Australian parents’ use of universal child and family health services: A consumer survey

This study aimed to explore Australian parents’ use of universally available well‐child health services. It used an online survey of 719 parents of children aged from birth to 5 years in all states and territories to examine patterns of service use and consumer preferences. In Australia, several health professional groups provide advice to pregnant women, infants, children, and parents, offering health promotion, developmental screening, parenting support, and referral to specialist health services if required. The survey examined parents’ use of different child and family health providers, and their preferences for support with several common parenting issues. The study indicated that families with young children obtain primary healthcare from a range of service providers, often more than one, depending on children's ages and needs. Parents frequently visit general practitioners for immunisation and medical concerns. They attend dedicated child and family health nurses for parenting advice and well‐child checks and prefer them as an information source for many health issues. However, a substantial proportion of parents (44.1%) do not currently visit a child and family health nurse, often because they not only do not perceive a need but also sometimes because these services are unknown, inaccessible, or considered unsuitable. They may seek advice from less qualified sources. There is potential for increased collaboration between child and family health providers to ensure effective resource use and consistency of parenting information and advice. Nursing services may need to address accessibility and appropriateness of care.     

The influence of perceived accessibility and expertise of healthcare professionals,and service austerity,on mothers' decision-making

Mothers often make key decisions regarding their children's health. They hold core beliefs and attitudes towards healthcare providers, relying on healthcare services to provide support, advice and reassurance. It is crucial that health providers form authentic relationships with families with young children, in order to effectively provide healthcare, support and information as needed. In this paper, we explore mothers' views on the accessibility and expertise of healthcare professionals caring for their child's health. A case study, using a geographic post code as the case boundary was used. Focus groups and semi-structured interviews with mothers of children aged under five years old were conducted. Participants (n = 33) were recruited from local playgroups and six focus groups (19 participants) and 14 individual interviews were conducted. Qualitative data were analysed using thematic analysis. General Practice (including general practitioners [GPs] and practice nurses) was considered to be the preferred option when seeking timely healthcare advice and information. Participant mothers were open to accessing professional advice concerning their child's health, from a range of health professionals and understood the role and potential contribution of various health professionals. However, some factors, influenced mothers' decision-making. These were captured in three themes: maternal perceptions of GPs as accessible experts; practice nurses as approachable and reassuring sources of advice; and difficulty in accessing health visiting services primarily due to service funding cuts. Further investment in primary care services, including expansion of the practice nurse role and an increase in health visiting service provision, may help to provide sufficient support for mothers seeking healthcare advice. In addition, healthcare service strategies, which engage with mothers and ensure nurses are recognised as knowledgeable, accessible, supportive and a suitable alternative to GPs, would be beneficial.     

Developing the EQUIPED approach to quality management using multi-grounded theory

Aim

This study aimed to develop a theoretical approach to quality management for dietetics services operating in primary care settings in Australia.

Methods

Multi-grounded theory was used to develop a theoretical approach to quality management across three phases. A preliminary approach was developed in the first phase using empirical data outlining quality management activities employed by primary care dietetics services. In the second phase, the preliminary approach was matched to theoretical data captured from the Australian National Safety and Quality in Primary and Community Healthcare Standards, the Quality in Nutrition Care Model for Dietitians, and complex adaptive systems theory. Central concepts were defined and described in the final phase.

Results

Seventeen small (n = 7) and medium-large (n = 10) dietetics services from all Australian states and territories, except Tasmania, participated. The theoretical approach to quality management comprised 107 rules organised into six attractors (culture, integrated care, evidence-based care, safe environment and care, client partnerships and personalised care) and 10 governance elements. Rules had one or more foci that aimed to: improve quality within the service (internally focused), improve care by influencing other healthcare professionals (externally focused), improve the client relationship (client-focused), or monitor and respond to external systems (system-focused).

Conclusions

The theoretical approach developed in this study produced a set of rules that primary care dietetics services can use to inform quality management activities. The use of multi-grounded theory should be investigated in other healthcare disciplines and settings to address quality.     

