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Rural communities continue to experience shortages of doctors, placing increased work demands on the existing rural medical workforce. This paper investigates patterns of geographical variation in the workload and work activities of GPs by community size. Our data comes from wave 1 of the Medicine in Australia: Balancing Employment and Life longitudinal study, a national study of Australian doctors. Self-reported hours worked per usual week across eight workplace settings and on-call/ after-hours workload per usual week were analysed against seven community size categories. Our results showed that a GP's total hours worked per week consistently increases as community size decreases, ranging from 38.6 up to 45.6h in small communities, with most differences attributable to work activities of rural GPs in public hospitals. Higher on-call workload is also significantly associated with smaller rural communities, with the likelihood of GPs attending more than one callout per week ranging from 9% for metropolitan GPs up to 48-58% in small rural communities. Our study is the first to separate hours worked into different work activities whilst adjusting for community size and demographics, providing significantly greater insight to the increased hours worked, more diverse activities and significant after-hours demands experienced by current rural GPs. [ABSTRACT FROM AUTHOR]

A qualitative study was conducted to explore in-depth issues relating to the health costs of chronic illness as identified in a previous study. A key theme that emerged from interviews carried out was the benefits and challenges of private health insurance (PHI) membership, and choices older Australians with multimorbidity make in accessing health services, with and without PHI. This is the focus of this paper. Semistructured interviews were conducted with 40 older people with multiple chronic conditions. Data were analysed using content analysis. Key motivators for maintaining PHI included: fear of an inability to access timely health care; the opportunity to exercise choice in service provider; a belief of being 'better off' both medically and financially, which was often ill-founded; and the core values of self reliance and independence. Most described financial pressure caused by rising PHI premiums as well as other out-of-pocket health related expenses. Many older people who can ill afford PHI still struggle to maintain it, potentially at the cost of their quality of life, based on beliefs about costs of health care that they have never properly assessed. The findings highlight the degree to which people whose resources are constrained are prepared to go to maintain access to private hospital care. Attention should be given to assisting older people to make informed and valid choices of health insurance derived from the facts, rather than being based on fear and assumptions. [ABSTRACT FROM AUTHOR]

Australia's health reform documents make reference to the need to address health equity and strengthen population health planning. They make a stronger case about the need to address equity than policy documents that have preceded them. However, they do not make clear that health care is one of many determinants of health and equity, and that planning for health care, social care and social health outcomes are necessary for effectiveness. In other words, population health planning is much more than health care planning. Population health plans vary in their intent and design, depending on the population catchment for the plan, the remit of the organisations involved and the paradigms from which the plan is written. A stronger vision is necessary if population health plans are to affect health inequities. Comprehensive population planning is necessarily intersectoral with engagement across a wide cross-section of government department policies, portfolios and data sources, with a focus on the determinants of health and inequity, and a sound foundation of social values. This paper unpacks the elements of population health planning, the data sources that may be used and their interrogation in terms of the determinants of health, and presents core principles that distinguish population health planning from other types of planning to ensure that planning is comprehensive and able to be actioned. [ABSTRACT FROM AUTHOR]

The Australian National Health Reform agenda includes aims to reduce health disadvantages and provide equitable access. However, this reform will be implemented through state and territory governments, and as such will be built on existing conceptualisations of health as a social justice concept (core to understandings of social determinants). A selection of state and territory health policy documents were analysed within a critical discourse framework focussing on their use of terms relating to social determinants. Analysis revealed that the understandings of social justice concepts vary across Australia and are generally apolitical, belying core concerns inherent in a social determinants understanding. Such differentiation bears recognition by reformers seeking to implement national consistency. This paper also considers how health professionals might become aware of their own cultural enmeshment in neo-liberal frameworks of understanding, recognising a social determinants framework as counter-cultural and hence requiring radical thinking. [ABSTRACT FROM AUTHOR]

This paper outlines the development of a model for an Indigenous peer mentoring program. The aim of this program is to improve the health of Indigenous people living in the western suburbs of Melbourne, Australia. Although the benefits of peer mentoring are well documented, particularly in relation to disease prevention, little has been written about the specific benefits for Indigenous people. While developing this model, it became apparent that to be successful, peer mentoring programs for Indigenous people need to be flexible, informal and draw on the knowledge and skills of the local community in partnership with local services. [ABSTRACT FROM AUTHOR]

When considering the delivery of primary health care in the community, some populations remain virtually invisible. While people with intellectual disability might seem to share few characteristics with refugees and humanitarian entrants, there are a number of difficulties that both groups share when accessing and receiving primary health care. Commonalities include communication barriers, difficulties accessing past medical records and the complexity of health needs that confront the practitioner providing health care. These issues and additional systemic barriers that prevent the delivery of optimal health care to both groups are explored. Integrated multidisciplinary care is often required for the delivery of best practice care; however, such care can be difficult for each group to access. In May 2010, the specific Medicare Health Assessment Item numbers for both of these groups were incorporated into a group of more generic Item numbers. This has resulted in a lost opportunity to enhance the evidence surrounding health care delivery to these vulnerable populations. This paper recognises the importance of health policy in leading affirmative action to ensure these populations become visible in the implementation of the National Primary Health Care Strategy. [ABSTRACT FROM AUTHOR]

The final report of the National Health and Hospital Reform Commission (NHHRC) called for a strengthened consumer voice and empowerment. This has salience for the development of health policy concerning chronic illnesses. This paper compares the recommendations for chronic illness care made in the NHHRC final report with suggestions made by people with chronic illness and family carers of people with chronic illness in a recent Australian study. Sixty-six participants were interviewed in a qualitative research project of the Serious and Continuing Illness Policy and Practice Study (SCIPPS). Participants were people with type II diabetes mellitus, chronic obstructive pulmonary disease or chronic heart failure. Family carers were also interviewed. Content analysis was undertaken and participants' recommendations for improving care were compared with those proposed in the NHHRC final report. Many suggestions from the participants of the SCIPPS qualitative research project appeared in the NHHRC final report, including the need to improve care coordination, health literacy and the experience of Indigenous Australians. The research project also identified important issues of family carers, immigrants and people with multiple illnesses, which were not addressed in the NHHRC final report. More specific attention is needed in health reform to improve the experience of family carers, Indigenous peoples, immigrants to Australia and people with multiple illnesses. To align more closely with their needs, health reform must be explicitly informed by the voices of people with chronic illness and their family carers. The NHHRC recommendations must be supplemented with proposals that address the needs of these people for support and the problems associated with poor care coordination. [ABSTRACT FROM AUTHOR]

