Australia and New Zealand health policy最新文献

{"title":"A comparative evaluation of pharmacy services in single and no pharmacy towns.","authors":"V Bruce Sunderland,&nbsp;Suzanne D Burrows,&nbsp;Andrew W Joyce","doi":"10.1186/1743-8462-3-8","DOIUrl":"https://doi.org/10.1186/1743-8462-3-8","url":null,"abstract":"<p><strong>Background: </strong>Recent attention has focused on access of communities to pharmacy services in rural areas. To increase access to pharmacy services in rural Western Australia some doctors have been granted a licence to dispense medication on the rationale that a pharmacy would not be economically viable in that community. However, there have been no studies conducted on whether a doctor dispensing service adequately provides a pharmacy service with respect to access and quality.</p><p><strong>Method: </strong>Residents of seven single pharmacy towns and seven non-pharmacy rural towns were surveyed to evaluate pharmacy services delivered by a pharmacist and doctor. The towns were chosen to match closely on key demographic features, with an average population of 1,246 and 1,263 respectively. A random sample of 150 households from each town was sent the questionnaire on pharmacy services (1050 in each group). Data was also collected from the Health Insurance Commission (HIC) on dispensing locations for the residents of the two groups of towns.</p><p><strong>Results: </strong>There was a significant difference in access to pharmacy services with 82.4% of participants from pharmacy towns accessing medications within their town compared to 51.3% of non-pharmacy town participants. The HIC data supported these trends with pharmacy town residents having relatively higher prescription rates within their town compared to non-pharmacy town residents where they were more likely to access prescriptions out of their town.</p><p><strong>Conclusion: </strong>Pharmacy town participants were more satisfied with access to health and pharmacy services within their town. Continuation of the doctor dispensing policy requires a greater consideration of the pharmacy needs of rural residents.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"3 ","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2006-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-3-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26111565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy challenges from the \"White\" Senate inquiry into workplace-related health impacts of toxic dusts and nanoparticles.","authors":"Thomas A Faunce,&nbsp;Haydn Walters,&nbsp;Trevor Williams,&nbsp;David Bryant,&nbsp;Martin Jennings,&nbsp;Bill Musk","doi":"10.1186/1743-8462-3-7","DOIUrl":"https://doi.org/10.1186/1743-8462-3-7","url":null,"abstract":"<p><p>On 22 June 2005 the Senate of the Commonwealth of Australia voted to establish an inquiry into workplace harm related to toxic dust and emerging technologies (including nanoparticles). The inquiry became known as the \"White\" Inquiry after Mr Richard White, a financially uncompensated sufferer of industrial sandblasting-induced lung disease who was instrumental in its establishment. The \"White\" Inquiry delivered its final report and recommendations on 31 May 2006. This paper examines whether these recommendations and their implementation may provide a unique opportunity not only to modernize relevant monitoring standards and processes, but related compensation systems for disease associated with workplace-related exposure to toxic dusts. It critically analyzes the likely role of the new Australian Safety and Compensation Council (ASCC) in this area. It also considers whether recommendations related to potential workplace related harm from exposure to nanoparticles could commence a major shift in Australian healthcare regulation.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"3 ","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2006-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-3-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26094437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Political economy and population health: is Australia exceptional?","authors":"Anne-marie Boxall, Stephanie D Short","doi":"10.1186/1743-8462-3-6","DOIUrl":"10.1186/1743-8462-3-6","url":null,"abstract":"<p><strong>Background: </strong>It is accepted knowledge that social and economic conditions--like education and income--affect population health. What remains uncertain is whether the degree of inequality in these conditions influences population health and if so, how. Some researchers who argue that inequalities are important, say there is a relationship between political economy, inequality and population health. Their evidence comes from comparative studies showing that countries with neo-liberal political economies generally have poorer population health outcomes than those with social or Christian democratic political economies. According to these researchers, neo-liberal political economies adopt labour market and welfare state policies that lead to greater levels of inequality and poorer population health outcomes for us all.</p><p><strong>Discussion: </strong>Australia has experienced considerable social and economic reforms over the last 20 years, with both major political parties increasingly adopting neo-liberal policies. Despite these reforms, population health outcomes are amongst the best in the world.