Journal articles on the topic 'Managed mental health care Australia'
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1
Keleher, Helen, and Virginia Hagger. "Health Literacy in Primary Health Care." Australian Journal of Primary Health 13, no. 2 (2007): 24. http://dx.doi.org/10.1071/py07020.
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Health literacy is fundamental if people are to successfully manage their own health. This requires a range of skills and knowledge about health and health care, including finding, understanding, interpreting and communicating health information, seeking of appropriate care and making critical health decisions. A primary health system that is appropriate and universally accessible requires an active agenda based on research of approaches to address low health literacy, while health care providers should be alert to the widespread problems of health literacy which span all age levels. This article reviews the progress made in Australia on health literacy in primary health care since health literacy was included in Australia's health goals and targets in the mid-1990s. A database search of published literature was conducted to identify existing examples of health literacy programs in Australia. Considerable work has been done on mental health literacy, and research into chronic disease self-management with CALD communities, which includes health literacy, is under way. However, the lack of breadth in research has led to a knowledge base that is patchy. The few Australian studies located on health literacy research together with the data about general literacy in Australia suggests the need for much more work to be done to increase our knowledge base about health literacy, in order to develop appropriate resources and tools to manage low health literacy in primary health settings.
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Dwyer, Judith, and Sandra G. Leggat. "Mental health care: commitment to action?" Australian Health Review 30, no. 2 (2006): 133. http://dx.doi.org/10.1071/ah060133.
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THE COUNCIL OF AUSTRALIAN GOVERNMENTS (the peak intergovernmental forum in Australia, comprising the Prime Minister, State Premiers, Territory Chief Ministers and the President of the Australian Local Government Association) focused on mental health care at its meeting in February. They agreed that more money is needed, and asked their public servants to prepare an action plan urgently.1 The action plan is expected to contain a stronger focus on mental health promotion and early intervention, and perhaps a more flexible approach to the housing and care needs of people who can?t ?manage on their own?. A stronger role for the non-government sector is anticipated, as well as increased access to psychologists and other health professionals in primary care, and efforts to improve access for people with mental illness to employment, community activities, rehabilitation and respite care.
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Rosenberg, Sebastian, and Carol Harvey. "Mental Health in Australia and the Challenge of Community Mental Health Reform." Consortium Psychiatricum 2, no. 1 (March 20, 2021): 40–46. http://dx.doi.org/10.17816/cp44.
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Australia was one of the first countries to develop and implement a national mental health plan, 30 years ago. This national approach belied the countrys federal structure, in which the federal government takes responsibility for primary care while state and territory governments manage acute and hospital mental health care. This arrangement has led to significant variations across jurisdictions. It has also left secondary care, often provided in the community, outside of this governance arrangement. This article explores this dilemma and its implications for community mental health, and suggests key steps towards more effective reform of this vital element of mental health care.
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Morris, Philip. "Managed Care—A Personal View." Australasian Psychiatry 5, no. 3 (June 1997): 127–28. http://dx.doi.org/10.3109/10398569709082110.
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In the last few months our College has begun a serious debate about funding methods for psychiatric services. One of the funding models being considered is that of ‘managed care’. I practised in the United States from 1987 to late 1992 at a time when US style managed care reached its apogee as a form of financing for medical care, including psychiatric services. With this experience I am in a position to make some observations about the nature of managed care and the likely implications if it is introduced into Australian psychiatric practice.
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Banfield, Michelle A., Karen L. Gardner, Laurann E. Yen, Ian S. McRae, James A. Gillespie, and Robert W. Wells. "Coordination of care in Australian mental health policy." Australian Health Review 36, no. 2 (2012): 153. http://dx.doi.org/10.1071/ah11049.
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Objective. To review Australian mental health initiatives involving coordination of care. Methods. Commonwealth government websites were systematically searched for mental health policy documents. Database searches were also conducted using the terms ‘coordination’ or ‘integration’ and ‘mental health’ or ‘mental illness’ and ‘Australia’. We assessed the extent to which informational, relational and management continuity have been addressed in three example programs. Results. The lack of definition of coordination at the policy level reduces opportunities for developing actionable and measurable programs. Of the 51 mental health initiatives identified, the three examples studied all demonstrated some use of the dimensions of continuity to facilitate coordination. However, problems with funding, implementation, evaluation and competing agendas between key stakeholders were barriers to improving coordination. Conclusions. Coordination is possible and can improve both relationships between providers and care provided. However, clear leadership, governance and funding structures are needed to manage the challenges encountered, and evaluation using appropriate outcome measures, structured to assess the elements of continuity, is necessary to detect improvements in coordination. What is known about the topic? The issues of integration of services and coordination of care have been a part of the National Mental Health Strategy documents for almost 20 years, but reports and evaluations continually note a lack of solid progress on these reforms. What does this paper add? This paper examines how the key elements of continuity that underpin coordination have been addressed in three examples of Australian mental health initiatives aimed at improving integration and coordination. What are the implications for practitioners? Coordination of care for mental health is possible and can improve both relationships between providers and care provided, but attention should be paid to the role of informational, relationship and management continuity in program design and implementation.
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Birch, Rachael C., Kitty-Rose Foley, Allan Pollack, Helena Britt, Nicholas Lennox, and Julian N. Trollor. "Problems managed and medications prescribed during encounters with people with autism spectrum disorder in Australian general practice." Autism 22, no. 8 (September 15, 2017): 995–1004. http://dx.doi.org/10.1177/1362361317714588.
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Autism spectrum disorder is associated with high rates of co-occurring health conditions. While elevated prescription rates of psychotropic medications have been reported in the United Kingdom and the United States, there is a paucity of research investigating clinical and prescribing practices in Australia. This study describes the problems managed and medications prescribed by general practitioners in Australia during encounters where an autism spectrum disorder was recorded. Information was collected from 2000 to 2014 as part of the Bettering the Evaluation and Care of Health programme. Encounters where patients were aged less than 25 years and autism spectrum disorder was recorded as one of the reasons for encounter and/or problems managed ( n = 579) were compared to all other Bettering the Evaluation and Care of Health programme encounters with patients aged less than 25 years ( n = 281,473). At ‘autism spectrum disorder’ encounters, there was a significantly higher management rate of psychological problems, and significantly lower management rates of skin, respiratory and general/unspecified problems, than at ‘non-autism spectrum disorder’ encounters. The rate of psychological medication prescription was significantly higher at ‘autism spectrum disorder’ encounters than at ‘non-autism spectrum disorder’ encounters. The most common medications prescribed at ‘autism spectrum disorder’ encounters were antipsychotics and antidepressants. Primary healthcare providers need adequate support and training to identify and manage physical and mental health concerns among individuals with autism spectrum disorder.
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Anderson, Josephine, Kathleen O'Moore, Mariam Faraj, and Judith Proudfoot. "Stepped care mental health service in Australian primary care: codesign and feasibility study." Australian Health Review 44, no. 6 (2020): 873. http://dx.doi.org/10.1071/ah19078.
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Objective In 2015, the Australian Government introduced several mental health reforms, including the requirement that Primary Health Networks (PHNs) provide stepped care services for Australians with mental health needs such as anxiety and depression. This paper reports on the development and feasibility study of StepCare, an online stepped mental healthcare service in general practice that screens patients, provides immediate feedback to patients and general practitioners (GPs), transmits stepped treatment recommendations to GPs and monitors patients’ progress, including notification of deterioration. Methods The present codesign and feasibility study in one PHN examined: (1) the acceptability and feasibility of StepCare to GPs, practice staff and patients; (2) the impact of StepCare on clinical practice; and (3) the barriers to and facilitators of implementation. Results Thirty-two GPs, 22 practice staff and 418 patients participated in the study. Overall, patients, practice staff and GPs found StepCare acceptable and feasible, commending its privacy, the mental health screening, monitoring and feedback. They also made suggestions for service improvements. GPs reported that StepCare helped with their identification and management of patients with common mental health issues. Conclusions Preliminary data suggest that StepCare may be acceptable and feasible in Australian general practice, helping GPs identify and manage common mental health problems in their patients. The study provides implications for policy and practice, and points the way to future translational research into stepped mental health care. What is known about the topic? Depression and anxiety are common illnesses in primary care and GPs are ideally placed to implement stepped care approaches enabling early detection and accessible, effective care. What does this paper add? Developed in and for general practice, StepCare is the first fully integrated stepped approach to primary mental health care in Australia. As a first step in a translational research program evaluating the effectiveness of StepCare, this paper reports data regarding the feasibility and acceptability of the service. What are the implications for practitioners? Integrated into the workflow of general practice, StepCare is an online service that helps GPs detect new cases of depression and anxiety, provide evidence-based stepped care treatments and monitor patients’ progress.
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Clinton-McHarg, Tara, Lauren Gibson, Kate Bartlem, Sonya Murray, Jade Ryall, Mark Orr, Janet Ford, and Jenny Bowman. "Barriers to the Provision of Preventive Care to People Living with Mental Health Conditions: Self-Report by Staff Working in an Australian Community Managed Organisation." International Journal of Environmental Research and Public Health 19, no. 8 (April 7, 2022): 4458. http://dx.doi.org/10.3390/ijerph19084458.
