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The views expressed here are based on my professional experience as a consultant obstetrician, and previous role as clinical head of service for a small (<1800 births/year) obstetric unit in Perth metro. The obstetric unit in which I work has no 24/7 on‐site staffed theatre capacity, no high dependency unit, and at night is staffed by a resident medical officer and junior obstetric registrar, with a consultant on‐call within 30 min travel time. Based on my review of the literature on obstetric services nationally and various state guidelines (see Sources section), other Australian metro‐located obstetric services appear to have similar challenges, but in this paper I focus on the health service models and patient safety systems that I am most familiar with (Perth metro) and ask why obstetric services in this, and by inference, other areas of the country which have similar high population density, would continue to have these staffing/service profiles. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a major and growing public health issue. Multidisciplinary tertiary pain services cannot meet patient demand and greater involvement of primary care is needed. The aims of this study were to understand the needs and priorities of Australian primary health networks (PHNs) related to the management and secondary prevention of chronic pain; map current PHN chronic pain initiatives and identify gaps; highlight key enablers to implementation; and highlight solutions identified by PHNs to increase capacity to commission initiatives. Methods: Mixed methods were used, including: a review of PHN needs assessments; and consultation with PHN executive-level staff and program managers from 27 out of the 28 PHNs, and the WA Primary Health Alliance (WAPHA – a state alliance between three Western Australian PHNs) via telephone interviews, online surveys, a workshop, a deliberative dialogue and email consultation. Results: Chronic pain was identified as a health and/or service need by approximately half of PHNs. Barriers for PHNs to identifying chronic pain as a need or priority are highlighted. Gaps identified by the mapping included: initiatives related to the secondary prevention of chronic pain (post-surgery or post-injury), digitally enabled consumer and health professional chronic pain initiatives, and chronic pain initiatives for specific populations groups such as Aboriginal and Torres Strait Islander people. Among existing PHN practice, two exemplar evidence-based initiatives suitable for scale-up across PHNs in Australia were identified: multidisciplinary community-based pain programs, and an online health professional capacity-building initiative, Project ECHO (chronic pain). Solutions identified by PHNs to increase capacity to commission initiatives included: co-funding initiatives across different PHN funding streams, collaborative initiatives between PHNs, and co-commissioning with government and non-government partners. Conclusions: Chronic pain has been classified as a disease in itself through the World Health Organization. PHNs recognising chronic pain as a distinct condition in PHN needs analysis and data collection would lead to more dedicated funding. PHNs could do more to improve the secondary prevention and management of chronic pain. A self-identified need for greater collaboration across PHNs and co-commissioning with local and state governments and non-government partners would help to build PHN capacity. Few studies focus on Australian Primary Health Networks (PHNs) and little is known about the needs, priorities and scope of work of PHNs related to the management and secondary prevention of chronic pain. This paper describes the needs and priorities of PHNs; maps current PHN chronic pain initiatives and identifies gaps; and highlights key enablers to implementation. It also highlights solutions identified by PHNs to increase capacity to commission initiatives. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged the mental health of communities worldwide, with the triple pressures of financial insecurity, lockdowns, and worry about the infection. Australia rapidly deployed resources to protect the mental wellbeing of the community through supplementing existing services, supporting at-risk groups, investing in social supports, embracing technology, and supporting the health workforce. This paper describes the Australian Government's investment in mental health during the COVID-19 pandemic in relation to the 10 priority areas identified in Australia's National Mental Health Pandemic Response Plan. The COVID-19 pandemic and associated public health measuresgenerated substantial and ongoing challenges for the mental health and wellbeing of Australian communities. Australian Government funded initiatives were rapidly instituted between different levels of government and with community mental health organisations. These policy actions aimed to provide agile responses to promote community resilience and strengthen services for vulnerable groups, including older people, those with existing mental health conditions, Aboriginal and Torres Strait Islander peoples, and health and essential service providers. [ABSTRACT FROM AUTHOR]

