identification initiatives which assess for early physical changes in an individual's health, as well as recognising the social and emotional causes of ill health. The Centre has undertaken early identification activities for groups in the community at risk of health problems, has identified environmental hazards and, where possible, taken appropriate action. The Centre has made links with other community agencies which participate in and support the comprehensive Early Identification and Intervention Program.
Koori Training in Basic Health Skills
Authors: Clark Judy , Crunden Angela
Published: August 2009

The program, Koori Training in Basic Health Skills, was developed by the Lakes Entrance Community Health Centre at the request of, and in consultation with, the local Koori community. At the time, it was the only health training program available in Victoria developed specifically for Koori Health Workers at the grassroots level. It was a competency-based training program lasting for three months, and focussing on the development of basic observation and assessment skills. This enabled participants to provide immediate and ongoing management, including appropriate referral, of people with acute or chronic health problems.
A Men?s Night Out
Authors: Donaldson Anne
Published: August 2009

A Men's Night Out' was conducted in Charlton, an isolated rural town in Northern Victoria. A community health nurse from the Inglewood and District Community Health Centre planned and presented the program in August 1993.
South Port Day Links: Working with the Community
Authors: Statkus Julie
Published: August 2009

With a focus on transport and information, and in recognition of the changing structure of neighbourhoods, South Port Day Links has developed and facilitated creative ways of linking people who are frail, are aged, who experience disabilities, or who are carers in their community. Day Links works at the community level and is successful because of the high level of participation by local residents. It has a primary health care approach with an emphasis on increasing and maintaining the social, as well as physical, aspects of people's lives which allows individuals to participate more fully in their community.
The Discharge Brokerage Program
Authors: Dowling Pat
Published: August 2009

In response to government policies on case mix funding and Diagnosis Related Groups (DRGs), Caulfield Community Care Centre, in consultation with the Inner South Community Health Service in Victoria, made a submission for government funding to run an early discharge program. It was called a Discharge Brokerage Program rather than an early discharge program, because of not wanting patients to be anxious about leaving hospital early.
Mealmakers Program: Linkages for Health
Authors: Holbery Eileen , Quinn Marie
Published: August 2009

The Mealmakers Program is an initiative for the promotion of health through early intervention. Community members and three health agencies linked together to plan and implement a program aimed at improving the wellbeing of children attending a pre-school in a disadvantaged area of Victoria. The Program has four components: a food program providing nutritious meals daily; a dental health monitoring and treatment program; the provision of accessible information on healthy eating for the children and their families; and practical education on growing vegetables. The Program now has assured funding, and community ownership, which is responsible for the Program's functions, the employment of staff, and extensive networking with health care professionals.
Cigarette Smoking and Schizophrenia: A Public Health Issue
Authors: Polgar Stephen , McGartland Michael , Hales Tracey
Published: August 2009

Cigarette smoking has been causally linked with a range of detrimental health consequences. Following the introduction of population-wide anti-smoking measures there has been an overall reduction in the prevalence of smoking to about 25% of the Australian population. These results, however, do not apply across the board as one of the most disadvantaged groups in our community, people with schizophrenia, do not appear to be receiving benefit from these public health measures. Further, the quality of life and even the ability to live independently in the community for this group might be compromised by these very same public health measures. Approximately 75% of people with schizophrenia smoke and those who have a psychiatric disability on average spend about 30% of their income on this habit. Recent research suggests that at least for some of these people, smoking is not simply a vice, but a means of obtaining a medication necessary for symptomatic relief of their disorder. Public health measures are required which take into account the evidence concerning the specific needs and social situations of people with schizophrenia.
A Round Peg in a Square Hole: Changes in a Rural Health Service
Authors: Smith Debra , Wilkin Catherine
Published: August 2009

The cultural partnerships which have been formed as a result of the decision to restructure a rural health service are discussed here. Previously, some aged care services and allied health staff in hospitals were responsible to the medical superintendent, and community health services answered to hospital chief executive officers in each location. The organisational principles, key elements of the structure, and changes in management are analysed using change management and primary care literature. The changes have been implemented within the context of several health cultures, which are often not only different by definition, but are also in direct competition with each other. Twelve months after restructuring the service, staff have responded positively to the changes so that now a partnership exists between management and staff. It is clear, however, that primary socialisation had made it difficult for the system to cope with these changes. Funding of primary health care remains an issue, and although there is an increasing reliance by medical services on the primary health care service system, there has not been a corresponding shift in resources. Changes have been significant at the local level, although much remains to be resolved before the health service becomes a health promoting service rather than a medically dominated sickness service.
Bicultural Stress: An Aboriginal Community Perspective
Authors: Salisbury Christine , Follent Sue
Published: August 2009

A survey was designed to assess and to compare the levels of stress being experienced by Aboriginal and Torres Strait Islander and non-Aboriginal respondents. The survey covered a range of areas including demographics, access to transport, drug and alcohol use, use of public services, identification of stressful events in the past 12 months and a self evaluation of stress symptoms. The groups were matched by age, sex and income. The results showed differences between the stressful events and stress symptoms reported by the two groups, with the Aboriginal and Torres Strait Islander group reporting considerably higher levels. There were significant differences in access to transport and use of public health facilities. The barriers to the use of public health services were identified. A major finding was that 69% of the Aboriginal and Torres Strait Islander sample experienced more than one loss through death compared to 5% of the non-Aboriginal sample in the previous 12 months. It was concluded that the Aboriginal and Torres Strait Islander sample experienced more stressful events, had more stress related symptoms and used public mental health services less than the non-Aboriginal sample. The barriers to use of services were a lack of cultural sensitivity and the discomfort experienced by the Aboriginal and Torres Strait Islander sample when accessing services. A partnership with the Aboriginal and Torres Strait Islander community is required to develop a public health service that is acceptable and useful to the Aboriginal and Torres Strait Islander sample.
Problematising Poisons: Embodied Knowledge and Environmental Health Risks
Authors: Cameron Prue
Published: August 2009

