Search

Objective: We estimated the cost to the public health system of treating Injecting-Related Injuries and Diseases (IRIDs) in the three most populous states in Australia in the 12 months over 2005/06. Methods: We conducted a cost of illness analysis from the perspective of the public health system. Costs of treating IRIDs in the community were estimated from health service utilisation surveys of injecting drug users and physicians (yielding data on Government subsidised physician visits, medicines prescribed and emergency department presentations). Data on admitted hospitalisations in public hospitals due to IRIDs were extracted from State Government databases. Appropriate costs were attached to all Government-borne services and prescriptions to estimate the total cost to the public health system of treating IRIDs in 2005/06 in Queensland, NSW and Victoria. Results: Our estimate of the cost to the public health system of treating IRIDs in Queensland, NSW and Victoria in 2005/06 was $20 million. Conclusion: IRIDs are an under-recognised harm resulting from injecting drug use, but the economic burden of IRIDs in Australia are non-negligible. Research is needed to identify cost effective programs to reduce the clinical and economic burden caused by IRIDs, particularly to reduce hospitalisations due to IRIDs. Implications: General practitioners, clinicians and other health workers need to be alert to IRIDs in their injecting drug user clients to prevent progression to more serious disease and consequent elevation of the associated economic costs. Key words: economic burden, cost of illness, injecting drug use, injecting-related injury and disease. doi: 10.1111/j.1753-6405.2009.00407.x

eHealth is an emerging service sector which has great potential to improve health care delivery to rural and remote communities, facilitate health surveillance, and promote health education and research. Despite [...]

The article discusses the tense policy layering and promotion of artificial standards in Australian health-care politics in the 1990s. It also analyzes the reforms introduced to support private health insurance in Australia at the end of the 1990s.

Objective: To provide an overview of qualitative methodologies for health researchers in order to inform better research practices. Approach: Different possible goals in health research are outlined: quantifying relationships between variables, identifying associations, exploring experience, understanding process, distinguishing representations, comprehending social practices and achieving change. Three important issues in understanding qualitative approaches to research are discussed: the partiality of our view of the world, deductive and inductive approaches to research, and the role of the researcher in the research process. The methodologies of phenomenology, grounded theory, discourse analysis, ethnography, ethnomethodology and action research are illustrated. Conclusion: In order to undertake high-quality qualitative research, it is important for researchers to consider their analytic focus and methodological position. Key words: Qualitative research; health services research.

Objective: To evaluate a Better Outcomes of Mental Health Care Access to Allied Psychological Services Program for general practice patients referred for high-prevalence mental disorders. Methods: Participants were South Australian general practitioners (GPs; n=26) and their patients referred for treatment of high-prevalence psychological disorders, of whom 229 provided baseline measures, 106 provided post-treatment measures, and 85 provided follow-up data three months after termination of treatment. Interventions were Focused Psychological Strategies supplied by mental health specialists; outcome variables included GP satisfaction, patient satisfaction, psychological distress, life impairment, and health service usage. Results: Satisfaction with the treatment program was high for both the GPs and the referred patients. Patients who attended three or more treatment sessions showed reduced distress and disability, and gains were maintained three months later. Health service usage declined with acceptance of referral regardless of treatment experience. Conclusions: Lack of controls and missing data were methodological weaknesses. Results support the effectiveness of integrated primary mental health care to reduce psychological distress and disability, while impact on service usage warrants further investigation. Implications: Reduction of suffering and increased economic productivity may both result from this public health initiative to increase access to effective treatments for common chronic mental conditions. Key words: Mental disorders, depression, program evaluation, primary health care, delivery of health care.

Programme budgeting and marginal analysis (PBMA) is becoming an increasingly popular tool in setting health service priorities. This paper presents a novel multi-attribute utility (MAU) approach to setting health service priorities using PBMA. This approach includes identifying the attributes of the MAU function; describing and scaling attributes; quantifying trade-offs between attributes; and combining single conditional utility functions into the MAU function. We illustrate the MAU approach using a PBMA case study in mental health services from the Community Health Sector in metropolitan South Australia. Keywords: Priority setting; Programme budgeting; Marginal analysis; Decision analysis; Multi-attribute utility theory; Mental health; Australia

