Journal articles on the topic 'Integrated delivery of health care Australian Capital Territory'
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Islam, Md Irteja, Sharif Bagnulo, Yiwen Wang, Robyn Ramsden, Trent Wrightson, Amanda Masset, Richard Colbran, Mike Edwards, and Alexandra Martiniuk. "Job Satisfaction of Health Practitioners Providing Outreach Health Services during COVID-19 in Rural New South Wales (NSW) and the Australian Capital Territory (ACT), Australia." Healthcare 11, no. 1 (December 20, 2022): 3. http://dx.doi.org/10.3390/healthcare11010003.
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Outreach health practitioners play a key role in enhancing access to healthcare for remote, rural, regional, and Aboriginal and Torres Strait Islander communities in Australia. Outreach health practitioners are those providing ongoing and integrated health services in communities that would otherwise have limited access. In the context of the COVID-19 pandemic, it is important to understand the job satisfaction of health workers as it correlates with long-term retention of the workforce, as well as effectiveness in the role and clinical outcomes for patients. Method: The study analysed data from 258 outreach health practitioners who responded to two cross-sectional surveys conducted by the NSW Rural Doctors Network during the COVID-19 pandemic in 2020/21 and 2021/22 in NSW and the ACT, Australia. Both bivariate and multivariate analyses were employed to assess the associations between the outcome variable (outreach health practitioners’ job satisfaction) and independent variables (sociodemographic factors, motivation, self-confidence, communication, capability). Results: Overall, the study showed that 92.2% of health practitioners were satisfied in their role providing outreach health services during the COVID-19 pandemic. In the multivariable model, factors significantly associated with higher satisfaction included good communication with other local health practitioners, using telehealth along with in-person care, and having high self-rated capability compared to those health practitioners who said they had lower job satisfaction. Conclusions: Outreach health practitioners’ job satisfaction is important because poor satisfaction may lead to suboptimal healthcare delivery, poor clinical outcomes, and poor retention of staff in rural settings. These findings should be taken into consideration when developing future strategies to improve job satisfaction among rural outreach health practitioners and to enhance attraction, recruitment and retention and may be applicable to the broader health workforce.
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Saunders, Vicky, Maddison Beck, Jacqueline McKechnie, Michelle Lincoln, Christine Phillips, Jane Herbert, and Rachel Davey. "A Good start in life: Effectiveness of integrated multicomponent multisector support on early child development—Study protocol." PLOS ONE 17, no. 8 (August 3, 2022): e0267666. http://dx.doi.org/10.1371/journal.pone.0267666.
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Introduction Early childhood experiences have a lifelong impact on a child’s future. Social and environmental experiences and interactions have a profound relational effect on children’s physical and mental health which transfers agency to parents, caregivers and duty-bearers to care for the child’s welfare. In the Australian context early child development indices have been in decline in some communities. Hence, there is a sense of urgency to reverse these trends from an integrated perspective. A multisector, multi component program of interventions named A Good Start in Life is proposed and is being tested in the Australian Capital Territory across suburbs with high levels of early childhood development disadvantage. The aim of this study is to evaluate the outcomes and processes related to targeted interventions, designed to integrate child and family services within the local district and embed allied health programs into early childhood education, care services and playgroups. Methods and analysis The Good Start in Life study will use a quasi-experimental design (with a matched control geographical area) consisting of a combination of interventions that will build multisectoral collaboration across education, health and social services that connect and support families with children from birth to 5 years. The control area will be matched on demographic characteristics and early child development outcomes and trends over the pre-intervention period. Evaluation data will be collected at baseline, and then on an annual basis for a further three years. A mixed methods approach will be used to evaluate delivery processes: quantitative (checklists, questionnaires) and qualitative methods (observations, focus groups and key stakeholder interviews). Effectiveness of the programme will be evaluated by comparing early child development outcomes between the comparator areas from the Australian Early Development Census in 2024. The primary focus will be on reducing the number of children who are developmentally vulnerable on at least one early development index (EDI). Separate tests will be conducted for significant differences in the percentage of children at risk in each of the five individual EDI domains. These domains are physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication and general knowledge. Trial registration ACTRN12621001140842.
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Hindle, Don. "Health care funding in the Australian Capital Territory: From hospital to community." Australian Health Review 25, no. 1 (2002): 121. http://dx.doi.org/10.1071/ah020121.
