bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors affecting Medicare affordability
Authors: Swerissen Hal , Jordan Lucinda
Published: August 2009

The Commonwealth Government, currently, does not have a primary health care policy. Instead, policy is heavily focused on general practitioners (GPs) and, in particular, on payment arrangements. Since 2000 bulk-billing rates have declined significantly in Australia, raising concerns about affordability and access to health care. This paper examines the relationship between affordability, health need, the supply of GPs, and capacity to pay. Bulk-billing and per capita consultation rates are likely to be higher and co-payments lower in areas where GP supply is higher, health needs are high and capacity to pay is low. Implications for the Commonwealth Government?s new MedicarePlus package are also discussed in light of the findings.
Editorial: Strengthening clinical governance in primary health and community care
Authors: Swerissen Hal
Published: August 2009

Large numbers of people die each year in hospitals as a result of preventable errors. High profile cases like the Royal Bristol Infirmary in the UK or the King Edward Memorial Hospital in Western Australia highlight the problem in the popular media, putting pressure on governments, providers and the professions to improve safety and quality in hospitals. In Australia, the Quality in Australian Health Care study reviewed the medical records of 14,179 admissions to 28 hospitals and found that an adverse event occurred in 16.6% of cases, with 51% considered to have been preventable (Wilson et al., 1995).
The impact of non-health attributes of care on patients' choice of GP
Authors: Haas Marion
Published: August 2009

After completing a structured evaluation of their general practitioner (GP) in terms of non-health factors, 128 people who had visited their GP in the past six months for treatment of a minor condition were administered a discrete choice experiment (DCE) designed to evaluate their preferences for non-health attributes of care within a general practice consultation. SAS and SYSTAT were used to analyse responses. Trust, legitimation, recognition of and support for emotional distress, dignity, reassurance and information (whether it is asked for or not), were the attributes respondents valued most highly. In general, participants were unwilling to change GPs.
Clinical governance in community health care settings: Evidence and issues
Authors: Swerissen Hal , Jordan Lucinda
Published: August 2009

This paper identifies clinical governance frameworks within the literature that are applicable to community health care settings. The paper focuses on three main topics: the importance of developing a clinical governance framework within a community health service; the main elements of a clinical governance framework; and the process of implementing a suitable framework. Although research for primary care is more limited, the available evidence suggests that, as with hospitals, there are significant opportunities for improving the safety and quality of clinical practice in primary care through improved clinical governance. Frameworks for clinical governance, key elements for implementation, and methods of implementation are also identified.
Advancing consumer participation in primary health: The case of a Victorian Primary Care Partnership
Authors: Cordwell Lauren
Published: August 2009

This paper presents an overview of the North Central Metro Primary Care Partnership (NCMPCP) process to strengthen consumer participation. The NCMPCP is a voluntary alliance of 60 health and community services in Melbourne's Northern metropolitan region that aims to make positive, sustainable improvements to services from the perspective of clients, their carers and their families. The population of the NCMPCP catchment includes significant cultural and linguistic diversity and social and economic disadvantage. In strengthening consumer participation, consumers and service providers from NCMPCP member agencies identified the need for a consumer participation training resource to be developed to support the ongoing engagement of consumers in participation opportunities in primary health services. The development of a consumer participation training resource involved consumers and service providers from 14 agencies. Consumers were involved in all stages of needs identification, design, implementation and evaluation. The process to develop the consumer participation training resources has contributed to a greater understanding of consumer participation for the NCMPCP member agencies and has increased the level of engagement and participation by consumers. The process has highlighted the need for consumers and service providers to be trained, resourced and supported to carry out consumer participation work.
Reflections on integrating mental health into primary health care services in remote Indigenous communities in Far North Queensland and the Northern Territory
Authors: Haswell-Elkins Melissa , Hunter Ernest , Nagel Tricia , Thompson Carolyn , Hall Brenda , Mills Robert , Wargent Rachael , Tsey Komla , Knowles Leanne , Wilkinson Yvonne
Published: August 2009