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People living with mental health conditions experience a reduced life expectancy largely due to a higher prevalence of chronic diseases. Addressing health risk behaviours, including tobacco smoking, inadequate nutrition, harmful alcohol consumption, and physical inactivity (SNAP), through the provision of preventive care, is recommended to reduce this burden. Community Managed Organisations (CMOs) may play an important role in providing preventive care to consumers with mental health conditions, however, few studies have examined preventive care provision in CMO settings; and no studies have comprehensively assessed barriers to the provision of this care using a tool such as the Theoretical Domains Framework (TDF). To fill this research gap, we conducted an online survey among staff (N = 190) from one CMO in Australia to (1) identify barriers to preventive care provision (ask, advise, assist, connect) to address SNAP behaviours among consumers; and (2) explore associations between barriers and preventive care provision. Results demonstrate that while staff reported knowing how to provide preventive care and believed it would positively impact consumers; barriers including confidence in providing this care and consumer uptake of referrals, were identified. Further research among multiple CMOs is needed to identify care provision and associated barriers in the sector more widely.
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Mihalopoulos, Cathrine, Mary Lou Chatterton, Lidia Engel, Long Khanh-Dao Le, and Yong Yi Lee. "Whither economic evaluation in the case of COVID-19: What can the field of mental health economics contribute within the Australian context?" Australian & New Zealand Journal of Psychiatry 54, no. 12 (October 2, 2020): 1157–61. http://dx.doi.org/10.1177/0004867420963724.
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COVID-19 has resulted in broad impacts on the economy and aspects of daily life including our collective mental health and well-being. The Australian health care system already faces limitations in its ability to treat people with mental health diagnoses. Australia has responded to the COVID-19 outbreak by, among other initiatives, providing reimbursement for telehealth services. However, it is unclear if these measures will be enough to manage the psychological distress, depression, anxiety and post-traumatic distress shown to accompany infectious disease outbreaks and economic shocks. Decision making has focused on the physical health ramifications of COVID-19, the avoidance of over-burdening the health care system and saving lives. We propose an alternative framework for decision making that combines life years saved with impacts on quality of life. A framework that simultaneously includes mental health and broader economic impacts into a single decision-making process would facilitate transparent and accountable decision making that can improve the overall welfare of Australian society as we continue to address the considerable challenges that the COVID-19 pandemic is creating.
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Hazell, Philip, Titia Sprague, and Joanne Sharpe. "Psychiatric hospital treatment of children and adolescents in New South Wales, Australia: 12-year trends." BJPsych Open 2, no. 1 (January 2016): 1–5. http://dx.doi.org/10.1192/bjpo.bp.115.000794.
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BackgroundIt is preferable that children and adolescents requiring in-patient care for mental health problems are managed in age-appropriate facilities. To achieve this, nine specialist Child and Adolescent Mental Health Services (CAMHS) in-patient units have been commissioned in New South Wales (NSW) since 2002.AimsTo examine trends in child and adolescent in-patient admissions since the opening of these CAMHS units.MethodAnalysis of separation data for under 18-year-olds to CAMHS, adult mental health and paediatric units for the period 2002 to 2013 in NSW, comparing districts with and without specialist CAMHS units.ResultsSeparations from CAMHS, adult and paediatric units rose with time, but there was no interaction between time and health district type (with/without CAMHS unit). Five of eight health districts experienced increased separations of under 18-year-olds from adult units in the year of opening a CAMHS unit. Separations from related paediatric units increased in three of seven health districts.ConclusionsOpening CAMHS units may be followed by a temporary increase in separations of young people from adult units, but it does not influence the flow of patients to non-CAMHS facilities in the longer term.
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Sved Williams, Anne, and Jill Poulton. "Supporting Mental Health in the Community: New Systems for General Practice." Australian Journal of Primary Health 12, no. 2 (2006): 105. http://dx.doi.org/10.1071/py06029.
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General practitioners (GPs) manage nearly one-third of Australians seeking help for mental health problems, and frequently express their need for consultant psychiatric support in this work. The introduction of new Medical Benefits Schedule Item Numbers 291 and 293 to provide "one-off" psychiatric assessments on referral from GPs offered the potential for providing this support, and a single point-of-entry scheme was organised to provide ease of access to appointments. The aims were to establish a single point of entry for psychiatrist assessment using Item 291, to evaluate the take-up rates of Item 291 in South Australia (SA) through this service and to evaluate the acceptability to GPs and psychiatrists of a psychiatric primary care consultation-liaison (c-l) model. Results were: 26 psychiatrists joined the project; 64 GPs referred 78 patients for assessment, providing 24% of the Australian take-up rate for Item 291, for 8% of the population; evaluation showed high approval ratings from GPs who particularly appreciated the single contact point; and positive evaluation by psychiatrists of the primary care c-l model. The conclusions were that a single contact point provided ease of access to psychiatrists for GPs; GP and psychiatrist groups evaluated Item 291 very positively; and consumer and carer evaluation are essential for further primary care c-l development.
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O'Dea, Bridianne, Catherine King, Mirjana Subotic-Kerry, Kathleen O'Moore, and Helen Christensen. "School Counselors’ Perspectives of a Web-Based Stepped Care Mental Health Service for Schools: Cross-Sectional Online Survey." JMIR Mental Health 4, no. 4 (November 20, 2017): e55. http://dx.doi.org/10.2196/mental.8369.
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Background Mental health problems are common among youth in high school, and school counselors play a key role in the provision of school-based mental health care. However, school counselors occupy a multispecialist position that makes it difficult for them to provide care to all of those who are in need in a timely manner. A Web-based mental health service that offers screening, psychological therapy, and monitoring may help counselors manage time and provide additional oversight to students. However, for such a model to be implemented successfully, school counselors’ attitudes toward Web-based resources and services need to be measured. Objective This study aimed to examine the acceptability of a proposed Web-based mental health service, the feasibility of providing this type of service in the school context, and the barriers and facilitators to implementation as perceived by school counselors in New South Wales (NSW), Australia. Methods This study utilized an online cross-sectional survey to measure school counselors’ perspectives. Results A total of 145 school counselors completed the survey. Overall, 82.1% (119/145) thought that the proposed service would be helpful to students. One-third reported that they would recommend the proposed model, with the remaining reporting potential concerns. Years of experience was the only background factor associated with a higher level of comfort with the proposed service (P=.048). Personal beliefs, knowledge and awareness, Internet accessibility, privacy, and confidentiality were found to influence, both positively and negatively, the likelihood of school counselors implementing a Web-based school mental health service. Conclusions The findings of this study confirmed that greater support and resources are needed to facilitate what is already a challenging and emotionally demanding role for school counselors. Although the school counselors in this study were open to the proposed service model, successful implementation will require that the issues outlined are carefully addressed.
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Podubinski, Tegan, Louise Townsin, Sandra C. Thompson, Anna Tynan, and Geoff Argus. "Experience of Healthcare Access in Australia during the First Year of the COVID-19 Pandemic." International Journal of Environmental Research and Public Health 18, no. 20 (October 12, 2021): 10687. http://dx.doi.org/10.3390/ijerph182010687.
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Changes in health-seeking behaviours and challenges in accessing care have been reported during the COVID-19 pandemic. This qualitative study examines Australian experiences related to healthcare access during the early months of the pandemic. The study aimed to identify key areas of concern as well as opportunities for services to prevent, manage and treat health concerns when normal access was disrupted. Fifty-nine semi-structured interviews were analysed. Participants were interviewed between August and December in 2020 over telephone or Zoom and were located across Australia. Rapid identification of themes with an audio recordings technique was used to generate themes from the data. Participants described a variety of influences on their health-seeking behaviours, resulting in decisions to delay care or being unable to reach care. Many individuals accessed health services via telehealth and offered a range of perceptions and views on its effectiveness and appropriateness. The findings illustrate that maintenance of health and access to healthcare and psychosocial support were compromised for some individuals, leading to negative impacts on both mental and physical health. This highlights the need to provide mechanisms to facilitate a person’s ability to access care in a timely manner during a pandemic.
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Fehily, Caitlin, Emma McKeon, Tegan Stettaford, Elizabeth Campbell, Simone Lodge, Julia Dray, Kate Bartlem, et al. "The Effectiveness and Cost of an Intervention to Increase the Provision of Preventive Care in Community Mental Health Services: Protocol for a Cluster-Randomized Controlled Trial." International Journal of Environmental Research and Public Health 19, no. 5 (March 7, 2022): 3119. http://dx.doi.org/10.3390/ijerph19053119.