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This paper presents an outline of the socio-demographic features of the Australian Capital Territory (the ACT) and of its health care system. I describe how health care resources are allocated in the government sector, present a moredetailed description of the way that hospital services are purchased, and summarise the government's policy directions for health. I argue that the main directions are sensible, and particularly those that support more integrated care that is largely based in the community. There appear to be no major weaknesses in the budget-share output-based funding model used in the purchase of hospital services, although the rationale for some of the components might be clarified.In total, the ACT government appears to be on the right track. However, I argue that more rapid progress might bepossible if there were greater collaboration between the Territory health authority and the relatively powerful private medical profession.
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Gatenby, Paul A. "Creation of an academic medical centre: Management and service delivery at the Canberra Clinical School." Australian Health Review 19, no. 1 (1996): 107. http://dx.doi.org/10.1071/ah960107.
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The Canberra Clinical School is attached to Woden Valley Hospital, the principalhospital in the Australian Capital Territory. The clinical school arose out of amemorandum of understanding signed between the University of Sydney and theACT Department of Health (as it then was) in March 1993. One of theaspirations of those who negotiated the memorandum of understanding was thatthe creation of the clinical school would lead to a cultural shift in attitudes towardschange within the health care system. This paper looks at the management structureof Woden Valley Hospital and at what the development of a clinical school inCanberra can achieve, particularly in relation to hospital and health servicemanagement.
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Almado, Haidar, Estie Kruger, and Marc Tennant. "Application of spatial analysis technology to the planning of access to oral health care for at-risk populations in Australian capital cities." Australian Journal of Primary Health 21, no. 2 (2015): 221. http://dx.doi.org/10.1071/py13141.
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Australians are one of the healthiest populations in the world but there is strong evidence that health inequalities exist. Australia has 23.1 million people spread very unevenly over ~20 million square kilometres. This study aimed to apply spatial analysis tools to measure the spatial distribution of fixed adult public dental clinics in the eight metropolitan capital cities of Australia. All population data for metropolitan areas of the eight capital cities were integrated with socioeconomic data and health-service locations, using Geographic Information Systems, and then analysed. The adult population was divided into three subgroups according to age, consisting of 15-year-olds and over (n = 7.2 million), retirees 65 years and over (n = 1.2 million), and the elderly, who were 85 years and over (n = 0.15 million). It was evident that the States fell into two groups; Tasmania, Northern Territory, Australian Capital Territory and Western Australia in one cluster, and Victoria, New South Wales, Queensland and South Australia in the other. In the first group, the average proportion of the population of low socioeconomic status living in metropolitan areas within 2.5 km of a government dental clinic is 13%, while for the other cluster, it is 42%. The clustering remains true at 5 km from the clinics. The first cluster finds that almost half (46%) of the poorest 30% of the population live within 5 km of a government dental clinic. The other cluster of States finds nearly double that proportion (86%). The results from this study indicated that access distances to government dental services differ substantially in metropolitan areas of the major Australian capital cities.
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Kerr, Rhonda, and Delia V. Hendrie. "Is capital investment in Australian hospitals effectively funding patient access to efficient public hospital care?" Australian Health Review 42, no. 5 (2018): 501. http://dx.doi.org/10.1071/ah17231.
