bluuebunny/crossref_metadata_2025 huggingface dataset:
The concept of health in older age: views of older people and health professionals
Authors: Giummarra Melita J , Haralambous Betty , Moore Kirsten , Nankervis Joan
Published: February 2010

This study aimed to explore how older people and
health professionals conceptualise health in older
age. Thirty-six older people and 41 health professionals
participated in 10 focus groups (five with
older people and five with health professionals)
and discussed concepts of health, the modifiable
aspects of health, and barriers and motivators to
undertaking health-promoting behaviour change.
Both older people and health professionals were
found to conceptualise health in a holistic manner.
While health professionals tended to place the
source of poor health on failures of social connectedness
and poor service delivery, older people
stressed the importance of taking ownership of
one?s own health and actively seeking out health
promoting activities and services.
Anaesthesia underpins acute patient care in hospitals
Authors: Thompson Walter R , Phillips Garry D , Cousins Michael J
Published: February 2010

The Australian and New Zealand College of
Anaesthetists (ANZCA) carried out a review of the
roles of anaesthetists in providing acute care
services in both public and private hospitals in
Europe, North America and South-East Asia. As a
result, ANZCA revised its education and training
program and its processes relating to overseastrained
specialists. The new training program,
introduced in 2004, formed the basis for submissions
to the Australian Medical Council, and the
Australian Competition and Consumer Commission/
Australian Health Workforce Officials? Committee
review of medical colleges. A revised
continuing professional development program will
be in place in 2007.
Anaesthetists in Australia and New Zealand play a
pivotal role in providing services in both public and
private hospitals, as well as supporting intensive
care medicine, pain medicine and hyperbaric
medicine. Anaesthesia allows surgery, obstetrics,
procedural medicine and interventional medical
imaging to function optimally, by ensuring that the
patient journey is safe and has high quality care.
Specialist anaesthetists in Australia now exceed
Australian Medical Workforce Advisory Committee
recommendations
Let's talk governance
Authors: Leggat Sandra G
Published: February 2010

AS THE Letters to the Editor illustrate, governance,
both good and bad, can influence the effectiveness
of the health care system. As reported by Dr
Playford and her colleagues (page 6), the health
workforce and educational leaders in Western Australia
suggested our lack of effective interprofessional
education required a ?good? governance
solution ? the government needed to fund, plan,
implement and monitor interprofessional education.
On the other hand, Dr Ranmuthugala suggested
that the continuing stream of health care
crises was a direct result of our apparent inability
to take a systems approach (page 5), which could
be argued is a symptom of ?bad? governance.
This issue launches a new section on Health
Care Governance. According to Wikipedia, most
simply put, ?Governance consists of assuring, on
behalf of those governed, a worthy pattern of
good while avoiding an undesirable pattern of
bad?. Therefore by definition, health system governance
would focus on planning, implementing
and evaluating the necessary structures and processes
to maximise good health outcomes and
minimise the bad or adverse outcomes. But for
some reason in health care our governance of the
system, the organisations and the individual providers
was not seen to be effective in promoting
good clinical outcomes and limiting bad clinical
outcomes. This necessitated the introduction of
?clinical governance? in the 1990s. Braithwaite
and Travaglia track the progression of clinical
governance in the first Health Care Governance
paper (page 10). In addition, Johnstone and Geelen-
Baass present a paper on business continuity
? an important concern of all governing bodies
(page 161).
Exploring experiences and attitudes about health care complaints among pregnant women, mothers and staff at an Opioid Treatment Service
Authors: Finney Lamb Cathryn E , Boers Marijke , Owens Angela , Copeland Jan , Sultana Tanya
Published: February 2010

There is little information about managing frontline
complaints with opioid-dependent women. Semistructured
interviews were conducted with a purposive
sample of 13 opioid-dependent women
and 10 staff at an Opioid Treatment Service. A
multidisciplinary team conducted a thematic analysis
on the transcripts. Difficulties that prevented
women making complaints included the anticipation
of not being taken seriously, the fear of
repercussions including infant removal, and practical
difficulties in making written complaints. Staff
reported that complaints at the dosing window
were often delivered emotively and could be personalised.
They had difficulty assessing complaints
to determine whether there were
substantive health care issues that should be
followed up. Women and staff believed that case
managers had a role in providing support for the
complaints process.
Teaching professional health care practice: considering the elements of emotions and artistry
Authors: Lehmann Jennifer
Published: February 2010

This commentary addresses the need to maintain
a role for emotions and artistry in human services
and health care practice and discusses some
approaches to including these issues in teaching
at the tertiary level.
Supporting the transition from student to professional — a case study in allied health
Authors: Smith Robyn , Pilling Samantha
Published: February 2010

