Australia and New Zealand health policy最新文献

{"title":"Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study.","authors":"Tanisha Jowsey,&nbsp;Yun-Hee Jeon,&nbsp;Paul Dugdale,&nbsp;Nicholas J Glasgow,&nbsp;Marjan Kljakovic,&nbsp;Tim Usherwood","doi":"10.1186/1743-8462-6-22","DOIUrl":"https://doi.org/10.1186/1743-8462-6-22","url":null,"abstract":"<p><strong>Background: </strong>In response to the escalating burden of chronic illness in Australia, recent health policies have emphasised the promotion of patient self-management and better preventive care. A notable omission from these policies is the acknowledgment that patients with chronic illness tend to have co-morbid conditions. Our objectives were: to identify the common challenges co-morbidity poses to patients and carers in their experiences of self-management; to detail the views and perceptions of health professionals about these challenges; and to discuss policy options to improve health care for people with co-morbid chronic illness. The method included semi-structured interviews and focus groups with 129 purposively sampled participants. Participants were people with Type 2 diabetes, chronic obstructive pulmonary disease and/or chronic heart failure as well as carers and health care professionals. Content analysis of the interview data was conducted using NVivo7 software.</p><p><strong>Results: </strong>Patients and their carers found co-morbidity influenced their capacity to manage chronic illness in three ways. First, co-morbidity created barriers to patients acting on risk factors; second, it complicated the process of recognising the early symptoms of deterioration of each condition, and third, it complicated their capacity to manage medication.</p><p><strong>Conclusion: </strong>Findings highlight challenges that patients with multiple chronic conditions face in relation to preventive care and self-management. Future clinical policy initiatives need to move away from single illness orientation toward strategies that meet the needs of people with co-morbid conditions and strengthen their capacity to self-manage. These patients will benefit directly from specialised education and services that cater to the needs of people with clusters of co-morbidities.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2009-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-22","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28385750","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":"Increasing the use of evidence in health policy: practice and views of policy makers and researchers.","authors":"Danielle M Campbell,&nbsp;Sally Redman,&nbsp;Louisa Jorm,&nbsp;Margaret Cooke,&nbsp;Anthony B Zwi,&nbsp;Lucie Rychetnik","doi":"10.1186/1743-8462-6-21","DOIUrl":"https://doi.org/10.1186/1743-8462-6-21","url":null,"abstract":"<p><strong>Background: </strong>Better communication is often suggested as fundamental to increasing the use of research evidence in policy, but little is known about how researchers and policy makers work together or about barriers to exchange. This study explored the views and practice of policy makers and researchers regarding the use of evidence in policy, including: (i) current use of research to inform policy; (ii) dissemination of and access to research findings for policy; (iii) communication and exchange between researchers and policy makers; and (iv) incentives for increasing the use of research in policy.</p><p><strong>Methods: </strong>Separate but similar interview schedules were developed for policy makers and researchers. Senior policy makers from NSW Health and senior researchers from public health and health service research groups in NSW were invited to participate. Consenting participants were interviewed by an independent research company.</p><p><strong>Results: </strong>Thirty eight policy makers (79% response rate) and 41 researchers (82% response rate) completed interviews. Policy makers reported rarely using research to inform policy agendas or to evaluate the impact of policy; research was used more commonly to inform policy content. Most researchers reported that their research had informed local policy, mainly by increasing awareness of an issue. Policy makers reported difficulty in accessing useful research syntheses, and only a third of researchers reported developing targeted strategies to inform policy makers of their findings. Both policy makers and researchers wanted more exchange and saw this as important for increasing the use of research evidence in policy; however, both groups reported a high level of involvement by policy makers in research.</p><p><strong>Conclusion: </strong>Policy makers and researchers recognise the potential of research to contribute to policy and are making significant attempts to integrate research into the policy process. These findings suggest four strategies to assist in increasing the use of research in policy: making research findings more accessible to policy makers; increasing opportunities for interaction between policy makers and researchers; addressing structural barriers such as research receptivity in policy agencies and a lack of incentives for academics to link with policy; and increasing the relevance of research to policy.