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Objective This study asks ‘Is capital investment in Australian public hospitals effectively funding patient access to efficient hospital care?’ Methods The study drew information from semistructured interviews with senior health infrastructure officials, literature reviews and World Health Organization (WHO) reports. To identify which systems most effectively fund patient access to efficient hospitals, capital allocation systems for 17 Organisation for Economic Cooperation and Development (OECD) countries were assessed. Results Australian government objectives (equitable access to clinically appropriate, efficient, sustainable, innovative, patient-based) for acute health services are not directly addressed within Australian capital allocation systems for hospitals. Instead, Australia retains a prioritised hospital investment system for institutionally based asset replacement and capital planning, aligned with budgetary and political priorities. Australian systems of capital allocation for public hospitals were found not to match health system objectives for allocative, productive and dynamic efficiency. Australia scored below average in funding patient access to efficient hospitals. The OECD countries most effectively funding patient access to efficient hospital care have transitioned to diagnosis-related group (DRG) aligned capital funding. Measures of effective capital allocation for hospitals, patient access and efficiency found mixed government–private–public partnerships performed poorly with inferior access to capital than DRG-aligned systems, with the worst performing systems based on private finance. Conclusion Australian capital allocation systems for hospitals do not meet Australian government standards for the health system. Transition to a diagnosis-based system of capital allocation would align capital allocation with government standards and has been found to improve patient access to efficient hospital care. What is known about the topic? Very little is known about the effectiveness of Australian capital allocation for public hospitals. In Australia, capital is rarely discussed in the context of efficiency, although poor built capital and inappropriate technologies are acknowledged as limitations to improving efficiency. Capital allocated for public hospitals by state and territory is no longer reported by Australian Institute of Health and Welfare due to problems with data reliability. International comparative reviews of capital funding for hospitals have not included Australia. Most comparative efficiency reviews for health avoid considering capital allocation. The national review of hospitals found capital allocation information makes it difficult to determine ’if we have it right’ in terms of investment for health services. Problems with capital allocation systems for public hospitals have been identified within state-based reviews of health service delivery. The Productivity Commission was unable to identify the cost of capital used in treating patients in Australian public hospitals. Instead, building and equipment depreciation plus the user cost of capital (or the cost of using the money invested in the asset) are used to estimate the cost of capital required for patient care, despite concerns about accuracy and comparability. What does this paper add? This is the first study to review capital allocation systems for Australian public hospitals, to evaluate those systems against the contemporary objectives of the health systems and to assess whether prevailing Australian allocation systems deliver funds to facilitate patient access to efficient hospital care. This is the first study to evaluate Australian hospital capital allocation and efficiency. It compares the objectives of the Australian public hospitals system (for universal access to patient-centred, efficient and effective health care) against a range of capital funding mechanisms used in comparable health systems. It is also the first comparative review of international capital funding systems to include Australia. What are the implications for practitioners? Clinical quality and operational efficiency in hospitals require access for all patients to technologically appropriate hospitals. Funding for appropriate public hospital facilities, medical equipment and information and communications technology is not connected to activity-based funding in Australia. This study examines how capital can most effectively be allocated to provide patient access to efficient hospital care for Australian public hospitals. Capital investment for hospitals that is patient based, rather than institutionally focused, aligns with higher efficiency.
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Bail, Kasia, Paul Arbon, Marlene Eggert, Anne Gardner, Sonia Hogan, Christine Phillips, Nicole van Dieman, and Gordon Waddington. "Potential scope and impact of a transboundary model of nurse practitioners in aged care." Australian Journal of Primary Health 15, no. 3 (2009): 232. http://dx.doi.org/10.1071/py09009.
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Aged care is a growing issue in Australia and other countries. There are significant barriers to meeting the health needs of this population. Current services have gaps between care and lack communication and integration between care providers. Research was conducted in the Australian Capital Territory to investigate the potential role of the aged care nurse practitioner in health service delivery in aged care settings. A multimethod case study design was utilised, with three student nurse practitioners (SNP) providing care to aged care clients across three sectors of health service delivery (residential aged care facilities, general medical practices and acute care). Data collection consisted of in-depth interviews and journal entries of the SNP, as well as focus groups and surveys of multidisciplinary staff and patients over the age of 65 years in the settings frequented by the SNP. The aged care SNP were found to cross professional and organisational boundaries, cross intra- as well as interorganisational boundaries and to contribute to more seamless patient care as members of a multidisciplinary aged care team. The aged care nurse practitioner role consequently has the potential to function in a networked rather than a hierarchical manner, and this could be a key element in addressing gaps in care across care locales and between disciplines.
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McRae, Ian, and Mai Pham. "When is a GP home-visit program financially viable?" Australian Journal of Primary Health 22, no. 6 (2016): 554. http://dx.doi.org/10.1071/py15074.
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Despite a decline in GP home visits in Australia, these services remain an important aspect of healthcare access and delivery for the aged population. Home visits can both provide better care and decrease use of ambulance and emergency department (ED) services. The net costs of providing GP visits are complex, depending on the relative costs of home visits and ED attendances, the number of ED attendances saved by GP visits, and the number of services provided per day by a visiting GP. The Australian Capital Territory government created the General Practice Aged Day Service (GPADS) program in March 2011. Using data and information from this program as a basis, we examine the financial aspects of a daytime home-visit program in the Australian context. Whether or not a program is financially viable depends on a range of parameters; if all factors are aligned a program can generate net savings. While there is no information available on the net health benefits of home visits relative to ED attendance, these differences need not be large for the program to be cost-effective.