Aim: To explore how compassion is received by patients in a hospital setting and how compassion is expressed by health professionals in a hospital setting. Background: Compassion is important to health professionals and patients. Perceived deficits in compassion in healthcare have led increasing concerns about the quality of care for patients. To better understand compassionate practice in a hospital setting we used narrative inquiry to explore the expression of compassion by health professionals and the experience of receiving compassion by patients. Design: Narrative Inquiry. Reported in line with Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods: Qualitative interviews were conducted with 24 patients and health professionals in Australia. Data were collected between August 2018 and August 2019. Narrative analysis processes were used to develop a thematic framework. Results: Compassionate practice is presented as an overarching theme and comprises of three themes: (1) Amalgamation of various knowledges and skills (2) Delivery of meaningful actions which alleviate suffering and (3) Meeting individual needs and prevention of further preventable suffering. The expression of compassion by health professionals involved the fusion of many skills and knowledges. Patients received compassion through the actions of the health professional which alleviated their suffering. Conclusion: Compassionate practice is both important, and complex. Presence, skilled and purposeful action and the alleviation of suffering are essential to the expression and receipt of compassion in the hospital setting. Impact: Findings from this study contribute to the growing body of literature on compassionate practice in health settings, specifically in how it is expressed and received in a hospital setting. The complexity of compassion is explained for health professionals. Compassion was shown to be embedded in the caring moments between health professionals and patients. This paper explains the different elements that comprise compassion which can guide health professional practice. The importance of seemingly small acts has a big impact on patients, families and health professionals. There is a need for greater stakeholder value and recognition of this aspect of practice. [ABSTRACT FROM AUTHOR]

With long colonial histories, Aboriginal and Torres Strait Islander Peoples in Australia experience lower life expectancy and a higher burden of illness. To this day, Indigenous Peoples experience interpersonal, systemic, and institutional racism in the mainstream public health system of Australia, leading to the underuse of mainstream health services and resulting in many Indigenous Australians living in a state of persistent crisis. Extreme and unacceptable levels of institutional racism have been identified in the hospitals and health services of Queensland, Australia, using the Marrie Institutional Racism Matrix (MIRM), an evidence-based assessment tool for identifying, measuring, and monitoring racism in institutional settings. This paper aims to identify ways to address institutional racism against Indigenous Peoples in the health care sector. Specifically, using publicly available documents, a case study analysis of the Institute for Urban Indigenous Health (IUIH), a network of Aboriginal Community Controlled Health Services, is conducted using the MIRM as a guide. The conclusion is that the IUIH actively works to address institutional racism by (a) including Indigenous people in key decision-making processes and structures; (b) undertaking numerous community engagement strategies; (c) building partnerships within and outside the health sector to address the social determinants of health; and (d) working in ways that align with Indigenous ways of being and doing. It is argued that mainstream health services need to be aware of institutional racism and learn from the approaches of Indigenous-led organizations to create institutions that are inclusive of Indigenous members of society. [ABSTRACT FROM AUTHOR]

With the aging population, the tide of chronic disease is rising with attendant increases in health service need. Integrated care and patient-centred approaches, which established partnerships between a regional Hospital and health service (HHS), the local primary health network and local general practitioners (GPs), were identified as exemplars of an approach needed to support growing community health needs. This paper summarises the findings from a process evaluation of four GP–specialist care integration programs with the aim of identifying recommendations for embedding integrated GP–specialist care into routine practice within the HHS. The process evaluation of the integration programs drew on input from a multidisciplinary expert advisory group and data collected through face-to-face semi-structured interviews with key stakeholders, as well as surveys of participating GPs and patients. Overarching findings were identified and grouped under six themes: interdisciplinary teamwork; communication and information exchange; the use of shared care guidelines or pathways; training and education; access and accessibility; and funding. Within each theme, key challenges and enablers emerged. The findings of this study highlight benefits and challenges associated with the establishment of integrated care between primary and secondary care providers, leading to the development of key recommendations for routine integration. [ABSTRACT FROM AUTHOR]