This paper considers the health implications of access to social capital (SC) using data from a survey of households in two suburbs in Adelaide, Australia. SC was conceptualised as comprising 'infrastructure'--the networks and values that facilitate access to resources; and 'resources'--the resources available through this infrastructure. Questionnaires were delivered to all households in the area, asking the adult with the next birthday to complete it. In all, 530 (50%) were returned. A partial least-squares path analysis was undertaken using demographic, SC and health latent variables, and a measure of perceived relative advantage. Three infrastructure (values, formal networks and informal networks) and four resource (help, acceptance by neighbours, civic activities and feelings of control) variables were considered. Mental and physical health were measured using the SF-12. The values variable was associated with all the resource variables, the informal networks variable was related to help, and the formal networks variable was associated with civic actions. There were significant sociodemographic differences in a number of the infrastructure and resource variables, as well as mental and physical health. Those who were better off materially also had greater access to elements of SC, and reported better health. Values, informal networks, help, and control were all directly or indirectly positively associated with better mental health. No SC variables were associated with physical health. Perceived relative advantage was positively associated with a number of SC variables and also mental and physical health. The implications for health promotion are discussed. Keywords: Social capital; Health inequities; Networks; Case study; Path analysis; Australia

Objective: This paper provides intraclass correlation coefficients (ICCs) for estimation of sample size inflation required in future cluster randomised trials in primary or residential care. Methods: Three cluster randomised trials were conducted among middle-aged and older adults in primary care and residential care in Australia and New Zealand between 1995 and 2002. Baseline means or proportions, mean change, and ICCs with their standard errors and 95% confidence intervals are reported for outcome variables used in the three studies. The ICCs were estimated from a one-way random effects model using the analysis of variance method. Results: ICCs for quality of life and psychological variables in the primary care studies were low (below 0.018). ICCs for clinical and physical activity variables ranged from 0 to 0.08. ICCs for health and functional status in residential care for the elderly were high, ranging from 0.025 to 0.514. Conclusions: The magnitude of the intraclass correlation varies with the venue of the trial, the outcome variables used, and the expected effect of the intervention. However, the intraclass correlations provided will be useful for more appropriate planning of residential and primary care-based trials in the future.

Objective: To ascertain general population perceptions of the importance of indicators comprising the Index of Relative Socioeconomic Disadvantage (IRSD). Methods: Data for this study came from a face-to-face Health Omnibus survey of 3,001 residents in metropolitan and country South Australia, conducted in 2003. Results: Overall, respondents viewed the IRSD indicators as important. Of the 14 indicators, seven were seen as important by more than two-thirds of respondents (ranging from 90% perceiving the number of families with children and a low income important to 68% perceiving the number of one-parent families with dependent children as important). Younger respondents and those of lower educational attainment were more likely to perceive the indicators as unimportant, compared with older people. For example, 14% of people aged 15-24 vs. 5% of people aged 55-64 (p Conclusions: While the general population generally recognises the IRSD indicators as important measures of area-based disadvantage, there were systematic age differences in the degree to which individual indicators were deemed important. There was a general lack of support for several indicators (such as proportion of people separated/divorced, houses with no cars). Implications: This research raises the question of which factors are important in representing area-based disadvantage for young people and equally the use of this index when examining variations in the health of young Australians.

Based on anthropological field research (1997-2000) within the Department of Health and Community Services in the Northern Territory in Australia, this paper explores the lingering features of colonial logic in the pastoral work of public health workers in the Northern Territory of Australia. The public health professionals drawn to work in this space are determined to remedy what is wrong with culturally acceptable solutions. But viewed from an anthropological perspective, the way in which health professionals conceptualise the problems they need to solve ultimately serves to reinforce the reality of the need for their continued tutelary presence. This paper aims to draw out the complex ways in which this interventionary effect is secured, concentrating in particular on the role played by progressive ideologies of participatory development and information sharing. It argues that through a complex process of forgetting, the otherwise innocuous gestures of public health goodwill recreate a mandate for more public health intervention. This is not a simple moral tale where analysts can easily identify good and bad practices and thus distance themselves from the difficulties involved. Rather, by emphasising the honest commitments to improvement in situations of mass illness and preventable disease that health professionals bring to their work, and the burden they bear in being conscious of the recent colonial past, the paper aims to avoid the judgement that this sort of work is easy to get right. Keywords: Aborigines; Public health; Postcoloniality; Cross-cultural pedagogy; Australia

Objective: To examine the impact of a multi-component health assessment on mortality and morbidity in Kimberley Aboriginal residents during a 13-year follow-up. Method: A population-based randomised controlled trial using linked hospital, cancer and death records to evaluate outcomes in 620 intervention and 6,736 control subjects. Results: The intervention group had a higher rate of first-time hospitalisation for any reason (IRR=1.37; 95% CI 1.25-1.50), a higher rate of injury-related hospital episodes (IRR=1.31; 95% CI 1.15-1.48) and a higher notification rate of alcohol-related cancers. There was a smaller difference in the rates of multiple hospitalisations (IRR=1.14; 95% CI 0.75-1.74) and no improvement in overall mortality compared with controls (IRR=1.08; 95% CI 0.91-1.29). Conclusions: There was no overall mortality benefit despite increased health service contact associated with the intervention. Implications: Although not influencing mortality rates, multi-component health assessment may result in a period of increased health service use in Aboriginal and Torres Strait Islander populations, thus constituting an 'intervention'. However, this should not be confused with systematic and sustained interventions and investment in community development to achieve better health outcomes.