A significant gap exists in knowledge about general practice nurses'(GPNs) patient care activities, despite their now strong presence in Australian general practice. The aim of this paper is to explore the extent of direct general practitioner (GP) involvement in nurse-patient consultations, and to compare consultations where nurse-specific Medicare items were claimable with consultations where they were not. Data from the Practice Nurse Work Survey, a national cross-sectional survey conducted between May 2007 and May 2008, were analysed. Of the total 5253 nurse- patient encounters, 29% did not involve any contact between the patient and a GP, either directly before, during or directly after the nurse consultation. Encounters without GP involvement were more likely to be indirect (e.g. by telephone) and off-site (e.g. home visits), and had higher rates of administrative actions such as documentation and arranging visits. Nurse-specific Medicare item numbers applied in less than half (42%) of nurse-patient encounters. Encounters where no such item applied were more likely to involve medical examinations, blood tests, electrical tracings, physical function tests, removal of sutures, test results, assisting at operations and preparing for procedures. These results confirm that existing data collections do not capture the extent and nature of GPNs' clinical work. [ABSTRACT FROM AUTHOR]

Climate change is an important issue for Australia. Climate change research forecasts that Australia will experience accelerated warming due to anthrogenic activities. Australia's aging society will face special challenges that demand current attention. This paper discusses two issues in relation to climate change and older Australians: first, pharmacology and autoregulation; and second, mental health among older Australians. [ABSTRACT FROM AUTHOR]

Little is known about the incidence, prevalence, and impact of patient-initiated aggression against general practice staff in Australia or how medically related professional organisations respond to this. The few available Australian studies suggest that up to about two-thirds of Australian GPs experience patient-initiated aggression within a 12-month period. This paper reports on relevant professional stakeholder organisations' perceptions of and response to aggression perpetrated against their members working in Australian general practices. Thirteen organisations each nominated a representative to undertake a one-off semi-structured interview. Respondents informed the study findings from organisational, practice level, and Divisions of General Practice perspectives. While all professional organisations were cognisant of the presence of violence and aggression in Australian general practice, very few offered proactive measures in the management of difficult or aggressive patients, or practical support to their members. Organisations with fewer members involved in general practice were overall more supportive and proactive with regard to education, training, and publications than were organisations with a greater proportion of their membership involved in general practice settings. Respondents believed the current socio-political climate provided opportunity for a greater organisational response, but there was uncertainty regarding the appropriate response in view of a lack of evidence base. [ABSTRACT FROM AUTHOR]

The Medical Schools Outcomes Database (MSOD) is an ongoing longitudinal tracking project of medical students from all medical schools in Australia and New Zealand. It was established in 2005 to track the career trajectories of medical students and will directly help develop models of workforce flow, particularly with respect to rural and remote shortages. This paper briefly outlines the MSOD project and reports on key methodological factors in tracking medical students. Finally, the potential impact of the MSOD on understanding changes in rural practice intentions is illustrated using data from the 2005 pilot cohort (n = 112). Rural placements were associated with a shift towards rural practice intentions, while those who intended to practice rurally at both the start and end of medical school tended to be older and interested in a generalist career. Continuing work will track these and future students as they progress through the workforce, as well as exploring issues such as the career trajectories of international fee-paying students, workforce succession planning, and the evaluation of medical education initiatives. [ABSTRACT FROM AUTHOR]

The Australian health care workforce has benefited from an increasing migration of nurses over the past decades. The nursing profession is the largest single health profession, making up over half of the Australian health care workforce. Migration of nurses into the Australian nursing workforce impacts significantly on the size of the workforce and the capacity to provide health care to the Australian multicultural community. Migration of nurses plays an important role in providing a solution to the ongoing challenges of workforce attraction and retention, hence an understanding of the factors contributing to nurse migration is important. This paper will critically analyse factors reported to impact on migration of nurses to Australia, in particular in relation to: (1) globalisation; (2) Australian society and nursing workforce; and (3) personal reasons. The current and potential implications of nurse migration are not limited to the Australian health care workforce, but also extend to political, socioeconomic and other aspects in Australia. [ABSTRACT FROM AUTHOR]

Providing health care to newly arrived refugees within the primary health care system has proved challenging. The primary health care sector needs enhanced capacity to provide quality health care for this population. The Primary Care Amplification Model has demonstrated its capacity to deliver effective health care to patients with chronic disease such as diabetes. This paper describes the adaption of the model to enhance the delivery of health care to the refugee community. A 'beacon' practice with an expanded clinical capacity to deliver health care for refugees has been established. Partnerships link this practice with existing local general practices and community services. Governance involves collaboration between clinical leadership and relevant government and non-government organisations including local refugee communities. Integration with tertiary and community health sectors is facilitated and continuing education of health care providers is an important focus. Early incorporation of research in this model ensures effective feedback to inform providers of current health needs. Although implementation is currently in its formative phase, the Primary Care Amplification Model offers a flexible, yet robust framework to facilitate the delivery of quality health care to refugee patients. [ABSTRACT FROM AUTHOR]

Improving collaboration and coordination in primary and community health is a national priority. Two major approaches have been taken: strengthening interorganisational and interprofessional collaboration. This paper reviews current and emerging models of partnerships: divisions of general practice and primary care partnerships (organisational models); and collaboration between general practitioners with practice nurses and with allied health professionals (interprofessional models). The models are reviewed in terms of the governance and formalisation of the partnership arrangements and the level of collaboration they achieve. The organisational models have had different purposes and taken different forms, the 'hub and spoke' model of divisions and decentralised 'network' relationships of primary care partnerships, both of which have broadly achieved their aims. Interprofessional collaboration involves a complex mix of allegiances and interests that influences the level of collaboration that is achieved. A combination of approaches is needed to achieve more coordinated and integrated primary health care. The implications for several current policy debates are discussed: the establishment of local integrated and comprehensive primary health care centres, regional level primary care organisations and alternative payment mechanisms. [ABSTRACT FROM AUTHOR]

In this article, the author comments on the significance of partnerships in the improvement of health care system and the potential of the Divisions of General Practice to assume the role of regional structures in Australia. He mentions that partnerships are essential in health reform because it build on the foundation of patient-provider relationships. He believes that it is also vital in having effective relationships between governments, health care providers and other health sectors.