</p><p><strong>Summary: </strong>Australia appears to contest theories suggesting a link between political economy and population health. To progress our understanding, researchers need to concentrate on policy areas outside health--such as welfare, economics and industrial relations. We need to do longitudinal studies on how reforms in these areas affect levels of social and economic inequality, as well population health. We need to draw on social scientific methods, especially concerning case selection, to advance our understanding of casual relationships in policy studies. It is important to find out if, and why, Australia has resisted the affects of neo-liberalism on population health so we ensure our high standards are maintained in the future.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"3 ","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26056423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rational antibiotic use in China: lessons learnt through introducing surgeons to Australian guidelines.","authors":"Yan Zhang,&nbsp;Ken Harvey","doi":"10.1186/1743-8462-3-5","DOIUrl":"https://doi.org/10.1186/1743-8462-3-5","url":null,"abstract":"<p><strong>Background: </strong>World-wide concern about increasing antibiotic resistance has focused attention on strategies to improve antibiotic use. This research adapted Australian best-practice guidelines on the prophylactic use of antibiotics in surgery to a Beijing teaching hospital and then used them as a quality assessment and improvement tool, supplemented by educational interventions. Qualitative data about factors influencing antibiotic use was also obtained.</p><p><strong>Methods: </strong>Australian and international guideline materials were amalgamated with the help of Chinese experts. Antibiotics prescribed for surgical prophylaxis in 60 consecutive patients undergoing clean or clean-contaminated surgery (120 total) were then compared with guideline recommendations in three phases; a pre-intervention period from June to August, 2002, an intervention period from June to August 2003 and post-intervention period from September to November 2003. During the intervention phase, feedback about prescriptions not in accord with the guideline was discussed with around 25 prescribers every two weeks. In addition, local factors influencing antibiotic use were explored with 13 junior surgeons and 8 high level informants.</p><p><strong>Results: </strong>While agreement was reached on the principles of antibiotic surgical prophylaxis there was no consensus on detail. Of 180 patients undergoing clean surgery throughout all phases of the study, antibiotic prophylaxis was administered to 78% compared to 98% of the 180 patients undergoing clean-contaminated surgery. Second and third generation cephalosporin antibiotics predominated in both low-risk clean and clean-contaminated operations. The timing of prophylaxis was correct in virtually all patients. The duration of prophylaxis was less than 24 hours in 96% of patients undergoing clean surgery compared to only 62% of patients undergoing clean-contaminated surgery. The intervention produced no improvement in the duration of prophylaxis nor the overuse and inappropriate choice of unnecessary broad-spectrum and expensive drugs. Interviews and focus groups revealed that an important explanation for the latter problem was Chinese government policy which expected hospitals to support themselves largely through the sale of drugs.</p><p><strong>Conclusion: </strong>Improving antibiotic use in China will require hospital funding reform, more authoritative best-practice guidelines, and hospital authorities embracing quality improvement.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"3 ","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2006-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-3-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26052849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The contribution of general practice based research to the development of national policy: case studies from Ireland and Australia.","authors":"J E Pirkis,&nbsp;G A Blashki,&nbsp;A W Murphy,&nbsp;I B Hickie,&nbsp;L Ciechomski","doi":"10.1186/1743-8462-3-4","DOIUrl":"https://doi.org/10.1186/1743-8462-3-4","url":null,"abstract":"<p><strong>Background: </strong>This paper aims to describe the influence of general practice based research on the development of two specific policy initiatives, namely the Heartwatch Programme in Ireland and the Better Outcomes in Mental Health Care (BOiMHC) program in Australia. A case study approach was used to explore the extent to which relevant general practice based research shaped these initiatives.</p><p><strong>Results: </strong>In both case studies, a range of factors beyond general practice based research shaped the initiative in question, including political will, the involvement of stakeholders (including key opinion leaders), and the historical context. Nonetheless, the research played an important role, and was not merely put to 'symbolic use' to support a position that had already been reached independently. Rather, both case studies provide examples of 'instrumental use': in the case of Heartwatch, the research was considered early in the piece; in the case of the BOiMHC program, it had a specific impact on the detail of the components of the initiative.</p><p><strong>Conclusion: </strong>General practice based research can influence policy-making and planning processes by strengthening the foundation of evidence upon which they draw. This influence will not occur in a vacuum, however, and general practice researchers can maximise the likelihood of their work being 'picked up' in policy if they consider the principles underpinning knowledge transfer.