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Preventive care to address chronic disease risk behaviours is infrequently provided by community mental health services. In this cluster-randomised controlled trial, 12 community mental health services in 3 Local Health Districts in New South Wales, Australia, will be randomised to either an intervention group (implementing a new model of providing preventive care) or a control group (usual care). The model of care comprises three components: (1) a dedicated ‘healthy choices’ consultation offered by a ‘healthy choices’ clinician; (2) embedding information regarding risk factors into clients’ care plans; and (3) the continuation of preventive care by mental health clinicians in ongoing consultations. Evidence-based implementation strategies will support the model implementation, which will be tailored by being co-developed with service managers and clinicians. The primary outcomes are client-reported receipt of: (1) an assessment of chronic disease risks (tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol use and physical inactivity); (2) brief advice regarding relevant risk behaviours; and (3) referral to at least one behaviour change support. Resources to develop and implement the intervention will be captured to enable an assessment of cost effectiveness and affordability. The findings will inform the development of future service delivery initiatives to achieve guideline- and policy-concordant preventive care delivery.
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Sutton, Keith, Anton N. Isaacs, Kim Dalziel, and Darryl Maybery. "Roles and competencies of the Support Facilitator in Australia’s recovery-oriented mental health initiative: a qualitative study from Gippsland, Victoria." Australian Health Review 41, no. 1 (2017): 91. http://dx.doi.org/10.1071/ah15183.
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Objective This study explored the roles and competencies of Support Facilitators (SFs) engaged in the implementation of the Partners in Recovery initiative in a rural region of Victoria. Methods Semi-structured interviews were conducted with 32 stakeholders involved in the initiative, of which 15 were SFs. Results Two main themes and 10 subthemes emerged from the data: (1) SF competencies (which included an understanding of local services as well as administrative and social skills); and (2) the SF role (which included them being a single point of contact, providing care coordination, assisting the client to become self-reliant, achieving good outcomes for clients with confronting behaviours, judiciously using flexible funding, clearly outlining their role with clients and maintaining boundaries and performing a different role from that of the mental health case manager). Conclusions The roles and competencies of the SF in the Partners in Recovery initiative in Gippsland were congruent with the defined characteristics of a care coordination approach. The results highlight how the SF role differs from that of traditional clinical case managers. These findings are important for future mental health service policy development, education and training of mental health practitioners and recruitment of personnel to care coordination roles. What is known about the topic? There is a growing body of literature highlighting the importance of care coordination in delivery of positive outcomes for people with chronic and complex health problems. However, little is documented about the care coordination role of SFs as part of the Partners in Recovery initiative in Australia. What does this paper add? This paper identifies the roles and competencies of SFs in the Partners in Recovery initiative in a rural region of Victoria. The paper highlights that the emergent competencies and role functions are congruent with the defined characteristics of a care coordination approach but differ from that of mental health case managers. What are the implications for practitioners? These findings are important for future mental health service policy development, education and training of mental health practitioners and recruitment of personnel to care coordination roles.
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Pavuluri, Mani. "American and Australasian Systems in Psychiatry: Crossing the Bridge." Australasian Psychiatry 10, no. 2 (June 2002): 163–65. http://dx.doi.org/10.1046/j.1440-1665.2002.00425.x.
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Objective: To familiarize Australasian psychiatrists about differences in the psychiatric systems of the United States and Australasia. A secondary objective is to contribute towards a multi-leveled collaboration between the Australian and New Zealand College of Psychiatrists and the American College of Psychiatry and Neurology. Conclusions: There appear to be multiple differences, including in aspects of training, acquiring credentials, cross accreditation, the effect of managed care on clinical practice, volume of research, and interpersonal relations. Despite differences in the systems, it seems critical to anchor oneself to the bio-psycho-social model in order to maintain the integrity of psychiatric practice.
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Rose, Grenville, Elena Cama, Loren Brener, and Carla Treloar. "Knowledge and attitudes towards hepatitis C and injecting drug use among mental-health support workers of a community managed organisation." Australian Health Review 37, no. 5 (2013): 654. http://dx.doi.org/10.1071/ah13134.
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Objectives People with mental illness are at significantly higher risk of acquiring hepatitis C virus (HCV) compared with the general population. This study assessed knowledge of and attitudes towards people with HCV and people who inject drugs (PWID) among support workers of clients with mental illness. Methods Support workers from a community managed organisation (CMO) in Australia were recruited to complete an online cross-sectional survey. The survey collected data about their knowledge of HCV and attitudes towards PWID and people with HCV. Results Valid responses were received from 117 support workers. Although HCV knowledge was moderate, there were significant knowledge gaps around transmission and treatment of HCV. Higher HCV knowledge was significantly associated with more positive attitudes towards PWID, but not with attitudes towards people with HCV. Participants had more positive attitudes towards people with HCV than towards PWID. Additionally, those with more positive attitudes towards HCV tended to also have more positive attitudes towards PWID. Conclusions Given that people with mental illness are at higher risk of acquiring HCV, these results point to the need for education targeted at support workers of clients with mental illness to increase HCV knowledge and promote positive attitudes towards PWID and people with HCV. What is known about this topic? The limited research available suggests that there are gaps in HCV knowledge among mental-health-service providers, although such research has generally targeted physicians. What does this paper add? This paper is the first to assess HCV knowledge, attitudes towards PWID and HCV among mental-health support workers. The findings suggest that although HCV knowledge is moderate, significant gaps exist, which are related to negative attitudes towards PWID. What are the implications for practitioners? Supportive and non-judgemental care is essential for people with mental illness and HCV, due to the potential for a double stigma arising from negative attitudes towards both mental illness and injecting drug use. This paper highlights the importance of targeted education for workers in the mental-health sector, to increase HCV knowledge and promote positive attitudes towards people with co-occurring mental-health, substance use problems and HCV.
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Procter, Nicholas G. "Mental Health Workforce Collaboration and Partnership: Towards a response to World Health Assembly Resolution WHA 57.19." MIGRATION LETTERS 3, no. 1 (April 16, 2006): 43–52. http://dx.doi.org/10.33182/ml.v3i1.30.
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Using Australia as the main example, the aim of this paper is to consider selective aspects of the forthcoming World Health Report 2006 as it sets an agenda to create a responsive and dynamic health workforce. At the core of a culturally competent mental health workforce will be clinicians prepared to question and respond to particular health experiences and what they, managers and policy makers of all persuasions see as different perceived causes of concern, optimal care and culturally appropriate support and treatment. The enlargement of focus contained in this paper is intended to stimulate more informed and compassionate awareness and respect for alternative points of view held between health and human service workers and communities from culturally and linguistically diverse backgrounds.
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Emond, Kate, Melanie Bish, Michael Savic, Dan I. Lubman, Terence McCann, Karen Smith, and George Mnatzaganian. "Characteristics of Confidence and Preparedness in Paramedics in Metropolitan, Regional, and Rural Australia to Manage Mental-Health-Related Presentations: A Cross-Sectional Study." International Journal of Environmental Research and Public Health 18, no. 4 (February 15, 2021): 1882. http://dx.doi.org/10.3390/ijerph18041882.
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Mental-health-related presentations account for a considerable proportion of the paramedic’s workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann–Whitney and Kruskal–Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations (p = 0.001). Compared to male paramedics, females were less confident (p = 0.003), although equally prepared (p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations.
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LaMonica, Haley M., Tracey A. Davenport, Jane Burns, Shane Cross, Stephanie Hodson, Jennifer Veitch, and Ian B. Hickie. "Technology-Enabled Mental Health Service Reform for Open Arms – Veterans and Families Counselling: Participatory Design Study." JMIR Formative Research 3, no. 3 (September 19, 2019): e13662. http://dx.doi.org/10.2196/13662.
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Background The impact of mental ill-health on every aspect of the lives of a large number of Australian Defence Force (ADF) personnel, their partners, and their families is widely recognized. Recent Senate inquiries have highlighted gaps in service delivery as well as the need for service reform to ensure appropriate care options for individuals who are currently engaged with mental health and support services as well as for those who, for a variety of reasons, have not sought help. To that end, successive Australian governments generally and the Department of Veterans’ Affairs specifically have prioritized veteran-centric reform. Open Arms is an Australia-wide service that provides counseling and support to current and former ADF personnel, and their family members, for mental health conditions. Objective The aim of this study was to develop and configure a prototypic Web-based platform for Open Arms – Veterans & Families Counselling (formerly Veterans and Veterans Families Counselling Service) with the Open Arms community to enhance the quality of mental health services provided by Open Arms. Methods The study aimed to recruit up to 100 people from the Open Arms community (current and former ADF personnel and their families, health professionals, service managers, and administrators) in regions of New South Wales, including Sydney, Canberra, Maitland, Singleton, and Port Stephens. Participants were invited to participate in 4-hour participatory design workshops. A variety of methods were used within the workshops, including prompted discussion, review of working prototypes, creation of descriptive artifacts, and group-based development of user journeys. Results Seven participatory design workshops were held, including a total of 49 participants. Participants highlighted that the prototype has the potential to (1) provide the opportunity for greater and better-informed personal choice in relation to options for care based on the level of need and personal preferences; (2) ensure transparency in care by providing the individual with access to all of their personal health information; and (3) improve collaborative care and care continuity by allowing information to be shared securely with current and future providers. Conclusions Our findings highlight the value of actively engaging stakeholders in participatory design processes for the development and configuration of new technologies.