At present, there is a perceived and functional separation of mental health services from the general delivery of primary health care services in remote Indigenous communities in most places in the country. There are a range of issues underlying this separation; many are historical but continue to influence patterns of thinking about mental and physical health. With the increasing shift of focus of care at primary level from being largely reactive to presentations of acute illnesses towards proactive and strategically guided approaches to the management of chronic diseases, coupled with similar national strategic documents guiding mental health care into a primary health care format, the opportunity to integrate the provision of mental and physical health care has never been better. Accompanying this integration should be a reflection and improvement on models of care that address needs of Indigenous people in a more culturally and contextually appropriate manner, as is clearly defined in an increasing range of Indigenous health policy documents. This paper will begin with a summary of the link between mental and physical health supported by key references. It will then briefly reflect on the current organisation of mental and physical health services in remote Indigenous settings of Far North Queensland and the Northern Territory, identifying some of the major disadvantages being experienced. The paper will close with a description of the approach and some early outcomes to address these issues by the Indigenous Stream of the AIMhi project (Australian Integrated Mental Health Initiative), which is a major National Health & Medical Research Council (NH&MRC) Strategic Partnership initiative that began implementing a framework of research activities in mid-2003.
Improving general practice survey response rates: Bells (primers), whistles (reminders) and carrots (incentives).
Authors: Harris Claire , Day Neil , Young Doris , Potiriaids Maria , Southern Donna , Dunt David
Published: August 2009

Poor response rates of general practitioners (GPs) to surveys are common and result in incomplete data with limited validity. This study of a GP integration index survey implemented via the Divisions of General Practice examines the effects of various strategies on GP response rates. Several strategies were adopted to engage Divisions and subsequently support them in the implementation of the survey to their members. A detailed "Implementation Kit", including protocols for questionnaire dissemination, reminder schedules and sample materials was provided. Factors that appeared to improve response rates were smaller size of Division, addressing questionnaires to practice managers rather than sending directly to GPs, personal contact with GP or practice manager, increasing the number of reminders, and payment or gift for completing the survey. Surveying a large number of GPs is both costly in terms of money and time and strategies that improve response rates are more difficult to implement with very large numbers. Larger Divisions or others surveying large numbers of GPs should consider the option of using a sampling strategy, and direct resources into following up non-responders more intensively.
Capacity building initiatives within the Divisions of General Practice setting in Victoria, Australia.
Authors: Naccarella Lucio , Tacticos Theonie , Sims Jane , Potiriadis Maria
Published: August 2009

The General Practice Education, Support and Community Linkages Program (the Program) supported uptake of the Enhanced Primary Care (EPC) Medicare Benefits Schedule items. A goal underpinning the Program was to build the capacity of Divisions of General Practice to support GPs' EPC item usage. Capacity building was operationalised as: workforce development, organisational development, and resource allocation. This paper reports on the extent to which the Program built the Divisions' capacity to support GPs' EPC item usage. Telephone interviews were conducted with participating Division Chief Executive Officers (CEOs), EPC Coordinators and GP Trainers. Division CEOs, EPC Coordinators and GP trainers corroborated that the Program contributed to Divisions' capacity to support GPs' EPC item usage. Responses reflected interviewees' respective roles and position in Divisions. Given CEOs' strategic roles, they were more positive about the Program, EPC Coordinators and GP Trainers were less positive, given their pragmatic roles. It appeared that respondents had not explicitly considered the Program as a capacity building exercise. We infer that they may have been too close to implementation to see the Program's overarching policy and strategy. The evaluation highlighted the importance of implementing and evaluating capacity building initiatives explicitly using capacity building frameworks. To assist program sustainability, future schemes in the general practice setting would benefit from an explicit reference to capacity building in their stated objectives.
Guest Editorial: Indicators and Public Health Policy
Authors: Ackland Michael J , Choi Bernard CK , Ansari Zahid
Published: August 2009

This issue includes a paper from the Victorian Department of Human Services, Australia, addressing applications of data on ambulatory care sensitive condition hospitalisations. This work has been very important for Victoria as it provides robust new indicators of access and quality of primary care services that have direct application to current public health policy.
On the surface, this work appears to be the result of a simple set of analyses of routine hospitalisations data; commonplace data that are usually presented in bureaucratic reports that have a life gathering dust on the desks of public sector health administrators. How could such data excite anybody or provoke a practical policy or strategic response?
Service Provision Factors that Affect the Health and Wellbeing of People Living in a Lower SES Environment: The Perspective of Service Providers
Authors: Savage Sally , Bailey Susan , Wellman David , Brady Sharon
Published: August 2009