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Jakobs, Olivia M., Elizabeth M. O'Leary, Mark F. Cormack, and Guan C. Chong. "A working model for the extraordinary review of clinical privileges for doctors and dentists in the Australian Capital Territory." Australian Health Review 34, no. 2 (2010): 170. http://dx.doi.org/10.1071/ah08694.
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The extraordinary (unplanned) review of clinical privileges is the means by which an organisation can manage specific complaints about individual practitioners’ clinical competence that require immediate investigation. To date, the extraordinary review of clinical privileges for doctors and dentists has not been the subject of much research and there is a pressing need for the evaluation and review of how different legislated and non-legislated administrative processes work and what they achieve. Although it seems a fair proposition that comprehensive processes for the evaluation of the clinical competence of doctors and dentists may improve the overall delivery of an organisation’s clinical services, in fact, little is known about the relationship between the safety and quality of specific clinical services, procedures and interventions and the efficiency or effectiveness of established methodologies for the routine or the extraordinary review of clinical privileges. The authors present a model of a structured approach to the extraordinary review of clinical privileges within a clinical governance framework in the Australian Capital Territory. The assessment framework uses a primarily qualitative methodology, underpinned by a process of systematic review of clinical competence against the agreed standards of the CanMEDS Physician Competency Framework. The model is a practical, working framework that could be implemented on a hospital-, area health service- or state- and territory-wide basis in any other Australian jurisdiction. What is known about the topic?In Australia, there is a national standard for credentialing and defining the scope of clinical practice for doctors working in hospital settings. However, there are no published reports in the national arena on established processes for the extraordinary review of clinical privileges for doctors or dentists and, despite the major inquiries investigating health system failures in Australian hospitals, the effectiveness and adequacy of existing processes for the extraordinary review of clinical privileges has not yet been prioritised nationally as an area for improvement or reform. Internationally, health care organisations have also been slow to establish frameworks for the management of complaints about doctors or dentists. What does this paper add?This paper makes a significant contribution to the national and international safety and quality literature by presenting an exposition of a working model for the extraordinary review of clinical privileges of doctors and dentists. The authors describe a methodology in the public health sector that is territory-wide (not hospital-based), peer-reviewed, objective, fair and responsive. Because the model is a practical, working framework that could be implemented on a hospital-, area health service- or state- and territory-wide basis in any other Australian jurisdiction, this paper provides an opportunity for policy makers and legislators to drive innovative change. Although incursions into the provision of care by other health professionals have been avoided, the model could be readily adopted by clinical leaders from the nursing and allied health professions. What are the implications for practitioners?An organisation dedicated to investigating serious complaints with a real sense of urgency, objectivity and transparency is far less likely to fester a climate of disquiet or anger amongst staff, or to trigger concerns of a ‘cover-up’ or disregard for accountability than an organisation not adopting such an approach. Anecdotal experience suggests the model has the potential to minimise, if not prevent, the occurrence of the kinds of complaints that become much-publicised in the media. This is positive because these types of damaging high profile cases often have the effect of diminishing community confidence in the health care system, in particular, confidence in the medical profession’s ability to self-regulate. Often, they also lead to a misrepresentation of the medical profession in the media, which is unfair since the overwhelming majority of doctors do meet the standards of their profession.
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Haswell-Elkins, Melissa, Ernest Hunter, Tricia Nagel, Carolyn Thompson, Brenda Hall, Robert Mills, Rachael Wargent, Komla Tsey, Leanne Knowles, and Yvonne Wilkinson. "Reflections on integrating mental health into primary health care services in remote Indigenous communities in Far North Queensland and the Northern Territory." Australian Journal of Primary Health 11, no. 2 (2005): 62. http://dx.doi.org/10.1071/py05023.