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Waterreus, Anna, and Vera A. Morgan. "Treating body, treating mind: The experiences of people with psychotic disorders and their general practitioners – Findings from the Australian National Survey of High Impact Psychosis." Australian & New Zealand Journal of Psychiatry 52, no. 6 (September 9, 2017): 561–72. http://dx.doi.org/10.1177/0004867417728806.
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Objectives: To describe from the perspective of people living with psychotic illness their use of general practitioner services over a 12-month period and the experiences, attitudes and challenges general practitioners face providing health care to this population. Methods: A two-phase design was used. Phase 1, screening for psychosis, occurred in public specialised mental health services and non-government organisations within seven catchment sites across Australia. In Phase 2, 1825 people who were screened positive for psychosis were randomly selected for interview which included questions about frequency and reason for general practitioner contact in the 12 months prior to interview. General practitioners (1473) of consenting participants were also surveyed. Results: Almost all (90.3%) survey participants had consulted a general practitioner in the 12-month period, on average 8.9 times, and 28.8% of attenders had consulted 12 times or more. The majority (83.5%) attended one general practitioner practice. Most (77.6%) general practitioners wanted to be involved in the mental health care of their patient. Although 69.1% said the management of their patient was not problematic for their practice, one in five general practitioners reported issues related to patient non-compliance with treatment and non-attendance at scheduled appointments; time constraints; and lack of feedback from treating mental health services. Conclusion: People with psychotic disorders consult general practitioners, some very frequently. Most Australian general practitioners believe they have a responsibility to review the physical and mental health of their patients. Improved communication between general practitioners and mental health services, and easier access to mental health support, may help general practitioners manage the complex mental, physical and social problems of their patients.
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Chambers, Megan F., Alison M. Saunders, Brendan D. New, Catherine L. Williams, and Anna Stachurska. "Assessment of children coming into care: Processes, pitfalls and partnerships." Clinical Child Psychology and Psychiatry 15, no. 4 (October 2010): 511–27. http://dx.doi.org/10.1177/1359104510375932.
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Children in out-of-home care (OOHC) present with high levels of physical, developmental and emotional and behavioural difficulties, yet often fail to receive appropriate services. This article describes a joint health and welfare service specifically developed to provide comprehensive physical, developmental and mental health assessments to a cohort of children entering long-term care in one region of Sydney, New South Wales (NSW), Australia. Paediatric, allied health, dental and psychosocial assessments were co-ordinated from a single referral from the child’s welfare case manager. Follow-up appointments were held 6—12 months later to assess the outcomes of recommendations. Physical, mental health and developmental difficulties in the children are reported, the implications for service requirements are presented and process blocks described. There is a need for a specific co-ordinating service to overcome the inherent fragmentation of this group (related both to transience and change in the welfare sector, and levels of comorbidity and chronicity in health presentations). Health and Welfare services must operate together, with an awareness of the processes and resource constraints in each sector, if they are to deliver sustainable and reliable health care to this vulnerable group.
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Miller, Elizabeth M., Joanne E. Porter, and Rebecca Peel. "Palliative and End-of-Life Care in the Home in Regional/Rural Victoria, Australia: The Role and Lived Experience of Primary Carers." SAGE Open Nursing 7 (January 2021): 237796082110362. http://dx.doi.org/10.1177/23779608211036284.
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Introduction Palliative support services (generalist or specialist) can provide much-needed assistance to carers who are providing palliative and end-of-life care in their homes, but access to such services in regional and rural areas of Australia is poorly understood. Objectives This study aimed to explore the role and lived experience of primary carers who are providing palliative and end-of-life care in the home in regional/rural Victoria, Australia. Methods Nine female participants, of whom six were bereaved between 7 and 20 months were interviewed using a semistructured interview technique. Each interview was audio-recorded, transcribed verbatim, and analyzed thematically. Results Two themes emerged: “ Negotiating healthcare systems” which described the needs for multidisciplinary supports and “ The caring experience” which discussed daily tasks, relationships, mental and physical exhaustion, respite, isolation, medication management, and grief and loss. Findings show that regional/rural carers have an added burden of travel stress as well as feeling overwhelmed, isolated, and physically and emotionally exhausted. Carers would benefit from greater flexibility for short-term respite care. The engagement of specialist palliative care services assisted the participants to navigate the health care system. Some participants did not understand the value of palliative care, highlighting the need for general practitioners to conduct early conversations about this with their patients. Education is needed to build capacity within the primary palliative care workforce, confirming the importance of timely referrals to a specialist palliative care practitioner if pain or symptom control is not effectively managed. Conclusion Providing palliative and end-of-life care in the home is an exhausting and emotionally draining role for unpaid, primary carers. Multiple supports are needed to sustain primary carers, as they play an essential role in the primary health care system.
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Shah, Karan K., Fliss E. M. Murtagh, Kevin McGeechan, Su Crail, Aine Burns, Anh D. Tran, and Rachael L. Morton. "Health-related quality of life and well-being in people over 75 years of age with end-stage kidney disease managed with dialysis or comprehensive conservative care: a cross-sectional study in the UK and Australia." BMJ Open 9, no. 5 (May 17, 2019): e027776. http://dx.doi.org/10.1136/bmjopen-2018-027776.
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ObjectiveTo measure health-related quality of life (HRQoL) and well-being in older people with end-stage kidney disease (ESKD) and to determine the association between treatment type and sociodemographic characteristics on these outcome measures. In addition, to assess the convergent validity between the HRQoL and well-being measure and their feasibility and acceptability in this population.DesignProspective cross-sectional study.SettingThree renal units in the UK and Australia.Participants129 patients with ESKD managed with dialysis or with an estimated glomerular filtration ≤10 mL/min/1.73 m2and managed with comprehensive conservative, non-dialytic care.Outcome measuresHRQoL and well-being were assessed using Short-Form six dimensions (SF-6D, 0–1 scale); Kidney Disease Quality of Life (KDQOL-36) (0–100 scale) and Investigating Choice Experiments Capability Measure-Older people (ICECAP-O, 0–1 scale). Linear regression assessed associations between treatment, HRQoL and well-being. Pearson’s correlation coefficient assessed convergent validity between instruments.ResultsMedian age of 81 years (IQR 78–85), 65% males; 83 (64%) were managed with dialysis and 46 (36%) with conservative care. When adjusted for treatment type and sociodemographic variables, those managed on dialysis reported lower mean SF-6D utility (−0.05, 95% CI −0.12 to 0.01); lower KDQOL Physical Component Summary score (−3.17, 95% CI −7.61 to 1.27); lower Mental Component Summary score (−2.41, 95% CI −7.66 to 2.84); lower quality of life due to burden (−28.59, 95% CI −41.77 to −15.42); symptoms (−5.93, 95% CI −14.61 to 2.73) and effects of kidney disease (−16.49, 95% CI −25.98 to −6.99) and lower overall ICECAP-O well-being (−0.07, 95% CI −0.16 to 0.02) than those managed conservatively. Correlation between ICECAP-O well-being and SF-6D utility scores was strong overall, 0.65 (p<0.001), but weak to moderate at domain level.ConclusionsOlder people on dialysis report significantly higher burden and effects of kidney disease than those on conservative care. Lower HRQoL and well-being may be associated with dialysis treatment and should inform shared decision-making about treatment options.Trial registration numberUK (IRAS project ID: 134360andREC reference 14/LO/0291) and Australia (R20140203 HREC/14/RAH/36).
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McCauley-Elsom, Kay, and Jayashri Kulkarni. "Managing Psychosis in Pregnancy." Australian & New Zealand Journal of Psychiatry 41, no. 3 (March 2007): 289–92. http://dx.doi.org/10.1080/00048670601172798.
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Objective: This article provides an introduction to the complex issues surrounding the management of women who have a history of psychosis and who become pregnant. Balancing the mental wellbeing of the woman and the safety and wellbeing of the baby is a complex task for both the expectant mother and the health professionals involved in her care. Clinical picture: Within this article the complexity of the issues will be outlined as a case report of a woman with a history of psychotic related disorders, who was also pregnant. Treatment: The woman was being case managed by a Mental Health Service in Victoria, Australia, and was included on the National Register of Antipsychotic Medications in Pregnancy Register (NRAMP) recently established at the Alfred Psychiatry Research Centre (APRC). Outcome: The profile of women with a history of previous mental illness, and who are pregnant, often includes a poor psychosocial history and involvement with child protection agencies with regard to custody of the children. Well meant but poorly coordinated decisions by health professionals result in sub-optimal outcomes for both mother and infant. Conclusion: There is a need for the exploration of the management and experiences of women who have a history of psychosis and who are pregnant. This case example highlights the complexity of issues surrounding the management of this vulnerable group of women and their babies.
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Pham, Clarabelle, Tiffany K. Gill, Elizabeth Hoon, Muhammad Aziz Rahman, Deirdre Whitford, John Lynch, and Justin Beilby. "Profiling bone and joint problems and health service use in an Australian regional population: The Port Lincoln Health Study." Australian Health Review 37, no. 4 (2013): 504. http://dx.doi.org/10.1071/ah13064.
