bluuebunny/crossref_metadata_2025 huggingface dataset:
The Dynamics of Community Education in Male Reproductive Health: Findings from an Australian Study
Authors: Holden Carol , Poljski Carolyn , Andrews Catherine , Cock Megan , Wolfe Rory , de Krester David
Published: August 2009

A significant number of men are affected by reproductive health disorders; however, the level of awareness and education for some disorders is limited. Our aim was to explore the dynamics of community education activities being undertaken in Australia that address or include information on male reproductive health issues, to identify health promotion initiatives that help raise the awareness of male reproductive health disorders. A survey was distributed to medical practitioners, health services and community organisations across Australia to identify organisations providing male reproductive health information. Those organisations that had evaluated their activity were further analysed to determine if their focus was effectively providing education on male reproductive disorders. Of the 299 education activities reporting the inclusion of male reproductive health information, prostate cancer was the most commonly addressed health issue (55.5%). Only 89 activities (29.8%) had been evaluated by the education providers, to determine whether their aims had been met. Several factors were found to have an impact on the perceived success of education activities, including (i) the focus, but only for prostate cancer, prostate disease and testicular cancer activities (ii) method of delivery (face-to-face group presentations and one-on-one discussions), and (iii) location (remote areas). While the overall evaluation of community education activities focusing on male reproductive health is limited, several factors have been identified from this survey that may impact on the success of future male specific health promotion activities.
Editorial: Taking Consumer Participation Seriously
Authors: Swerissen Hal
Published: August 2009

This issue of the Australian Journal of Primary Health has a strong consumer participation theme. Hegney et al. discuss the extent to which consumers are comfortable with the advance practice role for registered nurses. Johnson et al. tackle the broader role issue of consumer representation and participation in health service planning, management and review. Meehan-Andrews et al. explore the issues involved in getting rural consumer perspectives for health care planning and quality assurance. Pettigrew explores the expectations of older patients and the "senior friendly" hospital.
CADS: Carer and Depression Support Group
Authors: Smith Debra
Published: August 2009

This article is about a small community group of consumers and professionals working together to provide support for people with depression and their carers. The group runs regular support groups, and recently held a community forum on depression. The group is a good example of partnerships and consumer-driven services.
The First Private Practice as a Registration Authority Authorised Nurse Practitioner in Australia
Authors: Cashin Andrew
Published: August 2009

The first private practice conducted, owned by and advertised as an authorised nurse practitioner practice in Australia was established in February 2004. A mental health nurse practitioner established the practice in a medical centre to provide counselling and mental health services for individuals, couples and families. This paper discusses the first 18 months of operation and considers the experience in the context of the small amount of published data, internationally, related to nurse owned and run private practices in general, and nurse practitioner practices. The practical steps of setting up, reimbursement and meeting challenges, in particular, are discussed. Diary entries and copies of emails were used as data through which the experience was tracked. The conclusion was reached that private practice as a nurse practitioner is possible. Scope of practice and financial remuneration are limited by the current third party reimbursement arrangements under Medicare and the lack of provision of PBS provider numbers to nurse practitioners.
Older Patients' Expectations of a "Senior-Friendly Hospital"
Authors: Pettigrew Simone
Published: August 2009

With the ageing of populations around the world, hospitals seeking to maximise the satisfaction of their patients will need to ensure their services meet the expectations of the growing segment of older patients. Four focus groups were conducted in Perth, Western Australia, to explore those aspects of a hospital stay that are considered to be most important to older patients. The focus group participants nominated nursing care, meals, admission procedures, communication processes and physical facilities as those aspects of hospital service that are of particular importance to older patients. They noted that these issues are likely to be relevant to some degree to all patients but that, due to the needs of older patients, they become especially critical in later years. These findings have similarities with those generated by other studies but are more extensive than described elsewhere and thus provide more detailed guidance for hospital managers seeking to ensure their facilities are senior-friendly.
People Management in Victorian Community Health Services: An Exploratory Study
Authors: Leggat Sandra G , Bartram Timothy , Stanton Pauline
Published: August 2009

Recent studies have identified the importance of a suitable workforce in achieving health care goals. This paper reports on a study investigating human resource management (HRM) in the public health sector in Victoria. Using survey methodology we found limited use of strategic human resource management, although the community health service respondents reported greater sophistication in HRM than the hospital respondents, particularly in relation to performance management. We explore possible reasons for these differences, such as the values of the community health sector, governance and experience with system reform.
General Practitioners' Help-seeking Intentions for Mental Health Problems
Authors: Davies Fiona , Deane Frank P , Dalley Andrew
Published: August 2009