Contemporary policy responses to environmental risk increasingly endorse the need for community participation in decision making around these issues. It is suggested that this process requires a greater understanding of the social construction of environmental risk which legitimises the knowledges and experiences of community members. Environmental health risks are most commonly framed within the discourses of science and epidemiology. These scientific knowledges construct particular meanings around the risks associated with environmental issues. The 'objective and value-free' context of mechanisms, such as laboratory tests, defining safety levels and population based statistical data, locates the meanings of risk within a depersonalised and fundamentally disembodied framework. It is argued that this marginalises and disempowers the meanings, values and everyday practices through which people negotiate risks in their lives. Work in progress which examines the ways people construct meanings about the environmental health risks to which they are exposed is discussed using the case of the herbicide atrazine in Tasmania, Australia. The paper draws on data from in-depth interviews with key individuals concerned about the contamination of drinking water by this herbicide. A central theme in this analysis is the concept of embodied knowledge in the construction of meanings. The argument that the body at risk is a key site of contestation in environmental health debates is developed. This conceptualisation increases the space for community engagement and action in public policy outcomes.
Continuity of Care from the Consumer Perspective
Authors: C. Kalucy Elizabeth , Jolley Gwyneth , Yeng Lewis Soi
Published: August 2009

Do consumers' views on the concept of continuity of care differ from those of health workers and policy makers? Eight focus groups were conducted in Adelaide and in rural South Australia with consumers who had used a range of health services. Their concept of continuity of care included being cared for beyond the episode of consultation by health workers who took into account many aspects of their health and social situation, and being linked to other health and community services. The issues that affected consumers' experience of continuity of care were: availability of services; access including transport and language; communication with and between health workers; information transfer; and access to information. Most of the consumers nominated themselves or their general practitioners as their current care co-ordinator. They felt that formal care co-ordination for chronic and complex conditions was necessary when many workers were involved. The features of the consumers' views on continuity of care were closest to the definition from the National Review of Primary Health Care: involving collaboration and communication between all the providers engaged in the care of an individual and the recognition that consumers and their carers should be seen as members of the health care team.
Moderate Vision Impairment and Children?s Health Rights: What Counts as Primary Health Care?
Authors: Aroni Rosalie , Abel Larry
Published: August 2009

There are a number of issues which need to be raised when examining the impact of vision impairment on children's lives. In a pilot study, the problems raised predominantly by primary caregivers of children with mild to moderate vision impairments indicate that current health care practices still tend to be defined in narrow biomedical terms in this area. This is because the psychosocial impacts of these degrees of impairment are not adequately understood by families, health and other professionals and are therefore not effectively dealt with. This often creates a situation in which families are sent from one health service delivery domain to another with no one service taking responsibility for providing the needed assistance - often with parents taking on advocacy roles which in human terms produce extreme strain (Rees & Emerson, 1984).
Primary Health Care Under Pressure: A Case Study of Amalgamation in Victoria
Authors: McCoppin Brigid , Birrell Christine
Published: August 2009

Amalgamation of community health centres has become a fairly common response to Victorian government changes in primary health care policy (both Labor and Coalition). This is a study of one such amalgamation and of its effects. The amalgamation brought staff and management many difficulties of adjustment, but it has produced a larger organisation which, while it has some residual problems, appears well fitted to withstand the pressure of today's policy directions and to meet future demands.
Mindsets: The Barriers to Empowering Health Options for People with Disabilities
Authors: Temby Dianne , Cooper Margaret
Published: August 2009

The capacity and the political will of service providers to facilitate effective rehabilitation, which places the person at the centre of all rehabilitative actions, is sorely challenged in a service environment permeated by a philosophy of economic rationalism and control of clients. People who cannot imagine how they would cope or manage with a disability tend to generalise the impossibility to all people with disabilities. Stereotyping can then occur and people might then be labelled according to someone else's limited perception. This can lead to depersonalization and marginalisation of the labelled group. This has been the experience of some disabled individuals in Australian society. These sorts of attitudes and behaviours towards people with disabilities and/or chronic health problems may be driven by a worldview that is based on the functional limitations model. If an individual has reduced self-management and autonomy and is socially isolated, then other human possibilities and choices become limited, including employment. Such individuals will remain trapped in the downward spiral of limited options, disillusionment and disempowerment if rehabilitation officers and other health workers continue to do 'more of the same'.
Podiatry and General Practice: The Joint Role of Meeting Client Needs
Authors: Reilly Angela
Published: August 2009

The general practitioner (GP) plays an important role in an individual's understanding of her/his health needs and the ways in which a particular health professional will meet those needs (COAG, 1995; Davis & George, 1993). If awareness by the GP of another profession's role is limited, the consumer may feel disempowered by a system which does not provide the expected service (COAG, 1995). Choice and direction of intervention will remain limited by the GP's lack of knowledge of the profession, and as such, the individual's needs might not be met.