Inequalities in health and wellbeing within low socioeconomic (SES) environments are well documented. Factors inherent to the health care system itself, such as inaccessible, inflexible or inappropriate service provision, contribute to the poorer health status of residents of low SES areas. This paper explores the issues of service provision in low SES areas, documenting the perceptions of service providers about the service needs of residents, in order to understand the systemic factors that negatively impact on health and wellbeing. A total of 54 health and welfare service providers from two adjacent low SES suburbs within regional Victoria were interviewed using qualitative research methods. Key findings indicate that successful navigation of health care services by residents within these low SES environments is being impeded by issues of access, a lack of appropriate early intervention options or measures, and general resident disempowerment. Central to the improvement of service provision is the need for services to become economically, geographically and culturally accessible. In particular, the importance of community involvement in health planning and health promoting services must be reflected in the ethos of service provision.
Small Area Analysis of Diabetes Complications: Opportunities for Targeting Public Health and Health Services Interventions
Authors: Ansari Z , Ackland MJ , Carson NJ , Choi BCK
Published: August 2009

The objective of this paper is to present small area analyses of diabetes complications in Victoria, Australia, and to illustrate their importance for targeting public health and health services interventions. Local government areas in Victoria were aggregated into 32 Primary Care Partnerships (PCP), which are voluntary alliances of primary care providers. The 32 PCP areas were used as the basic geographic units for small area analyses. Admission rates for diabetes complications were age and sex standardised using the direct method and the 1996 Victorian population as the reference. Admission rate ratios were calculated using the Victorian admission rates as the reference. The 95 per cent confidence intervals for the standardised admission rate ratios were based on the Poisson distribution. There was a wide variation (almost fivefold) in admission rates for diabetes complications across the PCP catchments, with the lowest standardised rate ratio of 0.37 and the highest of 1.75. There were 11 PCPs (seven metropolitan, four rural) with admission rate ratios significantly higher than the Victorian average. The seven metropolitan PCPs contributed more than 43% of all admissions and bed days for diabetes complications in Victoria. Small area analyses of diabetes complications are an exciting new development aimed at stimulating an evidence-based dialogue between local area health service providers, planners and policy-makers. The purpose is to provide opportunities to target public health and health services interventions at the local level to improve the management of diabetes complications in the community.
Differences in Satifaction Ratigns of Carer-Respite Services between Carer Types: Results of a Western Australian Evaluation
Authors: Northcote Jeremy , Hancock Peter J
Published: August 2009

Respite care offers caregivers a temporary relief from the duties of their caring role. This study examines whether caregivers' satisfaction ratings of the agencies that coordinate respite care services vary according to their relationship to the care-receiver. One hundred and seventy-seven clients of Australian Red Cross Carer Respite Centres in Western Australia were surveyed by telephone to determine their satisfaction levels with the information and referral services they received. Those caring for children - although expressing a generally high level of satisfaction - indicated significantly lower levels of satisfaction than other carer groups on two specific criteria: the initial provision of information and the ability of the centre to cater to all their needs. It is recommended that service providers, health practitioners and researchers alike pay close attention to different carer types in the design, implementation and evaluation of respite programs.
"Are We There Yet?" - Consumer Participation in Mental Health Services
Authors: Browne Graeme , Courtney Mary
Published: August 2009

Public policy in Australia recommends that the relationship between consumers and mental health professionals should be one of equals and that consumers be encouraged to have input into service delivery at every level. This approach requires a significant change in attitude for mental health professionals and within services. Although consumer input into mental health service delivery has improved, there is still a long way to go. Unfortunately, consumers consider many of the efforts by mental health services to be tokenistic. This paper considers some of the issues regarding consumer participation, including the changing community attitudes towards people with a mental illness, the concept of recovery, challenges for health professionals and the impediments to consumer participation.
Attitudes to, and Use of, Evidence-based Medicine in two Sydney Divisions of General Practice
Authors: L Callen Joanne , Fennell Kate , H McIntosh Jean
Published: August 2009

Previous surveys suggested Australian GPs felt positive towards evidence-based medicine (EBM) but had reservations about practising it. Strategies to promote EBM in Australian general practice were implemented by the Royal Australian College of General Practitioners (RACGP) and published online in 1998. The aim of this study was to explore attitudes to and use of EBM in a population of Sydney GPs four years after publication of the strategies. A postal survey was conducted in 2003 among a group of GPs in Sydney (n=135) with a response rate of 31%. The survey assessed: attitudes to and barriers to practising EBM; preferred methods in moving from opinion-based medicine to EBM; awareness and use of EBM resources; and ability to interpret research evidence. Two- thirds of respondents felt positive towards EBM. Time pressure was the most commonly perceived barrier to practising EBM and use of evidence-based guidelines was the most popular method in moving towards EBM. Among 70% of respondents, at least 40% of clinical practice was evidence-based. Awareness of the databases The Cochrane Library and Medline was high, but use of database information was rare. There was partial understanding of technical terms used in EBM. While overall these GPs had a positive attitude towards EBM, they indicated some reluctance to applying it. Thus it is probable that in this GP group EBM was used less than optimally. The evidence provided by this study suggests that the RACGP strategies to promote appropriate use of EBM in general practice need heightened emphasis among the GPs surveyed. The study's low response rate prevents any generalisation of findings to the Australian general practice workforce.
Towards a Measure of Function for Home and Community Care Services in Australia: Part 1 - Development of a Standard National Approach
Authors: Eagar Kathy , Owen Alan , Marosszeky Nicholas , Poulos Roslyn
Published: August 2009