Clinical directorate service structures (CDs) have been widely implemented in acute settings in the belief that they will enhance efficiency and patient care by bringing teams together and involving clinicians in management. We argue that the achievement of such goals depends not only on changing its formalised structural arrangements but also the culture of the organisation concerned. We conducted comparative observational studies and questionnaire surveys of two large Australian teaching hospitals similar in size, role and CD structure. Martin's conceptualisation of culture in terms of integration, differentiation and fragmentation was applied in the analysis of the data. The ethnographic work revealed that compared to Metropolitan Hospital, Royal Hospital was better supported and more favourably viewed by its staff across six categories identified in both settings: leadership, structure, communication, change, finance and human resource management. Royal staff were more optimistic about their organisation's ability to meet future challenges. The surveys revealed that both staff groups preferred CD to traditional structures and shared some favourable and critical views of them. However Royal staff were significantly more positive, reporting many more benefits from CDs e.g. improved working relations, greater accountability and efficiency, better cost management, more devolvement of management to clinicians and a hospital more strategically placed and patient focused. Metropolitan staff were more likely to claim that CDs failed to solve problems and created a range of others including disunity and poor working relationships. There was greater consensus of views among Royal staff and more fragmentation at Metropolitan where both intensely held and uncertain attitudes were more common. The outcomes of implementing CDs in these two similar organisations differed considerably indicating the need to address cultural issues when introducing structural change. Martin's framework provides a useful antidote to researchers' tendency to locus at only one level of culture. Keywords: Hospitals; Organisational culture; Clinical directorates; Australia

Research on patterns of self-rated health and health service use suggests that women report having poorer health than men, and that, after controlling for health measures, women are more likely to obtain formal health care. Proposed reasons for these differences have included that women's self-rated health is more strongly influenced by psychosocial factors or negative affect and that women are likely to obtain services when at better levels of self-rated health, compared with men. Our study explored gender differences in the effects of non-health attributes on decisions to obtain primary medical services for an Australian community-based sample of 4140 adults from two age groups: 40-44 years and 60-64 years. Participants provided information on measures of physical and mental health, and on predisposing and enabling factors that could affect their levels of health service use. Information on visits made to general practitioners (GPs) in a 6-month period was obtained from the national insurer. We found that men and women who obtained no GP services reported comparable levels of physical and mental health and that, for both men and women, measures of health needs were most strongly associated with their obtaining care. After controlling for measures of mental and physical health and enabling factors, we found that non-health factors that could predispose an individual to obtain care had greater impact on men's but not women's decisions to obtain any GP services. Our findings do not support the hypothesis that in choosing to obtain medical care, women are more strongly influenced by non-health factors compared with men. Keywords: Gender; Health service use; Predisposing factors; Australia

Objective: To explore the extent of congruence between the views of service providers and young people (on adolescents' health concerns, barriers to accessing health services and ideal service model) in order to improve and increase the appropriateness, quality and usage of primary health care services. Methods: A qualitative data collection technique was used. During 2001/02, focus groups were conducted in urban and rural locations with adolescents (in and out of mainstream education), general practitioners, community health staff and youth health workers. Results: Service providers and young people identified a similar range of health concerns for young people, with young people adding additional issues of great importance to them that service providers felt were not in their 'domain of treatment'. There was reasonable congruence in regard to 'ideal service model' with some differences relating to methods of information delivery. However, for 'barriers to accessing services' there were major discrepancies. Conclusions: While there is some common understanding between young people and service providers on certain aspects of health services, there are clearly areas where perceptions differ. This discrepancy matters because it may adversely affect the quality of provider-adolescent interaction and the willingness of adolescents to access services. Implications: To deliver optimal health services to young people, the differences in understanding regarding services need to be addressed. Strategies could include promotion to, and encouragement of, young people to seek help, continuing professional education of providers and changes in remuneration policies.

Objective: To compare rates of self-reported use of health services between rural, remote and urban South Australians. Methods: Secondary data analysis from a population-based survey to assess health and well-being, conducted in South Australia in 2000. In all, 2,454 adults were randomly selected and interviewed using the computer-assisted telephone interview (CATI) system. We analysed health service use by Accessibility and Remoteness Index of Australia (ARIA) category. Results: There was no statistically significant difference in the median number of uses of the four types of health services studied across ARIA categories. Significantly fewer residents of highly accessible areas reported never using primary care services (14.4% vs. 22.2% in very remote areas), and significantly more reported high use ([greater than or equal to] 6 visits. 29.3% vs. 21.5%). Fewer residents of remote areas reported never attending hospital (65.6% vs. 73.8% in highly accessible areas). Frequency of use of mental health services was not statistically significantly different across ARIA categories. Very remote residents were more likely to spend at least one night in a public hospital (15.8%) than were residents of other areas (e.g. 5.9% for highly accessible areas). Conclusion: The self-reported frequency of use of a range of health services in South Australia was broadly similar across ARIA categories. However, use of primary care services was higher among residents of highly accessible areas and public hospital use increased with increasing remoteness. There is no evidence for systematic rural disadvantage in terms of self-reported health service utilisation in this State. (Aust N Z J Public Health 2004; 28: 426-32)