The objectives of this study were to determine general practitioners' (GPs) intentions to seek help for drug and alcohol problems and persistent suicidal thoughts, as well as their preferred sources of help. A postal survey of all GPs in the Illawarra region of New South Wales was conducted. One hundred and thirty-six GPs completed the questionnaire. Participants indicated they were most likely to seek help for drug and alcohol problems from a GP, the NSW Doctors' Health Advisory Service, family, or friends. GPs with persistent suicidal thoughts were most likely to seek help from a psychiatrist, GP, or family. GPs reported greater intentions to seek help from psychiatrists, psychologists, phone help-lines and family for persistent suicidal thoughts compared to drug and alcohol problems. However, as depression increased, intentions to seek help from GPs and family decreased. Family and other GPs were preferred sources of help for both types of problem described in this study. GP spouses often experience high levels of burden for caring for children, their GP spouse, and at times the practice itself. The importance of GPs' spouses suggests they should be included in any programs aimed at strengthening the helping support systems for GPs. It may also be useful to educate GPs generally about how to work with colleagues who are seeking help, and the sorts of barriers they may experience in doing so.
Accessing Primary Health Care: A Community Survey of Issues regarding General Practice and Emergency Department Services in an Outer Metropolitan Area
Authors: McGaw AJ , Jayasuriya P , Bulsara C , Thompson S C
Published: August 2009

This survey aimed to identify views of residents of an outer metropolitan location towards general practice (GP) services, after-hours care and their use of emergency departments (ED). Four hundred respondents were selected randomly using quota sampling and interviewed by telephone. Respondents wanted a GP who was "easy to talk to", who listened and was interested in them, competent, straightforward and thorough. Of those who were dissatisfied, the main concerns were GPs' unwillingness to listen to the patient and rushing the consultation. GP visits occurred for specific health problems - most commonly fever, tiredness and respiratory conditions. Preventive advice regarding health and lifestyle issues was not mentioned as a reason for attending GPs. Appointment availability and financial issues impeded access to GPs. Most people who used an ED did so because of the unavailability of GP services, showing that access block starts in general practice, with the severity of their illness/injury being the second major reason.
GPs Confidence in and Barriers to Implementing Smoking Cessation Activities: Compared to Dentists, Dental Hygienists and Pharmacists
Authors: Edwards David , Freeman Toby , Litt John , Roche Ann M
Published: August 2009

GP smoking cessation interventions have been found to be highly efficacious. However, reported uptake is low, and little is known about barriers or comparisons with other health professionals. The objectives of this study were to examine GPs' provision of smoking cessation activities, confidence and perceived barriers, and compare the results to other health professions (dentists, dental hygienists and pharmacists). A random sample of South Australian GPs (n = 269) were surveyed. Comparisons were made with dentists, dental hygienists and pharmacists for whom similar data had been obtained. Participants were surveyed on their confidence, perceived barriers, level of smoking cessation activity and practice and demographic factors. GPs reported greater provision of and greater confidence in a range of brief smoking cessation interventions than other professions and perceived fewer barriers to the provision of smoking cessation activities. Confidence and system barriers were reported as the most common factors that impeded greater provision of smoking cessation activities. It was concluded that confidence and system barriers need to be addressed to increase rates of smoking cessation interventions provided by these professional groups. Skills-based training that develops confidence would be beneficial for all health professional groups and would increase the number of smokers receiving advice and assistance to quit smoking.
General Practice Based Multidisciplinary Care Teams in Australia: Still some unanswered questions. A discussion paper from the Australian General Practice Network
Authors: Yates Rachel , Wells Leanne , Carnell Kate
Published: August 2009

Evidence indicates that general practice-based multidisciplinary teams can offer a means of addressing some of the key issues currently facing Western health systems, especially workforce and chronic disease management. Elements of team-working have been addressed in research and policy initiatives both overseas and in Australia, yet some important aspects of primary health care multidisciplinary team-working still remain unclear in the Australian context. This discussion paper has been developed by the Australian General Practice Network (AGPN) to raise awareness of and promote thought on four questions relating to multidisciplinary team-working that AGPN considers important but that, as yet, have not been fully addressed. (Except where indicated, it is not a position statement about AGPN's views on this matter.) Questions considered are: Who is in the team? What makes a successful team? How should teams be funded in Australia? Who coordinates the team? Each question broadly considers what is already known about the area through purposeful literature reviews of the published and grey literature, current policy impacting on the area, and suggested areas for policy development in the context of Australian general practice and primary care.
Health Literacy in Primary Health Care
Authors: Keleher Helen , Hagger Virginia
Published: August 2009

