Search

To describe the characteristics of tobacco control programs (TCPs) delivered by Aboriginal Community Controlled Health Services (ACCHSs) in New South Wales (NSW), Australia. A key informant from each ACCHS in NSW completed a 30‐item online survey. For each TCP, ACCHSs were asked to provide: the target population group, program aims and activities, funding source, and whether the program had been monitored or evaluated and reflected principles of community control and engagement. Twenty‐five of 38 eligible ACCHSs completed the survey (66% response rate). Overall, 64% of services reported currently delivering at least one TCP, almost all of which aimed to promote quitting (95%). Programs involved brief intervention for tobacco cessation (71%), referral to quit services (67%), or use of printed resources (67%). Funding sources included Local Health Districts (52% of programs), the Commonwealth Government (48%) and NSW Ministry of Health (43%). Most programs were aimed at all Aboriginal people who smoke (76%); 19% targeted women or families during pregnancy/birth. Many TCPs used culturally tailored resources (86%) and employed Aboriginal staff (86%), and 48% had been evaluated. A third of participating ACCHS did not have a specific TCP to address smoking among Aboriginal people, and delivery of programs was characterised by an uncoordinated approach across the state. Aboriginal staff and culturally tailored messages were a focus of existing TCP programs. Findings highlight the need for more investment in TCPs for Aboriginal people to ensure all ACCHSs can deliver evidence‐based programs.

Auditing clinical practice and providing performance feedback is commonly used as a method of monitoring and attempting to improve the quality of healthcare. The scope of the research evidence on audit and feedback strategies to improve patient care across an oncology treatment centers is currently unclear. A scoping review of the literature was conducted to explore the research in this area. After assessing included studies for scientific rigor, only four intervention studies were considered to use a sound research design. The low number of studies make it difficult to draw clear conclusions about the effectiveness of systems-level audit and feedback. This area represents an important field for future research.Audit and feedback is commonly used as a method of both monitoring and attempting to improve the quality of healthcare. No review has examined the literature on systems-level audit and feedback strategies to improve the quality of oncology care. This scoping review examines the number, care focus (technical, nontechnical, or both) and methodological quality of published intervention studies which have used systems-level audit and feedback intended to improve the quality of care delivered in oncology treatment centers. Medline, Embase, PsycINFO, and the Cochrane database were searched, from inception to March 2021, for intervention studies which examined the effectiveness of systems-level audit and feedback in improving care for cancer patients. Studies which met the Effective Practice and Organization of Care (EPOC) minimum design criteria were then assessed using the EPOC risk of bias tool. Study characteristics and outcomes were extracted for those meeting methodological criteria. A narrative approach was used to synthesize the results. A total of 32 intervention studies met the inclusion criteria, of which 53% focused on technical aspects of care, 31% focused on nontechnical and 16% focused on both. Four of the included 32 studies met the EPOC minimum design criteria (13%). Most studies had a before–after study design (75%; n= 24) and methodological quality of the final four studies was moderate. Audit and feedback studies involving oncology treatment centers have primarily focused on technical care aspects. The low number and moderate methodological quality of the studies make it difficult to draw clear inferences about the effectiveness of systems-level audit and feedback. Furthermore, high-quality audit and feedback interventions are required across technical and nontechnical aspects of care to quantify the effectiveness of strategies for improving cancer care and ensure healthcare resources are being optimized.

Nurses play an important role in caring for patients who are dying in hospital, so it is important to understand their perceptions of the factors that may influence the quality of that care. Much of the existing literature is focused on end-of-life care provision in western settings. Little is known about how nurses’ perceptions of end-of-life care provision may differ across Asian and Western locations. Understanding the similarities and differences between the perceptions of nurses in Asian and Western locations about the barriers to the provision of high-quality end-of-life care may help guide education and policy initiatives to improve end-of-life care in each location.

To examine general practitioners’ views about how health assessments for older people should be conducted.

To assess the use of Medicare‐subsidised health services by women with and without dementia.