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"3 ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2006-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-3-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26013743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Australian experiment: the use of evidence based medicine for the reimbursement of surgical and diagnostic procedures (1998-2004).","authors":"Sue P O'Malley","doi":"10.1186/1743-8462-3-3","DOIUrl":"https://doi.org/10.1186/1743-8462-3-3","url":null,"abstract":"<p><strong>Background: </strong>In 1998 a formal process using the criteria of safety, effectiveness and cost-effectiveness (evidence based medicine) on the introduction and use of new medical procedures was implemented in Australia. As part of this process an expert panel, the Medical Services Advisory Committee (MSAC) was set up. This paper examines the effectiveness of this process based on the original criteria, that is, evidence based medicine.</p><p><strong>Method: </strong>The data for this analysis was sourced primarily from that made available in the public domain. The MSAC web site provided Minutes from MSAC meetings; Annual Reports; Assessment and Review reports; Progress status; and Archived material.</p><p><strong>Results: </strong>The total number of applications submitted to the MSAC has been relatively low averaging approximately only fourteen per year. Additionally, the source of applications has quickly shifted to the medical devices, equipment and diagnostic industry as being the major source of applications. An overall average time for the processing of an application is eighteen months. Negative recommendations were in most cases based on insufficient clinical evidence rather than clinical evidence that clearly demonstrated a lack of clinical effectiveness. It was rare for a recommendation, either positive or negative, to be based on cost-effectiveness.</p><p><strong>Conclusion: </strong>New medical procedures are often the result of a process of experimentation rather than formally conducted research. Affordability and the question of who should pay for the generation, collection and analysis of the clinical evidence is perhaps the most difficult to answer. This is especially the case where the new procedure is the result of a process of experimentation with an old procedure. A cost-effective way needs to be found to collect acceptable levels of evidence proving the clinical effectiveness of these new procedures, otherwise the formal processes of evaluation such as that used by the Australian MSAC since 1998 will continue to run the risk of committing Type II errors, that is, denying access to medical procedures that are beneficial and efficient.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"3 ","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2006-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-3-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26010822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring social capital in a known disadvantaged urban community--health policy implications.","authors":"Anne W Taylor,&nbsp;Carmel Williams,&nbsp;Eleonora Dal Grande,&nbsp;Michelle Herriot","doi":"10.1186/1743-8462-3-2","DOIUrl":"https://doi.org/10.1186/1743-8462-3-2","url":null,"abstract":"<p><strong>Background: </strong>To assess the social capital profile of a known disadvantaged area a large cross-sectional survey was undertaken. The social capital profile of this area was compared to data from the whole of the state. The overall health status of the disadvantaged area was assessed in relation to a wide variety of social capital related variables. Univariate and multivariate analysis were undertaken.</p><p><strong>Results: </strong>In the univariate analysis many statistically significant differences were found between the respondents in the disadvantaged area and the state estimates including overall health status, perceived attributes of the neighbourhood, levels of trust, community involvement and social activities. In the multivariate analysis very few variables were found to be statistically significantly associated with poorer health status. The variables that jointly predicted poorer health status in the disadvantaged area were older age, lower income, low sport participation, non-seeking help from neighbours and non-attendance at public meetings.</p><p><strong>Conclusion: </strong>Measuring social capital on a population level is complex and the use of epidemiologically-based population surveys does not produce overly valuable results. The inter-relational/dependence dichotomy of social capital is not yet fully understood making meaningful measurement in the broader population extremely difficult and hence is of questionable value for policy decision making.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"3 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2006-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-3-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25984001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developments in Australian general practice 2000-2002: what did these contribute to a well functioning and comprehensive Primary Health Care System?","authors":"Gawaine Powell Davies, Wendy Hu, Julie McDonald, John Furler, Elizabeth Harris, Mark Harris","doi":"10.1186/1743-8462-3-1","DOIUrl":"10.1186/1743-8462-3-1","url":null,"abstract":"<p><strong>Background: </strong>In recent years, national and state/territory governments have undertaken an increasing number of initiatives to strengthen general practice and improve its links with the rest of the primary health care sector. This paper reviews how far these initiatives were contributing to a well functioning and comprehensive primary health care system during the period 2000-2002, using a normative model of primary health care and data from a descriptive study to evaluate progress.