Health literacy is fundamental if people are to successfully manage their own health. This requires a range of skills and knowledge about health and health care, including finding, understanding, interpreting and communicating health information, seeking of appropriate care and making critical health decisions. A primary health system that is appropriate and universally accessible requires an active agenda based on research of approaches to address low health literacy, while health care providers should be alert to the widespread problems of health literacy which span all age levels. This article reviews the progress made in Australia on health literacy in primary health care since health literacy was included in Australia's health goals and targets in the mid-1990s. A database search of published literature was conducted to identify existing examples of health literacy programs in Australia. Considerable work has been done on mental health literacy, and research into chronic disease self-management with CALD communities, which includes health literacy, is under way. However, the lack of breadth in research has led to a knowledge base that is patchy. The few Australian studies located on health literacy research together with the data about general literacy in Australia suggests the need for much more work to be done to increase our knowledge base about health literacy, in order to develop appropriate resources and tools to manage low health literacy in primary health settings.
What can the Experiences of Primary Care Organisations in England, Scotland and New Zealand Suggest About the Potential Role of Divisions of General Practice and Primary Care Networks/Partnerships in Addressing Australian Challenges?
Authors: McDonald Julie , Powell Davies Gawaine , Cumming Jacqueline , Fort Harris Mark
Published: August 2009

This paper focuses on what can be learnt from the experiences of Primary Care Organisations (PCOs) in England, Scotland and New Zealand about the potential role of Divisions of General Practice (DGPs) and Primary Health Care Networks/Partnerships (PCN/Ps) in Australia, in addressing the challenges of ensuring access to a comprehensive range of primary health care services that are well coordinated and address population health needs. Responsibility for contracting and commissioning gives PCOs considerable leverage to influence the availability and range of primary health care services. A capitation-based funding system and associated patient enrolment enables a population focus and care over time, while aligned regional and local planning boundaries between PCOs and other health service planning boundaries also help with more coordinated approaches to planning, service development and service delivery. These elements are largely absent in the Australian health care system and set significant limitations on the role of DGPs and PCN/Ps. While DGPs can contribute to improving general practice quality and access to multidisciplinary care, and PCN/Ps can improve coordination, their scope of responsibilities and authority will need to be significantly strengthened to enable them to take a comprehensive approach to ensuring access to primary health care, service coordination and addressing population health needs.
A Review of Literature on Access to Primary Health Care
Authors: Ansari Zahid
Published: August 2009

The purpose of this review was to acquaint health care planners, policy-makers and health services researchers with the complexities and dimensions of the concept of access to primary health care as reflected in the international medical literature of the past three decades. The review provides a comprehensive and accessible summary of the numerous definitions and ideas about access, which have been suggested over this time, together with a synthesis of current thinking informed by these past perspectives. Critical Interpretive Synthesis (CIS) methodology was used to review the literature on access. 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, augmented by manual scans of material from deeper levels within the sites. The process by which the initial list of 665 potential references was reduced to the final list of 48 references was based on manual inspection of both abstracts and full articles using specific prioritisation criteria. Inter-observer agreement for reference selection using these criteria was checked by two investigators and found to be good (Kappa=0.83). Measuring and monitoring access to primary health care is challenging due to the complexity of the concept of access. To address this shortcoming, a single outcome-based measure of access to primary health care is proposed, pointing to a possible way forward for the concept of access as a practical tool with significant application to future health policy.
Integrated Disease Management Programs: Reflections and Learnings from Implementation
Authors: Willcox Jane , Gill Marie
Published: August 2009

Integrated Chronic Disease Management (ICDM) is a key focus of recent Victorian Government primary care partnership (PCP) and community health policy direction documents. Planning for a more ICDM approach has been informed by earlier integrated disease management (IDM) projects funded through the PCP Strategy. In 2001, five IDM pilot projects were funded, for three years, under the Department of Human Services (Victoria) IDM Initiative. The IDM projects aimed to inform future planning for chronic disease care by developing models of care that sought a better quality of life, fewer complications for individuals, and reduced overall use of health care resources. The projects trialled different processes and components of IDM to accommodate local priorities, resources and existing care practice with more than 1000 consumers collectively involved. The experience of building community programs targeting consumers with chronic disease resulted in key learnings about IDM and effecting change. Enablers and barriers were identified, and the relationship between best practice and key learnings explored in the areas of partnerships, service coordination and consumer engagement, to further understand the best approaches to improve care for people with chronic disease.
Sustaining Chronic Disease Management in Primary Care: Lessons from a Demonstration Project
Authors: Williams Anna , Harris Mark , Daffurn Kathy , Powell Davies Gawaine , Pascoe Shane , Zwar Nicholas
Published: August 2009