The aim of the project was to recommend, for national use, validated and reliable instruments for measuring the dependency of people eligible for Australian Home and Community Care (HACC) services. The project was split into two stages. Stage 1- reported here - reviewed the suitability of existing instruments and scales to measure levels of dependency within the target group and made recommendations on a set of measures for national field testing in Stage 2. The review covered four domains of function (domestic or instrumental, self-care, challenging behaviour, and cognitive) and recommended an instrument for each domain. A two-tier assessment system was developed. The first tier consists of a simple nine-item functional screen. It consists of seven items from the OARS instrument (Fillenbaum & Smyer, 1981) and two additional items to cover cognitive and behavioural functioning. The second tier consists of five functional assessment instruments, used only with those triggered for an assessment from the first tier assessment. The five instruments are the Barthel Index (Collin, Wade, Davies, & Horne, 1988) or the Functional Independence Measure (FIM, Granger et al., 1993) to assess self-care; the Lawton's Instrumental Activities of Daily Living (IADL) Scale, with modifications to make it suitable for the HACC program, to assess domestic functioning; the Australian Resident Classification Scale (RCS), with modifications to make it suitable for the HACC program, to assess behaviour; and the Folstein Mini-Mental State Examination (MMSE [30-point]) to assess cognition. The selected instruments were, on the weight of the available evidence, those that best met our criteria in terms of validity, reliability and acceptability. The performance of the instruments with a representative sample of HACC clients and services forms Stage 2 of the research; this empirical evidence is reported elsewhere in this Journal.
Re-orientation of Health Services towards Health Promotion: An Australian Case Study of Aborted Health Service Reform
Authors: Baum Fran , van Eyk Helen , Hurley Catherine
Published: August 2009

This paper examines a case study of local health care reform in Australia that had as one of its aims the desire to increase the health promotion and partnership work of the region. The case study highlights the pressures contemporary health systems are facing and the challenge of re-orientating health services towards health promotion in this environment. Qualitative research, including interviews, focus groups, a staff survey and policy analysis were used to identify health system professionals? perceptions of the impact of health care reform. The case study portrays a complex system that is subject to frequent change but little reform. Our case study indicates that features of health systems that encourage collaborative partnerships are those where there is: an environment that encourages trust; a common purpose among the key players; a supportive external environment; practical projects to work on; organisational stability; commitment from staff throughout organisations; willingness to commit resources; evidence that change is likely to improve outcomes for users; and an organisational environment in which learning from past experience is encouraged. A number of constraints and tensions that work against introducing a greater emphasis on health promotion and collaboration within the system studied are discussed, including tensions between central funding bureaucracies and health care agencies and the reform fatigue and increasing cynicism among staff resulting from continuous change. The paper concludes that against the chaotic background of contemporary health service reform it is very difficult to bring about genuine reform to achieve a shift to more emphasis on health promotion and partnerships.
The HIV Resource Nurse Role at the Royal District Nursing Service (Melbourne): Making A Difference for People Living with HIV/AIDS in the Community
Authors: Crock Elizabeth , Butwilowsky Judy-Ann
Published: August 2009

The care of people living with HIV/AIDS in the home and community can be complex and challenging, requiring high levels of knowledge, skill, preparedness and, importantly, the ability to engage with people belonging to marginalised groups. In 2003, the Royal District Nursing Service (RDNS) HIV/AIDS Team in Victoria, Australia, developed the new role of HIV Resource Nurse at two RDNS centres in Melbourne serving high numbers of people living with HIV/AIDS. Drawing from two case studies and interviews with two HIV Resource Nurses from one of the centres, this paper describes this practice innovation. Benefits (including a positive impact on client engagement with services, client care, relationships with other health care workers and job satisfaction) are outlined, along with challenges in the implementation and evolution of the role. Strategies to sustain and develop the HIV Resource Nurse role are proposed.
Managing Change in the Context of a Community Health Organisation
Authors: Telford Kerry , Maddock Anne , Isam Cathy , Kralik Debbie
Published: August 2009