This paper examines the provision of youth targeted Relationships and Sexuality Education (RSE) and sexual health interventions in the rural Australian context by examining the perspectives and experiences of a range of community stakeholders. Sixteen participants undertook one-on-one semi structured interviews. Four key themes emerged from the data and included: 'you're not going to get the whole town to start thinking about adolescent sexual health'; backlash, stigma and secrecy; being consistent, credible and available; and small-town communication. This study contributes to the limited literature about RSE and sexual health provision in regional and rural Australia and provides a voice for rural stakeholders who provide RSE and sexual health interventions by default or necessity. The findings of this study have practical implications for rural settings when addressing youth sexual health needs. [ABSTRACT FROM AUTHOR]

Abstract Young people with complex support needs who live outside metropolitan areas face unique challenges. Issues such as poor educational and employment opportunities, homelessness, racism, problematic substance use, challenging behaviour, disability and mental illness can be magnified and lead to judgment and marginalisation in small communities such as those in rural and regional areas. As a result of poor resourcing of services in these areas, young people may be forced to transition from place to place, service to service as a way of coping with life challenges. This paper presents findings from interviews and focus groups with service providers who support such young people in regional and rural Queensland, New South Wales and Victoria in Australia. Service providers reported similar challenges to professionals working in urban areas, such as navigating inter-agency and inter-professional work and dealing with funding shortages. However, these issues were amplified by the need to work across broad geographical areas, to recruit and retain skilled workers and to respond to the many structural and resource inadequacies in smaller communities. While services aimed to be responsive to young people, the challenges of providing support in a non-metropolitan context could create a context in which young people either disengaged from services or poor response resulted in systemic escalation to crisis. The implications for policy and practice are explored. Highlights • Supports to young people with complex support needs in non-metropolitan areas in Australia are poorly resourced. • Non-metropolitan services work best when they are based on relationship-based practice and local community needs. • Interagency collaboration is essential when working across broad geographical areas. [ABSTRACT FROM AUTHOR]

The launch of the third edition of the National guide to preventive health assessment for Aboriginal and Torres Strait Islander people in March 2018 heralds a renewed commitment to improving the delivery of preventive care, and should reinvigorate discussions on the effectiveness of Indigenous-specific health assessments and how best to implement them. A substantial body of evidence on adherence to guideline-recommended care has been generated through a research-based continuous quality improvement (CQI) initiative conducted between 2010 and 2014. The research, which involved clinical audits of more than 17 000 client records and 119 systems assessments relating to preventive care in 137 Indigenous primary healthcare centres across Australia, shows that a structured CQI program can improve the delivery of preventive health assessments and use of evidence-based guidelines. However, program implementation has also seen the emergence of new challenges. This paper reflects on four major lessons from this collaborative program of applied research that will lead to more effective delivery of preventive care. [ABSTRACT FROM AUTHOR]