Chronic disease self-management (CDSM) programs have been found effective in improving clinical, behavioural, and self-efficacy outcomes associated with a range of chronic illnesses, and evidence suggests that CDSM is effective in reducing health care costs and health service utilisation. As the setting where most chronic disease is managed, primary health care is an ideal setting for supporting CDSM. This study aimed to explore the uptake and sustainability of CDSM within routine activities of primary health care clinicians involved in the implementation of a demonstration project within an Area Health Service in Sydney NSW. Interviews and focus groups were conducted with managers and clinicians involved in the project. Findings included (1) widespread support from participants for CDSM (2) participating clinicians thought that CDSM was valuable to themselves, their clients and the health system (3) the program required clients to be able to speak and understand English and so presented many barriers for implementation in CALD communities, and (4) the program was not effective in engaging some key members of the primary care team; in particular, general practitioners. The study highlights system design issues including communication and continuity of care between service providers, workforce supply and demands of acute care delivery in the community that will need to be addressed for sustainable and effective CDSM to be achieved.
Challenges and Benefits of Implementing a Chronic Disease Self-management Program in an Aboriginal Community Controlled Health Setting
Authors: Abbott PA , Davison JE , Moore LF
Published: August 2009

The experience of Aboriginal health workers and general medical practitioners at the Aboriginal Medical Service Western Sydney in using patient-centred health measures as a part of chronic disease self-management program is discussed. Challenges encountered were lack of confidence in using these tools, adaptation of the tools without full understanding of their background and adequate testing, and lack of take-up of the care planning component by GPs. Benefits included improved communication between Aboriginal health workers, GPs and patients. The major benefit noted was that Aboriginal health workers felt the tools helped them to understand the barriers their most challenging patients faced to changing their health behaviour. This was motivating and encouraging for Aboriginal health workers, who often provide extensive support-both emotional and practical-to patients with high burdens of chronic disease and self-management difficulties.
Wellbeing, Job Satisfaction and Commitment among Australian Community Health Workers: The Relationship with Working Conditions
Authors: Noblet Andrew , Cooper Cary , McWilliams John , Rudd Annette
Published: August 2009

The Australian community health sector has undergone extensive organisational reform in recent times, and, in the push to enhance efficiencies and contain costs, there are indications that these changes may have undermined the wellbeing of community health personnel and their ability to provide high quality illness-prevention services. The aim of this study was to examine the working environments experienced by community health service employees and identify conditions that are predictive of employee stress. The study was guided by a tailored version of the demand-control-support model, whereby the generic components of the model had been augmented by more situation-specific stressors. The results of multiple regression analyses indicated that job control, and, to a lesser extent, social support, were closely associated with the outcome variables (psychological health, job satisfaction and organisational commitment). The more situation-specific stressors also accounted for significant proportions of explained variance. Overall, the results suggest that working conditions, particularly job control, social support and specific job stressors, offer valuable opportunities for protecting and enhancing the wellbeing of community health service personnel.
The Yoke of Care: How Parents and Parents-in-law Experience, Understand and Respond to Adult Children's Gambling Problems
Authors: Patford Janet
Published: August 2009

Clinical commentaries and research studies have described the effects of problem gambling on families, but they have usually focused on immediate rather than extended family members. To offset this bias, the present study aimed to develop a deeper understanding of the various ways in which parents and parents-in-law experience and understand adult children's gambling problems. Thirteen parents and two parents-in-law volunteered to participate in the study. Their experiences and perspectives were explored through in-depth interviews, emails and telephone discussions. Findings from the study indicate that the repercussions of an adult child's gambling may damage parents and parents-in-law financially, complicate their family relationships and erode their health and wellbeing. Implications for formal service provision are discussed.
Blood-borne Viruses and Risk Behaviours among Injecting Drug Users Recruited from Needle and Syringe Programs in Victoria's Eastern Metropolitan Region
Authors: SC Lim Megan , Sundaram Kavitha , K Aitken Campbell , E Hellard Margaret
Published: August 2009