The academic literature contains surprisingly little information regarding the design and conduct of surveys dealing with sensitive social issues. The present paper is an attempt to help fill that gap so that other researchers conducting similar projects can learn from our experience. In particular, I focus on the various challenges we encountered in carrying out a computer assisted telephone interview (CATI) survey of informal carers in Australia, our responses to these challenges and our learnings from this endeavour. In the present article, I discuss the following issues: cost-efficient sampling for small numbers; opt-out versus opt-in approaches to respondent participation; status errors in administrative data; reducing respondent refusals; interviewing non-English speakers; questionnaire topic order; carers who care for more than one person; and interviewer training, including interviewer and/or respondent distress. The conclusions were: (1) carers are generally willing and able to answer quite sensitive questions around caring, despite the fact that they may become distressed in doing so; (2) carers are willing to answer a rather long (25 min) telephone survey; (3) thorough interviewer training is critically important, with an emphasis on achieving a balance between sensitivity and efficiency; and (4) respondents should be given the opportunity at the end of the interview to make additional comments and to provide their contact details should they desire follow up from an appropriate authority. [ABSTRACT FROM AUTHOR]

There is increasing evidence that prevention of chronic disease is possible and that primary care can contribute to this. This paper aims to explore the development of policies and programs to improve chronic disease prevention via behavioural risk factor management in Australian general practice and the impact of these between 2 001 and the present. This involved a review of policy initiatives and developments in Australian general practice, drawing on published research over this period. Behavioural risk factor management has not been comprehensively implemented in the way in which it was originally envisaged under the SNAP (Smoking, Nutrition, Alcohol and Physical Activity) framework, with initiatives and programs emerging over time in a much less planned way, including Lifescripts and more recently the 45 -49 year health check. There has been a gradual development in capacity, especially in relation to workforce, education and training, educational materials, financial and decision support with divisions of general practice emerging to play a key facilitation role. Despite this, important gaps remain especially in relation to the use of team approaches within and outside the practice including access to referral services and programs. [ABSTRACT FROM AUTHOR]

Considerable interest in reform for primary health care and health more generally has emerged recently. There are concerns that primary and community services are fragmented, inequitable and inefficient, particularly for people with chronic and complex conditions. The evidence suggests there will be a significant increase in demand for these services and that stronger primary health care systems lead to better health outcomes. This paper makes a number of suggestions about the development of funding, payment, governance and organisational arrangements that could be part of a National Primary Health Care Strategy for Australia. [ABSTRACT FROM AUTHOR]

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

This paper discusses a health promotion intervention that sets out to develop local capacity to address chronic disease risk factors in a remote Australian community. Community focus groups, and researcher and community discussions, aimed to determine the community's health concerns and build a partnership for community action. The journey from conception to reality was difficult for a number of reasons that are described here. Despite these difficulties, a range of outcomes included the establishment of an organisational structure that involved a local health promotion committee as the principal decision-maker the establishment of a grants scheme to support locally determined initiatives and the formal incorporation of a community Health Promotion Committee (HPC) that ensured the sustainability of activities beyond the funded project period. The HPC is still coordinating health promotion activities. The promotion of community ownership of health promotion activities is a complicated process, given that time, resources, expertise and community involvement require a much longer-term commitment than that currently imposed by many funding bodies. [ABSTRACT FROM AUTHOR]

Despite considerable rhetoric, comprehensive primary health care remains largely a matter of a paper exercise. The theory promotes horizontal and vertical integration and the active participation of people in planning. Experience in Australia and elsewhere indicates that what is in place in health services is often primary medical care: the management of the needs of presenting individuals. The arguments for upstream interventions remain valid, bolstered by research on the social determinants of health. Two examples are given of primary health care that attempt to work upstream, before clinical interventions become necessary and illustrate the need for both horizontal and vertical integration. Consequences for policy and training are drawn. [ABSTRACT FROM AUTHOR]

Randomised trials of the Chronic Disease Self-Management Program (CDSMP) have shown improvements in health outcomes for people with arthritis, diabetes, heart disease and lung disease. The potential benefits of the CDSMP for people with cancer have not been researched, even though they can experience "chronic" symptoms after treatment. This paper reports on a pilot study conducted by The Cancer Council South Australia to determine whether the CDSMP was relevant and beneficial to people affected by cancer. Feedback was obtained via semi- structured telephone interviews with participants 4-6 weeks after the conclusion of the course. Most participants felt that the course was relevant to their cancer experience. Mixing with others who had experienced cancer appeared to be a key aspect of the program. Sharing experiences helped to break down their sense of isolation, and normalise the cancer experience: "I wasn't the only one who wasn't coping ". Other benefits included gaining motivation to improve their health and wellbeing, a sense of regaining control and a new-found confidence to achieving one's goals. Participants beyond the acute treatment phase appeared to benefit more from the program. This community-based program may bridge the gap for people who are adjusting after cancer treatment is completed. [ABSTRACT FROM AUTHOR]

More than 18,000 Australians die annually from diseases caused by tobacco. Indigenous Australians suffer a greater smoking-related disease burden than the remainder of the general public and have a higher prevalence of tobacco use than other Australians. The overall decline in smoking rates is slowest in women of low educational status between the ages of 25–44. This is of particular concern as these young women may be pregnant or raising young children. During pregnancy, the effects on the foetus from cigarette smoke include respiratory illness, low birthweight and Sudden Infant Death Syndrome. However, if the mother is able to give up smoking by her fourth month of pregnancy, her risk of delivering a low birthweight baby decreases to nearly that of a non-smoker. As part of the planning to develop an effective smoking cessation program for young Indigenous pregnant women, the Townsville Aboriginal and Islanders Health Services (TAIHS) surveyed a group of women to assess smoking habits, attitudes to smoking, nicotine dependence and readiness for change. This paper reports on this sums, and the results found can be used to develop a tailored, smoking cessation program for Indigenous women. [ABSTRACT FROM AUTHOR]

