Another minority group: use of aged care day programs and community leisure services by older people with lifelong disability

Objective: This study examined the extent to which programs available to the general aged community are accessible to older people with lifelong disability. Method: Forty Victorian generic aged day activity and community leisure programs used by older people responded to a survey that sought information on the extent to which such services are used by older people with a lifelong disability. Results: More than half of these services are accessed by a small number of people with lifelong disability and overall there was a willingness to include this group in generic services. Barriers and solutions to successful generic service use were reported. Conclusions: The findings indicate that the issues for people with lifelong disability differ little from those of other minority groups. It is proposed that disability services have a role in brokering services for their older clients, and continued planning and collaboration between disability and aged services will benefit all older people.

Evaluating health services with point of service feedback: perspectives and experiences of patients, staff and community volunteers in an inpatient rehabilitation facility

PURPOSE: To determine patient, staff and community volunteer opinions and experiences of point of service feedback (POSF) in an inpatient rehabilitation facility. METHOD: Participants were recruited by purposeful sampling. Two researchers conducted in-depth semi-scripted interviews with patients, staff or volunteers until no new issues emerged. Manually transcribed interview data underwent thematic analysis that grouped information into categories of related information. RESULTS: Twenty patients, 26 staff from 10 different professional groups, and 2 community volunteers were interviewed. Patient and volunteer data were grouped into five main categories: patients wanted their voice heard and acted on; patients could be positively and negatively affected by POSF; patients could be reluctant to evaluate staff; patients preferred POSF to post-discharge mailed questionnaires; and patients' feedback was influenced by the data collector. Staff wanted: feedback to help them improve the patient experience; and feedback that was trustworthy, usable and used. Staff believed that the feedback-collector influenced patients' feedback and affected how feedback could be used. CONCLUSIONS: Patients, staff and community volunteers identified issues that determine the appropriateness and usefulness of POSF. Policy and practise should address the preferences, needs and experiences of health service users and providers so that POSF produces maximum benefits for both patients and health services. Implications for Rehabilitation POSF can enhance patients' experiences of inpatient rehabilitation by providing a mechanism to be heard and communicating that patients are valued; care must be exercised with patients who find giving feedback stressful. Collecting POSF is most beneficial when coupled with methods to efficiently and effectively respond to feedback. POSF requires interpretation in light of its limitations including patients' ability to accurately and unreservedly communicate their experiences. Who collects POSF requires careful consideration; community volunteers have both advantages and disadvantages.

Health services should collect feedback from inpatients at the point of service: opinions from patients and staff in acute and subacute facilities

OBJECTIVE: Point of service feedback (POSF) enables patients to give health services feedback about their experiences during or immediately after care. Despite the increasing use of POSF, little is known regarding patients' and staffs' opinions of this practice and whether they consider it acceptable or useful. The study aimed to determine patient and staff opinions regarding POSF. DESIGN: A cross-sectional survey. SETTING: Acute and subacute healthcare facilities. PARTICIPANTS: Two hundred and forty-seven patients and 221 staff. RESULTS: Participants indicated that patients should be invited to evaluate health services when they are in hospital or subacute care and improving services was the most important reason for doing so. Staff indicated that:• collecting patients' feedback during their stay was an important part of providing care and not an interruption to it (n = 187 of 221, 85%).• collecting patients' feedback was best done with a variety of methods; talking directly with patients during their stay was the preferred option (n = 161 of 219, 74%).More patients preferred to:• give feedback during their stay (51%) than after discharge from care (15%).• give feedback by talking with someone (45%) than completing a questionnaire (31%).Some patients (14%) were concerned about reprisal from staff if they gave negative feedback. CONCLUSIONS: POSF can be acceptable and useful for evaluating health services and should be incorporated into a person-centred approach that allows patients to choose from a variety of feedback options both during and after their stay. To be most useful, feedback should be incorporated into a quality improvement system.

Health literacy: applying current concepts to improve health services and reduce health inequalities

The concept of 'health literacy' refers to the personal and relational factors that affect a person's ability to acquire, understand and use information about health and health services. For many years, efforts in the development of the concept of health literacy exceeded the development of measurement tools and interventions. Furthermore, the discourse about and development of health literacy in public health and in clinical settings were often substantially different. This paper provides an update about recently developed approaches to measurement that assess health literacy strengths and limitations of individuals and of groups across multiple aspects of health literacy. This advancement in measurement now allows diagnostic and problem-solving approaches to developing responses to identified strengths and limitations. In this paper, we consider how such an approach can be applied across the diverse range of settings in which health literacy has been applied. In particular, we consider some approaches to applying health literacy in the daily practice of health-service providers in many settings, and how new insights and tools--including approaches based on an understanding of diversity of health literacy needs in a target community--can contribute to improvements in practice. Finally, we present a model that attempts to integrate the concept of health literacy with concepts that are often considered to overlap with it. With careful consideration of the distinctions between prevailing concepts, health literacy can be used to complement many fields from individual patient care to community-level development, and from improving compliance to empowering individuals and communities.

Improving access for community health and sub-acute outpatient services: protocol for a stepped wedge cluster randomised controlled trial

BACKGROUND: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction.

METHODS/DESIGN: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial.

DISCUSSION: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care.

The state of legislation and policy protecting Australia's mangrove and salt marsh and their ecosystem services

Saline coastal wetlands, such as mangrove and coastal salt marsh, provide many ecosystem services. In Australia, large areas have been lost since European colonization, particularly as a result of drainage, infilling and flood-mitigation works, often starting in the mid-19th century and aimed primarily towards converting land to agricultural, urban or industrial uses. These threats remain ongoing, and will be exacerbated by rapid population growth and climate change in the 21st century. Establishing the effect of wetland loss on the delivery of ecosystem services is confounded by the absence of a nationally consistent approach to mapping wetlands and defining the boundaries of different types of coastal wetland. In addition, climate change and its projected effect on mangrove and salt marsh distribution and ecosystem services is poorly, if at all, acknowledged in existing legislation and policy. Intensifying climate change means that there is little time to be complacent; indeed, there is an urgent need for proper valuation of ecosystem services and explicit recognition of ecosystem services within policy and legislation. Seven actions are identified that could improve protection of coastal wetlands and the ecosystem services they provide, including benchmarking and improving coastal wetland extent and health, reducing complexity and inconsistency in governance arrangements, and facilitating wetland adaptation and ecosystem service delivery using a range of relevant mechanisms. Actions that build upon the momentum to mitigate climate change by sequestering carbon – ‘blue carbon’ – could achieve multiple desirable objectives, including climate-change mitigation and adaptation, floodplain rehabilitation and habitat protection.