Allied health graduates are entering an increasingly
complex and demanding workforce. They
require a mix of clinical competencies and broader
professional skills. Making the transition from the
learning environment of university to the workplace
can be difficult and challenging. Graduate
support programs are common in nursing and
medicine, but not in allied health. This case study
reports on the implementation and outcomes of a
structured program for allied health practitioners
making the transition from student to professional.
Implications for the health service and for education are discussed.
Options for expanding the health workforce
Authors: Brooks Peter M , Robinson Lynn , Ellis Niki
Published: February 2010

Health workforce reform remains a major challenge
for Australia. The recent Productivity Commission
report provided some guidance, but,
sadly, few of the recommendations have been
implemented. Health economies (and with them
the health workforce) will continue to expand as
the burden of disease increases. The important
issue is to expand the current workforce but
provide for a generalist stream that allows flexibility
and retraining. The future health workforce
needs to be able to provide patient-centred care,
to have a focus on public health and disease
prevention, use information and the new communication
technologies, to be able to work as part of
a team and partner with a range of organisations
and to be dedicated to quality improvement within
the health system.
From the book review editor
Authors: Day Gary
Published: February 2010

THIS EDITION of Australian Health Review brings together two useful and practical local texts, one dealing
with the drivers that shape and determine the health and wellbeing of our Australian Indigenous
population, and the other exploring the approaches and skills for working with communities around
health and human services.
Evaluation of a hospital volunteer program in rural Australia
Authors: Radha Prabhu V , Hanley Armita , Kearney Sue
Published: February 2010

A voluntary survey questionnaire that assessed
experience with and perception of the volunteering
program was mailed to 62 current and 9
former volunteers and 47 staff members of
Latrobe Regional Hospital (LRH). Sixty-one completed
questionnaires were returned.
The nature of hospital work attracted volunteers
(57%) and most volunteers felt oriented to the
hospital, supervised and supported. The volunteers
enjoyed working with patients and felt they
contributed to better services and staff and patient
support. There was a need felt that more training
and development, recognition, orientation and
supervision would be beneficial. Overall, most
volunteers rated their experience as good (60%)
to excellent (25%). Staff rated the contribution
from volunteers as good (41%) to excellent (47%).
Volunteers identified several areas of improvement,
including opportunities for further training
and supervision.
Volunteers play a crucial role within the health
care system. There is tremendous scope for further
development of the volunteer role and
increasing opportunities for training and development, recognition and encouragement.
The Australian health care system: reform, repair or replace?
Authors: Duckett Stephen J
Published: February 2010

A Festshrift gives us the opportunity to look both
backwards and forwards. Ken Donald?s career
stretches back to his intern days in 1963 and has
encompassed clinical and population health, academe,
clinical settings and the bureaucracy, and
playing sport at state and national levels. There
has been considerable change in the health care
system over the period of Ken?s involvement in the
sector with more change to come ? where have
those changes left us? This paper discusses
these changes in relation to performance criteria.
Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes
Authors: Harvey Peter W , Petkov John N , Misan Gary , Fuller Jeffrey , Battersby Malcolm W , Cayetano Teofilo N , Warren Kate , Holmes Paul
Published: February 2010

The Sharing Health Care SA chronic disease selfmanagement
(CDSM) project in rural South Australia
was designed to assist patients with chronic
and complex conditions (diabetes, cardiovascular
disease and arthritis) to learn how to participate
more effectively in the management of their condition
and to improve their self-management skills.
Participants with chronic and complex conditions
were recruited into the Sharing Health Care SA
program and offered a range of education and
support options (including a 6-week peer-led
chronic disease self-management program) as part
of the Enhanced Primary Care care planning process.
Patient self-reported data were collected at
baseline and subsequent 6-month intervals using
the Partners in Health (PIH) scale to assess selfmanagement
skill and ability for 175 patients across
four data collection points. Health providers also
scored patient knowledge and self-management
skills using the same scale over the same intervals.
Patients also completed a modified Stanford 2000
Health Survey for the same time intervals to assess
service utilisation and health-related lifestyle factors.
Results show that both mean patient self-reported
PIH scores and mean health provider PIH scores
for patients improved significantly over time, indicating
that patients demonstrated improved understanding
of their condition and improved their ability
to manage and deal with their symptoms. These
results suggest that involvement in peer-led selfmanagement
education programs has a positive
effect on patient self-management skill, confidence
and health-related behaviour.
The benefit and burden of "ageing-in-place" in an aged care community
Authors: Horner Barbara , Boldy Duncan P
Published: February 2010

