Australia and New Zealand health policy最新文献

{"title":"The use and misuse of health research by parliamentary politicians during the development of a national smokefree law.","authors":"George Thomson, Nick Wilson, Philippa Howden-Chapman","doi":"10.1186/1743-8462-4-24","DOIUrl":"10.1186/1743-8462-4-24","url":null,"abstract":"<p><strong>Background: </strong>We investigated the ways in which research evidence about the health effects from secondhand smoke (SHS) and smokefree policies was publicly used or regarded by New Zealand parliamentary politicians, during efforts to strengthen a smokefree law (ie, from 1997 to 2005).</p><p><strong>Methods: </strong>A documentary case study used published and unpublished material recording the use of research evidence by politicians. The material was collected for the period 1997-2005 from the parliamentary record, media and other databases. Additional searches were made to provide context for the politicians who used research.</p><p><strong>Results: </strong>Major themes identified included: (a) the employment of local estimates of SHS mortality, (b) linking specific health effects (eg, cancer) to SHS exposure, (c) a focus on the use of research relevant to bar workers, and (d) the use of research to downgrade the health effects, and attacks on the credibility of research showing health effects from SHS. Almost half of the 21 Members of Parliament (MPs), who spoke in parliament about SHS research during 2000-2005, denied or were sceptical about SHS harm. At least five MPs used tobacco industry funded or disseminated versions of research. There was some indirect evidence that the degree of exposure to the health sector, or the tobacco industry and its allies, may have been factors in the use by MPs of the research.</p><p><strong>Policy implications: </strong>The willingness of some of this group of politicians to adopt tobacco industry arguments suggests possible options within health promotion. These include the better enforcement of consumer protection laws (preventing deceptive information by the tobacco industry and its allies), and the adoption of an increased focus on tobacco industry behaviour within tobacco control efforts. These moves may have beneficial effects for the use of research in public health policymaking. The strengthening by the health sector of its advocacy capacity and effectiveness may also be a crucial step in the better use of research by politicians in the policymaking process.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":" ","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2007-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41059248","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":"Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices.","authors":"Adam G Elshaug,&nbsp;Janet E Hiller,&nbsp;Sean R Tunis,&nbsp;John R Moss","doi":"10.1186/1743-8462-4-23","DOIUrl":"https://doi.org/10.1186/1743-8462-4-23","url":null,"abstract":"<p><strong>Background: </strong>Internationally, many health care interventions were diffused prior to the standard use of assessments of safety, effectiveness and cost-effectiveness. Disinvestment from ineffective or inappropriately applied practices is a growing priority for health care systems for reasons of improved quality of care and sustainability of resource allocation. In this paper we examine key challenges for disinvestment from these interventions and explore potential policy-related avenues to advance a disinvestment agenda.</p><p><strong>Results: </strong>We examine five key challenges in the area of policy driven disinvestment: 1) lack of resources to support disinvestment policy mechanisms; 2) lack of reliable administrative mechanisms to identify and prioritise technologies and/or practices with uncertain clinical and cost-effectiveness; 3) political, clinical and social challenges to removing an established technology or practice; 4) lack of published studies with evidence demonstrating that existing technologies/practices provide little or no benefit (highlighting complexity of design) and; 5) inadequate resources to support a research agenda to advance disinvestment methods. Partnerships are required to involve government, professional colleges and relevant stakeholder groups to put disinvestment on the agenda. Such partnerships could foster awareness raising, collaboration and improved health outcome data generation and reporting. Dedicated funds and distinct processes could be established within the Medical Services Advisory Committee and Pharmaceutical Benefits Advisory Committee to, a) identify technologies and practices for which there is relative uncertainty that could be the basis for disinvestment analysis, and b) conduct disinvestment assessments of selected item(s) to address existing practices in an analogous manner to the current focus on new and emerging technology. Finally, dedicated funding and cross-disciplinary collaboration is necessary to build health services and policy research capacity, with a focus on advancing disinvestment research methodologies and decision support tools.</p><p><strong>Conclusion: </strong>The potential over-utilisation of less than effective clinical practices and the potential under-utilisation of effective clinical practices not only result in less than optimal care but also fragmented, inefficient and unsustainable resource allocation. Systematic policy approaches to disinvestment will improve equity, efficiency, quality and safety of care, as well as sustainability of resource allocation.