Background: Health helplines are integral to contemporary healthcare, offering fast, low-cost, and geographically unrestricted access to health information and advice. Although some health helplines offer support services (e.g., counselling), many function in ways that are similar to physically co-present (i.e., face-to-face) primary care consultations. However, due to the lack of physical presence, there are differences in the way health consultations are routinely managed on the telephone. This article explores some ways in which healthcare is managed at a distance, on a telephone helpline.Methods: Data are 196 recorded calls from the helpline, Healthdirect Australia. Using conversation analysis, this paper compares the delivery of healthcare over the telephone with what is known about physically co-present primary care consultations.Results: Through an exploration of the overall structure of these helpline calls, we show how Healthdirect Australia calls are organised in terms of eight distinct phases: call opening, establishment of reason-for-calling, check of caller safety, creation of a confidential patient file, medical information-gathering, health advice, caller survey questions, and call closing. We demonstrate how interactants organise their talk around these phases, with a particular focus on the shift between mandated administrative tasks and traditional medical tasks.Conclusions: Findings from this study suggest that there are systematic differences between the overall structure of health helplines and physically co-present primary care consultations. We demonstrate that the delivery of health information and advice via helplines can be challenging, but that service can be enhanced through continued efforts to inform understanding about how medical encounters routinely unfold in over-the-phone environments. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the effect of a Medical Assessment Unit (MAU) on older patients. Methods. Retrospective case-control study of patients 65 years and above admitted to the MAU (study group) and the general medical wards (control group) in Bankstown-Lidcombe Hospital from 1 October 2008 to 31 March 2009 with four most common Diagnosis-Related Groups (DRG) ('falls and gait disorder', 'chronic obstructive pulmonary disease (COPD)', 'other major respiratory diseases and 'cellulitis'). Main outcome measures. Length of stay (LOS) in Emergency Department (ED) and in the hospital, mortality, readmissions within 1 month, and discharge destination. Results. Eighty-nine patients were studied; 47 in the MAU group and 42 in the non-MAU group. The MAU cohort was significantly older (84.1±7.9 years v. 80.4±7.8 years, respectively, P=0.03); and had shorter ED LOS (4.9±3.0h v. 6.5±2.8h, P=0.012). Overall hospital LOS did not differ except for patients with 'cellulitis', (5.7±4.9 days for MAU cohort v. 14.8±6.8 days for non-MAU cohort, P=0.022). There was no significant difference in mortality, readmission rate or discharge destination. Conclusions. The MAU can be an effective service model for older patients. More research is required to confirm this and to define the key elements that are essential for its effectiveness. What is known about the topic? The Medical Assessment Unit is a model of care that has been developed in response to increasing Emergency Department presentations and rising demand on hospital beds. There has been some evidence that this model of care improves efficiency by reducing Emergency Department length of stay and overall hospital length of stay, but little published data targeting the Aged Care population group, who account for a high proportion of Emergency Department admissions. What does this paper add? This paper is a case-control study and provides additional evidence on the benefit of the Medical Assessment Unit model in the elderly population, specifically the benefits in the reduction of Emergency Department length of stay and overall hospital length of stay. This paper also assists in identifying key elements essential for the success of the Medical Assessment Unit model. What are the implications for practitioners? With increasing demand on healthcare, practitioners need to continually redesign how they deliver healthcare to maximise cost efficiency and effectiveness. We believe the Medical Assessment Unit is an effective new model of care. However, more research is required to further refine this model and also identify target patient groups who can most benefit from this model of care.

Simple Summary: A cancer diagnosis during adolescence or young adulthood presents unique medical and psychosocial challenges which must be addressed in the provision of quality, comprehensive cancer care. Tailoring services to the needs of this population requires careful work to identify, monitor and evaluate areas of care; however, published work in this area to guide service priorities is limited. This paper presents work done by the Australian Youth Cancer Services to operationalise and deliver quality care to adolescents and young adults with cancer, focusing on nationally coordinated service improvement initiatives and activity data collection in four areas that are of particular concern to young people diagnosed with cancer: clinical trial enrolment, oncofertility, psychosocial care and survivorship. This account may be instructive for health services seeking to improve the delivery and monitoring of cancer care provided to adolescents and young adults. Adolescents and young adults (aged 15–25 years) diagnosed with cancer have unique medical and psychosocial experiences and care needs, distinct from those of paediatric and older adult patients. Since 2011, the Australian Youth Cancer Services have provided developmentally appropriate, multidisciplinary and comprehensive care to these young patients, facilitated by national service coordination and activity data collection and monitoring. This paper reports on how the Youth Cancer Services have conceptualised and delivered quality youth cancer care in four priority areas: clinical trial participation, oncofertility, psychosocial care and survivorship. National activity data collected by the Youth Cancer Services between 2016–17 and 2019–20 are used to illustrate how service monitoring processes have facilitated improvements in coordination and accountability across multiple indicators of quality youth cancer care, including clinical trial participation, access to fertility information and preservation, psychosocial screening and care and the transition from active treatment to survivorship. Accounts of both service delivery and monitoring and evaluation processes within the Australian Youth Cancer Services provide an exemplar of how coordinated initiatives may be employed to deliver, monitor and improve quality cancer care for adolescents and young adults. [ABSTRACT FROM AUTHOR]