Little has been reported about the risk behaviour and service accessibility of injecting drug users (IDU) living beyond the inner suburbs of Melbourne. This study describes IDUs in the Department of Human Services' Eastern metropolitan region (EMR), including the prevalence of blood-borne viruses and risk behaviours. Fifty-two IDUs were recruited directly from EMR Needle and Syringe Programs (NSP) and through snowball recruitment. IDUs completed a questionnaire and provided a finger-prick blood specimen that was tested for the presence of HIV and Hepatitis C virus (HCV) antibodies. No participants were HIV antibody positive; 29 (56%) were HCV antibody positive. HCV seropositivity was associated with having a tattoo in univariate analysis. The prevalence of HCV in surveyed EMR IDUs was similar to that of Victorian IDUs surveyed in the National Needle and Syringe Program Survey; however, the EMR sample exhibited significantly greater levels of risk behaviour, including the sharing of needles and other injecting equipment, and unsafe sex. Similarly, EMR IDUs from outer and rural suburbs reported greater levels of risk behaviours and lower levels of HCV infection than those from the inner EMR. This study shows that with high levels of risk behaviour and relatively low access to NSP services, Victoria's EMR IDU population is vulnerable to future blood-borne virus outbreaks.
Congregate Housing for Old People: The Importance of the Physical Environment
Authors: Wikström Britt-Maj
Published: August 2009

In Sweden, congregate housing units for elderly people are in a dynamic transition. Reforms emphasise the right of continued integrity and respect when an older person needs service and support in their daily life. With older people's experiences of living in a congregate housing unit, important qualities of the physical environment and of practices and ideology of nursing were examined. Using a random selection from 30 congregate housing units, 59 residents were asked to participate in a semi-structured interview. The interviews were taped and analysed qualitatively. The results showed that residents regarded security and a flat of their own as unconditionally the most important features of a congregate housing unit. Security was provided by health professionals, nurses and nurses' assistants. An important aspect of the outdoor environment expressed by the elderly residents was to have access to a green spot and benches to rest on.
An Approach to Treating Depressive and Psychotic Illness in Indigenous Communities
Authors: Nagel Tricia , Robinson Gary , Trauer Thomas , Condon John
Published: August 2009

This study is one of the activities of a multi-site research program, the Australian Mental Health Initiative (AIMhi), funded by the National Health and Medical Research Council. AIMhi in the Northern Territory collaborated with Aboriginal mental health workers and Northern Territory remote service providers in developing a range of resources and strategies to promote improved Indigenous mental health outcomes. A brief intervention that combines the principles of motivational interviewing, problem solving therapy and chronic disease self-management is described. The intervention has been integrated into a randomised controlled trial. Early findings suggest that the strategy and its components are well received by clients with chronic mental illness, and their carers, in remote communities.
Medication Management for Community-dwelling Older People with Dementia and Chronic Illness
Authors: Kralik Debbie , Visentin Kate , March Geoff , Anderson Barbara , Gilbert Andrew , Boyce Merilyn
Published: August 2009

The purpose of this paper is to report the findings of an integrative review of the literature on medication management for individuals who live in the community and have both chronic illness and mild to moderate dementia. The aim of the review was to summarise what is known about this topic, evaluate and compare previous research on the topic of medication management for people with dementia, and locate gaps in current work, thus pointing to directions for future research. Dementia is a national health priority for Australia. A significant component of community care for people with dementia is the management and administration of the medications required for other chronic conditions. Medication management is a broad term that encompasses several aspects, such as client-centred medication review, rational prescribing and support, repeat prescribing, client information/education, capacity to communicate with multiple health providers and having access to medicines. Cognitive impairment has been associated with medication management issues so it is important to ensure quality outcomes of medicine use by community-dwelling older people with dementia. The literature revealed a number of issues, such as the importance of person-centred care, the need for the coordination of care, and consumer partnerships in medication management. These are all important considerations in planning primary care services to support people with dementia and chronic illnesses. People with dementia who have chronic illness require coordinated, tailored, and flexible care processes in the community. There exists a range of services and programs such as home medicine reviews to support people living in the community with chronic illness and dementia; however, there is little coordination of care and evaluation of interventions is, at best, inconsistent. Currently, Australia lacks an integrative primary health care (PHC) framework, within which consumer involvement in decision-making and/or care planning is valued and sought. Current services are limited in the degree to which there is collaboration between key partners and Australian PHC initiatives are fragmented and have limited impact on service delivery.
Domestic Violence Screening: Findings of a Pilot Project Conducted by Allied Health Staff in Community Health
Authors: Howard Jo
Published: August 2009