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":" ","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2007-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-4-23","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41008641","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":"Analysing NSW state policy for child obesity prevention: strategic policy versus practical action.","authors":"Lesley King, Caroline Turnour, Marilyn Wise","doi":"10.1186/1743-8462-4-22","DOIUrl":"10.1186/1743-8462-4-22","url":null,"abstract":"<p><strong>Background: </strong>There is increasing worldwide recognition of the need for government policies to address the recent increases in the incidence and prevalence of childhood obesity. The complexity and inter-relatedness of the determinants of obesity pose a genuine policy challenge, both scientifically and politically. This study examines the characteristics of one of the early policy responses, the NSW Government's Prevention of Obesity in Children and Young People: NSW Government Action Plan 2003-2007 (GAP), as a case study, assessing it in terms of its content and capacity for implementation.</p><p><strong>Results: </strong>This policy was designed as an initial set of practical actions spanning five government sectors. Most of the policy actions fitted with existing implementation systems within NSW government, and reflected an incremental approach to policy formulation and implementation.</p><p><strong>Conclusion: </strong>As a case study, the NSW Government Action Plan illustrates that childhood obesity policy development and implementation are at an early stage. This policy, while limited, may have built sufficient commitment and support to create momentum for more strategic policy in the future. A more sophisticated, comprehensive and strategic policy which can also be widely implemented and evaluated should now be built on this base.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"4 ","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2007-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2104535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27047569","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":"A pathway to a stronger research culture in health policy.","authors":"Jennifer Smith-Merry, James Gillespie, Stephen R Leeder","doi":"10.1186/1743-8462-4-19","DOIUrl":"10.1186/1743-8462-4-19","url":null,"abstract":"<p><strong>Background: </strong>There are currently limited pathways into a career in health policy research in Australia, due in part to a serious absence of health policy research capability in Australian universities.</p><p><strong>Discussion: </strong>We define what we consider health policy research and education should comprise. We then examine what is currently on offer and propose ways to strengthen health policy research in Australia.</p><p><strong>Summary: </strong>This paper, which is part analysis and part commentary, is offered to provoke wider debate about how health policy research can be nurtured in Australia.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"4 ","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2007-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2104534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27039983","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":"Addressing men's health policy concerns in Australia: what can be done?","authors":"James A Smith","doi":"10.1186/1743-8462-4-20","DOIUrl":"https://doi.org/10.1186/1743-8462-4-20","url":null,"abstract":"<p><p> There is a lack of consensus about what men's health constitutes in Australia. The absence of a widely accepted definition has been problematic for establishing state and national men's health policies. I consider that one impediment to the implementation of state and federal men's health policies has been a lack of willingness to approach men's health from a broad public health perspective. In particular, scant attention has been paid to exploring lay perspectives of how men define and understand health, and in turn, how these relate to significant policy problems such as men's health service use. I conclude by suggesting that a focus on men's lay perspectives of their health emerging from the United Kingdom and the Republic of Ireland provides a useful framework to guide men's health policy discussion in Australia.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"4 ","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2007-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-4-20","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27040484","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":"Impact of telephone triage on emergency after hours GP Medicare usage: a time-series analysis.","authors":"David Dunt,&nbsp;Robert Wilson,&nbsp;Susan E Day,&nbsp;Margaret Kelaher,&nbsp;Lyle Gurrin","doi":"10.1186/1743-8462-4-21","DOIUrl":"https://doi.org/10.1186/1743-8462-4-21","url":null,"abstract":"<p><strong>Background: </strong>The Australian government sponsored trials aimed at addressing problems in after hours primary medical care service use in five different parts of the country with different after hours care problems. The study's objective was to determine in four of the five trials where telephone triage was the sole innovation, if there was a reduction in emergency GP after hours service utilization (GP first call-out) as measured in Medicare Benefits Schedule claim data. Monthly MBS claim data in both the pre-trial and trial periods was monitored over a 3-year period in each trial area as well as in a national sample outside the trial areas (National comparator). Poisson regression analysis was used in analysis.</p><p><strong>Results: </strong>There was significant reduction in first call out MBS claims in three of the four study areas where stand-alone call centre services existed. These were the Statewide Call Centre in both its Metropolitan and Non-metropolitan areas in which it operated - Relative Risk (RR) = 0.87 (95% Confidence interval: 0.86 - 0.88) and 0.60 (95% CI: 0.54 - 0.68) respectively. There was also a reduction in the Regional Call Centre in the non-Metropolitan area in which it operated (RR = 0.46 (95% CI: 0.35 - 0.61) though a small increase in its Metropolitan area (RR = 1.11 (95% CI: 1.06 - 1.17). For the two telephone triage services embedded in existing organisations, there was also a significant reduction for the Deputising Service - RR = 0.62 (95% CI: 0.61 - 0.64) but no change in the Local Triage centre area.