Mapping oncology services in regional and rural Australia

Objective: To map clinical oncology services in regional and rural Australia. Design and setting: A self‐administered survey was sent to 161 regional hospitals administering chemotherapy (RHAC) in Australia. RHAC were categorised by state, Hospital Peer Group and the Australian Standard Geographical Classification (ASGC) Remoteness Areas classification. Main outcome measure(s): Survey data provided percentage and aggregate figures about availability of medical, radiation and surgical oncologists, chemotherapy nurses, breast cancer nurses, palliative care physicians and allied health professionals according to remoteness and state. Chemotherapy prescribing practices, adherence to occupational health and safety guidelines and availability of multidisciplinary clinics were also explored. Results: A 98% survey completion rate was achieved. Significant deficiencies in service provision were identified in RHAC. Only 21% of RHAC reported a resident medical oncology service, 7% had a radiation oncology unit, and 6% had a resident surgical oncologist. Only 24% of RHAC reported a dedicated palliative care specialist and 39% identified a dedicated oncology counselling service. Other issues included administration of chemotherapy by nurses outside a recognised facility or by nurses without recognised oncology training, limited availability of funded breast care nurses and lack of multidisciplinary clinics. Conclusion: Survey data highlight marked cancer service deficiencies in rural and regional Australia. It is not unreasonable to conclude that these deficiencies might contribute to poorer outcomes for cancer patients living in these areas. The results suggest the need for short‐ and long‐term measures to improve access to best‐practice cancer services for patients living in regional, rural and remote areas of Australia.     

Addressing the challenges of cross‐jurisdictional data linkage between a national clinical quality registry and government‐held health data

Objective: To describe the challenges of obtaining state and nationally held data for linkage to a non‐government national clinical registry. Methods: We reviewed processes negotiated to achieve linkage between the Australian Stroke Clinical Registry (AuSCR), the National Death Index, and state held hospital data. Minutes from working group meetings, national workshop meetings, and documented communications with health department staff were reviewed and summarised. Results: Time from first application to receipt of data was more than two years for most state data‐sets. Several challenges were unique to linkages involving identifiable data from a non‐government clinical registry. Concerns about consent, the re‐identification of data, duality of data custodian roles and data ownership were raised. Requirements involved the development of data flow methods, separating roles and multiple governance and ethics approvals. Approval to link death data presented the fewest barriers. Conclusion: To our knowledge, this is the first time in Australia that person‐level data from a clinical quality registry has been linked to hospital and mortality data across multiple Australian jurisdictions. Implications for Public Health: The administrative load of obtaining linked data makes projects such as this burdensome but not impossible. An improved national centralised strategy for data linkage in Australia is urgently needed.     

Approach to sustainable primary health care service delivery for rural and remote South Australia

ABSTRACT: We describe the operation of four University Teaching Practices established by the South Australian Centre for Rural and Remote Health (SACRRH) and the Adelaide University Department of General Practice. These practices were established in response to the acknowledged difficulty in recruiting and retaining GPs in rural South Australia. The practices are co-located with a hospital or accident and emergency service and community based nurses and allied health professionals. They provide integrated health care and multidisciplinary health care student placements in a learning environment where students experience rural multidisciplinary practice and country life. The study found that although the sites differed in significant ways, they all provided integrated care and effective placements for students. This style of health care delivery is flexible and broadly applicable. Sustainability is achieved through financially viability, attracting and retaining health care professionals and the development of electronic information systems, to support integrated practice.     

An assessment of Australian school physical activity and nutrition policies

Objective: This study's objective was to identify and assess existing physical activity and nutrition policies for Australian schools. Methods: Policies were identified through a search of the websites of national and state/territory education departments and school associations, and were subsequently assessed against specific criteria. Results: Policies were identified for government schools, but only for one non‐government school association. Physical activity policies were identified at the national level and for six of eight state/territories. The national policy was mandated, and most state/territory physical activity policies were mandated and consistent with the national policy. Several physical activity policies did not meet expert recommendations for time and instructor qualifications. Nutrition policies were identified at the national level and all eight states/territories. The national policy was not mandated, but all state/territory nutrition policies were mandated and consistent with the national policy and relevant guidelines. Most physical activity and nutrition policies lacked information about implementation monitoring. Conclusions: To improve school practices, policies are needed that are mandated and consistent with expert recommendations, use clear language, and specify monitoring and accountability mechanisms. Implications for public health: Improvements in school policies can promote physical activity and healthy eating behaviours to positively influence student outcomes across Australia.     

Diabetes management in a foreign land: A case study on Chinese Australians

The aim of this study was to understand the experience of Chinese migrants living with type 2 diabetes in Australia and explore their culturally specific diabetes management needs, habits and expectations in the Australian context to help shape an Australian Chinese diabetes service. A case study approach was employed across two Australian cities (Melbourne and Sydney), using participant‐observations and qualitative interviews. Purposive sampling was used to find diabetes education sessions for observation and facilitators for interviews before snowball technique was used to identify relevant clinicians. Thematic analysis with pattern matching was used for data analysis. A total of 18 participant‐observations and 12 interviews were conducted. Chinese migrants appeared to experience multiple barriers in accessing the Australian diabetes care service further complicated by the mismatch between the expectations of Chinese patients and the services available. Chinese patients were observed to be collectivistic‐orientated relying on friends for diabetes management. While health professionals appeared to be perceived as a source of reputable health information, they often did not provide ongoing support. When professional support was limited, Chinese patients adopted alternative strategies to address their diabetes, which often involved seeking help and information from peers. Some of this information was non‐reputable, potentially resulting in detrimental health outcomes. In conclusion, redesigning diabetes care services in line with the principles of collectivism may more appropriately match the Chinese migrants’ expectations and needs, and better support them in their diabetes journey.     