Change management has been recognised as a complex, dynamic process during which unanticipated events and behaviour may emerge. This is particularly the case for community health care organisations where the combination of a number of typical features serves to complicate change efforts. Change in complex organisations such as community health services is unlikely to be a straightforward process and is likely to require more than one approach. This review examines the various change management approaches in the literature, with a view to assessing their relevance to a community health organisational context. Debate around the strengths and limitations are reported along with the key elements of responsive change management processes.
How do we Canvass Rural Consumer Viewpoints for Health Care Planning and Quality Assurance? Methodological Considerations for Data Collection
Authors: Meehan-Andrews Terri , Jones Judith , Humphreys John
Published: August 2009

Consumer input is vitally important when planning health care services and monitoring health system performance. Australia's rural residents suffer poorer health status and health outcomes than do metropolitan residents; this, along with medical and health workforce shortages, makes this planning and monitoring especially relevant. In rural and remote regions people are geographically dispersed across diverse communities, often making it difficult to access and recruit consumers. This paper provides a framework to address the major issues associated with how best to canvass representative rural consumer views relating to health care services and quality assurance. The review provides a critical appraisal of the advantages and disadvantages of the main methodologies employed in rural health studies. Many of the problems associated with gaining representative rural consumer perspectives in relation to health can be overcome by planning the research process, adopting the appropriate survey tool and engaging potential participants.
Diagnosing and Treating Depressions in Nursing Home Residents: Challenges for GPs
Authors: Koritsas Stella , Davidson Sandra , Clarke David , O'Connor Daniel
Published: August 2009

Depression is more common in elderly people residing in nursing homes than it is in people of the same age residing in the community. In Australia, general practitioners (GPs) are the primary providers of medical services to the elderly in nursing homes; however, they often under-diagnose and/or inadequately treat depression in this population. The difficulties experienced by GPs are confounded by the breakdown in the continuity of care that is evident when a patient is admitted into a nursing home, by inadequate communication between GPs and nursing home staff, and systems within the nursing home that are not conducive to general practice. This paper discusses the challenges GPs face in diagnosing and treating depression in nursing home residents, and provides suggestions for strategies that may overcome these challenges.
Editorial: A Milestone
Authors: Swerissen Hal
Published: August 2009

This special issue of the Australian Journal of Primary Health on comparative approaches to primary health care is timely. The AJPH has been published for 12 years. Over that time it has developed a unique blend of research, comment and practice articles covering the range of interests embodied in primary health. We have regularly published special issues to highlight important themes. The first of these was in 1999 on health promotion evaluation. Subsequently, we have had issues on primary health care (2000), the future of primary health care (2002), chronic disease management (2003), addressing inequity through primary care (2004), reflections on the Australian primary health care sector (2005), and health care in community settings (2006).
Primary Health Care or Primary Medical Care: In Reality
Authors: Macdonald John
Published: August 2009

Despite considerable rhetoric, comprehensive primary health care remains largely a matter of a paper exercise. The theory promotes horizontal and vertical integration and the active participation of people in planning. Experience in Australia and elsewhere indicates that what is in place in health services is often primary medical care: the management of the needs of presenting individuals. The arguments for upstream interventions remain valid, bolstered by research on the social determinants of health. Two examples are given of primary health care that attempt to work upstream, before clinical interventions become necessary and illustrate the need for both horizontal and vertical integration. Consequences for policy and training are drawn.
Engaging Primary Health Care Providers in the Promotion of Healthy Weight among Young Children: Barriers and Enablers for Policy and Management
Authors: Hearn Lydia , Miller Margaret , Cross Donna
Published: August 2009

Recent national efforts to stem the alarming growth of childhood overweight and obesity in Australia have highlighted the importance of preventative strategies that focus beyond the child-on parents, families, primary health care providers (PHCPs) and child care services. But, while such efforts have to date focused on school-based interventions, once poor eating habits and sedentary lifestyles have set in, a growing body of research is indicating that PHCPs can play a more influential role in monitoring and modifying factors affecting prevention and early intervention in preschool children. This paper presents the findings of a systematic review to: (a) identify key barriers to the effective engagement of PHCPs with parents and child care staff in the promotion of healthy weight among children aged 2-6 years, (b) appraise "promising" interventions for strengthening the capacity of PHCPs to effectively deal with these barriers, and (c) synthesise policy options to encourage and engage PHCPs. The study draws on the lessons of promising interventions to highlight the urgent need to address organisational, attitudinal, knowledge, skills and training barriers, to facilitate the engagement of PHCPs in different settings-based environments (clinical, child care, home and community).
Promoting Best Practice in General Practitioner Management of Osteoarthritis of the Hip and Knee: Arthritis and Musculoskeletal Quality Improvement (AMQuIP) Program
Authors: Jones Kay , Piterman Leon
Published: August 2009