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Objectives To describe the burden of bone and joint problems (BJP) in a defined regional population, and to identify characteristics and service-usage patterns. Methods In 2010, a health census of adults aged ≥15 years was conducted in Port Lincoln, South Australia. A follow-up computer-assisted telephone interview provided more specific information about those with BJP. Results Overall, 3350 people (42%) reported current BJP. General practitioners (GP) were the most commonly used provider (85%). People with BJP were also 85% more likely to visit chiropractors, twice as likely to visit physiotherapists and 34% more likely to visit Accident and Emergency or GP out of hours (compared with the rest of the population). Among the phenotypes, those with BJP with co-morbidities were more likely to visit GP, had a significantly higher mean pain score and higher levels of depression or anxiety compared with those with BJP only. Those with BJP only were more likely to visit physiotherapists. Conclusions GP were significant providers for those with co-morbidities, the group who also reported higher levels of pain and mental distress. GP have a central role in effectively managing this phenotype within the BJP population including linking allied health professionals with general practice to manage BJP more efficiently. What is known about the topic? As a highly prevalent group of conditions that are likely to impact on health-related quality of life and are a common cause of severe long-term disability, musculoskeletal conditions place a significant burden on individuals and the health system. However, far less is known about access and usage of musculoskeletal-related health services and programs in Australia. What does this paper add? As a result of analysing the characteristics of the overall BJP population, as well as phenotypes within it, a greater understanding of patterns of health service interactions, care pathways and opportunities for targeted improvements in delivery of care may be identified. The results emphasise that participants with BJP utilised the services of a narrow range of providers, which may have workforce implications for these sectors. The funding models for physiotherapists and chiropractors in Australia involve a mix of private and fees for service, which limits access to those who have private health insurance or can pay directly for these services. What are the implications for practitioners? These analyses indicate the importance of linking allied health professionals with general practice to manage BJP more efficiently. Alternative and appropriate care pathways need to be more strongly developed and identified for effective management of these conditions rather than relying on a traditional range of practitioners. Alternatively, greater ease of access to allied health practitioners may enable more effective treatment and improved quality of life for those with BJP. There is an urgent need to develop an effective population-based model of integrated care for BJP within regional Australia.
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Scott, T. L., J. Liddle, N. A. Pachana, E. Beattie, and G. K. Mitchell. "Managing the transition to non-driving in patients with dementia in primary care settings: facilitators and barriers reported by primary care physicians." International Psychogeriatrics 32, no. 12 (February 20, 2019): 1419–28. http://dx.doi.org/10.1017/s1041610218002326.
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ABSTRACTObjectives:This research addresses dementia and driving cessation, a major life event for affected individuals, and an immense challenge in primary care. In Australia, as with many other countries, it is primarily general practitioners (GPs) who identify changes in cognitive functioning and monitor driving issues with their patients with dementia. Qualitative evidence from studies with family members and other health professionals shows it is a complicated area of practice. However we still know little from GPs about how they manage the challenges with their patients and the strategies that they use to facilitate driving cessation.Methods:Data were collected through five focus groups with 29 GPs at their primary care practices in metropolitan and regional Queensland, Australia. A semi-structured topic guide was used to direct questions addressing decision factors and management strategies. Discussions were audio recorded, transcribed verbatim and thematically analyzed.Results:Regarding the challenges of raising driving cessation, four key themes emerged. These included: (i) Considering the individual; (ii) GP-patient relationships may hinder or help; (iii) Resources to support raising driver retirement; and (iv) Ethical dilemmas and ethical considerations. The impact of discussing driving cessation on GPs is discussed.Conclusions:The findings of this study contribute to further understanding the experiences and needs of primary care physicians related to managing driving retirement with their patients with dementia. Results support a need for programs regarding identification and assessment of fitness to drive, to upskill health professionals and particularly GPs to manage the complex issues around dementia and driving cessation, and explore cost-effective and timely delivery of such support to patients.
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Haire, Bridget Gabrielle, Eloise Brook, Rohanna Stoddart, and Paul Simpson. "Trans and gender diverse people’s experiences of healthcare access in Australia: A qualitative study in people with complex needs." PLOS ONE 16, no. 1 (January 28, 2021): e0245889. http://dx.doi.org/10.1371/journal.pone.0245889.
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Introduction This study aimed to explore the experiences of healthcare access in a diverse sample of trans and gender diverse individuals with complex needs using qualitative methods. We recruited 12 individuals using trans community-based networks facilitated by the Gender Centre. Each individual participated in an in-depth, semi structured interview conducted by a peer interviewer. Interviews were analysed thematically. Findings Participants had a range of complex health needs to manage, including ongoing access to gender-affirming hormones, mental health care and sexual health care. Some also had chronic diseases. Accordingly, scheduling appointments and affording the co-payments required were major preoccupations. Most participants were not in full time work, and economic hardship proved to be a major compounding factor in issues of healthcare access, impacting on the choice of clinician or practice. Other barriers to accessing health included issues within health services, such as disrespectful attitudes, misgendering, ‘deadnaming’ (calling the person by their previous name), displaying an excessive interest is aspects of the participants’ life that were irrelevant to the consultation, and displaying ignorance of trans services such that the participants felt an obligation to educate them. In addition, participants noted how stereotyped ideas of trans people could result in inaccurate assumptions about their healthcare needs. Positive attributes of services were identified as respectful communication styles, clean, welcoming spaces, and signs that indicated professionalism, care and openness, such as relevant information pamphlets and visibility of LGBTIQ service orientation. Participants valued peer-based advice very highly, and some would act on and trust medical advice from peers above advice from medical professionals. Conclusion These findings demonstrate a need for comprehensive wrap-around service provision for trans people with complex needs which includes a substantial peer-based component, and addresses physical and mental health and social services conveniently and affordably.
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Moss, Alexandra, Toni Green, Simon Moss, Janique Waghorn, and Mary-Jessimine Bushell. "Exploring Pharmacists’ Roles during the 2019–2020 Australian Black Summer Bushfires." Pharmacy 9, no. 3 (August 19, 2021): 142. http://dx.doi.org/10.3390/pharmacy9030142.
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Background: Australians are no strangers to sudden natural disasters, such as bushfires. The effects of a natural disaster can devastate local communities and health care services. Currently, limited research has explored the role of the pharmacist during a natural disaster. This study explores the role of the Australian pharmacist during the 2019/2020 Black Summer Bushfires. Methods: Semi-structured phone interviews were conducted with ten community pharmacists who worked through the Black Summer Bushfires whose daily tasks and work environment were directly affected by the bushfires. Thematic analysis using NVivo®, a qualitative data analysis software was conducted. Results: Analysis of the transcripts generated six main themes: collaboration; trauma and mental health; power and communication; acute presentations; triaging and emergency prescribing. Pharmacists worked in close collaboration with doctors and members of the local community. They provided triaging services, timely health advice about chronic health problems, and managed acute issues, including wound and burn management and mental health support in traumatic conditions, sometimes without power and communication amenities. The challenges presented to pharmacists during the bushfires warranted creative and flexible approaches at times. Conclusion: This study highlights the need for mental health support and training for pharmacists, provisional prescribing privileges, and a clearer set of contingency regulations and legislation related to emergencies and natural disasters. Further research is warranted to gain greater insight into the roles undertaken by Australian pharmacists during natural disasters and their autonomy in decision making processes during such times.
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Jones, T., E. Harris, M. Roberts, D. Mawren, and S. Lee. "The characteristics of patients requiring readmission to an Australian forensic psychiatric intensive care unit." European Psychiatry 64, S1 (April 2021): S377. http://dx.doi.org/10.1192/j.eurpsy.2021.1009.
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IntroductionPsychiatric intensive care units (or PICU’s) emerged to manage high acuity patients outside the justice system. Studies have sought to better understand characteristics of those admitted to forensic or civilian PICU’s. Few, in contrast, have explored the frequency and contributors to readmission. The following study was conducted on Apsley unit, a Forensic PICU based in Melbourne, Australia, and seeks to understand the differences which would allow early identification of patients likely to require readmission and the provision of targeted interventions.ObjectivesExamine rates of and contributors to forensic PICU readmission over a 6-month period.MethodsA retrospective audit was conducted to collect clinical, problem behaviour (and strategies to manage), forensic history and demographic information for consecutively admitted patients to an 8-bed forensic PICU between March-September 2019.ResultsData analysis is ongoing. Interim analysis found that 96 patients were admitted during the 6-month study period: 74 (77.1%) had a single admission; 22 (22.9%) required readmission. Almost all were admitted from prison (96.9%), most had a psychosis diagnosis (80.2%) and substance abuse history (96.9%), and many had a personality disorder (24.0%) and history of adolescent antisocial behaviour (46.5%). Patients requiring readmission were significantly more likely to have been previously under compulsory mental health treatment (95.5% vs 75.3%, p=.039) and have a Positive Behaviour Support Plan developed during admission (85.7% vs 54.8%, p=.010).ConclusionsInterim analysis highlighted the multicomplexity for forensic PICU patients alongside the occurrence of problem behaviour during admission and history of compulsory treatment as indicators of increased risk for re-admission.