Background: Effectively addressing health disparities between Aboriginal and non-Aboriginal Australians is long overdue. Health services engaging Aboriginal communities in designing and delivering healthcare is one way to tackle the issue. This paper presents findings from evaluating a unique strategy of community engagement between local Aboriginal people and health providers across five districts in Perth, Western Australia. Local Aboriginal community members formed District Aboriginal Health Action Groups (DAHAGs) to collaborate with health providers in designing culturally-responsive healthcare. The purpose of the strategy was to improve local health service delivery for Aboriginal Australians.Methods: The evaluation aimed to identify whether the Aboriginal community considered the community engagement strategy effective in identifying their health service needs, translating them to action by local health services and increasing their trust in these health services. Participants were recruited using purposive sampling. Qualitative data was collected from Aboriginal participants and health service providers using semi-structured interviews or yarning circles that were recorded, transcribed and independently analysed by two senior non-Aboriginal researchers. Responses were coded for key themes, further analysed for similarities and differences between districts and cross-checked by the senior lead Aboriginal researcher to avoid bias and establish reliability in interpreting the data. Three ethics committees approved conducting the evaluation.Results: Findings from 60 participants suggested the engagement process was effective: it was driven and owned by the Aboriginal community, captured a broad range of views and increased Aboriginal community participation in decisions about their healthcare. It built community capacity through regular community forums and established DAHAGs comprising local Aboriginal community members and health service representatives who met quarterly and were supported by the Aboriginal Health Team at the local Population Health Unit. Participants reported health services improved in community and hospital settings, leading to increased access and trust in local health services.Conclusion: The evaluation concluded that this process of actively engaging the Aboriginal community in decisions about their health care was a key element in improving local health services, increasing Aboriginal people's trust and access to care. [ABSTRACT FROM AUTHOR]

Background: Alcohol-related harms cause great concern to Aboriginal and Torres Strait Islander (Indigenous) communities in Australia as well as challenges to policy makers. Treatment of alcohol use disorders forms one component of an effective public health response. While alcohol dependence typically behaves as a chronic relapsing condition, treatment has been shown to be both effective and cost-effective in improving outcomes. Provision of alcohol treatment services should be based on accurate assessment of treatment need.Aims: In this paper, we examine the likely extent of the gap between voluntary alcohol treatment need and accessibility. We also suggest potential approaches to improve the ability to assess unmet need.Discussion: Existing methods of assessing the treatment needs of Indigenous Australians are limited by incomplete and inaccurate survey data and an over-reliance on existing service use data. In addition to a shortage of services, cultural and logistical barriers may hamper access to alcohol treatment for Indigenous Australians. There is also a lack of services funded to a level that allows them to cope with clients with complex medical and physical comorbidity, and a lack of services for women, families and young people. A lack of voluntary treatment services also raises serious ethical concerns, given the expansion of mandatory treatment programmes and incarceration of Indigenous Australians for continued drinking. The use of modelling approaches, linkage of administrative data sets and strategies to improve data collection are discussed as possible methods to better assess treatment need. [Brett J, Lee K, Gray D, Wilson S, Freeburn B, Harrison K, Conigrave K. Mind the gap: what is the difference between alcohol treatment need and access for Aboriginal and Torres Strait Islander Australians? Drug Alcohol Rev 2016;35:456-460]. [ABSTRACT FROM AUTHOR]