A common feature of health reforms in western nations has been the transformation or (re)construction of health and health care as both a commodity and product. In the hospital sector, this transformation has become increasingly evident in the growth of for-profit involvement in service delivery. Investor-owned hospitals are now prominent providers of hospital care in Australia. This paper examines the changing nature of health care space through the changing portrayal and meaning of hospitals as represented by and encoded in the built environment. Public hospitals once occupied 'pride of place'. In contrast, up to the early 1980s, the private sector was seen as a cottage industry. However, increased levels of state subsidisation and government incentives and pro-market policies, combined with market-based opportunities for profit generation, have seen the emergence of large private hospital chains with a new corporate image to hospital care and the blurring of 'public' and 'private'. A significant factor in the reconstruction of hospital space in Australia has been the co-location of private and public hospitals. Co-location is a popular strategy proffered by State governments and one that has been quickly acted on by corporate providers. Using Mayne Health Ltd, Australia's largest for-profit hospital chain, and four specific case studies, this paper explores four variants of co-location. Each of these examples represent a different public and private hospital space. The growth of for-profit hospital chains signifies a new phase in the delivery of health care in Australia but also importantly the creation of a new hybridised 'health care' space. This space is neither private nor public but a reflection of the economic political and social processes underlying this transformation. Keywords: Private hospitals; Health care landscapes; Co-location; Privatisation; Corporatisation; Australia

Objective: To determine some of the key problems in pursuing equity in Australian health care and to identify some of the ways of overcoming these problems, particularly in Aboriginal and Torres Strait Islander health care. Methods: To identify and debate the key equity issues particularly related to Aboriginal and Torres Strait Islander health care but also with respect to public versus private and rural/remote versus metropolitan. Results: Political leadership and political will plus a more compassionate, less complacent society are crucial. Conclusions and implications: Political leadership is needed that can inspire a more compassionate society and which reflects better the informed values of the Australian people, adopting a communitarian paradigm. There is a need for a 'health care constitutional convention' to allow the values of the populace with respect to equity to be elicited and to ensure that voices of the disadvantaged are heard. In the specific context of Aboriginal and Torres Strait Islander health care, there is a need first to recognise and thereafter break down the racism that exists in many Australian institutions.

Objective: To assess and contrast women's views of antenatal, intrapartum and postnatal care based on data collected in three state-wide surveys of recent mothers conducted in 1989, 1994 and 2000. Methods: Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5-8 months after the birth. Results: 58.6% of women participating in the 1989 survey rated their antenatal care as 'very good' compared with 62.4% in 1994 and 66.5% in 2000 ([chi square]) for trend=15.01, p Conclusions: The conduct of three population-based surveys of recent mothers in Victoria over the past 10 years has provided valuable information for charting the impact of organisational changes on women's views and experiences of maternity care.

Australian health care does not fit into most neo-classical economics assumptions. Health care systems are best seen as social organizations, a view that leads to emphasizing such qualities as caring in community contexts.

A strategic review of Australia's health and medical research titled 'The Virtuous Cycle Working together for health and medical research' published by the Garvan Institute of Medical Research identifies four issues that place current health and medical research at risk. It suggests greater need for research that contributes to the health of the population. While many the recommendations are laudable the ground rules for research could still fail the public's health.

General practitioners working in Perth, Western Australia were surveyed on immunization. The conclusions showed general practitioners required ongoing education about contra-indications to immunization and additional information on the substitution of CDT for DTP. Approximately 20% of the GPs reported they did not fill out a Australian Childhood Immunization Register notification form.

An overview of the reforms in the health care policy for the aged in Australia was provided. This was tied up with the political aspects of the Australian health care system. Policy gaps in the reforms are critically reviewed including its implementation. The implications related with the delivery of services, informal carers and the quality of care for the elderly in the community and residential contexts were also studied.

Australia has demonstrated that a health care system that controls costs can still offer universal coverage and ensure adequate health outcomes for most of its people. Australia spent only 8.5% of its gross domestic product on health care in 1993, compared to 13.9% in the US that year. Health services are provided by both the private and public sector. Over 40% of all Australian physicians are general practitioners, compared to 10.7% in the US. Australia has kept costs low by limiting expensive technology, and controlling physician's fees and hospital budgets.