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Bellairs-Walsh, India, Sadhbh J. Byrne, Sarah Bendall, Yael Perry, Karolina Krysinska, Ashleigh Lin, Maria Michail, et al. "Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners’ Perspectives." International Journal of Environmental Research and Public Health 18, no. 24 (December 8, 2021): 12926. http://dx.doi.org/10.3390/ijerph182412926.
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General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs’ perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools–the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
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Iansek, Robert, and Mary Danoudis. "Patients’ Perspective of Comprehensive Parkinson Care in Rural Victoria." Parkinson's Disease 2020 (March 31, 2020): 1–7. http://dx.doi.org/10.1155/2020/2679501.
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Introduction. There is a higher prevalence of Parkinson’s disease (PD) in rural Australia and a poorer perceived quality of life of rural Australians with PD. Coordinated multidisciplinary teams specialised and experienced in the treatment of PD are recommended as the preferred model of care best able to manage the complexities of this disorder. There remains a lack of team-based specialised PD services in rural Australia available to people living with PD. This study aims to explore how the lack of specialised PD services impacts on the person’s experiences of the health care they receive in rural Victoria. This study compared the health-care experiences of two different cohorts of people with PD living in rural Victoria; one cohort living in East Gippsland have had an established comprehensive care model implemented with local trained teams and supported by a metropolitan PD centre, and the other cohort was recruited from the remainder of Victoria who had received standard rural care. Methods. This descriptive study used a survey to explore health-care experiences. Questionnaires were mailed to participants living in rural Victoria. Eligibility criteria included having a diagnosis of PD or Parkinsonism and sufficient English to respond to the survey. The validated Patient-Centred Questionnaire for PD was used to measure health-care experiences. The questions are grouped accordingly under one of the 6 subscales or domains. Outcomes from the questionnaire included summary experience scores (SES) for 6 subscales; overall patient-centeredness score (OPS); and quality improvement scores (QIS). Secondary outcomes included health-related quality of life using the disease-specific questionnaire PDQ39; disease severity using the Hoehn and Yahr staging tool; and disability using the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale, part II. Results. Thirty-nine surveys were returned from the East Gippsland group and 68 from the rural group. The East Gippsland group rated significantly more positive the subscales “empathy and PD expertise,” P=0.02, and “continuity and collaboration of professionals,” P=0.01. The groups did not differ significantly for the remaining 4 subscales (P>0.05) nor for the OPS (P=0.17). The QIS showed both groups prioritised the health-care aspect “provision of tailored information” for improvement. Quality of life was greater (P<0.05) and impairment (P=0.012) and disability were less (P=0.002) in the East Gippsland group. Conclusion. Participants who received health care from the East Gippsland program had better key health-care experiences along with better QOL and less impairment and disability. Participants prioritised provision of information as needing further improvement.
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Russell, Grant, Susannah Westbury, Sharon Clifford, Elizabeth Sturgiss, Anna Fragkoudi, Rob Macindoe, Deborah Stuart, Marina Kunin, Jill Walsh, and Cathie Scott. "Improving access for the vulnerable: a mixed-methods feasibility study of a pop-up model of care in south-eastern Melbourne, Australia." Australian Journal of Primary Health 28, no. 2 (February 25, 2022): 143–50. http://dx.doi.org/10.1071/py21188.
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Access to appropriate health and social care is challenging for vulnerable populations. We used a ‘pop-up’ delivery model to bring community-based services in contact with communities with poor access to health and social care. Our aim was to examine whether pop-up events improve access to essential health and social support services for selected vulnerable communities and increase collaboration between community-based health and social services. Set in south-eastern Melbourne, two pop-up events were held, one with people at risk of homelessness attending a community lunch and the other with South Sudanese women helping at-risk youth. Providers represented 20 dental, housing, justice, employment and mental health services. We made structured observations of each event and held semi-structured interviews with consumers and providers. Pre-post surveys of managers assessed acceptability and perceived impact. We reached 100 community participants who had multiple needs, particularly for dentistry. Following the events, participants reported increased knowledge of services and access pathways, community members spoke of increased trust and partnerships between service providers were fostered. The pop-up model can increase provider collaboration and provide new options for vulnerable populations to access needed services. ‘Bringing the service to the person’ is a compelling alternative to asking consumers to negotiate complex access pathways.
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Williams, Theresa Maureen, and Geoffrey Paul Smith. "Does training change practice? A survey of clinicians and managers one year after training in trauma-informed care." Journal of Mental Health Training, Education and Practice 12, no. 3 (May 8, 2017): 188–98. http://dx.doi.org/10.1108/jmhtep-02-2016-0016.
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Purpose The purpose of this paper is to describe the impact of a trauma-informed care (TIC) training programme on practice at the individual and workplace level in mental health and drug and alcohol services and to examine the implications of using training alone as a strategy for achieving system-level practice change. Design/methodology/approach A total of 271 clinicians and managers from public mental health and drug and alcohol services in Western Australia who had undertaken TIC training were invited to complete an on-line survey 12 months after training. Individual survey items were based on a five-point Likert scale with opportunity being provided for additional comments from respondents. Findings One year post-training, both clinicians and managers reported that training had increased their awareness and knowledge and had a positive impact on their attitudes towards TIC. Clinicians reported a moderate impact on their individual practice and both groups reported very limited success in bringing about change in their workplaces. Workforce development and organisational factors were identified by both clinicians and managers as being barriers to implementation. Research limitations/implications Only 30 per cent of the training participants responded to the survey and it is not possible to determine whether they differed from non-respondents. Findings were based on a self-report survey with no objective measure of behaviour change. Originality/value This “naturalistic” study examines the longer-term impact of training, from the perspective of clinicians and managers, on changing practice at the individual clinician and workplace level. It highlights the critical importance of understanding and addressing contextual factors where collective, coordinated behaviour change is needed in order to effect organisational change.
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Salomon, Carmela, Helena Britt, Allan Pollack, and Julian Trollor. "Primary care for people with an intellectual disability — what is prescribed? An analysis of medication recommendations from the BEACH dataset." BJGP Open 2, no. 2 (May 29, 2018): bjgpopen18X101541. http://dx.doi.org/10.3399/bjgpopen18x101541.
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BackgroundPeople with intellectual disability (ID) experience a range of health disparities. Little is known about differential primary care prescribing patterns for people with and without ID.AimTo compare medications recommended by GPs at encounters where ID is recorded versus other encounters.Design & settingAnalysis of national Australian GP medication data from the Bettering the Evaluation and Care of Health (BEACH) programme, January 2003–December 2012 inclusive.MethodMedication recommendations made at encounters where an ID-defining problem was recorded as a reason for encounter (RFE) and/or as a problem managed, were allocated to the ‘ID group’ (n = 563). These encounters were compared with all other encounters (the ‘non-ID group’, n = 1 004 095) during the study period. Following age–sex standardisation of ID group encounters, significant differences were determined by non-overlapping 95% confidence intervals (CIs).ResultsAntipsychotics and anticonvulsants were recommended more frequently at ID group encounters than at non-ID group encounters. Antidepressant and anxiolytic recommendation rates did not differ between groups. Narcotic analgesic and antihypertensive recommendations were significantly lower at ID group encounters.ConclusionHigher rates of epilepsy and mental illness, and off-label use of some antipsychotics and anticonvulsants for behaviour management in people with ID, may have contributed to medication recommendations observed in this analysis. Lower narcotic analgesic recommendations at ID group encounters may relate to complex presentations and the nature of problems managed, while lower antihypertensive recommendations may indicate some potential omission of routine blood pressure measurement.
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Knightbridge, Stephen M., Robert King, and Timothy J. Rolfe. "Using Participatory Action Research in a Community-Based Initiative Addressing Complex Mental Health Needs." Australian & New Zealand Journal of Psychiatry 40, no. 4 (April 2006): 325–32. http://dx.doi.org/10.1080/j.1440-1614.2006.01798.x.
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Objective: This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community. Method: Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions. Results: Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources. Conclusions: The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.
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Parsell, Cameron, Charlotte ten Have, Michelle Denton, and Zoe Walter. "Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness." Australian Health Review 42, no. 3 (2018): 303. http://dx.doi.org/10.1071/ah16277.
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Objectives The aims of the present study were to examine tenants’ experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access. Methods The present study used a mixed-method survey design (n = 75) and qualitative interviews (n = 20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically. Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented. Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare. What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services. What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in permanent supportive housing enabled illness self-management and greater control over lifestyle, and was associated with self-reported improved health and life satisfaction in formerly homeless tenants. What are the implications for practitioners? Integrated health care and supportive housing for the formerly homeless can improve self-reported health outcomes, enable healthier lifestyle choices and facilitate pathways into more appropriate and effective health care.