</p><p><strong>Results: </strong>There was a significant number of programs, at both state/territory and national level. Most focused on individual care, particularly for chronic disease, rather than population health approaches. There was little evidence of integration across programs: each tended to be based in and focus on a single jurisdiction, and build capacity chiefly within the services funded through that jurisdiction. As a result, the overall effect was patchy, with similar difficulties being noted across all jurisdictions and little gain in overall system capacity for effective primary health care.</p><p><strong>Conclusion: </strong>Efforts to develop more effective primary health care need a more balanced approach to reform, with a better balance across the different elements of primary health care and greater integration across programs and jurisdictions. One way ahead is to form a single funding agency, as in the UK and New Zealand, and so remove the need to work across jurisdictions and manage their competing interests. A second, perhaps less politically challenging starting point, is to create an agreed framework for primary health care within which a collective vision for primary health care can be developed, based on population health needs, and the responsibilities of different sectors services can be negotiated. Either of these approaches would be assisted by a more systematic and comprehensive program of research and evaluation for primary health care.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"3 ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2006-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1379649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25799876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remunerating private psychiatrists for participating in case conferences.","authors":"Jane E Pirkis,&nbsp;Alan N Headey,&nbsp;Philip M Burgess,&nbsp;Harvey A Whiteford,&nbsp;Josh P White,&nbsp;Catherine Francis","doi":"10.1186/1743-8462-2-33","DOIUrl":"https://doi.org/10.1186/1743-8462-2-33","url":null,"abstract":"<p><strong>Background: </strong>On 1 November 2000, a series of new item numbers was added to the Medicare Benefits Schedule, which allowed for case conferences between physicians (including psychiatrists) and other multidisciplinary providers. On 1 November 2002, an additional set of numbers was added, designed especially for use by psychiatrists. This paper reports the findings of an evaluation of these item numbers.</p><p><strong>Results: </strong>The uptake of the item numbers in the three years post their introduction was low to moderate at best. Eighty nine psychiatrists rendered 479 case conferences at a cost to the Health Insurance Commission of $70,584. Psychiatrists who have used the item numbers are generally positive about them, as are consumers. Psychiatrists who have not used them have generally not done so because of a lack of knowledge, rather than direct opposition. The use of the item numbers is increasing over time, perhaps as psychiatrists become more aware of their existence and of their utility in maximising quality of care.</p><p><strong>Conclusion: </strong>The case conferencing item numbers have potential, but as yet this potential is not being realised. Some small changes to the conditions associated with the use of the item numbers could assist their uptake.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"2 ","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2005-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-2-33","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25754901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation failures in the use of two New Zealand laws to control the tobacco industry: 1989-2005.","authors":"George Thomson,&nbsp;Nick Wilson","doi":"10.1186/1743-8462-2-32","DOIUrl":"10.1186/1743-8462-2-32","url":null,"abstract":"<p><strong>Background: </strong>We reviewed the implementation of New Zealand laws in relation to the activities of the tobacco industry and their allies. Material for two brief case studies was obtained from correspondence with official agencies, official information requests, internet searches (tobacco industry documents and official government sites), and interviews with 12 key informants.</p><p><strong>Results: </strong>The first case study identified four occasions over a period of 14 years where New Zealand Government agencies appeared to fail to enforce consumer protection law, although apparent breaches by the tobacco industry and their allies had occurred in relation to statements on the relative safety of secondhand smoke. The second case study examined responses to a legal requirement for the tobacco industry to provide information on tobacco additives. There was failure to enforce the law, and a failure of the political process for at least 13 years to clarify and strengthen the law. Relevant factors in both these cases of 'policy slippage' appear to have been financial and opportunity costs of taking legal action, political difficulties and the fragmented nature of government structures.</p><p><strong>Conclusion: </strong>Considered together, these case studies suggest the need for governments to: (i) make better use of national consumer laws (with proper monitoring and enforcement) in relation to tobacco; and (ii) to strengthen international law and resources around tobacco-related consumer protection. A number of options for achieving these aims are available to governments.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"2 ","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2005-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-2-32","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25750854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}