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2009-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-21","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28356353","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":"Moving beyond 'rates, roads and rubbish': How do local governments make choices about healthy public policy to prevent obesity?","authors":"Steven Allender,&nbsp;Erin Gleeson,&nbsp;Brad Crammond,&nbsp;Gary Sacks,&nbsp;Mark Lawrence,&nbsp;Anna Peeters,&nbsp;Bebe Loff,&nbsp;Boyd Swinburn","doi":"10.1186/1743-8462-6-20","DOIUrl":"https://doi.org/10.1186/1743-8462-6-20","url":null,"abstract":"<p><p> While the causes of obesity are well known traditional education and treatment strategies do not appear to be making an impact. One solution as part of a broader complimentary set of strategies may be regulatory intervention at local government level to create environments for healthy nutrition and increased physical activity. Semi structured interviews were conducted with representatives of local government in Australia. Factors most likely to facilitate policy change were those supported by external funding, developed from an evidence base and sensitive to community and market forces. Barriers to change included a perceived or real lack of power to make change and the complexity of the legislative framework. The development of a systematic evidence base to provide clear feedback on the size and scope of the obesity epidemic at a local level, coupled with cost benefit analysis for any potential regulatory intervention, are crucial to developing a regulatory environment which creates the physical and social environment required to prevent obesity.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2009-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-20","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28354332","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 geographic distribution of private health insurance in Australia in 2001.","authors":"John Glover,&nbsp;Sarah Tennant,&nbsp;Stephen Duckett","doi":"10.1186/1743-8462-6-19","DOIUrl":"https://doi.org/10.1186/1743-8462-6-19","url":null,"abstract":"<p><strong>Background: </strong>Private health insurance has been a major focus of Commonwealth Government health policy for the last decade. Over this period, the Howard government introduced a number of policy changes which impacted on the take up of private health insurance. The most expensive of these was the introduction of the private health insurance rebate in 1997, which had an estimated cost of $3 billion per annum.</p><p><strong>Methods: </strong>This article uses information on the geographic distribution of the population with private health insurance cover to identify associations between rates of private health insurance cover and socioeconomic status. The geographic analysis is repeated with survey data on expenditure on private health insurance, to provide an estimate of the rebate flowing to different socioeconomic groups.</p><p><strong>Results: </strong>The analysis highlights the strong association between high rates of private health insurance cover and high socioeconomic status and shows the substantial transfer of funds, under the private health insurance rebate, to those living in areas of highest socioeconomic status, compared with those in areas of lower socioeconomic status, and in particular those in the most disadvantaged areas. The article also provides estimates of private health insurance cover by federal electorate, emphasising the substantial gaps in cover between Liberal Party and Australian Labor Party seats.</p><p><strong>Conclusion: </strong>The article concludes by discussing implications of the uneven distribution of private health insurance cover across Australia for policy formation. In particular, the study shows that the prevalence of private health insurance is unevenly distributed across Australia, with marked differences in prevalence in rural and urban areas, and substantial differences by socioeconomic status. Policy formation needs to take this into account. Evaluating the potential impact of changes in private health insurance requires more nuanced consideration than has been implied in the rhetoric about private health insurance over the last decade.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2009-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-19","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28344532","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":"Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002-2008.","authors":"Elizabeth E Roughead,&nbsp;Susan J Semple","doi":"10.1186/1743-8462-6-18","DOIUrl":"https://doi.org/10.1186/1743-8462-6-18","url":null,"abstract":"<p><strong>Background: </strong>This paper presents Part 1 of a two-part literature review examining medication safety in the Australian acute care setting. This review was undertaken for the Australian Commission on Safety and Quality in Health Care to update a previous national report on medication safety conducted in 2002. This first part of the review examines the extent and causes of medication incidents and adverse drug events in acute care.</p><p><strong>Methods: </strong>A literature search was conducted to identify Australian studies, published from 2002 to 2008, on the extent and causes of medication incidents and adverse drug events in acute care.</p><p><strong>Results: </strong>Studies published since 2002 continue to suggest approximately 2%-3% of Australian hospital admissions are medication-related. Results of incident reporting from hospitals show that incidents associated with medication remain the second most common type of incident after falls. Omission or overdose of medication is the most frequent type of medication incident reported. Studies conducted on prescribing of renally excreted medications suggest that there are high rates of prescribing errors in patients requiring monitoring and medication dose adjustment. Research published since 2002 provides a much stronger Australian research base about the factors contributing to medication errors. Team, task, environmental, individual and patient factors have all been found to contribute to error.