The past two decades have seen a growing awareness of the unique challenges faced by carers and recognition of their valuable contribution to society. Accordingly, assumptions about car, giving (and receiving) are changing; researchers and policy-makers alike are beginning to incorporate notions which pay at least lip service to supporting or empowering caregivers and receivers through needs-led rather than service-led support. However, there remains a significant lack of understanding of many of the issues faced by carers and care-recipients. This lack of understanding surfaces in polices and programs that tend to ignore the experiences of significant cohorts of carers, particularly older cares, Indigenous carers and carers from remote regions. The program upon which this paper is based is unique in that it does indeed address many of the identified gaps in service provision vis-à-vis older carers in the community. The Western Australian (WA) Australian Red Cross (ARC) Older Carers Program (OCP) was developed to support the unique needs of carers aged 65 years and older (50 if Indigenous) who care for a person aged 18years or older and who have a permanent disability. The aim of the program was to provide intensive case planning, management and volunteer support that would assist older carers to more readily access respite and continue their caring role. To achieve this end, ongoing, individualised and holistic assistance involving carers in decision-making was an integral component of the OCP processes and activities. Nevertheless, in the course of our evaluation research of the program we found that, despite the overall success of the program in meeting its objectives, significant barriers to respite existed among a significant group of participants (which we will cart a ‘sub-group’). Our research identified these sub-groups as rural carers, single parents/carers, carers of high-need care recipients and ‘highly stressed’ carets. These unique needs in turn formed barriers to access and are an important consideration in further debate around the important issue of older carers in the community and respite care programs in Australia. [ABSTRACT FROM AUTHOR]

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf/Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing/formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing. [ABSTRACT FROM AUTHOR]

The care of people living with HIV/AIDS in the home and community can be complex and challenging, requiring high levels of knowledge, skill, preparedness and, importantly, the ability to engage with people belonging to marginalised groups. In 2003, the Royal District Nursing Service (RDNS) HIV/AIDS Team in Victoria, Australia, developed the new role of HIV Resource Nurse at two RDNS centres in Melbourne serving high numbers of people living with HIV/AIDS. Drawing from turn case studies and interviews with two HIV Resource Nurses from one of the centres, this paper describes this practice innovation. Benefits (including a positive impact on client engagement with services, client care, relationships with other health care workers and job satisfaction) are outlined, along with challenges in the implementation and evolution of the role. Strategies to sustain and develop the HIV Resource Nurse role are proposed. [ABSTRACT FROM AUTHOR]

The aim of this article is to provide a description of the establishment of an innovative approach to improving speech pathology services and community inclusion of people with complex communication needs in rural Victoria. The East Hume Regional Communication Service was established by Ovens and King Community Health Service in partnership with Wodonga Regional Health Service in 2004 as part of a ‘hub and spoke’ network of services across Victoria for people with complex communication needs. Unlike traditional speech pathology services that historically have focused on clinical one-to-one intervention, the Regional Communication Service has a strong focus on community capacity building, enhancing inclusion of people with complex communication needs through improved knowledge, skills and attitudes. This paper will review the relevant literature and outline the Victorian Government policy context within which the service was established. Service highlights and successful initiatives will be described and key factors contributing to the success of the .East Hume Regional Communication Service will be explored. Areas for process improvement during the initial two years of operation will also be discussed. This article will provide an insight into establishment of a service deliver, model addressing both individual needs and community inclusion that has the potential to be extended across multiple disciplines and areas of practice within rural Australia. [ABSTRACT FROM AUTHOR]

While various models of chronic disease management have been developed and evaluated, minimal data is available relating specifically to Australian general practice and, in particular, the role of the nurse within the multidisciplinary general practice team. This paper presents a multidisciplinary model of cardiovascular disease management, focused on Australian general practice, and identifies barriers and facilitators to its implementation. This model was developed from data arising from a series of investigations that (1) examined the epidemiology and current general practice management of cardiovascular disease (2) explored the demographics and role of the practice nurse, and (3) established strategic recommendations for future practice development. The model proposes an integrated and multidisciplinary cardiovascular disease management framework to inform policy-makers and health planners in the development of primary health services in Australian general practice. [ABSTRACT FROM AUTHOR]

Public policy in Australia recommends that the relationship between consumers and mental health professionals should be one of equals and that consumers be encouraged to have input into service delivery at every level. This approach requires a significant change in attitude for mental health professionals and within services. Although consumer input into mental health service delivery has improved, there is still a long way to go. Unfortunately, consumers consider many of the efforts by mental health services to be tokenistic. This paper considers some of the issues regarding consumer participation, including the changing community attitudes towards people with a mental illness, the concept of recovery, challenges for health professionals and the impediments to consumer participation. [ABSTRACT FROM AUTHOR]

The author reflects on the status of primary health care in Australia with emphasis on the issue whether or not a reform in health policies is necessary. The author contends that the challenges which will confront the country's health care system is well documented suggesting that indeed they are real. Issues such as ageing population and longer life expectancies, and prevalence of chronic illness among others are discussed.

The purpose of this article was to review and evaluate three Australian projects with a focus on smoking cessation and Aboriginal and Torres Strait Islander pregnant women, funded under the Tackling Indigenous Smoking Innovation Grants Scheme, Australian Department of Health. The aim was to determine the impacts of culturally appropriate smoking cessation support for pregnant Aboriginal and Torres Strait Islander women. To provide an equity-focused lens to the review, our team of Indigenous and non-Indigenous researchers utilised an Australian-developed assessment tool: the 'Cultural Identity Interventions Systematic Review Proforma'. The tool was used to measure cultural approaches across a range of domains, and these were independently assessed by two reviewers, along with an assessment of the projects' smoking cessation outcomes. The results were compared to the evidence base in relation to aims, methods, results and conclusions, and consensus for scoring was reached. The review found that these Tackling Indigenous Smoking projects about pregnancy intentionally and effectively incorporated culturally based approaches that sought to work with the participants in culturally informed ways. Each project utilised existing social networks and partnerships to provide their participants with access to a range of community resources, adding value to existing programs. Providing an equity lens to measure cultural approaches used in smoking cessation interventions is important. Despite this, there is a research gap between how to provide culturally appropriate support for Aboriginal and Torres Strait Islander pregnant women that meets their needs, is accessible and evidence-based in Australia. We advocate the ongoing use of the 'Cultural Identity Intervention Systematic Review' Proforma tool within Aboriginal and Torres Strait Islander health interventions to assess scientific rigour and ethical standards associated with Aboriginal and Torres Strait Islander health research principles and values. [ABSTRACT FROM AUTHOR]

