Do rural consumers expect a prescription from their GP visit? Investigation of patients' expectations for a prescription and doctors' prescribing decisions in rural Australia

Objective: To assess patients’ expectation for receiving a prescription and GPs’ perceptions of patient expectation for a prescription. Design: Matched questionnaire study completed by patients and GPs. Setting: Seven general practices in rural Queensland, Australia. Subjects: The subjects were 481 patients consulting 17 GPs. Main outcome measures: Patients’ expectation for receiving a prescription and GPs’ perceptions of patients’ expectation. Results: Ideal expectation (hope) for a prescription was expressed by 57% (274/481) of patients. Sixty-six per cent (313/481) thought it was likely that the doctor would actually give them a prescription. Doctors accurately predicted hope or lack of hope for a prescription in 65% (314/481) of consultations, but were inaccurate in 19% (93/481). A prescription was written in 55% of consultations. No increase in patients’ expectation, doctors’ perceptions of expectation, or decision to prescribe were detected for patients living a greater distance from the doctors. Conclusions: Rural patients demonstrated similar rates of hope for a prescription to those found in previous urban studies. Rural doctors seem to be similarly ‘accurate’ and ‘inaccurate’ in determining patients’ expectations. Rates of prescribing were comparable to urban rates. Distance was not found to increase the level of patient expectation, affect the doctors’ perception or to influence the decision to prescribe.

Start looking South: The refugee convention 50 years on

A review essay on books by (1) Efika Feller, Volker Turk, & Frances Nicholson (Eds), Refugee Protection in International Law: UNHCR's Global Consultations on International Protection (Cambridge, UK: Cambridge U Press, 2003); (2) Niklaus Steiner, Mark Gibney & Gil Loescher (Eds), Problems of Protection: The UNHCR, Refugees and Human Rights (New York: Routledge, 2003); & (3) Joanne Van Selm, Khotine Kamanga, John Morrison, Aninia Nadig, Sanja Spoljar-Vrzina, & Loes Van Willigen (Eds), The Refugee Convention at Fifty: A View from Forced Migration Studies (Maryland, Lexington, 2003).

Enhancing employment services for people with severe mental illness: the challenge of the Australian service environment

Objectives: Comparatively few people with severe mental illness are employed despite evidence that many people within this group wish to obtain, can obtain and sustain employment, and that employment can contribute to recovery. This investigation aimed to: (i) describe the current policy and service environment within which people with severe mental illness receive employment services; (ii) identify evidence-based practices that improve employment outcomes for people with severe mental illness; (iii) determine the extent to which the current Australian policy environment is consistent with the implementation of evidence-based employment services for people with severe mental illness; and (iv) identify methods and priorities for enhancing employment services for Australians with severe mental illness through implementation of evidence-based practices. Method: Current Australian practices were identified, having reference to policy and legal documents, funding body requirements and anecdotal reports. Evidence-based employment services for people with severe mental illness were identified through examination of published reviews and the results of recent controlled trials. Results: Current policy settings support the provision of employment services for people with severe mental illness separate from clinical services. Recent studies have identified integration of clinical and employment services as a major factor in the effectiveness of employment services. This is usually achieved through co-location of employment and mental health services. Conclusions: Optimal evidence-based employment services are needed by Australians with severe mental illness. Providing optimal services is a challenge in the current policy environment. Service integration may be achieved through enhanced intersectoral links between employment and mental health service providers as well as by co-locating employment specialists within a mental health care setting.

The role of migration in urban transition : studies of the relationship between migration and modernisation for Brisbane and Stockholm

Wilbur Zelinsky formulated a Hypothesis of Mobility Transition in 1971,in which he tried to relate all aspects of mobility to the Demographic Transition and modernisation. This dissertation applies the theoretical framework, proposed by Zelinsky and extended to encompass a family of transitions, to understand migration patterns of city regions. The two city regions, Brisbane and Stockholm, are selected as case studies, representing important city regions of similar size, but drawn from contrasting historical settings. A comparison of the case studies with the theoretical framework aims to determine how the relative contributions of net migration, the source areas of migrants, and the migration intensity change with modernisation. In addition, the research also aims to identify aspects of modernisation affecting migration. These aspects of migration are analysed with a "historical approach" and a "multivariate approach". An extensive investigation into the city regions' historical background provides the source, from which evidence for a relationship between migration and modernisation is extracted. With this historical approach, similarities and differences in migration patterns are identified. The other research approach analyse multivariate data, from the last two decades, on migration flows and modernisation. Correlations between migration and key aspects of modernisation are tested with multivariate regression, based on an alternative version of a spatial interaction model. The project demonstrates that the changing functions of cities and the structural modernisation are influential on migration. Similar patterns are found, regarding the relative contributions of net migration and natural increase to population growth. The research finds links between these changes in the relative contribution of net migration and demographic modernisation. The findings on variations in urban and rural source areas of migrants to city regions do not contradict the expected pattern, but data limitations prevent definite conclusion to be drawn. The assessment of variations in migration intensity resulted in the expected pattern not being supported. Based on Swedish data, the hypothesised increase in migration intensity is rejected. Interactional migration data also show patterns different from those derived from the theoretical framework. The findings, from both research approaches, suggested that structural modernisation affected migration flows more than demographic modernisation. The findings lead to a formulation of hypothesised patterns for migration to city regions. The study provides an important research contribution by applying the two research approaches to city regions. It also combines the study of internal and international migration to address the research objectives within a framework of transitional change.

Integrated power scheme simulator for human-system integration studies

We present a simulator of a hydropower company’s view of its scheme, and its broader market and network context, which has been developed to evaluate advanced displays for control room operations. Although simplified, the simulator captures all the main aspects of scheme operations. The simulator allows controlled studies to be performed that test the effectiveness of current vs advanced display concepts under normal vs unexpected operating conditions that can be scripted into the simulator.

The Integration of Rural Households Into Ruminant Livestock Industries in China

A major determinant of rural development in China is the way by which rural households integrate with rural industries. Three forms of integration – market integration, vertical integration and integration through local groups – are investigated. Policy measures that may facilitate household integration, household specialisation and market segmentation are identified. Findings for the ruminant livestock sector are widely applicable to other agricultural industries in China.