This article examines a pilot project that introduces screening for domestic violence into an allied health team at a community health service. The screening was delivered over a three-month period from May 2005, with 44 clients screened. It explores the context in which the project was initiated, the experience of allied health staff in undertaking the screening, and project findings. It concludes that although the screening did not result in significant numbers of women disclosing domestic violence, it enhanced the capacity of allied health staff to respond to women who have experienced domestic violence, and strengthened the linkages between allied health and counselling staff.
From "Treatment" to "Care": Developing Youth Drug Treatment Services using a Social Model of Health
Authors: Rogers Nich
Published: August 2009

The Youth Substance Abuse Service (YSAS) was conceived and developed as a youth alcohol and other drug (AOD) service when few adolescent treatment models existed. Although initially funded to provide drug support and treatment, our developing practice, training and research findings encouraged us to view our role more broadly. Now with 10 years' experience, YSAS increasingly draws on social health concepts and primary health practices to describe our work with young drug users. Through our growing practice and training experience we have developed services to meet client needs. Evaluation of these services and further research has refined our thinking and provided a theoretical basis for our work. This paper sets out to describe the evolution of a youth AOD service, and demonstrate how social health concepts and primary health practices have helped frame and facilitate our responses to young drug users during YSAS' first 10 years.
The Effectiveness of the Breakthrough Series Methodology
Authors: Jones Kay , Piterman Leon
Published: August 2009

In the context of substantial government expenditure on Primary Care Collaboratives in Australia, this study aimed to review the information available about the effectiveness of the Breakthrough Series methodology as an alternative quality improvement method and a form of continuing professional development for general practitioners (GPs) in Australia. A wide and comprehensive search was conducted seeking articles that provided information about four questions raised by GPs involved in the Monash Arthritis and Musculoskeletal Quality Improvement Program (AMQuIP) project: (1) follow-up studies (2) the generalisability, sustainability and validity of the methodology (3) randomised controlled trials using the methodology, and (4) continuing professional development programs. The search was conducted using several databases. The search found 102 articles, with 31 containing information relevant to the questions raised. Three articles reported and eight commented on follow-up; 25 commented on generalisability, 15 on sustainability, five on validity. No randomised controlled trials were located that used the methodology but seven commented on randomised controlled trials; three commented on continuing professional development. While the articles provide valuable information, many authors suggested further research is needed to provide greater insight into and understanding of the methodology as an alternative quality improvement method for use both in Australia and overseas.
Cultural Observations on Vietnamese Children's Oral Health Practices and Use of the Child Oral Health Services in Central Sydney: A Qualitative Study
Authors: Lamb C. Finney , Phelan C.
Published: August 2009

The research was conducted to describe Vietnamese-speaking parents' practices in children's oral health care and to identify barriers parents had in accessing child dental services after being notified that their child needed treatment. A qualitative study design was employed, using a stratified purposive sample of five focus groups and three semi-structured interviews. A multidisciplinary team conducted a thematic analysis on the translated transcripts of the focus groups and interview notes. The retention of four traditional patterns of oral care and service use may increase the risk of oral disease among Vietnamese children: traditional oral hygiene practices using salt; delayed introduction of tooth-brushing; not attending a dental clinic for preventive care; and the use of lay remedies, rather than dental care, to cure pain. Language was identified as the major barrier to attending the child dental service, following notification of treatment need. The results suggest that the retention of cultural oral health practices and patterns of service use may increase the risk of oral disease among Vietnamese children. Oral health messages need to provide information in the language spoken at home; messages about dental services and western and traditional practices in oral care.
Dentists' Perspectives on Infection Control in Relation to Blood-borne Viruses
Authors: Jenkinson K. M. , Temple-Smith M. , Lavery J. , Gifford S. M. , Morgan M.
Published: August 2009