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At present, there is a perceived and functional separation of mental health services from the general delivery of primary health care services in remote Indigenous communities in most places in the country. There are a range of issues underlying this separation; many are historical but continue to influence patterns of thinking about mental and physical health. With the increasing shift of focus of care at primary level from being largely reactive to presentations of acute illnesses towards proactive and strategically guided approaches to the management of chronic diseases, coupled with similar national strategic documents guiding mental health care into a primary health care format, the opportunity to integrate the provision of mental and physical health care has never been better. Accompanying this integration should be a reflection and improvement on models of care that address needs of Indigenous people in a more culturally and contextually appropriate manner, as is clearly defined in an increasing range of Indigenous health policy documents. This paper will begin with a summary of the link between mental and physical health supported by key references. It will then briefly reflect on the current organisation of mental and physical health services in remote Indigenous settings of Far North Queensland and the Northern Territory, identifying some of the major disadvantages being experienced. The paper will close with a description of the approach and some early outcomes to address these issues by the Indigenous Stream of the AIMhi project (Australian Integrated Mental Health Initiative), which is a major National Health & Medical Research Council (NH&MRC) Strategic Partnership initiative that began implementing a framework of research activities in mid-2003.
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Gilbert, Monica M., James A. Chamberlain, Carolynne R. White, Paul W. Mayers, Brendan Pawsey, Danny Liew, Matthew Musgrave, Kerry Crawford, and David J. Castle. "Controlled clinical trial of a self-management program for people with mental illness in an adult mental health service - the Optimal Health Program (OHP)." Australian Health Review 36, no. 1 (2012): 1. http://dx.doi.org/10.1071/ah11008.
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Objective. The objective of this study was to evaluate the effect and cost-effectiveness of a self-management intervention, delivered as part of routine care in an adult mental health service. Method. In a community mental health setting, routine care was compared with routine care plus a nine-session intervention (the Optimal Health Program) using a non-randomised controlled design. Adult (18–65 years) consumers of mental health services in the Australian Capital Territory were eligible for participation. Results. The Optimal Health Program was associated with significant improvements in health and social functioning as measured by the Health of the Nation Outcome Scale (average change relative to control: –3.17; 95% CI –4.49 to –1.84; P < 0.001). In addition, there was a reduction in hospital admissions in the treatment group (percentage of time in hospital reduced from 3.20 to 0.82; P = 0.07). This translated into a net cost saving of over AU$6000 per participant per year (uncertainty range AU$744 to AU$12 656). Conclusions. This study shows promising results for incorporating a self-management program into routine care to improve the health and social functioning of mental health consumers in a cost-effective manner. What is known about the topic? Current literature supports the efficacy of structured self-management programs for chronic conditions such as diabetes (type 1 and 2) and asthma, but there remains limited evidence that self-management programs improve outcomes for people with mental illness. What does this paper add? This study adds to the body of evidence supporting self-management as a cost-effective adjunct to routine care in mental health services. What are the implications for practitioners? Our study supports the feasibility of clinicians delivering cost-effective self-management programs as part of routine mental health service delivery.
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Elder-Robinson, Elaina, Abbey Diaz, Kirsten Howard, Darshit Rajeshkumar Parikh, Giam Kar, and Gail Garvey. "Quality of Life in the First Year of Cancer Diagnosis among Aboriginal and Non-Aboriginal People Living in Regional and Remote Areas of Australia." International Journal of Environmental Research and Public Health 19, no. 1 (December 29, 2021): 330. http://dx.doi.org/10.3390/ijerph19010330.
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Little is known of the quality of life (QoL) of cancer patients in the Northern Territory (NT) of Australia, where healthcare delivery is geographically challenged. This exploratory study describes QoL among Aboriginal and non-Aboriginal cancer patients in the NT, in the first year of diagnosis. Participants were recruited from the only cancer care centre in the NT and completed the Assessment of Quality-of-Life questionnaire (AQoL-4D). The results were descriptively analysed. The participants’ (n = 63; mean age 58.8 years) mean AQoL utility score was 0.72 (SD 0.26); patients scored lowest in the relationships and mental health dimensions of the questionnaire (mean 0.89, SD 0.19, and 0.89, SD 0.17, respectively). Participants living in remote and very remote areas (46%) reported higher QoL scores, compared with participants in the outer regional capital city of the NT in the overall (mean 0.76, SD 0.22 and 0.78, SD 0.20 vs. 0.67, SD 0.29, respectively), and mental health dimensions (mean 0.92, SD 0.09 and mean 0.94, SD 0.06 vs. 0.85, SD 0.22, respectively). The findings were suggestive of clinically meaningful differences across socioeconomic groups, cancer and treatment types, and comorbidity status. Mean QoL scores were consistent with previous reports in other Australian cancer cohorts. The findings suggest a need to support cancer patients’ mental health and relationships during the diagnosis and treatment phase of their cancer journey.