</p><p><strong>Conclusion: </strong>Medication-related hospital admissions remain a significant problem in the Australian healthcare system. It can be estimated that 190,000 medication-related hospital admissions occur per year in Australia, with estimated costs of $660 million. Medication incidents remain the second most common type of incident reported in Australian hospitals. A number of different systems factors contribute to the occurrence of medication errors in the Australian setting.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":" ","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2009-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-18","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40026816","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":"Health, ageing and private health insurance: baseline results from the 45 and Up Study cohort.","authors":"Emily Banks,&nbsp;Louisa Jorm,&nbsp;Sanja Lujic,&nbsp;Kris Rogers","doi":"10.1186/1743-8462-6-17","DOIUrl":"https://doi.org/10.1186/1743-8462-6-17","url":null,"abstract":"<p><p>Correction to Banks E, Jorm L, Lujic S, Rogers K. Health, ageing and private health insurance: baseline results from the 45 and Up Study cohort. ANZ Health Policy 2009; 6: 16.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2009-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-17","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28333970","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":"Health, ageing and private health insurance: baseline results from the 45 and Up Study cohort.","authors":"Emily Banks,&nbsp;Louisa Jorm,&nbsp;Sanja Lujic,&nbsp;Kris Rogers","doi":"10.1186/1743-8462-6-16","DOIUrl":"https://doi.org/10.1186/1743-8462-6-16","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the relationships between health and lifestyle factors, age and private health insurance (PHI) in a large Australian population-based cohort study of people aged 45 years and over; the 45 and Up Study. Unlike previous Australian analyses of relationships between health, lifestyle and PHI, it incorporates adjustment for multiple confounding socioeconomic and demographic factors. Recruitment into the 45 and Up Study began in February 2006 and these analyses relate to the first 103,042 participants who joined the study prior to July 2008.</p><p><strong>Results: </strong>The proportion with PHI decreased with increasing age. The factors independently and most strongly associated with having PHI were: higher income; higher educational attainment; not holding a health care concession card; not being of Aboriginal/Torres Strait Islander origin; being a non-smoker; high levels of self-rated health and functional capacity; and low levels of psychological distress. These factors increased the probability of having PHI by 16% to 125%, compared to individuals without these characteristics. PHI coverage was significantly but only marginally higher in people reporting non-melanoma skin cancer (adjusted RR 1.04, 95%CI 1.03-1.05), prostate cancer (1.09, 1.06-1.11) or an enlarged prostate (1.07, 1.06-1.09), those reporting a family history of a range of conditions (e.g. 1.02, 1.01-1.03 for a family history of heart disease; 1.03, 1.02-1.04 for a family history of prostate cancer) and lower in people reporting diabetes (0.92, 0.91-0.94) or stroke (0.91, 0.88-0.94), compared to people who did not have these medical or family histories. PHI was higher in those reporting certain surgical procedures with RRs (95%CI) of 1.12 (1.09-1.15) for hip replacement, 1.10 (1.08-1.13) for knee replacement and 1.12 (1.09-1.15) for prostatectomy, compared to those not reporting these interventions.</p><p><strong>Conclusion: </strong>Compared to the rest of the study population, those with PHI are richer, better educated, more health conscious, in better health and more likely to use certain discretionary health services. Hence, PHI use is generally highest among those with the least need for health care. Whether or not people have PHI is more strongly associated with demographic and lifestyle factors than with health status.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2009-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-16","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28374978","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":"Medical decision making for patients with Parkinson disease under Average Cost Criterion.","authors":"John E Goulionis,&nbsp;Athanassios Vozikis","doi":"10.1186/1743-8462-6-15","DOIUrl":"https://doi.org/10.1186/1743-8462-6-15","url":null,"abstract":"<p><p> Parkinson's disease (PD) is one of the most common disabling neurological disorders and results in substantial burden for patients, their families and the as a whole society in terms of increased health resource use and poor quality of life. For all stages of PD, medication therapy is the preferred medical treatment. The failure of medical regimes to prevent disease progression and to prevent long-term side effects has led to a resurgence of interest in surgical procedures. Partially observable Markov decision models (POMDPs) are a powerful and appropriate technique for decision making. In this paper we applied the model of POMDP's as a supportive tool to clinical decisions for the treatment of patients with Parkinson's disease. The aim of the model was to determine the critical threshold level to perform the surgery in order to minimize the total lifetime costs over a patient's lifetime (where the costs incorporate duration of life, quality of life, and monetary units). Under some reasonable conditions reflecting the practical meaning of the deterioration and based on the various diagnostic observations we find an optimal average cost policy for patients with PD with three deterioration levels.