Objective: To assess the use of Medicare‐subsidised health services by women with and without dementia. Methods: Data from women of the 1921–26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models. Results: A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non‐emergency GP attendances (short [<30 minutes] IRR=1.11 [1.07, 1.13]; long [>30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators. Conclusions: The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health: There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs).

Objective: To examine general practitioners’ views about how health assessments for older people should be conducted. Methods: General practitioners were randomly sampled from a national database of medical practitioners and invited to complete a survey. Survey items explored general practitioners’ views about essential components of a 75+ Health Assessment and who should assess each component, consultation time, use of standardised templates and tools, and home visits. Results: Overall, 185 (19.2%) general practitioners participated. Of 61 items presented, 24 were rated ‘essential’ by ≥70% of practitioners, with an average estimated consultation time of 65 minutes. Of the 24 essential items, it was perceived that 21 could be assessed by either a general practitioner or clinic nurse. Most practitioners indicated a standardised template (86%) and standardised tools for complex issues (79%) should be used, and home visits conducted (75%). Conclusions: General practitioners agreed on 24 items as essential for every health assessment, with assessments estimated to take more than one hour. Implications for public health: Increases to remuneration for prolonged assessments or mechanisms for improving efficiency and quality of assessments are needed. Acceptable mechanisms may include standardised patient‐reported tools, standardised templates and the use of non‐medical staff to assist with assessments.

Despite their central role in patient care, few studies have explored cancer nurses’ perspectives about errors within the health care system.

Background: Medical imaging outpatients often experience inadequate information provision and report high levels of anxiety. However, no studies have assessed patients’ receipt of preparatory information in this setting.Objective: To examine medical imaging outpatients’ perceived receipt or non-receipt of preparatory information from health professionals and imaging department staff prior to their procedure.Method: Computed tomography and magnetic resonance imaging outpatients at one Australian hospital self-completed a touchscreen computer survey assessing their perceived receipt of 33 guideline-recommended preparatory information items.Results: Of 317 eligible patients, 280 (88%) consented to participate. Eight percent (95% confidence interval: 5%-12%) of participants reported receiving all information items. The median number of information items not received was 18 (interquartile range: 8-25). Items most frequently endorsed as “not received”were: how to manage anxiety after(74%) and during the scan(69%). Items most commonly endorsed as “received” were: reason for referral(85%) and how to find the imaging department(74%).Conclusion: Few medical imaging outpatients recalled receiving recommended preparatory information. Preparatory communication needs to be improved to better meet patient-centered service imperatives.

A high level of support for tissue banking has been identified amongst both the general public and patients. However, much debate remains about the regulatory framework of tissue banks. This study explored the views of haematological cancer patients regarding tissue banking and how tissue banks should operate. Haematological cancer patients from three outpatient clinics in Australia completed a questionnaire examining their preferences for tissue banking as well as items about their sociodemographic characteristics, disease and treatment history. The majority of participants (95%) reported being willing to allow their leftover tissue to be used for medical research. Three quarters (76%) supported the idea of their medical record being linked to their tissue sample, and 77% preferred a blanket (one-off) consent model for future research use of their tissue sample. Only 57 (27%) participants had been asked to give a tissue sample for research, 98% of whom gave permission. The majority of haematological cancer patients are willing to donate their leftover tissue to a tissue bank and have their medical records linked to tissue samples and prefer a one-off consent process. These novel data from potential donors inform the debate about how tissue banks might operate. Strategic Research Partnership Grant from the Cancer Council NSW to the Newcastle Cancer Control Collaborative (New-3C) and infrastructure funding from the Hunter Medical Research Institute (HMRI). A.W. is supported by an Australian Research Council DECRA fellowship (DE150101262). T.C.M. was supported by a Leukaemia Foundation of Queensland Post-Doctoral Fellowship. A.B. is supported by National Health and Medical Research Council (APP1073317) and Cancer Institute NSW (13/ECF/1–37) Early Career Fellowships.