Ageing-in-place is usually viewed as a positive
approach to meeting the needs of the older person,
supporting them to live independently, or with
some assistance, for as long as possible. It
implies that older people prefer to live in their own
home, rather than in an institution or care centre.
However, there is little in the literature about the
implications of ageing-in-place for the individual or
their carers, or the burden this can place on
service providers and aged care communities.
In an action research study that investigated the
complexities and challenges of change in an aged
care community in Western Australia, the implications
of ageing-in-pace were apparent. The study
revealed how residents expressed a desire to agein-
place and identified it as a critical element of
quality of life and an important component of
social connection. The findings also revealed the
burden of ageing-in-place on carers, family and
the organisation, and sufficient attention must also
be paid to the wider impact on the individual, the
family and carers.
The Australian social inclusion agenda
Authors: Leggat Sandra G
Published: February 2010

LAST MONTH we saw the first meeting of the
Australia Social Inclusion Board. Members of the
Board ? Ms Patricia Faulkner, Monsignor David
Cappo, Ms Elleni Bereded-Samuel, Dr Ngaire
Brown, Mr Eddie McGuire, Mr Ahmed Fahour,
Professor Fiona Stanley and others ? are charged
with ensuring that every Australian has the
opportunity to be a full participant in the life of
the nation.1 In government terms, this means all
Australians have the opportunity to: secure a job;
access services; connect with family, friends,
work, personal interests and local community;
deal with personal crisis; and have their voices
heard.2 Monsignor Cappo has defined a socially
inclusive society as ?one where all people feel
valued, their differences are respected, and their
basic needs are met so they can live in dignity?.3
This issue of the journal explores social inclusion
from health care perspectives.
A survey of rehabilitation services in Australia
Authors: Graham Susan K , Cameron Ian D
Published: February 2010

A survey, which achieved a 54% response rate,
was completed to assess the availability and type
of rehabilitation health services in Australia. 1044
surveys were sent out and 561 were returned. The
details of a total of 346 rehabilitation services were
obtained. There were more services in metropolitan
compared with rural areas, more services in
New South Wales and Victoria than in the other
states, and a higher proportion of services led by
health care workers other than rehabilitation physicians
in rural compared with metropolitan areas.
There is likely to be a need for additional rehabilitation
services of all types across Australia. The
majority of rural, regional and remote areas are
likely to need additional physician-led, allied
health and nursing services. Further work is
needed to assess the size and catchment areas of
services in the capital cities and other large
population centres to assess whether additional
services are also needed in these areas.
Did general practice health assessments of older Australians improve equity?
Authors: Gill Gerard F , Geraghty Dominic P , FitzGerald Des G
Published: February 2010

Objective: To examine if claims for general practice
health assessments of older persons in Australia
over the period 1 November 1999 to 30
September 2002 were equitably distributed.
Design: Closed cohort study with data analysis
using logistic regression.
Setting: Private general practice in Australia.
Participants: All Australians aged 75 or more
years at 1 October 1999, who were eligible to
claim for a health assessment.
Measures studied: Medicare and Department of
Veterans? Affairs (DVA) medical claims data, and
personal characteristics of claimants: age, sex,
DVA beneficiary status, rurality and socio-economic
status of postcode of residence. Rurality was
classified by the Rural Remote and Metropolitan
Area Classification (RRMA) and socio-economic
status by the Index of Relative Socio-economic
Deprivation (IRSD) for the postcode.
Results: The cohort initially contained 886 185
subjects. Over the 35 months, 271 939 individuals
(31%) claimed at least one health assessment.
Those most likely to have claimed for a
health assessment were aged 80 to 84 years,
female, entitled to treatment under DVA arrangements,
lived in postcodes classified as RRMA
1?4 and classified as the most disadvantaged
IRSD quartile.
Conclusion: Over this period, general practice
health assessments appear to have been equitably
distributed except for those living in postcodes classified as RRMA 5?7.
Models of Care: Editorial
Authors: Yarmo-Roberts Deborah
Published: February 2010

THERE ARE TWO articles featured in the Models
of Care section; a research article entitled
?Measuring person-centred care in a subacute
health care setting? by Davis et al
(page 496) and a case study entitled ?Planning
for transition care? by Crombie and colleagues
(page 505). Both articles focus on client care
during a time period when clients require
clinical support but not the extent of care they
needed on admission to the hospital. Often
this means use of less costly equipment and
professional services. Sometimes this care is
provided in a unit or units attached to a
hospital and sometimes in stand-alone facilities.
This sub-acute system of care was largely
introduced to keep acute costs down while
meeting the growing demand for clients who
were too ill to return to their home.
Projected acute inpatient activity in New South Wales — aIM2005
Authors: Jones Neill , Hardes Greg , Ryan Stephen , Sheehan Jennifer , Cox Cathryn , Meleady Kathy , Jayasinha Hirani
Published: February 2010