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Charles, Janice, Christopher M. Harrison, and Helena Britt. "Management of Children's Psychological Problems in General Practice 1970–1971, 1990–1991 and 2008–2009." Australian & New Zealand Journal of Psychiatry 45, no. 11 (November 2011): 976–84. http://dx.doi.org/10.3109/00048674.2011.610743.
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Objective: The aim of this study was to examine changes over four decades in children's psychological problems managed in Australian general practice and to describe recent management of these problems. Method: Analysis of GP encounters with children, using data from the BEACH study, an on-going, cross-sectional, national survey of general practice, provides contemporary results. Comparisons with two related studies: 1970–1971 (from published reports), and 1990–1991 (secondary analysis), describe changes over time. Results: Changes over time: psychological problems accounted for 2% of all children's problems managed in 1971, 1.3% in 1990–1991 and 2.6% in 2008–2009. In 1971, non-organic enuresis accounted for 30% of children's psychological problems but only 2.7% in 2008–2009. Insomnia showed a similar pattern. Between 1990–1991 and 2008–2009, ADHD increased from 0.8% to 14.7%, and from 2000–2001 to 2008–2009, autism spectrum disorders rose from 4.9% to 11%. Current practice: most common psychological problems managed for children less than 18 years were anxiety, depression, intellectual impairment and ADHD. Among children aged 0–5 years, sleep disturbance and intellectual impairment were the main problems, for 6–11 year olds, anxiety and ADHD, and for 12–17 year olds, depression. Boys were significantly more likely to be managed for intellectual impairment, ADHD and autism spectrum disorders than were girls, who were more likely to be managed for depression. The medication rate was low at 19 per 100 psychological problems although higher for depression and ADHD. Referrals were given at a high rate. Counselling was also provided often, except in management of ADHD. Conclusions: Access to the three studies allowed consideration of trends over a forty year period, showing the development of newly defined conditions which have replaced childhood diagnoses of past decades. The results demonstrate that GP involvement in children's mental health care management has grown significantly over the past 20 years.
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Gardner, Glenn, Anne Gardner, Sandy Middleton, Julie Considine, Gerard Fitzgerald, Luke Christofis, Anna Doubrovsky, Margaret Adams, and Jane O'Connell. "Mapping workforce configuration and operational models in Australian emergency departments: a national survey." Australian Health Review 42, no. 3 (2018): 340. http://dx.doi.org/10.1071/ah16231.
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Objective Hospital emergency departments (ED) in Australia and internationally have been experiencing increased demand, resulting in reduced hospital quality, impaired access and adverse health outcomes. Effective evaluation of new ED service models and their effect on outcomes is reliant on baseline measures of the staffing configuration and organisational characteristics of the EDs being studied. The aim of the present study was to comprehensively measure these variables in Australian EDs. Methods Australian hospital EDs with 24-h medical and nursing cover were identified and invited to participate in the study. Telephone interviews were conducted with nursing or medical department managers to collect data related to hospital characteristics, ED workforce and training and ED service and operational models. Results Surveys were completed in 87% of the population sample (n = 135). Metropolitan EDs were significantly more likely to retain higher full-time equivalents (FTEs) in several medical (staff specialist, registrar, resident and intern) and nursing (nurse practitioner (NP), nurse educator, nurse unit manager and registered nurse) positions. NPs were employed by 52% of Australian EDs overall, but this ranged from 40% to 75% depending on jurisdiction. The most commonly used operational models were FastTrack teams (72% of EDs), short-stay/observational unit (59%) and patient liaison models for aged care (84%) and mental health (61%). EDs that employed NPs were significantly more likely to use FastTrack (P = 0.002). Allied health services most frequently available within these EDs were radiology (60%), social work (69%), physiotherapy (70%) and pharmacy (65%). Conclusions The present study has established a baseline measure of the staffing configuration and organisational characteristics of Australian EDs. What is known about the topic? EDs are overcrowded due, in part, to the combined effect of increased service demand and access block. Innovative service and workforce models have been implemented by health departments aiming to improve service and performance. National uptake of these service and workforce innovations is unknown. What does this paper add? The present study is the most comprehensive to date profiling Australian EDs covering hospital characteristics, workforce configuration, operational models and NP service patterns and practice. What are the implications for practitioners? Information from the present study will assist health service planners to evaluate workforce and service reform models, and to monitor trends in emergency service development.
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Gesesew, Hailay, Paul Ward, Kifle Woldemichael, and Lillian Mwanri. "Improving the UNAIDS 90-90-90 Treatment Targets: Solutions Suggested from a Qualitative Study of HIV Patients, Community Advocates, Health Workers and Program Managers in Jimma, Southwest Ethiopia." International Journal of Environmental Research and Public Health 17, no. 1 (January 6, 2020): 378. http://dx.doi.org/10.3390/ijerph17010378.
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Ethiopia’s performance toward the UNAIDS 90-90-90 targets is low. The present study explored interventions to improve delayed HIV care presentation (first 90), poor retention (second 90) and clinical and immunological failure (third 90). We employed a qualitative approach using in-depth interviews with 10 HIV patients, nine health workers, 11 community advocates and five HIV program managers. Ethical approvals were obtained from Australia and Ethiopia. The following were suggested solutions to improve HIV care and treatment to meet the three 90s: (i) strengthening existing programs including collaboration with religious leaders; (ii) implementing new programs such as self-HIV testing, house-to-house HIV testing, community antiretroviral therapy (ART) distribution and teach-test-treat-link strategy; (iii) decentralizing and integrating services such as ART in health post and in private clinics, and integrating HIV care services with mental illness and other non-communicable diseases; and (iv) filling gaps in legislation in issues related with HIV status disclosure and traditional healing practices. In conclusion, the study suggested important solutions for improving delayed HIV care presentation, attrition, and clinical and immunological failure. A program such as the teach-test-treat-link strategy was found to be a cross-cutting intervention to enhance the three 90s. We recommend further nationwide research before implementing the interventions.
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Brown, Ellie, and Brian O’Donoghue. "T238. RATES AND PREDICTORS OF RELAPSE IN AN AUSTRALIAN FIRST EPISODE PSYCHOSIS COHORT." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S323. http://dx.doi.org/10.1093/schbul/sbaa029.798.
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Abstract Background Clinical and functional recovery is usually achieved after treatment for a first episode of psychosis (FEP). Unfortunately, subsequent relapse remains common, occurring within a year for approximately 30% of individuals and within five years for 80%. What makes someone more likely to relapse remains poorly understood. Methods This study is a naturalistic cohort study of young people (15–25 years old) accessing an early intervention in psychosis service in Melbourne, Australia between 1st January 2011 and 31st December 2016. Demographic and clinical predictors of relapse were collected from patient records and analysed using Cox regression analysis. Results A total of 1220 young people presented with a FEP during the study period and 37.7% (N=460) experienced at least one relapse during their episode of care. Over half of all relapses resulted in an admission to hospital. Non-adherence to medication, substance use and psychosocial stressors precipitated relapses. Significant predictors of relapse in this sample were a diagnosis of a schizophrenia spectrum disorder or an affective psychotic disorder, amphetamine use, and substance use during treatment. Discussion These findings suggest that relapse occurs frequently for young people who have experienced FEP. This is one of the first studies to find that amphetamine use increases the risk of relapse. Clinical services, especially in Australasia, need to consider how best to manage this co-morbidity in young people with FEP.
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Ryan, Benjamin, Richard Franklin, Frederick Burkle, Erin Smith, Peter Aitken, and Peter Leggat. "Determining Key Influences on Patient Ability to Successfully Manage Noncommunicable Disease After Natural Disaster." Prehospital and Disaster Medicine 34, s1 (May 2019): s47—s48. http://dx.doi.org/10.1017/s1049023x19001122.
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Introduction:Natural disasters often damage the public health infrastructure required to maintain the wellbeing of people with noncommunicable diseases. This increases the risk of an acute exacerbation or complications, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of noncommunicable diseases will continue, if not increase, due to an increasing disease prevalence, sustained rise in the frequency and intensity of disasters, and rapid unsustainable urbanization in disaster-prone areas. However, the traditional focus of public health and disaster systems remains on communicable diseases, despite a low risk. There is now an urgent need to expand the public health response to include noncommunicable diseases.Aim:To explore the key influences on patient ability to successfully manage their noncommunicable disease after a natural disaster.Methods:A survey of people with noncommunicable diseases in Queensland, Australia, collected data on demographics, disease/condition, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with Bonferroni-adjustment were used to analyze data.Results:There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue and shortness of breath were common concerns for all noncommunicable diseases. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.Discussion:The key influences on successful self-management post disaster for people with noncommunicable diseases must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.
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Pai, Nagesh, and Matthew Warden. "Early Australian experience in the maintenance of schizophrenia management with 3-monthly paliperidone palmitate." Australasian Psychiatry 26, no. 6 (July 26, 2018): 628–34. http://dx.doi.org/10.1177/1039856218789770.