Objective: To determine the accuracy and clinical utility of patient self‐reported screening history. Methods: Aboriginal and Torres Strait Islander patients (≥18 years; n=587) were interviewed on their screening history according to recommended time intervals; these were matched to pathology data. Results: The proportion of patients meeting screening guidelines were 32%(95%CI 26%–39%) for diabetes, 43%(95%CI 38%–47%) for cholesterol and 4.1%(95%CI 2.2%–7.3%) for cervical cancer. When patients reported having had the test, their accuracy (PPV) was low: 38%(95%CI 30%–46%) for diabetes, 47%(95%CI 42%–52%) for cholesterol, 6.5%(95%CI 3.0%–12%) for cervical cancer. However, for the minority of patients who had been screened, positive recall (sensitivity) was high: 94%(95%CI 85%–98%) for diabetes, 83%(95%CI 77%–88%) for cholesterol, 90%(95%CI 55%–98%) for cervical cancer. The accuracy of patient recall was good for those who reported not having been screened (NPV): 90%(95%CI 77%–97%) for diabetes, 70%(95%CI 61%–78%) for cholesterol, 99%(95%CI 95%–100%) for cervical cancer. Conclusions: The results indicate that reliance on self‐report for patients’ screening history is inappropriate due to missed opportunities for health gain. However, patients who report not being tested are sufficiently accurate to ensure that ordering the test in this group will involve only a small percentage of unnecessary assays. Implications: GPs often rely on self‐report as a fast and inexpensive way to determine whether a patient requires screening. New strategies are needed to identify patients at risk.

To determine the accuracy and clinical utility of patient self‐reported screening history.

The National Bowel Cancer Screening Program (NBCSP) was introduced in Australia in 2006, offering free immunochemical Faecal Occult Blood Test (FOBT) to persons aged 50, 55 or 65. The study aimed to examine the prevalence of selfreported screening for colorectal cancer (CRC) using the FOBT and factors associated with not having an FOBT. A cross-sectional study of Australian general practice patients aged 50 and over with no personal history of CRC completed a health risk survey while waiting for scheduled appointments between November 2010 and November 2011. A total of 5671 patients from 12 practices were approached to participate. Of the 4707 eligible patients (adults attending for care who understood English and were capable of providing informed consent), 4062 (86%) consented to participate, with 2269 eligible to complete the FOBT items. Approximately half (52%) of participants reported ever having an FOBT. More than one-third (39.7%) of the sample reported having an FOBT in the prior three years. Those who recalled receiving a mailed kit as part of the NBCSP were five times more likely to report being screened. Those less likely to report screening were aged 50–59 years, were female and had been diagnosed with a form of cancer other than CRC. There is justification for the extension of the NBCSP to ensure a majority of the age-appropriate population is screened for CRC. Further work is needed to identify whether high rates of screening are achievable using the mailed-kit approach, and how to increase participation by females, those aged 50–69 years and those diagnosed with other cancers.

Objective:To examine agreement between patients’ self‐report and general practitioners’ perception of their patients’ health risk status and screening history.

To examine agreement between patients’ self‐report and general practitioners’ perception of their patients’ health risk status and screening history.

ABSTRACT A stratified random sample of 655 Australian general practitioners (GPs) was surveyed to determine their attitudes, knowledge and behaviour in relation to the human immunodeficiency virus (HIV) pandemic. Of the 486 respondents, 22% had one or more patients with HIV infection in their practice and 60% had been asked for information on HIV infection in the past month by at least one patient. The majority of respondents viewed screening and education of patients as part of their role, but 24% did not want to maintain a therapeutic relationship with HIV‐infected patients and 16% felt it was appropriate to refuse to treat this group. Although most respondents correctly identified the well known risk‐taking behaviours for HIV infection in homosexual men and intravenous drug users, they underestimated the risk to heterosexuals and exaggerated that associated with activities generally considered not to involve risk. The knowledge of appropriate infection control procedures of approximately 60% of the respondents was inadequate. A lack of time in consulting was the most commonly cited barrier to the routine assessment of, or enquiry into, risk‐taking behaviours of patients in the respondents' practices. Respondents noted that they required more knowledge of the clinical presentation and diagnosis of HIV infection, as well as education in counselling techniques and the risks of transmission associated with sexual and non‐sexual activities. They felt such information could best be imparted through printed material. These results indicate that most GPs are willing to play an active role in the diagnosis, treatment and prevention of HIV disease, but they require more accurate information in order to fulfil this role appropriately. The study identifies and addresses several barriers to GPs playing a more active role in the management of HIV disease.