Objectives: To describe the statewide projections
of acute inpatient activity in New South
Wales.
Methods: Data on acute inpatient activity in
NSW for the period 1998?1999 to 2003?04
were derived from the Admitted Patient Data
Collection. Regression analysis was used to
project trends in utilisation and length of stay by
age group, clinical specialty groups and stay
type (day-only and overnight). The projected
separation rates and length of stay were subject
to clinical review. Projected separation rates (by
age group, clinical speciality and stay type)
were applied to NSW population projections to
derive the projected number of separations.
Bed-days were calculated by applying projected
overnight average length of stay.
Results: Total acute inpatient activity in NSW
public hospitals is projected to increase from
around 1.05 million separations in 2004 to around
1.3 million separations by 2017 (24%). Same-day
separations are projected to increase from around
368 000 to around 514 000 (40%). Overnight separations
are projected to rise from around 690 000
in 2003?04 to around 798 000 in 2016?17 (18%).
Overnight bed-days are projected to increase from
around 3.7 million in 2003?04 to around 4.1
million bed-days in 2017 (12%). Differences
across age groups and clinical specialties are also
evident from the modelling.
Workload capacity measures for estimating allied health staffing requirements
Authors: Schoo Adrian M , Boyce Rosalie A , Ridoutt Lee , Santos Teresa
Published: February 2010

Workforce planning methodologies for the allied
health professions are acknowledged as rudimentary
despite the increasing importance of these
professions to health care across the spectrum of
health services settings. The objectives of this
study were to (i) identify workload capacity measures
and methods for profiling allied health workforce
requirements from a systematic review of the
international literature; (ii) explore the use of these
methods in planning workforce requirements; (iii)
identify barriers to applying such methods; and
(iv) recommend further action.
Future approaches to workforce planning were
explored through a systematic review of the literature,
interviews with key stakeholders and focus
group discussions with representatives from the
different professional bodies and health agencies
in Victoria.
Results identified a range of methods used to
calculate workload requirements or capacity. In
order of increasing data demands and costliness
to implement, workload capacity methods can be
broadly classified into four groups: ratio-based,
procedure-based, categories of care-based and
diagnostic or casemix-based. Despite inherent
limitations, the procedure-based measurement
approach appears to be most widely accepted.
Barriers to more rigorous workforce planning
methods are discussed and future directions
explored through an examination of the potential
of casemix and mixed-method approaches.
Drug treatment clients' readiness for hepatitis C treatment: implications for expanding treatment services in drug and alcohol settings
Authors: Treloar Carla , Holt Martin
Published: February 2010

This study explores the perception of and readiness
for hepatitis C treatment within a sample of 77
clients already participating in drug treatment, with
a view to identifying likely barriers and incentives to
hepatitis C treatment within a drug treatment population.
Participants with hepatitis C did not demonstrate
a consistent, indepth knowledge of the
infection, lacked confidence in symptom recognition,
and had little awareness of treatment options.
Those without obvious symptoms or liver deterioration
did not have a pressing interest in treatment,
and many had heard concerning stories about the
side effects of hepatitis C treatment. For those
coping with anxiety or depression, the increased
risk of a depressive episode under interferon treatment was a major barrier to treatment.
Turnaround in an aged persons' mental health service in crisis: a case study of organisational renewal
Authors: Stafrace Simon , Lilly Alan
Published: February 2010

This case study demonstrates how leadership
was harnessed to turn around a decline in the
performance of an aged persons? mental health
service ? the Namarra Nursing Home at Caulfield
General Medical Centre in Melbourne, Australia.
In 2000 the nursing home faced a crisis of public
confidence due to failings in the management of
quality, clinical risk and human resources within
the service. These problems reflected structural
and operational shortcomings in the clinical directorate
and wider organisation. In this article, we
detail the process of turnaround from the perspective
of senior executive managers with professional
and operational responsibility for the
service. This turnaround required attention to local
clinical accountability and transformation of the
mental health program from a collocated but operationally
isolated service to one integrated within
the governance structures of the auspicing organisation.
Waiting lists: waiting for the evidence!
Authors: Bradfield Owen M
Published: February 2010

On 26 February 2008, Victorian State Opposition
Leader Ted Baillieu described as a ?blow out? the
increase in average elective surgery waiting times
from 202 days in September 2007 to 235 days in
February 2008. Likewise, the Australian Medical
Association is concerned that 800 000 Australians
will leave private health insurance now that the
federal government has increased the income
threshold for the Medicare levy. They warn of
?further pressure? on public hospital waiting lists.
Public hospital waiting lists are frequently used for
political point scoring and are portrayed by the
media and politicians as indicators of health system
performance. Alarmingly, governments often
develop policies in response. This paper presents
the current evidence to see whether waiting lists
are valid indicators of health system performance
and presents some advice for policymakers.
The challenges of change management in Aboriginal community-controlled health organisations. Are there learnings for Cape York health reform?
Authors: Coombe Leanne L
Published: February 2010