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Forbat, Liz, Nikki Johnston, and Imogen Mitchell. "Defining 'specialist palliative care': findings from a Delphi study of clinicians." Australian Health Review 44, no. 2 (2020): 313. http://dx.doi.org/10.1071/ah18198.
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Objective This study aimed to achieve consensus regarding what distinguishes specialist from non-specialist palliative care to inform service organisation and delivery to patients with life-limiting conditions. Methods A three-phase Delphi study was undertaken, involving qualitative interviews and two questionnaire cycles. Thirty-one clinicians (nurses, doctors and social workers) working with a wide range of patients participated in interviews, of whom 27 completed two questionnaire cycles. Results Consensus was gained on 75 items that define specialist palliative care and distinguish it from non-specialist palliative care. Consensus was gained that specialist palliative care clinicians have advanced knowledge of identifying dying, skills to assess and manage complex symptoms to improve quality of life, have advanced communication skills and perform distinct clinical practices (e.g. working with the whole family as the unit of care and providing support in complex bereavement). Non-specialist palliative care involves discussions around futile or burdensome treatments, and care for people who are dying. Conclusions Areas of connection were identified: clinicians from disease-specific specialties should be more involved in leading discussions on futile or burdensome treatment and providing care to people in their last months and days of life, in collaboration with specialists in palliative care when required. What is known about the topic? At present there is no evidence-based definition or agreement about what constitutes specialist palliative care (as opposed to palliative care delivered by non-specialists) in the Australian Capital Territory. An agreed definition is needed to effectively determine the workforce required and its clinical skill mix, and to clarify roles and expectations to mitigate risks in not adequately providing services to patients with life-limiting conditions. What does this paper add? This paper offers, for the first time, an evidence-based definition that distinguishes specialist palliative care from non-specialist palliative care. End of life care and bereavement support are not just the remit of specialist palliative care clinicians. Clinicians from beyond specialist palliative care should lead discussions about futile or burdensome treatment. What are the implications for practitioners? The findings of this study can facilitate implementation of palliative care strategies by enabling practitioners and patients to distinguish who should be delivering what care.
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Scholz, Brett, Julia Bocking, and Brenda Happell. "How do consumer leaders co-create value in mental health organisations?" Australian Health Review 41, no. 5 (2017): 505. http://dx.doi.org/10.1071/ah16105.
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Objectives Contemporary mental health policies call for consumers to be involved in decision-making processes within mental health organisations. Some organisations have embraced leadership roles for consumers, but research suggests consumers remain disempowered within mental health services. Drawing on a service-dominant logic, which emphasises the co-creation of value of services, the present study provides an overview of consumer leadership within mental health organisations in the Australian Capital Territory. Methods Mental health organisations subscribing to the local peak body mailing list were invited to complete a survey about consumer leadership. Survey data were summarised using descriptive statistics and interpreted through the lens of service-dominant logic. Results Ways in which organisations may create opportunities for consumers to co-create value within their mental health services included soliciting feedback, involving consumer leaders in service design, having consumer leaders involved in hiring decisions and employing consumer leaders as staff or on boards. Strategies that organisations used to develop consumer leaders included induction, workshops and training in a variety of organisational processes and skills. Conclusions The findings of the present study extend the application of a service-dominant logic framework to consumer leadership within mental health organisations through consideration of the diverse opportunities that organisations can provide for consumer co-creation of service offerings. What is known about the topic? Policy calls for consumer involvement in all levels of mental health service planning, implementation and delivery. The extent to which service organisations have included consumer leaders varies, but research suggests that this inclusion can be tokenistic or that organisations choose to work with consumers who are less likely to challenge the status quo. Service literature has explored the way consumers can co-create value of their own health care, but is yet to explore consumers’ co-creation of value at a systemic level. What does the paper add? This paper outlines ways in which mental health organisations report involving consumers in leadership positions, including having consumers on boards, having consumers on recruitment panels and providing leadership training for consumers. These initiatives are considered in terms of the potential value co-created within mental health services by consumers in leadership, suggesting that consumer leaders are a resource to mental health organisations in terms of the value brought to service offerings. What are the implications for practitioners? Research suggests that medical professionals have been resistant to increased consumer leadership within mental health services. The findings of the present study emphasise the value that can be brought to service organisations by consumer leaders, suggesting that mental health practitioners may reconsider their approach and attitudes towards consumer leadership in the sector.