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Objectives: Real-world experience from a 6-month product familiarization programme (PFP) for 3-monthly paliperidone palmitate in schizophrenia maintenance treatment. Methods: Prescribers completed an online questionnaire for each patient at enrolment with further questions at second dose (re-supply) stage and a second survey of their overall experience at the end. Results: Ninety-four patients were enrolled and received a first dose and 23 received a second dose within the 6-month programme; 51.1% had been hospitalised for symptom relapse in the previous 2 years. Reasons for prescribing were convenience of 3-monthly dosing for patients (94.7%) and patient choice (54.6%). Prescribers followed-up at least once-monthly (69.6% cases) and indicated in 48.9% they would consider shared GP care. All patients were satisfied with symptom control and either maintained functioning or showed improvement. Clinicians felt confident with administration and identifying suitable patients and were all ‘satisfied’ or ‘somewhat satisfied’ with efficacy and tolerability. All felt patients’ treatment goals were either ‘met’ (81.3%) or ‘partly met’ (18.7%) and none reported dissatisfaction with relapse prevention. Conclusions: Convenient 3-monthly dosing was preferred by clinicians and patients, and symptoms were adequately managed. This has the potential to improve adherence and lead to better outcomes as patients only need four intramuscular doses per year.
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Reid, Sophie, Sylvia Kauer, and George Patton. "152. Using Cell Phones to Detect, Treat, and Manage Adolescent Mental Health: A Randomised Controlled Trial of the Mobiletype Program in Rural and Metro Primary Care Australia." Journal of Adolescent Health 48, no. 2 (February 2011): S96—S97. http://dx.doi.org/10.1016/j.jadohealth.2010.11.200.
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Gibson, Lauren, Kate Bartlem, Tara Clinton-McHarg, Magdalena Wilczynska, Alison Rasmussen, Jacqueline Bailey, Jade Ryall, Mark Orr, Janet Ford, and Jenny Bowman. "The Provision of Preventive Care for Chronic Disease Risk Behaviours to People with a Mental Health Condition: A Survey of Staff from One Australian Community Managed Organisation." Journal of Psychosocial Rehabilitation and Mental Health 8, no. 2 (April 23, 2021): 191–98. http://dx.doi.org/10.1007/s40737-021-00215-x.
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Pu, Lihui, Wendy Moyle, Cindy Jones, and Michael Todorovic. "468 - Can a Robotic Seal Called PARO Manage Chronic Pain in People with Dementia Living in Nursing Homes?" International Psychogeriatrics 32, S1 (October 2020): 190. http://dx.doi.org/10.1017/s1041610220003208.
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AbstractObjective: To evaluate the effect of interaction with a robotic seal (PARO) for pain management in nursing home residents living with dementia.Methods: Registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12618000082202), a pilot randomized controlled trial followed by semi-structured interviews were conducted between January 2018 and January 2019. Forty-three residents aged ?65 years living with dementia and chronic pain were recruited from three nursing homes in Australia. Participants were randomized to either a PARO group (individual, non-facilitated, 30-minute sessions, five days per week for six weeks) or a usual care group using a computer-generated random number. Observational pain behaviors were rated by researchers using the Pain Assessment in Advanced Dementia (PAINAD) scale and staff-rated pain levels were measured by the numeric rating scale. Medications regularly prescribed and as needed were quantified by the Medication Quantification Scale-III (MQS-III). Generalized estimating equation model and thematic analysis were used to analyze the data.Results: Participants in the PARO group had significantly lowered level of observed pain (-0.514, 95% confidence interval [CI] -0.774 to -0.254, p<0.001) and used fewer PRN medications (-1.175, 95% CI - 2.205 to -0.145, p=0.025) than those in usual care after controlling for age, gender, cognitive function and medications at baseline. There were no significant differences in staff-rated pain levels and regularly scheduled medications between the two groups. Interviews also indicated that the PARO intervention may reduce the pain experience through distraction and reminiscence of previous positive memories. Limitations of weight, voice and characteristics of PARO were identified.Conclusions and Implications: PARO shows promise in reducing pain and medications for nursing home residents living with dementia and chronic pain. This intervention might be incorporated into daily practice as an alternative to manage pain in people with dementia. Care staff need to balance the benefits and limitations of incorporating social robots into their clinical practice and residents’ individualized preferences need to be considered. Larger randomized controlled trials with longer time frames are warranted to further test the use of PARO in long-term care settings.
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Nguy, Jodie, Melissa Petrakis, and Michael Wilson. "Evaluation of a four-week Rehabilitation Assessment program introduced at an Australian Community Care Units setting: mental health consumers and clinicians perspectives." European Journal for Person Centered Healthcare 2, no. 3 (July 15, 2014): 359. http://dx.doi.org/10.5750/ejpch.v2i3.743.
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Background: Community Care Units (CCUs) are purpose built residential accommodation for adults with severe and enduring mental illness. The CCUs are staffed by clinical mental health staff 24 hours per day and there are consistent guidelines as to the process these programs utilise to prioritise who would most benefit from them. A CCU based in the Inner East of Melbourne, Australia, has utilised one bed as a ‘review program’ to assess patients’ functional livings skills and potential for engagement with the long-term rehabilitation program as part of a general more person-centered healthcare approach. Aims: The purpose was to evaluate: (1) patient perception of the program and if this benefits their rehabilitation, (2) the perception of clinicians who refer to the program and (3) the perception of clinicians of the CCU multidisciplinary team (MDT). Method: A purposive sample of patients and clinicians was employed. Semi-structured interviews were conducted with 7 patients who had participated in the review program between January 2010 - April 2012 and an online survey was conducted with responses from 5 case managers who had referred patients and 9 clinicians in the CCU MDT team who had participated in conducting the review. Results: Our results indicated that patients found the process somewhat overwhelming and an adjustment to their daily routine; they were generally unclear as to the rationale for referral to the program. Clinicians found the program to be a useful process in assisting a more in-depth understanding of their patients’ needs. Conclusion: Results suggest that review and modification to program delivery could enhance patient benefits and enhance more person-centered approaches to care.
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Morse, Daniel F., Sahil Sandhu, Kate Mulligan, Stephanie Tierney, Marie Polley, Bogdan Chiva Giurca, Siân Slade, et al. "Global developments in social prescribing." BMJ Global Health 7, no. 5 (May 2022): e008524. http://dx.doi.org/10.1136/bmjgh-2022-008524.
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Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the ‘Beyond the Building Blocks’ framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs.
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Stardust, Zahra, Johann Kolstee, Stefan Joksic, James Gray, and Siobhan Hannan. "A community-led, harm-reduction approach to chemsex: case study from Australia’s largest gay city." Sexual Health 15, no. 2 (2018): 179. http://dx.doi.org/10.1071/sh17145.
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Rates of drug use remain substantially higher among gay and bisexual men (GBM) and people living with HIV (PLHIV) in Sydney, New South Wales, Australia. The use of drugs to enhance sexual pleasure within cultures of Party and Play creates opportunities to discuss sexual health, mental health, consent and wellbeing. Community organisations with a history of HIV prevention, care, treatment are well-placed to respond. ACON’s (formerly the AIDS Council of New South Wales) multi-dimensional response to ‘chemsex’ includes: direct client services support for individuals seeking to manage or reduce their use; health promotion activities that support peer education; partnerships with research institutions to better understand cultures of chemsex; and policy submissions that call for drug use to be approached as a health, rather than a criminal, issue. The approach speaks the language of Party and Play subcultures; employs culturally relevant terminology and imagery; uses content designed, created and delivered by peers; and operates within a pleasure-positive, harm-reduction and community-led framework. These interventions have led to increased service uptake, strong community engagement, robust research partnerships and the recognition of GBM as a priority population in relevant strategies.
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Bradley, Valerie, Miso Kwak, Highsmith Rich, and Bevin Croft. "International advances in self-direction: themes from a disability leadership exchange." Journal of Integrated Care 29, no. 3 (March 2, 2021): 295–305. http://dx.doi.org/10.1108/jica-09-2020-0058.
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PurposeSelf-direction–also known as participant direction, personalization and self-directed care–is a service delivery model that enables people to manage their personal budget and purchase services and supports tailored to their needs based on a person-centered plan. This paper, the outcome of an international learning exchange on self-direction, describes approaches across four countries’ successful strategies, unresolved questions and recommendations to enhance self-direction globally.Design/methodology/approachThe findings are a product of discussions at the 2019 International Initiative for Mental Health Leadership and International Initiative for Disability Leadership Exchange on Advances in Self-Direction. Participants included people who are self-directing, providers and caregivers who support people who are self-directing, advocates, fiscal agents and public managers who administer self-direction from the United States, England, Australia and New Zealand.FindingsIn all four countries, people who self-direct exercise high levels of choice and control and are able to individualize their services and supports to promote a good life in the community. The exchange also revealed challenges and possible solutions to improve and expand self-direction.Practical implicationsThe results of the meeting provide guidance for public managers, providers and advocates for initiating and expanding self-direction.Originality/valueThis international meeting was a unique opportunity to compare self-direction across four different countries and across multiple perspectives, including people with disabilities, caregivers, providers and administrators.