The health status of Aboriginal and Torres Strait
Islander peoples continues to be significantly
poorer than Australia?s general population. Clearly
there is a need for change, hence the renewed
interest in transitioning to a community control
model for health services as a health intervention.
Yet this requires a significant change management
process, which is a process developed using
Western business philosophies, and may not be
applicable for community-controlled services that
need to operate within the Aboriginal cultural
domain.
This paper examines the literature on organisational
change management processes, and features
of Aboriginal community-controlled health
organisations and Aboriginal management styles.
It identifies challenges and synergies that can be
used to inform more effective transition processes
to a community-control model for health services.
The findings also highlight the need for a fundamental
systems change approach to achieve such
major reform agendas through the creation of a
?collective responsibility? to achieve the vision for
change, utilising participatory change management processes both internally and externally.
Primary care presentations at emergency departments: rates and reasons by age and sex
Authors: Siminski Peter , Bezzina Andrew J , Lago Luise P , Eagar Kathy
Published: February 2010

Primary care presentations at emergency departments
(EDs) have been the subject of much
attention in recent years. This paper is a demographic
analysis using administrative data from
the Emergency Department Information System
(EDIS) for 2005 of such presentations in New
South Wales EDs and of self-reported reasons for
presentation. Age and sex differences in the reasons
given by patients for such presentations are
analysed using data from a survey of patients
conducted in a subset of EDs in 2004.
The rate of ?potential primary care? presentations
varies greatly with age and to a lesser extent with
sex. Almost half (47%) of these presentations are
made by people under 25 years of age. Children
aged 0?4 years account for 14% of the total. The
pattern is distinctly different to the corresponding
rate of ED presentations that do not fit the ?potential
primary care? definition. Reasons given for ?potential
primary care? presentations are consistent
across all age groups, reflecting self-assessed
urgency, access to diagnostics and self-assessed
complexity. Older ?primary care? patients are particularly
unlikely to give reasons associated with GP
affordability or availability for their presentations.
Young adults? responses are consistent with the
overall population, and children under the age of
five seem most susceptible to availability issues.
The economic crisis, the Pharmaceutical Benefits Scheme, and the dilemmas of medicines policy
Authors: Löfgren Hans
Published: February 2010

AS THIS SPECIAL ISSUE of Australian Health Review
was finalised, the media reported daily on the
global financial debacle and its deepening into a
crisis in the real economy. The causes of the crisis
are hazy ? but its impact, across the globe, on
people?s lives is real and distressing. Many people
are affected by worsening poverty and deteriorating
access to health services and medicinal drugs.
In the United States, unemployment often means
the loss of health insurance, reinforcing risks of
financial and social disaster for many families
who would have previously considered themselves
comfortable middle class. For those lucky
enough to retain jobs, the cost of health insurance
may rapidly become unaffordable; ?Healthcare a
Budget-Buster for Families; Even County?s Middle
Class Can?t Afford It?, ran a typical recent headline
in a non-metropolitan newspaper.1
Even before the present crisis, tens of millions
of Americans were excluded from health insurance.
Those not excluded pay premiums to insurance
companies that spend vast resources trying
to insure the healthy, avoid the sick, and deny
payment for claims wherever possible. Gaining
power partly on a wave of resentment against the
excesses of neo-liberalism, President Barak
Obama has promised public health insurance for
those not otherwise covered. Should this reform
be successfully implemented, it will belatedly
bring to US citizens a level of security approximating
what Australians, and many Europeans,
have had for decades.
The PBS in a globalised world: free trade and reference pricing
Authors: Searles Andrew
Published: February 2010

In January 2005 Australia implemented the Australia?
United States Free Trade Agreement (AUSFTA).
The agreement had placed domestic health
policy and the Pharmaceutical Benefits Scheme
(PBS) in particular, on the trade negotiating table.
At the time Australians were told the PBS would
not be undermined, but why was it included in a
trade agreement? This article argues that recent
reforms to the PBS partially delivered on an issue
that the US has compelled its trade negotiators to
ensure since 2002: the elimination of reference
pricing. In Australia, reference pricing, as used by
the PBS, had been credited with obtaining money
when buying new medicines.
The impact of copayments and safety nets on PBS expenditure
Authors: Sweeny Kim
Published: February 2010

This article discusses the impact on patients of
changes in copayments and safety net thresholds
(SNT) within the Pharmaceutical Benefits Scheme
(PBS). Trends in the nominal and real values of
copayments and SNTs are examined, as are
changes in the numbers of types of patients. The
relationship between the number of safety net
cardholders and copayments and SNTs is estimated.
Increases in the number of copayments
necessary to reach the safety net threshold
restrict the number of patients able to benefit from
this provision. Policy for determining the levels of
copayments and safety net thresholds needs to be
put on a rationale basis in a way similar to the
determination of prices for PBS medicines.
Policy challenges of nanomedicine for Australia's PBS
Authors: Faunce Thomas A
Published: February 2010