</p><p><strong>Conclusion: </strong>The four telephone triage services were associated with reduced GP MBS claims for first callout after hours care in most study areas. It is possible that other factors could be responsible for some of this reduction, for example, MBS submitted claims for after hours GP services being reclassified from 'after hours' to 'in hours'. The goals of stand-alone call centres which are aimed principally at meeting population needs rather than managing demand may be being met only in part.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"4 ","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2007-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-4-21","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27041444","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":"From little things, big things grow: a local approach to system-wide maternity services reform in the absence of definitive evidence.","authors":"Anne-Marie Boxall,&nbsp;Kathy Flitcroft","doi":"10.1186/1743-8462-4-18","DOIUrl":"https://doi.org/10.1186/1743-8462-4-18","url":null,"abstract":"<p><strong>Background: </strong>For nearly two decades calls have been made to expand the role of midwives within maternity services in Australia. Although some progress has been made, it has been slow and, at system-wide level, limited. There are many barriers that prevent the expansion of midwifery-led services in Australia including funding arrangements for midwifery care, a lack of political will and resistance from powerful medical interest groups. The ongoing debate that exists about the evidence for the safety of midwifery-led care, particularly for the intrapartum phase, is likely to be an important reason why policy-makers are reluctant to implement system-wide reforms of maternity services.</p><p><strong>Discussion: </strong>Those opposed to the expansion of midwifery-led care argue that these services are only appropriate for low-risk women. They claim the evidence in support of midwifery-led care has too many holes in it to guarantee that services are safe for higher risk women. Midwifery advocates, however, argue there is no evidence to support the claim that midwifery-led services lead to poorer outcomes in any risk group. Despite this, funding for midwifery-led care outside hospitals remains limited. This article contends that calls for the system-wide expansion of midwifery-led care (such as through funding independently practising midwives) based on the available evidence are unlikely to succeed. There are too many methodological challenges in this area to ever \"prove\" that midwifery-led services are safe - except for the lowest risk women - and when there is doubt, policy-makers are likely to err on the side of caution.</p><p><strong>Summary: </strong>In order to expand access to midwifery care, advocates should abandon the idea of system-wide reform for now. Instead, they should concentrate on implementing small-scale, locally based changes because it is at this grass roots level that health professionals can work together to resolve the major sticking points - accurately assessing risk, identifying when it changes and responding appropriately. While a lack of political will is a major obstacle to reform it is amenable to change. We argue that system-wide reform is most likely to occur when policy-makers can reference examples of successful locally-based midwifery-led programs across Australia.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":" ","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2007-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-4-18","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41002000","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":"A pilot qualitative study of New Zealand policymakers' knowledge of, and attitudes to, the tobacco industry.","authors":"Sheena Hudson,&nbsp;George Thomson,&nbsp;Nick Wilson","doi":"10.1186/1743-8462-4-17","DOIUrl":"https://doi.org/10.1186/1743-8462-4-17","url":null,"abstract":"<p><strong>Background: </strong>The actions of policymakers are critical to advancing tobacco control. To evaluate the feasibility of using anonymous in-depth interviews to ascertain policymakers' knowledge about, and attitudes to, the tobacco industry, we undertook a pilot study involving New Zealand policymakers.</p><p><strong>Methods: </strong>Five politicians (from different political parties) and five senior officials, who were involved in tobacco control policy, were recruited for semi-structured, anonymous, face-to-face interviews.</p><p><strong>Results: </strong>Recruitment of appropriate senior policymakers was found to be possible. Interviewees were willing to answer questions fully and frankly about their knowledge and views of the tobacco industry.The preliminary data from this pilot suggest that some New Zealand politicians appeared to see contact with the industry as similar to contact with other groups, whereas the officials indicated at least a different style of relationship. Only one politician knew if their party accepted funding from tobacco companies. All but one of the interviewees thought that promotion of tobacco to under-16 s still occurs, albeit indirectly. The interviewees' knowledge of the investment in tobacco industries by New Zealand government agencies was low or absent.While most of those interviewed showed scepticism about tobacco company public relations efforts, this was absent in some cases. There was a wide understanding that the tobacco industry will use many tactics in the pursuit of profit, and to counteract government efforts to reduce the harm from smoking.