Dietetic practice in the management of gestational diabetes mellitus: A survey of Australian dietitians

Aim: To examine current Australian dietetic practice in the management of gestational diabetes, to identify models of dietetic care and to determine the need for national evidence‐based dietetic practice guidelines for gestational diabetes. Methods: A 55‐item cross‐sectional survey of Australian dietitians practicing in the area of gestational diabetes was undertaken. Participants were recruited via Dietitians Association of Australia interest group membership, public and private hospital maternity and diabetes services across Australia. The survey examined dietetic service provision, interventions, management recommendations, postnatal care, current guideline use and the perceived need for Australian evidence‐based dietetic management guidelines. Results: A total of 220 eligible dietitians participated in the survey. The majority (77%) reported that all women with gestational diabetes attending their service were referred to a dietitian. Group (33%) and individual consults (93%) were provided and 67% provided one to two dietetic consults per client. Fifty‐four per cent (54%) believed that their service currently offered adequate antenatal dietetic interventions and 8% adequate postnatal follow up for women with gestational diabetes. There were differences in the implementation of medical nutrition therapy by Australian dietitians in regards to nutrient recommendations. However, consistency was seen in key components of nutrition education. Dietitians perceived that there was a need for evidence‐based gestational diabetes dietetic practice guidelines (86%) and nutrition recommendations (87%). Conclusion: The survey results strongly indicate there is a need for evidence‐based gestational diabetes practice guidelines and nutritional recommendations and provide baseline data for future practice of Australian dietitians working in gestational diabetes.     

Sustainable primary health care services in rural and remote areas: innovation and evidence

Objective: To highlight how evidence from studies of innovative rural and remote models of service provision can inform global health system reform in order to develop appropriate, accessible and sustainable primary health care (PHC) services to ‘difficult‐to‐service’ communities. Methods: The paper synthesises evidence from remote and rural PHC health service innovations in Australia. Results: There is a strong history of PHC innovation in Australia. Successful health service models are ‘contextualised’ to address diverse conditions. They also require systemic solutions, which address a range of interlinked factors such as governance, leadership and management, adequate funding, infrastructure, service linkages and workforce. An effective systemic approach relies on alignment of changes at the health service level with those in the external policy environment. Ideally, every level of government or health authority needs to agree on policy and funding arrangements for optimal service development. A systematic approach in addressing these health system requirements is also important. Service providers, funders and consumers need to know what type and level of services they can reasonably expect in different community contexts, but there are gaps in agreed indicators and benchmarks for PHC services. In order to be able to comprehensively monitor and evaluate services, as well as benchmarks, we need adequate national information systems. Conclusions: Despite the gaps in our knowledge, we do have a significant amount of information about what works, where and why. At a time of global PHC reform, applying this knowledge will contribute significantly to the development of appropriate, sustainable PHC services and improving access.     

Australia and New Zealand's contribution to Pacific Island health worker brain drain

Objective: The paper aims to quantify Australia and New Zealand's contribution to the brain drain of Pacific Island health workers and to contribute firm evidence to the ongoing, highly‐contested health professional migration issue. Methods: The study uses the Australian and New Zealand 2006 census data to examine the number of Pacific Island born health professionals living in Australia and New Zealand and uses World Health Organization data to compare it against the numbers of health workers in Pacific Island countries. Results: Six hundred and fifty‐two Pacific Island born doctors and 3,467 Pacific Island born nurses and midwives are working in Australia and New Zealand, more than half of whom are from Fiji with significant numbers from Papua New Guinea, Samoa and Tonga as well. There are almost as many Fiji‐born doctors in Australia and New Zealand as there are in Fiji. There are more Samoa, Tonga and Fiji‐born nurses and midwives in Australia and New Zealand than in the domestic workforce. Conclusions: Migration of Pacific Island health professionals to Australia and New Zealand is very high and contributes to the shortage of health workers in Pacific Island countries. Implications: Australia and New Zealand are encouraged to actively address the issue in collaboration with Pacific Island partners with a number of solutions proposed.     