All major pharmaceutical companies are currently
investing significantly in the development of medicines
with a nanotechnology component. Such
research promises therapeutic drugs with greater
efficacy and a wider range of clinical indications.
Nanomedicines are just beginning to enter drug
regulatory processes, but within a few decades
could comprise a dominant group within the class
of innovative pharmaceuticals. The current thinking
of government safety and cost-effectiveness
regulators appears to be that these products give
rise to few if any nano-specific issues. This article
challenges that proposition and seeks to explore
what features of nanomedicines may create
unique or heightened policy challenges for government
systems of cost-effectiveness regulation.
The Australian Pharmaceutical Benefits Scheme
(PBS) is a key exemplar of the latter type of
regulation in that it links expert scientific evaluation
of cost-effectiveness with the pricing of PBSlisted
drugs. In the current global financial crisis
such systems are likely to become increasingly
attractive and how they handle the demands
made upon them by nanomedicines (including by
application of a variation of the precautionary
principle) is likely to be of considerable interest to
policy makers worldwide.
Medicines policy and drug company investments: the Irish experience
Authors: Lofgren Hans
Published: February 2010

THIS BOOK IS ABOUT MANIFESTATIONS of power in
medicines and pharmaceutical industry policy.
The main focus is on the Republic of Ireland but
there are chapters also on drug regulation in
Canada, Britain and Australia. The multinational
pharma companies loom larger in Ireland than in
most other countries; several chapters detail the
implications for this small country of the presence
of a major cluster of global drug companies.
Globalisation is the hallmark of the drug sector;
innovation and production occur within international
networks which are mirrored by interaction
between regulatory agencies which operate
similar systems of control and monitoring. Since
the 1990s, many aspects of product safety regulation
have been standardised across the developed
countries through the International Conference
on Harmonization (ICH) process, sponsored by
the regulatory agencies and industry associations
of the USA, the European Union and Japan.
While orchestrating vast scientific, economic and
technological resources, the big pharma companies
participate as insiders in national policy
processes, such as those described in this book.
Firms typically affirm a commitment to the health
and economic concerns of the local jurisdiction
? however governments cannot help but be
sensitive to their global reach and power to
choose where to invest.
Editorial: Models of Care
Authors: Yarmo-Roberts Deborah
Published: February 2010

PERCEPTIONS MAKE A DIFFERENCE. We all have
perceptions based on information at hand, our
gender, education, culture, history, values, likes
and dislikes. Based on our perceptions, we formulate
opinions and make decisions (or don?t
make decisions) that affect us and others around
us. Our perceptions influence everything from
our personal matters such as our friends and
partners to purchasing decisions, to our health
and even who we vote for in public office.
People with an intellectual disability in the discourse of chronic and complex conditions: an invisible group?
Authors: Tracy Jane M
Published: February 2010

TO THE EDITOR: Goddard et al, authors of ?People
with an intellectual disability in the discourse of
chronic and complex conditions: an invisible
group??1 are to be congratulated for raising discussion
about one of the most vulnerable groups
in Australia with respect to their receipt of optimal
health care. The authors conclude that
?developing interventions and strategies to
increase the knowledge of health care workers . . .
caring for people with intellectual disabilities will
likely improve the health care needs of this
population and their families?. In relation to this
identified need for health professional education
and training in the care of people with intellectual
disabilities, we would like to draw the attention
of your readers to some work undertaken by the
Centre for Developmental Disability Health Victoria
(CDDHV) to address this issue.
The CDDHV works to improve the health and
health care of people with developmental disabilities
through a range of educational, research and
clinical activities. In recent years there has been
an increasing awareness of the need for health
professional education in this area. Moreover, as
people with disabilities often have chronic and
complex health and social issues, focusing on
their health care provides a platform for interprofessional
education and a springboard for understanding
the essential importance and value of
interprofessional practice.
Recently, the CDDHV has taken a lead role in
developing a teaching and learning resource that
focuses both on the health care of people with
disabilities and on the importance and value of
interprofessional practice. This resource promotes
and facilitates interprofessional learning, and
develops understanding of the health and health
care issues experienced by people with disabilities
and those who support them.
?Health and disability: partnerships in action? is a
new video-based teaching and learning package,
produced through an interprofessional collaboration
between health professionals from medicine,
nursing, occupational therapy, physiotherapy,
paramedic practice, health science, social work,
speech pathology, dietetics and dentistry. Those
living with a disability are the experts on their
own experience and so their direct involvement
in and contribution to the education of health
care professionals is essential. The collaboration
between those featured in the video stories and
health professionals has led to the development of
a powerful resource that facilitates students and
practitioners developing insights into the health
and health care issues encountered by people
with developmental disabilities. We also believe
that through improving their understanding of,
and health provision to, people with disabilities
and those who support them, health professionals
will acquire valuable attitudes, knowledge and
skills applicable to many other patients in their
practice population.
Jane M Tracy
Education Director
Centre for Developmental Disability Health Victoria
Melbourne, VIC
AHR Moving forward
Authors: Leggat Sandra G
Published: February 2010

It is with growing sadness (but with expectations of time for some new activities in my life) that I announce that this is my final issue as editor of Australian Health Review (AHR). The new editor, Dr Gary Day from Griffith University in Queensland, is well suited to take over, with continued support from Dr Deborah Roberts, the Models of Care editor, and from the Editorial Board.