The aim of this study is to describe average out-of-pocket costs across different regions of Australia, as defined by Primary Health Network (PHN) boundaries, and assess the association between population characteristics and out-of-pocket costs for selected primary care services. A combination of descriptive and regression analysis was undertaken using administrative data from the Australian Department of Human Services reporting on the health services used across PHNs in Australia. Those in regional areas paid significantly more for Allied Health services than those in capital cities (A$5.68, P = 0.006). The proportion of an area's population aged 65 years and over was inversely related to out-of-pocket charges for Allied Mental Health (-A$79.12, P = 0.029). Some areas had both high charges and disadvantaged populations: Country South Australia, Northern Queensland, Country Western Australia, Tasmania and Northern Territory, or populations with poor health:Northern Territory and Tasmania. Although therewas a large amount of variation in out-of-pocket charges for primary care services between PHNs in Australia, there was little evidence of inequality based on health, age and socioeconomic characteristics of a population or the proportion of Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

Indigenous people have long maintained that strong cultural identities are critical to health and wellbeing. The purpose of this systematic review is to examine whether interventions that entail strategies to enable expression of cultural identities for Australian Indigenous peoples are associated with measurable improvements in health and wellbeing. Peer-reviewed articles that reported quantitatively expressed health and wellbeing outcomes involving Indigenous Australian participants only were included. The cultural intervention component was defined and assessed by Indigenous researchers on the team. A narrative analysis was conducted. The protocol was registered on PROSPERO (CRD420 15027387). Thirteen articles describing eleven studies were identified, including one randomised control trial (RCT), one cluster RCT and two studies with non-randomised controls. Other studies reported on case series or cross-sectional studies. All except two studies described multiple intervention strategies. Eight studies showed significant improvement in at least one psychosocial, behavioural or clinical measure, with two showing a positive direction of effect and one showing no improvement. Publication bias may discourage researchers to report negative findings of these interventions. Although studies vary in quality, this review provides evidence that interventions that include opportunities for expression of cultural identities can have beneficial effects for Australian Indigenous peoples. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including sexual health, chronic pain and population ageing in Australia.

The onset of the coronavirus disease 2019 (COVID-19) pandemic, caused by SARS-CoV-2, and the ensuing implementation of response measures directly impacted the delivery of Australian primary care services. Understanding how these measures affected practice activity is important for gauging both their effectiveness and implications for future service planning. During the first 2 years of the COVID-19 pandemic, a research project was undertaken to determine the impact of the pandemic on Australian general practice activity as a collaborative undertaking between researchers, general practitioners, data custodians, and five primary health networks from New South Wales and Victoria, Australia. The project methodology was based on an established research approach called action research, which involves participatory involvement from key stakeholders throughout the research process. The strength and success of the project's methodological approach stemmed from the synergistic interrelationship between the four key elements of: collaboration, repeated action research cycles (utilising electronic general practice data), engaged governance, and the production and dissemination of apposite knowledge outcomes. The project approach, knowledge outputs and lessons learned can be adapted to future research undertakings across any primary care setting and highlight the utility of action research and interdisciplinary research collaboration to produce knowledge directly relevant to clinical practice. The COVID-19 pandemic directly impacted the delivery of primary care services. We detail a research project framework used during the first 2 years of the COVID-19 pandemic to understand how general practice activity was impacted by the pandemic. The knowledge outputs and lessons learned can be adapted to future research undertakings across any primary care setting and highlight the utility of action research and interdisciplinary research collaboration to produce knowledge directly relevant to clinical practice. [ABSTRACT FROM AUTHOR]

Background: The Australian Health Concession Card (HCC) policy aims to improve access to affordable health services and medicines by providing reduced patient cost-sharing. This study explored the association between HCC holding and health service utilisation, as well as health-related lifestyles and obesity in Australian adults. Methods: The Australian National Health Survey data were used to derive three sets of study outcomes. Multivariable generalised linear regression models were used to estimate the association between concessional status and study outcomes after controlling for socio-demographic factors. Results: HCC holders, compared to their non-concessional counterparts, had more visits to GPs (1.01, 95% CI: 0.74–1.30), specialists (0.23, 95% CI: 0.02–0.44), outpatient clinics (0.19, 95% CI: 0.06–0.31), and had more hospital admissions (0.04, 95% CI: −0.05–0.91). There was no significant difference in visits to doctors and health professionals about mental health problems among HCC holders and their counterparts. Moreover, less HCC holders consumed alcohol on ≥3 days a week (OR: 0.75, 95% CI: 0.59–0.93) and had less of an alcohol risk that exceeded the 2001 alcohol guidelines (0.83, 95% CI: 0.69–0.99). Conclusions: This study revealed evidence that reduced patient cost-sharing provided by HCC policy was positively correlated with more health service utilisation after adjusting for socio-demographic characteristics. Strategies to prioritise resources are necessary. The association between patient cost-sharing and health service utilisation are important for health promotion and healthcare resources allocation. This study revealed significant evidence that reduced patient cost-sharing provided by Health Concession Card (HCC) policy was positively correlated with more health service utilisation by Australian adults. Our findings imply that future promotion efforts are warranted to improve mental health services to reach vulnerable groups and integrate needs assessments when allocating limited health service resources. [ABSTRACT FROM AUTHOR]

Background: Studies show widespread widening of socioeconomic and health inequalities. Comprehensive primary health care has a focus on equity and to enact this requires more data on drivers of the increase in inequities. Hence, we examined trends in the distribution of income, wealth, employment and health in Australia. Methods: We analysed data from the Public Health Information Development Unit and Australian Bureau of Statistics. Inequalities were assessed using rate ratios and the slope index of inequality. Results: We found that the social gradient in health, income, wealth and labour force participation has steepened in Australia, and inequalities widened between the quintile living in the most disadvantaged areas and the quintile living in the least disadvantaged areas. Conclusion: Widening income, wealth and employment inequalities have been accompanied by increasing health inequalities, and have reinforced and amplified adverse health effects, leading to increased mortality inequality. Effective comprehensive primary health care needs to be informed by an understanding of structural factors driving economic and health inequities. Over recent decades, Australia has become more unequal in terms of income, wealth, employment, and health. We analysed publicly available Australian data and found that the social gradient in health, income, wealth and labour force participation have all steepened. This makes calls for comprehensive primary health care even more urgent as one strategy to address underlying structural factors driving these worsening inequities. [ABSTRACT FROM AUTHOR]