To examine the extent to which individual‐ and community‐ level characteristics account for differences in risky alcohol consumption.

Objective:To examine the extent to which individual‐ and community‐ level characteristics account for differences in risky alcohol consumption.

Objective:This study examines the effectiveness and costs of follow‐up phone calls in improving response rates to a community survey.

This study examines the effectiveness and costs of follow‐up phone calls in improving response rates to a community survey.

Health care providers play a pivotal role in preventing and reducing the burden associated with the misuse of alcohol, yet one group whose role in the alcohol offensive has not yet been systematically explored is ambulance officers. This study attempted to firstly, measure the prevalence and type of alcoholrelated incidents attended by ambulance officers, and secondly, identify both current practice and perceived role in reducing alcohol-related harms. A cross-sectional, descriptive survey of 264 NSW Ambulance Officers was conducted in June and July 2006. Results indicated that alcohol plays a significant role in the work of ambulance officers with estimates of 20% of all call-outs involving alcohol. Though the majority of officers indicated that they usually or always asked patients whether they have been drinking, far fewer asked about quantity and frequency of alcohol use and only small proportions undertook formal screenings, offered brief advice or referred patients to an appropriate drug and alcohol service. Officers indicated that they are willing to undertake a number of other actions as part of alcoholharm reduction efforts, suggesting that many ambulance officers consider health promotion to be integral to the role of an ambulance officer. Ambulance officers are ideally suited to identify and detect ‘at-risk’ drinkers and there are a number of unrealised opportunities for expansion of the health promotion role, which they appear willing to undertake.

Objectives:To determine the level of support by licensees, police and the general public for interventions to reduce alcohol‐related harm associated with licensed premises and to identify differences between the three groups. Methods:Participants were 108 licensees of premises licensed to sell alcohol; 132 police officers; 200 members of the public. Questionnaires were administered either through work settings or by mail. Respondents’ levels of agreement with interventions to reduce alcohol‐related harm associated with licensed premises: responsible service of alcohol; security and crowd control; policing; patron transport; and linking of alcohol‐related harm to licensed premises and communication. Results:Police and members of the public were significantly more likely than licensees to agree with strategies under licensee control, such as subsidising patron transport and training staff to deal with intoxicated patrons. Police were more likely than licensees and members of the public to agree with strategies requiring community action and changes to liquor licensing laws. Licensees had significantly lower levels of agreement than the other groups about licensees’ responsibility to reduce alcohol‐related harm as a consequence of drinking at their premises. Conclusions:While there was good agreement between police officers and members of the public about strategies for reducing alcohol‐related harm at licensed premises, licensees held divergent views about strategies within their control. Licensees were less likely than police and members of the public to agree they were responsible for reducing alcohol‐related harm resulting from drinking at their premises.

To determine the level of support by licensees, police and the general public for interventions to reduce alcohol‐related harm associated with licensed premises and to identify differences between the three groups.