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Tabatabaei-Jafari, Hossein, Nasser Bagheri, Christian Lueck, Mary Anne Furst, Jose A. Salinas-Perez, and Luis Salvador-Carulla. "Standardized Systematic Description of Provision of Care for Multiple Sclerosis at a Local Level: A Demonstration Study." International Journal of MS Care, December 13, 2022. http://dx.doi.org/10.7224/1537-2073.2022-014.
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Abstract Background: This study evaluates and describes the pattern of services provided for people living with multiple sclerosis (MS) in a local area as a starting point for a more global assessment. Methods: A health care ecosystem approach has been followed using an internationally standardized service classification instrument—the Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC)—to identify and describe all services providing care to people with MS in the Australian Capital Territory, Australia. Available services were classified according to the target population into those specifically dedicated to people living with MS and those providing general neurologic services, both public and private, and across both social and health sectors. Results: A limited range of services was available. There were no local facilities providing or coordinating multidisciplinary integrated care specific to people with MS. Subspecialty services specific to MS were limited in number (6 of the 28 services), and use of specialist services provided in neighboring states was frequently reported. Overall, very few services were provided outside the core health sector (4%). Conclusions: The provision of care to people living with MS in the Australian Capital Territory is fragmented and relies heavily on generic neurology services in the public and private sectors. More widespread use of the DESDE-LTC as a standardized method of service classification in MS will facilitate comparison with other local areas, allow monitoring of changes over time, and permit comparison with services provided for other health conditions (eg, dementia, mental disorders).
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Abdel-Latif, Mohamed E., Oyelola Adegboye, Gen Nowak, Faiz Elfaki, Barbara Bajuk, Kathryn Glass, and David Harley. "Variation in hospital morbidities in an Australian neonatal intensive care unit network." Archives of Disease in Childhood - Fetal and Neonatal Edition, January 2, 2023, fetalneonatal—2022–324940. http://dx.doi.org/10.1136/archdischild-2022-324940.
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ObjectiveThere is an expectation among the public and within the profession that the performance and outcome of neonatal intensive care units (NICUs) should be comparable between centres with a similar setting. This study aims to benchmark and audit performance variation in a regional Australian network of eight NICUs.DesignCohort study using prospectively collected data.SettingAll eight perinatal centres in New South Wales and the Australian Capital Territory, Australia.PatientsAll live-born infants born between 23+0and 31+6weeks gestation admitted to one of the tertiary perinatal centres from 2007 to 2020 (n=12 608).Main outcome measuresEarly and late confirmed sepsis, intraventricular haemorrhage, medically and surgically treated patent ductus arteriosus, chronic lung disease (CLD), postnatal steroid for CLD, necrotising enterocolitis, retinopathy of prematurity (ROP), surgery for ROP, hospital mortality and home oxygen.ResultsNICUs showed variations in maternal and neonatal characteristics and resources. The unadjusted funnel plots for neonatal outcomes showed apparent variation with multiple centres outside the 99.8% control limits of the network values. The hierarchical model-based risk-adjustment accounting for differences in patient characteristics showed that discharged home with oxygen is the only outcome above the 99.8% control limits.ConclusionsHierarchical model-based risk-adjusted estimates of morbidity rates plotted on funnel plots provide a robust and straightforward visual graphical tool for presenting variations in outcome performance to detect aberrations in healthcare delivery and guide timely intervention. We propose using hierarchical model-based risk adjustment and funnel plots in real or near real-time to detect aberrations and start timely intervention.
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Oyeyemi, Abisoye S., Hilda Chinwe Afakwu, Esievaodje Akpofure, and Luke Evans Izibekien. "Neonatal tetanus surveillance in Bayelsa state of Nigeria: a five-year review." Online Journal of Public Health Informatics 11, no. 1 (May 30, 2019). http://dx.doi.org/10.5210/ojphi.v11i1.9882.