Background: Using the World Health Organization's 'Guide to Tailoring Immunization Programmes' (TIP), a three-step program was developed by health services in partnership with a marginalised community in New South Wales, Australia. The aim was to improve immunisation rates of 1-year-old children. For Step 1, nurses identified and monitored local children overdue for immunisation from a national register, and sent parents or family doctors reminders by mail or telephone. For Step 2, parents were offered appointments at a local health centre; and for Step 3, they were offered home visits. Methods: An economic costing study was undertaken to examine the program's resource use. Costs were collected between 1 June 2020 and 31 May 2021. Case records were obtained for 139 children. Results: A total of 56 children became up to date after receiving TIP services; most after receiving Step 1 services (n = 37). Total annual costs (A$) for the program were $34 250 or $246 per case; or $612 per case becoming up to date. At $44 per case and $98 per case becoming up to date, Step 1B: personalised reminders, was the lowest costing step. Sensitivity analysis showed a possible 8% program savings through employment of nurses with a lower salary and use of video conference meetings. Conclusion: This study provides information to the local health provider on the cost of TIP alongside their community-based programs. It also identified ways in which TIP could be made more cost-effective. Decision-makers can use this information to consider whether the investment in TIP is recommended. Reaching pockets of under-immunised children requires tailored strategies for addressing local barriers. The World Health Organization developed the Tailoring Immunization Programmes guide to assist health services to identify areas of low coverage, gain understandings of barriers to vaccine uptake and develop tailored strategies. An economic costing of a Guide to Tailoring Immunization Programmes program serving marginalised families in the Maitland area of NSW was undertaken. [ABSTRACT FROM AUTHOR]

Background: Standard practice after all vaccinations in Australia is to observe patients for 15 min. During the coronavirus disease 2019 (COVID-19) pandemic, could the risk of contracting and dying from COVID-19 acquired in the waiting room be greater than the risk of dying from post-vaccine anaphylaxis when leaving immediately? Methods: The risks are modelled for a patient aged 70+ years attending for annual influenza vaccination in a typical Australian general practice clinic. The risk of death from anaphylaxis is estimated based on known rates of anaphylaxis shortly after influenza vaccination. The risk of acquiring COVID-19 during a 15-min wait and then dying from that infection is estimated using the COVID-19 Aerosol Transmission Estimator and COVID-19 Risk Calculator. Results: Other than at times of extremely low COVID-19 prevalence, the risk of death from anaphylaxis for a patient aged 70+ years leaving immediately after influenza vaccine is less than the risk of death from COVID-19 acquired via aerosol transmission during a 15-min wait. The risk of death from COVID-19 is greatest for the unimmunised and when masks are not worn. Conclusions: A more nuanced approach to advice post-vaccination is recommended that considers current COVID-19 prevalence and virulence, the characteristics of the waiting room, the risk of anaphylaxis, and the patient's susceptibility to death from COVID-19. There are many circumstances where it would be safer for a patient to leave immediately after vaccination. Should patients continue to be observed for 15 min post-vaccination in a waiting room during the COVID-19 pandemic? In a typical general practice influenza vaccination clinic, unless the background rate of COVID-19 in the community is very low, patients aged >70 years are found to be at greater risk of dying from COVID-19 acquired waiting post-vaccination than from anaphylaxis if leaving immediately. The routine application of 15-min of observation post-vaccination should be replaced with a more nuanced approach. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity has a bi-directional association with the growing burden of musculoskeletal (MSk) dysfunction and pain. It seems inevitable that MSk practitioners will see increasing numbers of patients who are overweight and or obese and require this to be addressed as part of their management. Little evidence exists to describe the engagement of patients and their MSk practitioner in weight management as an adjunct or direct component of their intervention or therapy. Methods: A self-administered electronic survey was constructed with 13 items to collect self-reported data from Australian practitioners who have a focus on MSk management. The target group was from a multidisciplinary MSk network of 350 members. Results: A total of 204 completed surveys were analysed from respondents working in one of seven MSk- related professions. It was found that 70% of patients/clients seen by respondents were overweight or obese and that <18% of these patients had weight management included as part of their treatment. Conclusions: Sixty percent of the respondents in this survey indicated that they do not include weight management as part of their practice despite 70% of their patients/clients being overweight and or obese. With the exception of Medical Practitioners and Exercise Physiologists, in this survey, the other therapists including Chiropractors, Osteopaths, Physiotherapists and Occupational Therapists, indicated that they lacked confidence, knowledge and methods to engage a systematic approach to weight management with their patients/clients. A large percentage of presentations for musculoskeletal management are overweight/obese, and it is reported that musculoskeletal conditions are impacted by this co-morbid issue. It is little known to what extent musculoskeletal clinicians manage overweight/obesity as part of their practice, and this research found most musculoskeletal clinicians do not manage this issue, claiming they do not have the knowledge or skill to include this in their scope. This finding prompts consideration of limitations in scope of practice and subsequent curriculum change. [ABSTRACT FROM AUTHOR]