The prevalence of blood-borne viruses (BBV) continues to increase in Australia, as does the need for vigilant infection control. Despite this, some Australian health practitioners demonstrate poor compliance with recommended infection control practices. The aim of this study was to examine the experiences and attitudes of dentists regarding infection control, patients with BBV, occupational risk, and related matters, and identify reasons for non-compliance with infection control guidelines. A purposive sample of 25 Victorian dentists took part in semi-structured interviews between November 2003 and November 2004. Interviews were taped, transcribed and coded for thematic analysis. The majority of participants expressed compliance with standard precautions; however, many admitted to changing their routine infection control practices for patients known or assumed to have a BBV. Approximately half disclosed minor changes, such as double gloving; a small minority reported having treated people with a BBV at the end of a session. Most participants experienced apprehension about the risk of occupational exposure to BBV and admitted this as the reason for changing infection control practices. Reasons offered by participants for poor compliance included ignorance of either the effectiveness of standard precautions or BBV transmission, or confusion and frustration regarding inadequate or impractical infection control guidelines. It is suggested that infection control guidelines be specifically designed for dental practice, and that these be promoted in both undergraduate dental education and professional development.
The Hidden Experience of Violence during Pregnancy: A Study of 400 Pregnant Australian Women
Authors: Walsh Deborah
Published: August 2009

This article will report on the results of research into violence experienced by women during pregnancy, undertaken at a large public tertiary obstetric hospital in Australia. Participants in the research included 400 women from diverse backgrounds, recruited from the Royal Women's Hospital Antenatal clinic in Melbourne. The methodology for the research included a structured interview framework into which was incorporated a modified version of the Abusive Behaviour Inventory (ABI). The instrument measured both physical and psychological abuse indicators. The study found that 20% (n=80) of women interviewed reported experiencing violence during their pregnancy and that they did not disclose this to their health care professionals, thus suffering the abuse in silence. An increase in physical violence was reported by 6% (n=25); however, the majority of women reported that the level of violence and abuse remained the same throughout the pregnancy. It was found that a range of abusive behaviours were reported by the women interviewed, which resulted in three very distinct profile groups emerging from the data. A greater awareness of the prevalence of this phenomenon in the peri-natal population, together with ongoing access to research in this area, will benefit health care professionals in developing sensitive practice strategies for working with women affected by violence during pregnancy. Through a deeper understanding of associated issues, practitioners can work towards creating an environment where women feel safe enough to break their silence and be confident that their disclosures will be responded to appropriately, without pressure to leave the relationship.
Guest Editorial
Authors: Renhard Russell , Einfeld Steve
Published: August 2009

This is the first occasion the Journal has published a special issue on safety and quality in primary health, although of course individual articles on the subject have appeared in its pages. The timing of the issue reflects significant world-wide interest evidenced in a growth of specialist safety and quality-related journals, conferences, World Health Organization programs, as well as policy initiatives by governments all over the world.
"No-man's-land" between occupational health and safety legislation and the disability service sector
Authors: Cameron Gaye
Published: August 2009

The aim of this paper is to draw attention to a significant and growing tension that exists between the application of Occupational Health and Safety (OHS) legislation and the obligations of disability service providers under disability legislation and funding agreements with governments. Our purpose in highlighting this tension is to seek a body of knowledge to inform the courts and judicators of the complexities of implementing OHS and disability service work, and to gain a sound understanding of the synergies already in existence with OHS practices and the disability sector. We also need to keep in mind that we don?t compromise the rights of people with disabilities, nor the health and safety of the people who work with them.
Another look at the culture-quality-performance link
Authors: Elmer Shandell , Kilpatrick Sue
Published: August 2009

Quality improvement is usually driven by quality, safety and risk agendas leading to a focus on measurements of the outputs of care; outputs such as fewer complaints, fewer accidents and adverse events. An oft-neglected theme is the impact of the quality improvement initiative within the organisation itself. This paper presents the findings of the first stage of an evaluation that has examined the changes which have occurred within organisations since participating in a quality improvement initiative. These findings indicate that engaging with a quality improvement program can change the nature of social interactions within the organisation. In this way, quality improvement programs can impact on organisational culture, particularly in relation to organisational learning. Thus, this paper argues that successful engagement with a quality improvement program can enhance organisational learning, and, in turn, build organisational capacity.
Supporting quality care in general practice: The collaboratives approach
Authors: Buiso Catuscia , Newton Bill
Published: August 2009

An important role of divisions of general practice is to support general practice to build capacity for the delivery of quality care. The purpose of this paper is to discuss the National Primary Care Collaboratives Program and the impact this quality improvement initiative has had on building practice capacity to achieve improvements in the management of chronic disease. "The Collaboratives" are an international phenomenon, which, over the last three years, has been implemented in Australia and has achieved impressive results consistent with the success documented in other countries. This paper explores the key elements contributing to the success of the program and discusses the opportunities that have strengthened the ability of participating divisions to support general practice to deliver quality care.
Quality improvement in Indigenous primary health care: History, current initiatives and future directors
Authors: Bailie Ross , Sibthorpe Beverly , Gardner Karen , Si Damin
Published: August 2009