This paper reports on the outcomes of a pilot study to optimise general practitioner (GP) management of patients with osteoarthritis (OA) of the hip and knee by identifying gaps between their current practice and best practice. The Breakthrough Series collaborative methodology with several Plan-Do-Study-Act (PDSA) cycles was employed. Participants comprised two Victorian Divisions of General Practice (one rural, one metropolitan), 12 general practitioners/practices (GPs/practices), 10 patients per GP/practice. GPs/practices attended an orientation and three learning workshops and a videoconference. GPs/practices completed PDSA cycles between workshops and reported results at the workshops. GPs/practices reported use of guidelines, change in patient management and change in practice management/systems. All recruited patients completed the SF-12v2 Health survey and WOMAC Osteoarthritis Index questionnaire twice; nine patients participated in face-to-face interviews twice. Follow-up activities including focus groups and face-to-face interviews were held six months after the final workshop. All GPs/practices used the guidelines/key messages, introduced "new" management strategies to patients, and made positive changes to their practice management/systems. Patients reported positive changes and outcomes. There was little difference between rural and metropolitan results. By using a structured methodology and evidence-based guidelines/key messages, GPs can introduce new patient management strategies, and by identifying gaps in practice management/systems, positive change can be achieved.
Partnership Management: Working Across Organisational Boundaries
Authors: Walker Rae , Pietsch Jonathan , Delaney Lisa , Hahn Barry , Wallace Carolyn , Billings Kitty
Published: August 2009

The short paper that follows is fundamentally about evidence-based practice. In Kuruvilla, Mays, Pleasant and Walt's (2006) terms it was an exercise in the application of research to service development and evidence-based practice. In Walter, Nutley, and Davies' (2003) taxonomy it resulted in a professional intervention, the development of which was led by research users seeking evidence to inform practice development. The team emerged out of a social network of individuals interested in partnership development issues (Kalucy, McIntyre, & Jackson-Bowers, 2007). The resulting paper was the foundation for a significant investment, by the Department of Human Services, in building capacity for partnership leadership in Victoria.

The team that undertook this research-to-practice project consisted of three Primary Care Partnership (PCP) executive officers/managers, one of whom was also executive officer to the Statewide Chairs and Managers Group, a university researcher, and a final year undergraduate student working as a volunteer. The executive officer to the Statewide Chairs and Managers Group formed the team to explore broad issues of PCP development and to report to the chairs. The Statewide Chairs and Managers Group was the pathway through which the group's work would reach decision-makers. After a series of meetings to clarify the issues to be addressed, a developmental process for working with the chairs and managers was designed. The executive officers/managers were key to clear issue definition and appropriate process; the researcher to linking the issues to the partnership evidence base. The process relied on tapping the tacit knowledge of PCP managers and chairs and relating this to the relevant body of research. In this process implicit learning needs in regard to partnership leadership were articulated within a framework developed out of a complex research project undertaken with similar partnerships elsewhere.
The university researcher on the team had a long history of research into partnerships and networks in the field of primary health care. The specific research project in question was a National Health and Medical Research Council-funded study of trust in the relationships between organisations in a Primary Care Partnership. The study of trust in a partnership is necessarily a study of partnership processes more generally. It was the general learning about partnership processes from this and related research that turned out to be so useful for the service system.
The report of this work, that follows, was written in a form suitable for decision-making. It is not a research report but it is built on strong research-based frameworks that were "tested" in the local context. The recommendations are specific to PCPs in Victoria but will also be familiar to partnership workers elsewhere. The predicted effects of the recommendations are supported by research evidence.
Editorial
Authors: Walker Rae
Published: August 2009

The Australian Journal of Primary Health provides a voice for researchers, and research informed practitioners, interested in the health of the community and the provision of primary health care services. The Journal builds on a long tradition of multi-disciplinary research and practice in primary care, and reflects widely held values that emphasise illness prevention and social inclusion. The priority placed on prevention and social inclusion by the new Commonwealth Government suggests that our readers may be able to look forward to a more optimistic future than many anticipated only a year ago.
Research Implementing the Flinders Model of Self-management Support with Aboriginal People who have Diabetes: Findings from a Pilot Study
Authors: W. Battersby Malcolm , Ah Kit Jackie , Prideaux Colleen , Harvey Peter W. , Collins James P. , Mills Peter D.
Published: August 2009