Evaluation of the Australian adaptation of the Keeping It Together (KIT‐Australia) information package with carers of children with special needs

Background: Australian carers of children with special needs have expressed concerns about the limited availability and accessibility of suitable information resources. The ‘Keeping It Together’ (KIT) information package was developed and trialled in Canada and found to be effective in meeting the information needs of this population. Aim: The study aimed to evaluate the KIT‐Australian Adaptation (KIT‐Australia) to determine if it met its purpose of providing carers of children with special needs with strategies to access resources, organise information and communicate with others about their child. The study also aimed to determine whether additional changes were required to increase the KIT‐Australia’s utility. Methods: Eighteen carers of children with special needs participated in the study. All participants had accessed services from the Royal Children’s Hospital, Melbourne, Victoria. Demographic information was collected and carers were orientated to the KIT‐Australia prior to using it. After eight weeks, a telephone survey interview was completed with each participant. A content analysis of qualitative and quantitative data provided the results. Results: Most participants stated that they would continue to use the KIT‐Australia, and would recommend it to other carers. Six key themes were identified: getting started, accessing resources, organising and storing information, communicating information about my child to others, recommendations and non‐use of the KIT‐Australia. Conclusions: Preliminary data from this study suggests that the KIT‐Australia met its purpose of assisting carers of children with special needs, to access resources, organise information and communicate with others about their child. Participant recommendations to improve the usability of the KIT‐Australia should be implemented for future editions of the resource. Further research may be required to adapt and facilitate use of the KIT‐Australia in other Australian states and territories.     

What factors affect physicians' labour supply: Comparing structural discrete choice and reduced‐form approaches

Little is known about the response of physicians to changes in compensation: Do increases in compensation increase or decrease labour supply? In this paper, we estimate wage elasticities for physicians. We apply both a structural discrete choice approach and a reduced‐form approach to examine how these different approaches affect wage elasticities at the intensive margin. Using uniquely rich data collected from a large sample of general practitioners (GPs) and specialists in Australia, we estimate 3 alternative utility specifications (quadratic, translog, and box‐cox utility functions) in the structural approach, as well as a reduced‐form specification, separately for men and women. Australian data is particularly suited for this analysis due to a lack of regulation of physicians' fees leading to variation in earnings. All models predict small negative wage elasticities for male and female GPs and specialists passing several sensitivity checks. For this high‐income and long‐working‐hours population, the translog and box‐cox utility functions outperform the quadratic utility function. Simulating the effects of 5% and 10% wage increases at the intensive margin slightly reduces the full‐time equivalent supply of male GPs, and to a lesser extent of male specialists and female GPs.     

Rural general practitioner apprehension about work related violence in australia

Aims: To identify levels of Australian rural general practitioners’ apprehension about violence, factors effecting apprehension and the effect of apprehension on service provision. Method: Six focus groups were held with rural GPs from Western Australia, New South Wales and Victoria. A questionnaire was developed on the basis of the focus group data and all GPs in these three areas were surveyed. Results: The results indicated GPs were more apprehensive about providing after hours care than during business hours. Significant gender differences were found with women being more often apprehensive than men and more likely to withdraw after hours services. Conclusion: This study shows that that levels of apprehension about violence affect GPs’ willingness to provide after hours services. Future provision of general practice after hours services and home visits in rural areas requires the availability of a safe working environment to reduce GPs’ apprehension about workplace violence. What Is Already Known: Overseas research has shown that many GPs are apprehensive about workplace violence and that female GPs are more likely to be apprehensive about it than male GPs. No Australian studies about GPs’ levels of apprehension about workplace violence have previously been undertaken. What this study adds: This study showed that many Australian rural GP respondents feel apprehensive about work‐related violence especially after hours and when undertaking home visits after hours. Female respondents were significantly more likely to feel apprehensive about workplace violence than male respondents and to make changes to services because of the risk of violence than male GPs, most commonly by not providing services such as home visits or after hours surgery attendances.     

Experiences and Challenges of Implementing Universal Health Coverage With China’s National Basic Public Health Service Program: Literature Review,Regression Analysis,and Insider Interviews