Background Understanding decision-making about health service provision is increasingly important in an environment of increasing demand and constrained resources. Multiple factors are likely to influence decisions about which services will be provided, yet workforce is the most noted factor in the rural physiotherapy literature. This paper draws together results obtained from exploration of service level decision-making (SLDM) to propose 'conceptual' models of rural physiotherapy SLDM. Method A prioritized qualitative approach enabled exploration of participant perspectives about rural physiotherapy decision-making. Stakeholder perspectives were obtained through surveys and in-depth interviews. Interviews were transcribed verbatim and reviewed by participants. Participant confidentiality was maintained by coding both participants and sites. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of regional, rural and remote communities. Results Thirty-nine surveys were received from participants in 11 communities. Nineteen in-depth interviews were conducted with physiotherapists and key decision-makers. Results reveal the complexity of factors influencing rural physiotherapy service provision and the value of a systems approach when exploring decision-making about rural physiotherapy service provision. Six key features were identified that formed the rural physiotherapy SLDM system: capacity and capability; contextual influences; layered decision-making; access issues; value and beliefs; and tensions and conflict. Conclusions Rural physiotherapy SLDM is not a one-dimensional process but results from the complex interaction of clusters of systems issues. Decision-making about physiotherapy service provision is influenced by both internal and external factors. Similarities in influencing factors and the iterative nature of decision-making emerged, which enabled linking physiotherapy SLDM with clinical decision-making and placing both within the broader healthcare context. The conceptual models provide a way of thinking about decisions informing rural physiotherapy service provision. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Health care organizations need to be responsive to the needs of increasingly diverse patient populations. We compared the contents of six publicly available approaches to organizational responsiveness to diversity. The central questions addressed in this paper are: what are the most consistently recommended issues for health care organizations to address in order to be responsive to the needs of diverse groups that differ from the majority population? How much consensus is there between various approaches?Methods: We purposively sampled six approaches from the US, Australia and Europe and used qualitative textual analysis to categorize the content of each approach into domains (conceptually distinct topic areas) and, within each domain, into dimensions (operationalizations). The resulting classification framework was used for comparative analysis of the content of the six approaches.Results: We identified seven domains that were represented in most or all approaches: organizational commitment, empirical evidence on inequalities and needs, a competent and diverse workforce, ensuring access for all users, ensuring responsiveness in care provision, fostering patient and community participation, and actively promoting responsiveness. Variations in the operationalization of these domains related to different scopes, contexts and types of diversity. For example, approaches that focus on ethnic diversity mostly provide recommendations to handle cultural and language differences; approaches that take an intersectional approach and broaden their target population to vulnerable groups in a more general sense also pay attention to factors such as socio-economic status and gender.Conclusions: Despite differences in labeling, there is a broad consensus about what health care organizations need to do in order to be responsive to patient diversity. This opens the way to full scale implementation of organizational responsiveness in healthcare and structured evaluation of its effectiveness in improving patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose – While ageing with an intellectual (learning) disability has been subject to increased research in recent years, there remains little knowledge regarding the daily practice issues that disability workers struggle most to support in this cohort. The purpose of this paper is to gain feedback directly from staff regarding the problems they experience in daily work, and to evaluate whether any changes to legislation or practice could potentially alleviate identified areas of concern. Design/methodology/approach – A Delphi project was conducted over three rounds with participants from rural areas of New South Wales (NSW). The panel was composed of support workers who assist people ageing with a learning disability. Participants were asked their perceptions of the main practice issues facing them while they provide support. Findings – The panel identified 29 issues that were considered problematic in the provision of support to people ageing with a learning disability. A thematic analysis indicated three main themes of access to services; time constraints; and funding. Research limitations/implications – The participants in this study were all disability workers employed by non-government organisations in rural NSW, and as such, many of the issues identified may be specific to this population cohort and geographic setting. Any generalisation of these results to other locations or populations must be considered within these limitations. Originality/value – Identification of the issues facing disability staff may facilitate government, health care providers and disability organisations to proactively plan to address current and future problem areas. The consequent effect of improving practices can assist individuals to receive better support and lead to a corresponding improvement in their quality of life. The current implementation of the National Disability Insurance Scheme in Australia is an ideal opportunity for cross-sectoral collaboration to change practice to facilitate better support for a highly vulnerable group of the community. [ABSTRACT FROM AUTHOR]