Australian Health Review is over 30 years old and has achieved growing recognition both nationally and internationally. It has been a pleasure to have contributed to this excellent journal. The landscape of Australian health policy and management journals has changed over the past few years and further changes, to better meet the needs of authors and readers, are in store for AHR in 2010 and beyond.

Over my tenure as editor, with much assistance from Professor Judith Dwyer, Dr Deborah Roberts, Dr Gary Day, Prue Power and the Editorial Board, and the publishing team at the Australasian Medical Publishing Company, we have achieved many milestones. Amalgamation of AHR with other journals will continue to strengthen the Australian presence in international scholarly publications. The online manuscript service has proved an efficient and effective mechanism for authors, reviewers and editors. The number of papers submitted for consideration has continued to grow, with over 100 papers submitted each year, of which about 60% are published. This large number of papers has meant that I am enormously grateful to the AHR reviewers. The 2009 reviewers are acknowledged in this issue (page 696). Thank you for volunteering your precious time to this most important task. The large number of papers has also meant that the page numbers of each issue have crept up to try to ensure authors do not have to wait too long to see their work in print.

This year we established the Australian Health Review student paper awards, and in this issue we have published the undergraduate (page 541) and postgraduate (page 549) student award papers. Please ensure you read these excellent papers by Australian students.

We have had an impressive set of guest editors who demonstrate the importance of AHR in Australian health policy and management and who enabled the journal to present at the forefront of key developments in these areas.

This issue has a wide variety of papers on topics such as health information, health service utilisation, models of care, public health, quality and safety and workforce ? areas of critical importance for health policy and management now and into the future.

Best wishes for the future.

Signing off now,

Sandra G Leggat, Editor

Australian Health Review.
Trends in the paramedic workforce: a profession in transition
Authors: Joyce Catherine M , Wainer Jo , Archer Frank , Wyatt Andrea , Pitermann Leon
Published: February 2010

Ambulance services play a key role in the Australian health system, as the primary providers of pre-hospital clinical care, emergency care and specialised transport.1 Although at present there is a strong focus on broad health system reform, and health workforce reform specifically, little attention has been paid to the place of pre-hospital clinical care and the paramedic workforce that provides these services. Despite their significant role in the health system, there is no strategic national approach by government to the development of ambulance services or the paramedic workforce.

In this paper, we review current and emerging trends impacting on the paramedic workforce. We examine changes in patterns of ambulance service provision and the nature of clinical work undertaken by paramedics, as well as developments in education, training and career pathways. We focus on the current situation in Victoria to illustrate and identify a number of important implications of current changes, for the profession, service and training providers, and policy makers.
Refugees and oral health: lessons learned from stories of Hazara refugees
Authors: Finney Lamb Cathryn E , Michaels Cecily , Klinken Whelan Anna
Published: February 2010

Australia is one of a few countries with a resettlement program for refugees. The organisation and provision of health services for refugees pose challenges to health service managers and service providers. Some groups have experienced severe trauma and, in the case of Hazara refugees, years of persecution and displacement. This qualitative study gained access to Hazara refugees in order to gain an understanding of their oral health experiences and to seek participant views on factors that impacted on their oral health status. All participants had poor oral health status, multiple tooth extractions, and had placed a low priority on their oral health. They had experienced violence and traumatic events associated with war and looting. Participants reported that they had limited access to dental practitioners and oral education; lived for extended periods with oral pain and untreated oral problems; and treated oral pain with traditional pain remedies and tooth extractions. Service providers need to consider that elements of the refugee experience may affect health-seeking behavior and adherence to treatment.
Patient and carer perceptions of cancer care in South Australia
Authors: Beckmann Kerri R , Olver Ian N , Wilson Brenda , Roder David M , Foreman Linda M , Young Graeme P
Published: February 2010

Quality of care from the patient?s perspective is an increasingly important outcome measure for cancer services. Patients? and carers? perceptions of cancer care were assessed through structured telephone interviews, 4?10 months post-discharge, which focused on experiences during the most recent hospital admission. A total of 481 patients with a primary diagnosis of cancer (ICD-10 C codes) were recruited, along with 345 carers nominated by the patients. Perceptions of clinical care were generally positive. Less positive aspects of care included not being asked how they were coping, not being offered counselling, and not receiving written information about procedures. Results also highlighted inadequate discharge processes. Carers were more likely than patients to report negative experiences. Perceptions of care also differed by cancer type.
Physiotherapy-led triage clinic for low back pain
Authors: Blackburn Megan S , Nall Cary , Cary Belinda , Cowan Sallie M
Published: February 2010