A pilot program for Aboriginal people with diabetes on Eyre Peninsula, South Australia, aimed to test the acceptability and impact of using the Flinders model of self-management care planing to improve patient self-management. A community development approach was used to conduct a twelve-month demonstration project. Aboriginal health workers (AHWs) conducted patient-centred, self-management assessment and care planning. Impacts were measured by patient-completed diabetes self-management assessment tool, goal achievement, quality of life and clinical measures at baseline and 12 months. Impact and acceptability were also assessed by semi-structured interviews and focus groups of AHWs. Sixty Aboriginal people with type 2 diabetes stated their main problems as family and social dysfunction, access to services, nutrition and exercise. Problems improved by 12% and goals by 26%, while quality of life scores showed no significant change. Self-management scores improved in five of six domains. Mean HbA1c reduced from 8.74-8.09 and mean blood pressure was unchanged. AHWs found the process acceptable and appropriate for them and their patients. It was concluded that a diabetes self-management program provided by AHWs is acceptable, improves self-management and is seen to be useful by Aboriginal communities. Barriers include lack of preventative health services, social problems and time pressure on staff. Enablers include community concern regarding the prevalence and mortality associated with diabetes.
Developing a Competitive Advantage: Considerations from Australia for the Recruitment and Retention of Rural and Remote Primary Health Workers
Authors: Allan Julaine , Ball Patrick
Published: August 2009

Globally, health workforce shortages in rural and remote areas significantly affect the capability of health systems, both public and private, to deliver their services. Regional and national governments and academic and professional bodies have been active in attempting to address the situation. This paper overviews the extensive human resources literature on recruitment and retention. Findings are contrasted with recent Australian and international research literature investigating health workforce issues. The context of rural health service delivery, workforce issues and recruitment and retention strategies implemented are discussed. Recruitment and retention issues for the rural and remote health workforce would be well understood if human resources knowledge was applied to the problem. However, few retention strategies were identified other than for general practitioners and no analyses of their effectiveness could be found. Health employers need to use the body of knowledge developed in the business sector to implement recruitment and retention strategies consistently, evaluate them and report the findings. "Silos" created by a sector or discipline-specific approach can be broken down by seeking knowledge from a number of disciplines. Health research can then focus on developing models of health care that address professional and community needs.
Strengthening clinical governance in community health
Authors: Brown Alison , Mason Vicky , Lyon Anne
Published: August 2009

This paper outlines the work of the Clinical Governance in Community Health Project that aims to strengthen clinical governance systems in the Victorian community health sector. While clinical governance in community health is not new, the work of the project has aimed to develop a more consistent approach to safety and quality. This represents a strategic response to policy imperatives at a state and national level, which has resulted in a transition to a client population that has greater acuity and complexity in their health and social needs. The project has focused on the areas of clinical risk management, credentialling, defining scope of practice, clinical indicators and board reporting. The project has been evaluated through an annual sector survey which has demonstrated that the majority of respondents have used resources created by the project. Ninety-four per cent of respondents indicated that they had reviewed their clinical governance reporting processes in the previous 12 months. The project has strong governance from a steering group comprised of stakeholders from the community health sector, the acute sector, state government, accreditation agencies and insurance authorities, with the project work being completed by working groups consisting of community health chief executive officers, managers and clinicians. This has resulted in high levels of engagement and ownership by the sector.
Safety and quality in primary care: The view from general practice
Authors: J Booth Barbara , Snowdon Teri , F Harris Mark , Tomlins Ron
Published: August 2009

This article aims to provide a general practice perspective on quality and safety in primary health care. As the health care system has evolved over the past 50 years, so have approaches to ensuring it delivers high quality care. Traditional education has been joined by a range of initiatives from psychological, organisational, marketing, epidemiological and social disciplines. Most of these methods are successful in some situations, but need to be tailored to suit the specific context. There is still imperfect guidance in how to do this. Improvements in performance of 5% to 15% seem to be the best that have been achieved in randomised controlled trials. Quality initiatives in Australian general practice have changed considerably in keeping pace with these developments, moving from an educational paradigm to a more whole-of-system approach. They have been introduced or emerged in ways that are sometimes coherent, sometimes not. Australian general practice is a complex system that is hard to imagine organisationally as a well-oiled machine. The Royal Australian College of General Practitioners has developed a quality framework as a conceptual model to help make sense of the current pattern of quality activities and build a strategic awareness to guide future initiatives.
Editorial
Authors: Gardner Heather
Published: August 2009