Background: The Community Health Program of the 1970s was an attempt to introduce a national community health model. However, although community-based health care is an important element of the health systems of all Australian states and territories, the definition of what constitutes a 'community health service' in Australia today is not clear. Methods: A search of government websites failed to provide information about the types and characteristics of services that would be included in the term. Therefore, semi-structured interviews were conducted with 13 key informants in roles with responsibility for primary and community health services from health departments in all Australian states and territories. Questions explored their understanding of community health services as they operated in their jurisdiction. The study adopted a blended inductive and deductive orientation within a qualitative descriptive method. Results: There was little consistency in the way community health services were described across jurisdictions. The defining attributes of a 'community health centre' described by an international peak body did not apply to services in the majority of jurisdictions in Australia. Victoria was more aligned with the description than other jurisdictions, with organisations defined through legislation and a separate funding stream to support aspects of service delivery. Conclusions: Those designing and implementing national health system programs and reforms need to be aware that terms, such as 'community health', do not mean the same thing across jurisdictions; attempts to create consistency have to recognise differences that will affect new initiatives, as well as the spread of successful policies and programs from one jurisdiction to another. Without a consistent description, it is difficult to explore the current role of community-based health care across Australia in improving access to health care. 'Community health' is an important element of Australian health systems and recognised as such in national policy. Interviews with 13 key informants in roles with responsibility for primary and community health services from health departments in Australian states/ territories found little uniformity in the way community health was described. Inconsistencies in the use of the term 'community health' and the complexity of the multi-jurisdictional context need to be acknowledged when considering the design and implementation of national health system programs and reforms. [ABSTRACT FROM AUTHOR]

Background: Accelerated by the coronavirus disease 2019 (COVID-19) pandemic, Australia has shifted towards greater use of telehealth to deliver care for rural and remote communities. This policy direction might risk a shift away from the traditional model of informed person-centred care built around care relationships to a technology-mediated health transaction. Potential opportunity costs of widespread telehealth services on the quality of care for rural and remote communities remain understudied. Methods: A qualitative study was conducted in three local health districts of rural New South Wales, Australia. Data were collected through in-depth interviews. A total of 13 participants was interviewed. Data were analysed using thematic analysis. Results: Patient participants perceived telehealth as an alternative when specialist care was limited or absent. Both patients and clinicians perceived that the deeper caring relationship, enabled through face-to-face interactions, could not be achieved through telehealth services alone, and that telehealth services are often superficial and fragmented in nature. Patients in this study contended that virtual consultations can be distant and lacking in personal touch, and risk losing sight of social circumstances related to patients' health, thereby affecting the trust placed in healthcare systems. Conclusions: Simply replacing face-to-face interactions with telehealth services has the potential to reduce trust, continuity of care, and effectiveness of rural health services. Telehealth must be used to assist local clinicians in providing the best possible care to rural and remote patients within an integrated service delivery model across diverse rural contexts in Australia. The widespread use of telehealth services for rural and remote communities might risk a shift away from the traditional model of informed person-centred care to a technology-mediated health transaction. Replacing face-to-face interactions with telehealth services has the potential of reducing trust, continuity of care, and effectiveness of health services. Telehealth must be used to assist local clinicians in providing the best possible care to rural and remote patients within the integrated service delivery model and across diverse rural contexts in Australia. [ABSTRACT FROM AUTHOR]

The demand and complexity of the health needs of older people is growing. Traditionally siloed, condition-centric care is no longer appropriate. It is costly to the Australian health system and life-threatening to the individual. In parallel to demographic change is increasing global awareness of the impact of social, behavioural, and environmental factors on health outcomes. Although significant when not addressed, the amenable nature of many personal contextual factors is an opportunity to improve health and quality of life. A move away from reactive, episodic models of health care delivery towards patient focussed integrated care is required to meet the changing demands of an aging population. This forum article provides a reflection on the current state of integration for older people with complex needs through the lens of a local community facing model: OPEN ARCH. Australia still has some way to go to establishing system level enablers for an integrated approach to care. However, the OPEN ARCH experience furthers the evidence for ground-up approaches of integrated care that can meet the increasing demand and complexity of older people's needs. A move away from reactive, episodic models of health care delivery towards patient-focussed integrated care is required to meet the changing demands of an aging population. This forum article provides a reflection on the current state of integration for older people with complex needs through the lens of a local community facing model: OPEN ARCH. The OPEN ARCH experience furthers the evidence for ground-up approaches of integrated care that can meet the increasing demand and complexity of older people's needs. [ABSTRACT FROM AUTHOR]

Background: GPs are integral to the COVID-19 vaccination rollout, providing education and administering vaccines. We sought to describe how counselling relating to COVID-19 vaccination was impacting Australian general practice consultations. Methods: We conducted an online, mixed-methods, cross-sectional survey of Australian community-based primary care from 7 to 15 July 2021. This survey, number 15 in a series of recurrent cross-sectional surveys conducted over a 14-month period, explored how counselling relating to COVID-19 vaccination was impacting general practice consultations, through multiple selection and open text responses; it also included questions on respondent and practice characteristics, and pandemic-related stress and strain. We calculated descriptive statistics for quantitative variables, and analysed free-text responses using an inductive content analysis approach. Results: We received 73 responses (72 GPs) across all states/territories. Discussions with patients about COVID-19 vaccines and vaccination were common, increasing the duration of routine consultations by 6 min on average (s.d. 2.9). Respondents described the impact of the resulting time pressures, and the stress and challenges of participating in COVID-19 vaccine communication and administration. Although our results are illuminating, they are limited by the small sample, with some different characteristics from national estimates, an uncertain response rate and the inability to pilot the survey prior to distribution. Conclusions: The significant impact on general practice consultation from COVID-19 vaccine counselling is on a background of ongoing pandemic-related stress and strain. With a strong track record of population vaccination, GPs are well-placed to deliver COVID-19 immunisations to the Australian population. However, they must be represented in planning and coordination, to reduce the overall burden on primary care. The COVID-19 vaccination program is a crucial element of the Australian pandemic management plan and goal to return to 'normal' life, and primary care is a vital player in vaccine provision. Integrating new population-wide vaccinations into existing general practice has had a significant, but not well-documented, impact on primary care. Our study describes the experiences of general practice in Australia nearly 5 months into the vaccine rollout. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) play a central role during the COVID-19 pandemic, and yet awareness of their mental health is limited. Methods: A nationwide online survey of self-identified frontline healthcare workers was conducted between 27 August and 23 October 2020. Participants were recruited through health and professional organisations, colleges, universities, government contacts, and media. A subset of the findings on GPs and hospital medical staff (HMS) was used for this study. Results: Of 9518 responses, there were 389 (4%) GPs and 1966 (21%) HMS. Compared with HMS, GPs received significantly less training on personal protective equipment usage or care for COVID-19 patients, and less support or communication within their workplace. GPs were significantly more concerned about household income, disease transmission to family and being blamed by colleagues if they became infected, all of which were associated with worse psychological outcomes. Significantly more GPs reported burnout, and experienced moderate-to-severe emotional exhaustion than HMS. Both groups used similar coping strategies, except fewer GPs than HMS used digital health applications or increased alcohol consumption. Less than 25% of either group sought professional help. Conclusions: GPs are vital in our healthcare systems, yet face unique workplace challenges and mental health stressors during the pandemic. Targeted workplace and psychological support is essential to protect wellbeing among the primary care workforce. The COVID-19 pandemic poses an additional threat to mental health for healthcare workers. We identified unique workplace challenges and stressors faced by GPs that were different from hospital medical staff. Significantly more GPs reported burnout, and experienced moderate-to-severe emotional exhaustion than hospital medical staff. Targeted workplace and psychological support is essential to protect wellbeing among the primary care workforce. [ABSTRACT FROM AUTHOR]