Background Patient or person centred care is widely accepted as the philosophy and practice that underpins quality care. An examination of the Australian National Chronic Disease Strategy and literature in the field highlights assumptions about the self-manager as patient and a focus on clinical settings. Objective and Conclusion This paper considers patient or person centred care in the light of empowerment as it is understood in the health promotion charters first established in Alma Ata in 1977. We argue that patient or person centred care can be reconfigured within a social justice and rights framework and that doing so supports the creation of conditions for well-being in the broader context, one that impacts strongly on individuals. These arguments have broader implications for the practice of patient centred care as it occurs between patient and health professional and for creating shared responsibility for management of the self. It also has implications for those who manage their health outside of the health sector. [ABSTRACT FROM AUTHOR]

Objectives: The present paper aims to: (i) describe how the Mental Health Commission in New Zealand works and has contributed to the substantial enhancement of mental health resources and services; (ii) determine whether mental health reform policies will ever be implemented properly without an independent monitor with official influence at the highest levels of government; and (iii) demonstrate how variants on this model work in other Western countries and how it can be adapted to the Federated system in Australia.Conclusions: It is recommended that the Australian National Mental Health Plan 2003-2008 should be complemented by a long-standing national mental health commission (or similarly constituted body), which is also able to report independently from and to the government, with direct access to the Prime Minister, Premiers and Australian Health Ministers. Its aims would be to monitor service effectiveness and identify gaps in service provision, training and performance of the work force, management and government. It would be informed by consumer, carer and provider experience, and by reviews of evidence-based research regarding health needs and cost-effective services. It should accurately cost such service gaps, and advise government on a strategy for implementing them. It could also promote and advise formally on enhancing community awareness, decreasing stigma and discrimination and improving workforce recruitment and retention. [ABSTRACT FROM AUTHOR]

Background: This is the eighth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for disinvestment within a large Australian health service. One of the aims was to explore methods to deliver existing high quality synthesised evidence directly to decision-makers to drive decision-making proactively. An Evidence Dissemination Service (EDS) was proposed. While this was conceived as a method to identify disinvestment opportunities, it became clear that it could also be a way to review all practices for consistency with current evidence. This paper reports the development, implementation and evaluation of two models of an in-house EDS.Methods: Frameworks for development of complex interventions, implementation of evidence-based change, and evaluation and explication of processes and outcomes were adapted and/or applied. Mixed methods including a literature review, surveys, interviews, workshops, audits, document analysis and action research were used to capture barriers, enablers and local needs; identify effective strategies; develop and refine proposals; ascertain feedback and measure outcomes.Results: Methods to identify, capture, classify, store, repackage, disseminate and facilitate use of synthesised research evidence were investigated. In Model 1, emails containing links to multiple publications were sent to all self-selected participants who were asked to determine whether they were the relevant decision-maker for any of the topics presented, whether change was required, and to take the relevant action. This voluntary framework did not achieve the aim of ensuring practice was consistent with current evidence. In Model 2, the need for change was established prior to dissemination, then a summary of the evidence was sent to the decision-maker responsible for practice in the relevant area who was required to take appropriate action and report the outcome. This mandatory governance framework was successful. The factors influencing decisions, processes and outcomes were identified.Conclusion: An in-house EDS holds promise as a method of identifying disinvestment opportunities and/or reviewing local practice for consistency with current evidence. The resource-intensive nature of delivery of the EDS is a potential barrier. The findings from this study will inform further exploration. [ABSTRACT FROM AUTHOR]

Background: Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives: To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples' preferences, needs, opportunities and barriers to palliative care. Methods: A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly's hierarchy of evidence-for-practice in qualitative research. Results: Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples' experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions: The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas. [ABSTRACT FROM AUTHOR]