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ObjectiveTo assess the performance of neonatal tetanus surveillance in Bayelsa state of Nigeria.IntroductionNeonatal tetanus (NT) though a preventable disease, remains a disturbing cause of neonatal morbidity and mortality particularly in low income countries where maternal and child care are substandard and antitetanus immunization coverage is still poor. The disease, which is mostly fatal, is particularly common in hard to reach and rural areas where deliveries take place at home or with untrained attendants without adequate sterile procedures and in unclean environment. Since eliminating NT became a global target, significant reductions in NT deaths have been reported. The most recent estimates by WHO (2015) put death of newborns due to NT at 34,019, a 96% reduction from the situation in the late 1980s.All countries are committed to “elimination” of maternal and neonatal tetanus (MNT), i.e., a reduction of NT incidence to below one case per 1000 live births per year in every district. A strong neonatal tetanus surveillance (NTS) is however required to achieve this. As of March 2018, only 14 countries were yet to eliminate MNT and this includes Nigeria.The different types of NTS recommended are conducted to varying degrees of efficiency and effectiveness in Nigeria under the major surveillance strategy – the Integrated Disease Surveillance and Response (IDSR). These include routine monthly surveillance, zero reporting, active surveillance and retrospective record review.Nigeria comprises six geopolitical zones, 36 states and a Federal Capital territory (FCT), and is made up of 774 Local Government areas (LGA) (districts) – an LGA being the lowest administrative level. This study was conducted in Bayelsa state – one of the six states in the south zone. It is made up of eight LGAs, more than half of which are riverine and consists of many hard-to-reach communities, where formal functional health facilities are few and far between. Health workers are in short supply and funding of health care delivery is poor in the state.MethodsThis was a retrospective review of all confirmed cases of neonatal tetanus that were managed at the two tertiary hospitals in the state - Niger Delta University Teaching Hospital Okolobiri (NDUTH), and Federal Medical Centre Yenagoa (FMC) - between January 2009 and December 2013. These were the only two public facilities that had the capacity to manage NT cases in the state. Relevant data including sociodemographics, pregnancy and birth history of patients, cord care and tetanus toxoid immunization of mothers were abstracted from the case files. The cases were traced to the office of the State Epidemiologist, where all cases were expected to be documented and investigated in line with the existing neonatal tetanus surveillance. Ethical approval was obtained from the Research and Ethics Committee of NDUTH for the research and permission was given to access case files.ResultsA total of 48 cases were managed in both facilities (36/75.0% in NDUTH and 12/25.0% in FMC) in the period under review but only 13 cases (27.1%) were reported to the office of the State Epidemiologist. Figure 1 shows the number of cases per year of review. The cases were resident in seven out of the eight LGAs. The mean age of cases was 8.98 (SD = 5.14) days and 29 (60.4%) were male while 19 (39.6%) were female. Available evidence showed that only 2.1% of the cases were protected at birth (mothers had TT2+); 91.7% of mothers did not have antenatal care and all the mothers were delivered by traditional birth attendants; 70.8% had their umbilical cord cut with new (?sterile) blade; and 43.8% had their cord treated with methylated spirit, others were treated with just water or some herbal preparation. Educational attainment of mothers of cases was primary (54.2%) and secondary (45.8%).ConclusionsThere were gaps in Neonatal Tetanus Surveillance in Bayelsa State as only 27.1% of cases were captured at the state level. Many mothers and their newborns were still not protected against tetanus, and delivery and cord care were done in unhygienic conditions. There is an urgent need to strengthen NT surveillance, improve vaccination against tetanus, and encourage skilled birth attendance in the state.References1. WHO. Immunization, Vaccines and Biologicals: Tetanus. http://www.who.int/immunization/diseases/tetanus/en/. Accessed on 23 Jul 20182. WHO. Immunization, Vaccines and Biologicals: Maternal and Neonatal Tetanus Elimination (MNTE): The initiative and challenges.http://www.who.int/immunization/diseases/MNTE_initiative/en/ Accessed on 23 Jul 2018.3. WHO. WHO-recommended standards for surveillance of selected vaccine-preventable disease. WHO. 20034. Bayelsa State Ministry of Health. Health facilities and their distribution across the Local Government Areas of Bayelsa State. 2010.