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2009-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-15","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28261557","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 preventive health agenda: what will this mean for workforce development?","authors":"Kathleen C Lilley,&nbsp;Donald E Stewart","doi":"10.1186/1743-8462-6-14","DOIUrl":"https://doi.org/10.1186/1743-8462-6-14","url":null,"abstract":"<p><p> The formation of the National Health and Hospitals Reform Commission (NHHRC) and the National Preventative Task Force in 2008, demonstrate a renewed Australian Government commitment to health reform. The re-focus on prevention, bringing it to the centre of health care has significant implications for health service delivery in the primary health care setting, supportive organisational structures and continuing professional development for the existing clinical and public health workforce. It is an opportune time, therefore, to consider new approaches to workforce development aligned to health policy reform. Regardless of the actual recommendations from the NHHRC in June 2009, there will be an emphasis on performance improvements which are accountable and aligned to new preventive health policy, organisational priorites and anticipated improved health outcomes.To achieve this objective there will be a need for the existing population health workforce, primary health care and non-government sectors to increase their knowledge and understanding of prevention, promotion and protection theory and practice within new organisational frameworks and linked to the community. This shift needs to be part of a national health services research agenda, infrastructure and funding which is supportive of quality continuing professional development.This paper discusses policy and practice issues related to workforce development as part of an integrated response to the preventive agenda.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2009-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-14","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28192489","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":"Health facilities at the district level in Indonesia.","authors":"Peter Heywood,&nbsp;Nida P Harahap","doi":"10.1186/1743-8462-6-13","DOIUrl":"https://doi.org/10.1186/1743-8462-6-13","url":null,"abstract":"<p><strong>Background: </strong>At Independence the Government of Indonesia inherited a weak and unevenly distributed health system to which much of the population had only limited access. In response, the government decided to increase the number of facilities and to locate them closer to the people. To staff these health facilities the government introduced obligatory government service for all new graduates in medicine, nursing and midwifery. Most of these staff also established private practices in the areas in which they were located. The health information system contains little information on the health care facilities established for private practice by these staff. This article reports on the results of enumerating all health facilities in 15 districts in Java.</p><p><strong>Methods: </strong>We enumerated all healthcare facilities, public and private, by type in each of 15 districts in Java.</p><p><strong>Results: </strong>The enumeration showed a much higher number of healthcare facilities in each district than is shown in most reports and in the health information system which concentrates on public, multi-provider facilities. Across the 15 districts: 86% of facilities were solo-provider facilities for outpatient services; 13% were multi-provider facilities for outpatient services; and 1% were multi-provider facilities offering both outpatient and inpatient services.</p><p><strong>Conclusion: </strong>The relatively good distribution of health facilities in Indonesia was achieved through establishing public health centers at the sub-district level and staffing them through a system of compulsory service for doctors, nurses and midwives. Subsequently, these public sector staff also established solo-provider facilities for their own private practice; these solo-provider facilities, of which those for nurses are almost half, comprise the largest category of outpatient care facilities, most are not included in official statistics. Now that Indonesia no longer has mandatory service for newly graduated doctors, nurses and midwives, it will have difficulty maintaining the distribution of facilities and providers established through the 1980s. The current challenge is to envision a new health system that responds to the changing disease patterns as well as the changes in distribution of health facilities.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2009-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-13","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28250992","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}