BackgroundPublic health service is an important component and pathway to achieve universal health coverage (UHC), a major direction goal of many countries. China’s National Basic Public Health Service Program (the Program) is highly consistent with this direction.ObjectiveThe aim of this study was to analyze the key experience and challenges of the Program so as to present China’s approach to UHC, help other countries understand and learn from China’s experience, and promote UHC across the world.MethodsA literature review was performed across five main electronic databases and other sources. Some data were obtained from the Department of Primary Health, National Health Commission, China. Data obtained included the financing share of the national/provincial/prefectural government among the total investment of the program in 32 provinces in 2016, their respective per capita funding levels, and some indicators related to program implementation from 2009 to 2016. The Joinpoint regression model was adopted to test the time trend of changes in program implementation indicators. Face-to-face individual interviews and group discussions were conducted with 48 key insiders.ResultsThe program provided full life cycle service to the whole population with an equitable and affordable financing system, enhanced the capability and quality of the health workforce, and facilitated integration of the public health service delivery system. Meanwhile, there were also some shortcomings, including lack of selection and an exit mechanism of service items, inadequate system integration, shortage of qualified professionals, limited role played by actors outside the health sector, and a large gap between the subsidy standard and the actual service cost. The Joinpoint regression analysis demonstrated that 13 indicators related to program implementation showed a significant upward trend (P<.05) from 2009 to 2016, with average annual percent change values above 10% for 6 indicators and below 6% for 7 indicators. Three indicators (coverage of health records, electronic health records, and health management among the elderly) rose rapidly with annual percent change values above 30% between 2009 and 2011, but rose slowly or remained stable between 2011 and 2016. In 2016, the subsidy standard per capita in the eastern, central, and western regions was equivalent to US $7.43, $7.15, and $6.57, respectively, of which the national-level subsidy accounted for 25.50%, 60.57%, and 79.52%, respectively.ConclusionsThe Program has made a significant contribution to China’s efforts in achieving UHC. The Program focuses on a key population and provides full life cycle services for the whole population. The financing system completely supported by the government makes the services more equitable and affordable. However, there are a few challenges to implementing the Program in China, especially to increase the public investment, optimize service items, enhance quality of the services, and evaluate the health outcomes.     

柳州市基层医疗卫生机构儿童保健服务能力调查

目的:了解柳州市基层医疗卫生机构儿童保健服务能力现状,为相关部门制定政策提供参考依据。方法:采用普查的方式调查柳州市123家基层医疗卫生机构的辖区基本情况、人员及设施设备投入和服务开展情况。结果:123家基层医疗卫生机构中,每万常住人口拥有基层医疗卫生机构儿童保健医生0.32名、注册护士0.25名,每平方公里儿童保健医生0.0070名、注册护士0.0055名。39.84%的机构无执业(助理)医师,32.52%的机构近5年有儿童保健人员到上级医院进修。儿童保健门诊用房面积达到自治区要求的机构不足40%;视力检查、听力筛查、心理行为发育评估和膳食营养分析工具配置率分别为89.43%、36.59%、22.76%和9.76%。开展的7项儿童保健服务中,心理行为发育测验(24.39%)、耳及听力保健服务(74.80%)开展比例低,其他5项均超过90%。城乡机构间儿童保健服务人员、设施设备投入和服务开展情况存在差异,贫困县情况更严峻。结论:柳州市基层医疗卫生机构儿童保健服务能力与国家标准相比,还存在一定差距。政府有必要合理配置医疗资源,加强儿童保健人员的培养,规范儿童保健门诊建设,全面提高基层医疗卫生机构儿童保健服务能力。     

全科医生在上海社区卫生服务中的作用

论述了全科医生在上海社区卫生服务中的作用,指出全科医生应成为:社区卫生保健需求与资源信息的掌握者;社区常见疾病诊治的第一责任者;社区群体与个体预防服务的提供者;家庭与人群保健的维护者;社区医疗卫生资源均衡利用的协调与管理者;继承发扬传统中医学的实践者,并提出了保障这些作用发挥的相应措施。     

Issues with medication supply and management in a rural community in Queensland

Objective: To identify the key issues reported by rural health‐care providers in their provision of medication supply and related cognitive services, and in order to advise health workforce and role development and thus improve the quality use of medicines in rural communities. Design: Exploratory semistructured interview research. Setting: A rural community comprising four towns in a rural health service district in Queensland, Australia. Participants: Forty‐nine health‐care providers (medical practitioners, pharmacists, nurses and others) with medication‐related roles who serviced the study community, identified through databases and local contacts. Main outcome measures: Medication‐related roles undertaken by the health‐care providers, focusing on medication supply and cognitive services; challenges in undertaking these roles. Results: Medical and nursing providers reported challenges in ensuring continuity in supply of medications due to their existing medical workload demands. Local pharmacists were largely involved in medication supply, with limited capacity for extended cognitive roles. Participants identified a lack of support for their medication roles and the potential value of clinically focused pharmacists in medication management services. Conclusions: Medication supply may become more efficient with extended roles for certain health‐care providers. The need for cognitive medication management services suggests potential for clinical pharmacists' role development in rural areas.