The aims of this study were to evaluate a physiotherapy-led triage clinic (PLTC) and investigate general practitioner satisfaction with the PLTC. A retrospective cohort study was undertaken from January to December 2005 at a Melbourne tertiary teaching hospital. Outcomes assessed included waiting times to first appointment, patient attendance and surgery conversion rates. Outcomes were compared with the hospital 2002 benchmark data. GP satisfaction was evaluated by a survey.

One-hundred and five new patients attended the PLTC clinic during the evaluation period. Patients waited 9 weeks for a PLTC appointment compared with 26 weeks for the general orthopaedic clinic and 23 weeks for the spinal orthopaedic clinic. Sixty-seven percent of the patients triaged in the PLTC were discharged from the orthopaedic outpatient department without requiring an orthopaedic surgeon consultation. Referring GPs were at least as satisfied with the management of their patients through the PLTC as with usual management in the general orthopaedic clinic.

A PLTC can significantly reduce waiting times for orthopaedic outpatient appointments in a public hospital. Many patients can be managed by these experienced physiotherapists and their GPs, without the need for face-to-face contact with an orthopaedic surgeon. Pilot results indicated that GPs whose patients are managed in this PLTC were satisfied with this model for their patients with low back conditions.
Information systems for community health: are we addressing the right strategy?
Authors: Jayasuriya Rohan
Published: February 2010

Computerised information systems for community health services have evolved withadvances in information technology (IT) in Australia and overseas. However, thereis evidence from other sectors for the need to distinguish between an informationsystems (IS) strategy and an IT strategy. This paper uses case studies of computerisedinformation systems developed in New South Wales to identify issues that lead tosuccess and failure. These issues show that many of the shortcomings can beattributed to a poor IS strategy. The paper discusses the shortcomings of an IT-drivenstrategy. It argues that an IS strategy needs to be congruent with the organisationalstrategy for community health and that the system design should satisfy theinformation needs of service personnel if the information is to be used.
The strategy of casemix
Authors: Dowling John
Published: February 2010

While the political debate rages over whether casemix brings economic benefitsfor Australian health care, managers are observing a pragmatic change to theirbusiness and some are using casemix to understand and manage their businessbetter. Casemix is a useful tool in this environment of increasing managementaccountability and process re-engineering.This article reviews casemix from a process innovation perspective; commentson its real use for strategic health care management; and suggests a simple matrixused by St John of God hospitals throughout Australia to implement and measureprogress towards quality casemix-managed hospitals. The management motivationfor this matrix was to promote hospital resourcing decisions supplemented bycasemix information.
Australian registered nurses and sex-based harassment in the healthcare industry
Authors: Madison Jeanne , Gates Richard
Published: February 2010

This paper discusses sex-based harassment in the nursing profession in Australia. Thepaper generates industry-specific hypotheses which may provide insights into sex-basedharassment in the Australian context. A good understanding of sex-based harassmentin health care is essential for reducing and eliminating the problem and its toxicsequelae.
Best practice in the health sector
Authors: Podger Andrew
Published: February 2010

The Commonwealth Government is increasing its emphasis on public health andquality of care, which will require a capacity to measure health outcomes and developstrategies for continuous improvement. The reforms being considered by the Councilof Australian Governments (COAG) are designed to improve the quality of healthservices by allowing the Commonwealth to concentrate on broader strategic analysisand performance measures. The health industry will need to take a pivotal role inimproving service delivery through collaboration with industry leaders and aimingfor best practice.
Silk road: Opportunities for foreign-owned health care clinics in China
Authors: Kin Lee Tin
Published: February 2010

Hospitals and other health care providers are being squeezed by decliningreimbursement and capitated revenues. As this happens they are looking to expandinto rapidly developing and newly industrialised countries. This article will focus onthe People?s Republic of China as a country with opportunities for developing privatehospitals and health care facilities.
Patient outcomes paramount
Authors: Adams Tony
Published: February 2010

Rejoinders to ?Why a traditional health outcomes approach will fail in health care?
The hospital financing system in Germany
Authors: Oswald Beate
Published: February 2010

In common with other western countries, German health expenditure had been increasing at a rapid rate in recent years, especially in the hospital sector. This paper describes the reaction of the German legislator and summarises what has happenedover the last few years following the introduction of the extensive Legal Reform Act.The paper puts the main emphasis on a new differentiated benefit system for hospitals, which is a requirement from 1996 onwards, after a transitional period. It shows the single components and the modalities of the new system and the possibilities of combining the new types of payment.