This paper addresses the question: "What is the current situation for Aboriginal primary health care services in relation to continuous quality improvement (CQI) in clinical care and what is needed for sustainable practice to be achievable five years from now?" The paper describes a number of recent CQI initiatives that evolved within an accountability framework, the origins of which are based on a top-down government approach to performance measurement. Over the last decade there has been a shift to a more negotiated approach and most recently to an emerging agenda that focuses more on systems to support CQI at the primary care coalface. Further development should aim to capitalise on the synergies between different CQI-related initiatives and effectively align quality improvement with performance measurement. Principles of CQI and key challenges for the future are identified.
A reflection on Victoria's Statewide Homelessness Assessment and Referral Framework as a quality improvement initiative
Authors: Holst Heather , Walsh Clogagh
Published: August 2009

This paper reflects on one of several recent quality initiatives in homelessness services in Victoria, Australia. The question, "Are we confident that this will improve service quality?" is considered in the context of the development and implementation of the Statewide Homelessness Assessment and Referral Framework.
Quality of rural primary health care: Including the consumer
Authors: Hoodless Mary , Bourke Lisa , Evans Frank
Published: August 2009

In rural Australia, models of primary health care are as diverse as the communities themselves. Differing facilities, health disciplines, individual providers, local contexts, funding models and reporting make measuring quality of care very difficult. This paper proposes that quality can be measured in three ways - through industry driven benchmarks, through consumer satisfaction, and through consumer and community decision-making. Further, this paper argues that quality of care needs to include a consumer domain. If consumers are able to influence how they receive support, care and/or treatment, they are more likely to receive appropriate services and interventions and have positive outcomes. A case study is presented to discuss how the three levels of quality are applied within a rural organisation, highlighting the challenges and effort required to sustain genuine community participation. The paper concludes with a discussion of these issues and the many challenges embedded in consumer-driven approaches to quality of care.
Advance care planning and quality improvement
Authors: Kirsner Sara
Published: August 2009

Ensuring that people's future medical treatment choices are respected (advance care planning) enhances quality of care, which is an integral component of quality improvement. Research has demonstrated that a system-wide approach to advance care planning can result in an increased uptake of advance care plans and ensures that the process can be incorporated into quality improvement activities. Specific and practical quality improvement activities related to advance care planning can enhance a system-wide approach and ensure that demonstrable benefits to quality and care occur.
Goals and Targets for Health: Their Limitations as an Approach to Promoting Health
Authors: Baum Frances
Published: August 2009

Setting goals and targets for health has become a popular activity with health promoters around the world. In this paper, it is argued that this approach to planning for health has a tendency to focus on a medical and behavioural definition of health to the detriment of more holistic approaches that focus on communities and their participation in improving health. Goals and targets are generally associated with the illness care sector and not well suited to health promotion that seeks to tackle underlying social or environmental causes of ill-health. The paper concludes with suggestions for alternative approaches to health promotion that draw on the more holistic view of health promoted by Healthy Cities and like projects. Approaches that enhance the capacities of organisations and communities to take action to plan for their own health are advocated. National governments have an important role in supporting and legitimising local and regional action through policy and resource provision.
Exercise, Health and Well-Being in Older Australians
Authors: J. Kirkby Robert , Cass Jeremy , Carouzos Helen
Published: August 2009

Exercise can be an effective medicine for many of the health problems of older Australians. Although older adults are the major consumers of health care services they are among the most physically unfit of our community and represent the group least likely to exercise. Exercise has substantial physical and psychological benefits for older people, particularly older women. A review of the literature has indicated that older people are deterred from exercise activities by environmental barriers (poor weather, lack of appropriate facilities), personal beliefs (inaccurate perceptions about their needs or abilities to exercise), and health obstacles (fear of injury, discomfort from conditions such as arthritis). The limited research on why older Australians exercise has suggested that motives such as 'to improve my fitness', 'to get exercise', 'to be fit' and 'I like the company' are likely to be rated highly. Encouraging older people to exercise has clear advantages, not only to the health and wellbeing of the individual, but also, to the community through possible savings to the health care system, and the contributions of older people.