Objective: To describe and critique methodological aspects of school‐based interventions that involve a broader community initiative. Methods: An electronic search of 11 databases and manual search of references for intervention studies published in peer‐reviewed journals from January 2000 to August 2004. To be included in the review, alcohol needed to be a primary focus of the study, the intervention to be school based and include grades between five and 12, and the intervention needed to involve the community. Results: Sixteen articles were selected for inclusion in the review. Methodologically, several studies excluded reporting important details (e. g. follow‐up periods unclear), process measures were ignored by some studies (e. g. exposure to intervention), and some employed less than optimal outcome measures (such as attitudes and knowledge). Student education, some form of parental involvement and researchers providing resources to the school, were the most frequently employed intervention strategies. Conclusions: There is a clear need to conduct more rigorous evaluation studies and to increase reporting standards for school‐based interventions. There is also tentative scope to include the community more broadly, rather than focus on established relationships within the school environment. Implications: As evidence suggests, there is limited effectiveness in school‐based interventions. It may be beneficial to do lowest‐cost interventions that have some evidence for effect, complemented by strategies identified by expert opinion, until further rigorous evidence arises.

Objective: To describe and critique methodological aspects of school‐based interventions that involve a broader community initiative.

Background.This paper describes one outcome of a randomized controlled trial of community action for cancer prevention, Cancer Action in Rural Towns. The aims are to [1] explore the effectiveness of community action in decreasing adolescent smoking in rural Australian towns; and [2] describe the relationship between adolescent smoking rates and demographic variables.

Background. This article describes one outcome of a randomized controlled trial of community action for cancer prevention. The aims of this article were to (a) explore the effectiveness of a community action program in decreasing community smoking rates in rural Australian towns and (b) describe the relationship between adult smoking quit and uptake rates and demographic variables.

Background.The effect of community action on cervical cancer screening rates was explored in 20 rural Australian towns.

Background.Perceived competencies and support for formal postgraduate training across a range of preventive and other interactional skills were examined in three medical groups.

To assess the prevalence, type, location of and injuries from home accidents, including falls and other accidents, and to explore whether variables including socio‐demographic characteristics, medication use and home hazards were associated with all home accidents and falls.

Objectives:To assess the prevalence, type, location of and injuries from home accidents, including falls and other accidents, and to explore whether variables including socio‐demographic characteristics, medication use and home hazards were associated with all home accidents and falls. Method:657 older people were interviewed about accidents in the previous four weeks. For a subsample (n=425), a home hazard check was completed. Results:Of the 101 accidents reported, 51% (n=51) were falls and 50% (n=50) were other accidents. The most common location for all accidents was outside (30%). Most resulted in minor injury to the legs (43%) or arms (39%). Medical treatment was sought for 14% of accidents. Having more than five hazards and infrequent home visits by healthcare providers were associated with having at least one accident and at least one fall. Use of a walking aid was also associated with falling. Conclusion:Rates of falls and other accidents are considerable. Implications:Work is required to confirm the importance of the relationships suggested and to provide data on the burden of injury associated with non‐fall accidents.

Objective: To assess the prevalence and predictors of perceived unmet needs among women diagnosed with breast cancer, with a particular focus on the impact of location (rural/urban). Method: A random sample of women in NSW diagnosed with breast cancer was surveyed during 1995–96. The Breast Cancer Patients' Needs Questionnaire (BR‐CPNQ) explores patients' perceived needs across five domains: psychological, health information, physical/daily living, patient care/support and interpersonal communication. Items assessing breast cancer specific needs and access to services and resources were included. Of 235 eligible rural women, 134 (57%) consented to participate and 129 (55%) returned completed surveys. Of 196 eligible urban women, 102 (52%) consented to participate and 100 (51%) returned completed surveys. Results: For 12 of the 52 items, at least one‐third of the sample reported ever having a moderate/high need for help. Of the 15 highest moderate or high unmet needs, 10 related to health information and three to psychological needs. There were few differences in the prevalence of needs reported by rural and urban women. Only in the physical/daily living domain were rural women more likely than urban women to report some need for help (OR=2.59, 95% Cl 1.21–5.52). Conclusions: Unmet needs, particularly in the information and psycho‐social domains, are reported by both rural and urban women with breast cancer, with sub‐groups experiencing different types of needs. Implications: There is a need to develop and trial targeted and innovative strategies to meet the health information and psychological needs of women with breast cancer, and the physical/daily living needs of rural women diagnosed with breast cancer.