Background: People with severe mental illness have a higher rate of premature death than the general population, largely due to primary care preventable diseases. There has been little research on the health profile of this population attending Australian general practices. Methods: In this nationwide cross-sectional study, MedicineInsight data for adult patients regularly attending general practices in 2018 were analysed to estimate the prevalence of schizophrenia or bipolar disorders (SBD) and investigate the health profile of people with SBD compared with other patients. Multilevel models clustered by practice (n = 565) and patient, and practice characteristics were created. Results: The prevalence of recorded SBD was 1.91% (95% CI = 1.88%–1.94%) among the 618 849 patients included. Patients with recorded SBD were more likely than other patients to have records of health risk factors, particularly smoking (aOR = 3.8, 95% CI = 3.6–3.9) and substance use (aOR = 5.9, 95% CI = 5.6–6.3), and higher probabilities of comorbidities including cardiovascular diseases (aOR = 1.3, 95% CI = 1.2–1.4), cancer (aOR = 1.1, 95% CI = 1.0–1.2), diabetes mellitus type 2 (aOR = 2.2, 95% CI = 2.0–2.3), chronic kidney diseases (aOR = 1.7, 95% CI = 1.5–2.0), chronic liver diseases (aOR = 3.3, 95% CI = 2.6–4.0) and chronic respiratory diseases (aOR = 1.7, 95% CI = 1.7–1.8). Conclusions: The higher prevalence of health risk factors and comorbidities among patients with recorded SBD underscores the need for proactive health risk monitoring and preventive care to address this health inequity. People with severe mental illness die about 20 years earlier than those in the general population, mostly due to preventable diseases. Data on those who attend general practice in Australia are lacking. This study describes higher rates of socioeconomic disadvantage, risk factors such as smoking and chronic diseases such as diabetes mellitus type 2 relative to other patients. The results add further weight to the call for more proactive preventive care for people with severe mental illness to address this health inequity. [ABSTRACT FROM AUTHOR]

The home care package (HCP) scheme provides funds to eligible older Australians for social, personal and clinical care services, and aims to assist people to age in-home. Uncorroborated evidence suggests older Australians rely on health professionals – especially general practitioners – to prompt HCP assessments, choose service providers and manage HCP funds thereafter. This was confirmed in a survey involving 502 older Australians aged >65 years receiving HCP funds. As more Australians survive to older age, further research is needed to establish with general practitioners their needs regarding the delivery of in-home care information, clinic practice resources, trainee education and continuing professional development. Health care professionals often have regular contact with their older patients, and understand their changing health needs. The home care package scheme provides funds to eligible older Australians for social, personal and clinical care services, aiming to help people to age in place. Uncorroborated evidence suggests older Australians rely on health professionals to prompt home care package assessments, choose service providers and manage packages thereafter. Little is known, however, about the confidence of health professionals in the community to provide this guidance. [ABSTRACT FROM AUTHOR]

An editorial is presented on the celebrating 25 volumes of the Australian Journal of Primary Health (AJPH). Topics inlcude AJPH had its origins as a newsletter of the Victorian Community Health Association (VCHA), managing the Journal has transferred to the Australian Institute for Primary Care, and the structure of the Journal and its collaborative co-ordinating mechanisms were innovative in their linkages key organisations in the field.

The concept of commissioning is starting to gain traction in the Australian health system. Primary Care Networks began operations in July 2015 with a remit around commissioning health services. Despite the centrality of this concept, we know relatively little about commissioning in Australia. Other systems have experimented with it for some time, and this paper reviews the evidence and lessons inherent within the international literature. The study defines commissioning, and explores experiences of others who have adopted commissioning approaches and the evidence concerning the outcomes of these experiments. Commissioning is a difficult topic in many senses and its application to a complex area such as health reform can make it even more challenging. Ultimately, this evidence suggests that commissioning is more than simply a technical or operational process, but one that is value-based and relational. This is not to downplay the technical aspects, which in many jurisdictions have resulted in explicit and evidenced-based approaches to planning and priority setting. However, if new commissioning organisations, such as Primary Health Networks, are to have an impact, they need to balance the operational and relational elements of commissioning. [ABSTRACT FROM AUTHOR]

Crystal methamphetamine (commonly known as 'ice') use is currently a deeply concerning problem for some Australian Indigenous peoples and can cause serious harms to individual, families and communities. This paper is intended to support best practice responses by primary health-care staff working with Australian Indigenous people who use methamphetamine. It draws on a systematic search of relevant databases to identify literature from January 1999 to February 2014, providing an overview of prevalence, treatment, education and harm reduction, and community responses. The prevalence of methamphetamine use is higher in Indigenous than non-Indigenous communities, particularly in urban and regional settings. No evidence was identified that specifically related to effective treatment and treatment outcomes for Indigenous Australians experiencing methamphetamine dependence or problematic use. While studies involving methamphetamine users in the mainstream population suggest that psychological and residential treatments show short-term promise, longer-term outcomes are less clear. Community-driven interventions involving Indigenous populations in Australia and internationally appear to have a high level of community acceptability; however, outcomes in terms of methamphetamine use are rarely evaluated. Improved national data on prevalence of methamphetamine use among Indigenous people and levels of treatment access would support service planning. We argue for the importance of a strength-based approach to addressing methamphetamine use, to counteract the stigma and despair that frequently accompanies it. [ABSTRACT FROM AUTHOR]