The advent of the Australian Journal of Primary Health - Interchange reflects the changes which are taking place in the Australian health sector and the increased and increasing importance of primary health care and community health services. The significant role of primary care in maintaining health and enhancing wellbeing is at last being recognised, and the relationships between primary care, continuing care, and acute care are being redefined and the connections made, so that improvement in continuity of care can be achieved.
The COAG Reforms and Community Health Services
Authors: Duckett Stephen , Hogan Tracie , Southgate Jan
Published: August 2009

Ultimately, the reform directions announced by the Council of Australian Governments (COAG) in April 1995 have the potential to touch all aspects of health care and community wellbeing, and the impact will be felt as much by community health services, and for groups with special needs, such as people from non-English speaking backgrounds, as it will for acute care services.
The View From the Far Side An International Public Health—Primary Care Interface
Authors: Altmann Anne , Robinson Priscilla , Ruff Tilman
Published: August 2009

In this paper, first-hand experience of a three-year project in Indonesia is used to explore the relationship between public health and primary care—disciplines which are too rarely considered in partnership. The Healthy Start for Child Survival Project in Lombok, Indonesia, which has now been running for two years, has integrated them in a way which utilises the strengths of both approaches. The result is a comprehensive series of practical and appropriate health interventions based on the collection of qualitative and quantitative data. Avenues of intervention revolve around active outreach involving both antenatal and postnatal strategies, including strategies to reduce morbidity and mortality from tetanus, hepatitis and acute respiratory infection. The positive effects of these interventions are now visible in the huge improvements to the health status of the local child population. The final stage of the project is designed to identify ways in which the health of the local population can be further improved, and to ensure the sustainability of these interventions after the project has been completed. The extent to which the knowledge gained could be applied to public health and primary care in Australia is discussed.
Communication Between General Practitioners and their Non-English Speaking Patients in Melbourne
Authors: Pirkis Jane , Tallis Graham
Published: August 2009

In this paper, the degree of correspondence between languages spoken by general practitioners (bilingual and monolingual) and their patients; the proportion of general practice consultations at which language is a barrier; ethnic health issues faced by general practitioners; and the extent to which general practitioners make use of interpreters and/or use other strategies to address language barriers, are investigated. The information for the descriptive study was elicited through self-completion questionnaires from general practitioners in the Melbourne Division of General Practice. Of the respondents, 41% were bilingual. However, only 24% of respondents shared a common language with their largest patient language group (other than English). 35% of respondents stated that they came into contact with patients with whom they found it difficult to communicate in English at least once per day. The specific ethnic mix of respondents' practices varied considerably, and respondents who shared a common language with their largest patient group were significantly more likely to have high proportions of their total patient load accounted for by that group. However, 11% of respondents' largest patient groups accounted for over 25% of their total consultations, despite their sharing no common language with this group. The most common strategy for dealing with language barriers was asking a friend or relative to interpret. The use of professional interpreters was relatively uncommon, primarily because of cost and lack of availability.
An Innovative Approach to a Public Podiatry Program
Authors: de Souza Hebe
Published: August 2009

Podiatry services have traditionally been seen to cater for aged people and people with diabetes, providing limited ongoing clinical care at regular intervals. In the following paper, the need for a planned approach to a podiatry program is identified, and the methods used to implement a program that conforms to the Ottawa Charter for Health Promotion (1986) is described.
Best Practice in Primary Health Care
Authors: Legge David , Wilson Gai , Butler Paul , Wright Maria , McBride Tony , Attewell Robyn
Published: August 2009

The purpose of the work reported here was to delineate the strategies of practice which are associated with excellent outcomes in contemporary primary health care in Australia, and to provide wider access to exemplary and illustrative cases. One hundred and eighty five published accounts of primary health care practice were collected and abstracted. Ninety nine of these cases were evaluated, each by a panel of two or three reviewers, and the 25 most highly rated cases were studied in more detail through interviews with the authors and other protagonists. Eight broad strategies of primary health care practice were identified which appeared to have contributed to excellent outcomes in the cases studied: consumer and community involvement; collaborative local networking; strong vertical partnerships; intersectoral collaboration; integration of the macro and micro; organisational learning; policy participation; and good management. Some of the finer elements of practice which are encompassed by each of these broad strategies and some of the dynamics through which they appear to contribute to good outcomes are delineated. Illustrative cases are cited which might serve as benchmarks to inspire and guide the wider pursuit of excellence in primary health care.