</p><p><strong>Conclusion: </strong>In-depth anonymous interviews appear to be feasible and can be productive for exploring sensitive tobacco-related policy issues with policymakers. The preliminary data from this group of New Zealand policymakers suggest important knowledge gaps, but also general distrust of this industry. From a tobacco control perspective, the results may suggest a greater focus by advocates on the funding of political parties by the tobacco industry, and on government agency investment in the tobacco industry.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"4 ","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2007-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-4-17","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26847855","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":"Depression in multicultural Australia: policies, research and services.","authors":"Harry Minas,&nbsp;Steven Klimidis,&nbsp;Renata Kokanovic","doi":"10.1186/1743-8462-4-16","DOIUrl":"10.1186/1743-8462-4-16","url":null,"abstract":"<p><strong>Background: </strong>Depression is one of the leading causes of disability in Australia. The cultural and linguistic diversity of the Australian population poses a significant challenge to health policy development, service provision, professional education, and research. The purpose of this study is to explore the extent to which the fact of cultural and linguistic diversity has influenced the formulation of mental health policy, the conduct of mental health research and the development of mental health services for people with depression from ethnic minority communities.</p><p><strong>Methods: </strong>The methods used for the different components of the study included surveys and document-based content and thematic analyses.</p><p><strong>Results: </strong>Policy is comprehensive but its translation into programs is inadequate. Across Australia, there were few specific programs on depression in ethnic minority communities and they are confronted with a variety of implementation difficulties. The scope and scale of research on depression in Ethnic minority communities is extremely limited.</p><p><strong>Conclusion: </strong>A key problem is that the research that is necessary to provide evidence for policy and service delivery is lacking. If depression in Ethnic minority communities is to be addressed effectively the gaps between policy intentions and policy implementation, and between information needs for policies and practice and the actual research that is being done, have to be narrowed.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"4 ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2007-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-4-16","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26844235","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":"Divisions of general practice in Australia: how do they measure up in the international context?","authors":"Judith Smith,&nbsp;Beverly Sibthorpe","doi":"10.1186/1743-8462-4-15","DOIUrl":"https://doi.org/10.1186/1743-8462-4-15","url":null,"abstract":"<p><strong>Background: </strong>Since the late 1980s, there has been evidence of an international trend towards more organised primary care. This has taken a number of forms including the emergence of primary care organisations. Underpinning such developments is an inherent belief in evidence that suggests that well-developed primary care is associated with improved health outcomes and greater cost-effectiveness within health systems. In Australia, primary care organisations have emerged as divisions of general practice. These are professionally-led, regionally-based, and largely government-funded voluntary associations of general practitioners that seek to co-ordinate local primary care services, and improve the quality of care and health outcomes for local communities.</p><p><strong>Discussion: </strong>In this paper, we examine and debate the development of divisions in the international context, using six roles of primary care organisations outlined in published research. The six roles that are used as the basis for the critique are the ability of primary care organisations to: improve health outcomes; manage demand and control costs; engage primary care physicians; enable greater integration of health services; develop more accessible services in community and primary care settings; and enable greater scrutiny and assurance of quality of primary care services.</p><p><strong>Summary: </strong>We conclude that there has been an evolutionary approach to divisions' development and they now appear embedded as geographically-based planning and development organisations within the Australian primary health care system. The Australian Government has to date been cautious in its approach to intervention in divisions' direction and performance. However, options for the next phase include: making greater use of contracts between government and divisions; introducing and extending proposed national quality targets for divisions, linked with financial or other incentives for performance; government sub-contracting with state-based organisations to act as purchasers of care; pursuing a fund-holding approach within divisions; and developing divisions as a form of health maintenance organisation. The challenge for the Australian Government, should it wish to see divisions' role expand, is to find mechanisms to enable this without compromising the relatively strong GP engagement that increasingly distinguishes divisions of general practice within the international experience of primary care organisations.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"4 ","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2007-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-4-15","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26826684","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}