Primary health care nurse perception and men’s expectation of the role of the primary health care nurse in providing men’s health services in the primary care setting in Victoria

 This study adds significantly to the current paucity of knowledge around men's health in Australian primary care and in particular stresses the need for men's health care education to be more reliable and systematic foundation for men's sexual health, mental health and health promotion.

Providing health services to migrants and refugees settling in Victoria, Australia: an analysis of the complexity, cost and policy implications for public health

The aim of the research was to identify factors related to the increased costs of providing health services to clients from a non-English speaking background (NESB), using a cross-sectional analysis of the administrative records of clients using community health services in the Northern Metropolitan region of Melbourne for the 2001/2002 financial year. The higher cost of providing services to NESB clients was influenced by four factors: increased consultation time, group attendance to an appointment, increased interpreting costs and the type of service provider. Family members and multilingual staff play a significant role in providing informal interpreting services or low-cost support for NESB consultants, and these activities should receive appropriate support. Additional funding is needed to support interpreting requirements when dealing with the health needs of NESB clients.

The contribution of psychological assessment to community mental health services

Specialist psychological assessment plays a potentially important role in multidisciplinary community mental health settings. This portfolio describes and evaluates this psychological assessment and provides four case studies.

A survey of occupational therapists providing services under the Better Access to Mental Health initiative

The Australian government launched the Better Access to Mental Health initiative in 2006, to help more people access psychological therapies. Occupational therapists can register to offer these services, and this survey aimed to investigate their participation within the first 12 months of operation.
Two surveys were conducted with occupational therapists registered to offer Better Access to Mental Health services, at the six and twelve month mark of the initiative. These surveys collected both quantitative and qualitative data. While the demographic profile of occupational therapists remained stable across the surveys, the client population varied over time. Depression and anxiety were the most common conditions treated under this scheme. Occupational therapists reported generally positive attitudes towards the initiative, and did not identify any pressing training needs. However, the current rebate for services was a source of dissatisfaction for many respondents.
This survey has established a baseline for further investigation in this area. The provision and outcomes of this particular initiative needs to be a priority for future research to secure occupational therapy's place in this developing area of practice, thereby providing consumers with greater choice and access to intervention at a primary health level.

Barriers to care for depressed older people : perceptions of aged care among medical professionals

The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care, multiple co-morbidities, reluctance by older people to discuss depression, negative attitudes among carers, as well as a lack of skills all contributed to a failure to detect and treat depression. The implications of these findings for training programs for professional carers are discussed.

Ischaemic heart disease and Australian immigrants: the influence of birthplace and language skills on treatment and use of health services

Admission rates for ischaemic heart disease (IHD), and the use of invasive cardiovascular procedures, separation mode and length of stay (LOS) were compared between Australians from non-English speaking background (NESB; n=8627) and English speaking background (ESB; n=13162) aged 20 years and over admitted to Victorian urban public hospitals. The study covered the period from 1993 to 1998. It was found that, compared with their ESB counterparts, the incidence of admission for acute myocardial infarction was significantly higher for NESB men and women before and after controlling for confounding factors. The age-adjusted ratios for NESB women compared with their ESB counterparts ranged from 1.23 to 1.89 for cardiac catheterisation, from 0.23 to 0.27 for percutaneous transluminal coronary angioplasty (PTCA), and from 1.04 to 1.80 for coronary artery bypass grafting (CABG).
Procedure rates were comparable in men for cardiac catheterisation and CABG but higher for PTA rates in NESB men (OR: 1.29, 95%CI: 1.11-1.50) than their ESB counterparts. Both NESB men (β=0.04, 95%CI: 0.01-0.07) and women (β=0.03, 95%CI: 0.02-0.08) experienced significantly longer hospital stays than their ESB counterparts. These findings indicate there may be systematic differences in patients’ treatment and service utilisation in Victorian public hospitals. The extent to which physicians’ bias and
patients’ choice could explain these differences requires further investigation.

Amalgamation of health services in South-West Victoria: reinvention or survival?

In Australia 'the hospital' has long been considered the cornerstone of small, rural health services. However, this premise has been altered significantly by the introduction of casemix loading and diagnostic-related groups that promote a rationalised output-based model of management. In the light of these changes, many rural health services have struggled to reinvent themselves by establishing a range of service models such as Multi-purpose Service (MPS) and Health Streams, while maintaining traditional models (i.e. bush nursing centres, nursing homes and aged-care facilities). These changes are about survival. This paper analyses one such case in south-west Victoria, the Macarthur and District Community Outreach Service, and compares the outcomes with other similar Victorian rural health research projects. Particular attention is paid to the nature of the health services, the management of change and the proposed health outcomes for the local rural communities. In conclusion, it is argued that this study adds to the body of knowledge surrounding the construction of models of community health and development programming, These models impact upon future rural and remote area initiatives throughout Australia.

A proposed smart-card solution for Australian health services : the problems encountered

This case study describes the experience of a state government health department in evaluating the use of smart card technology to redesign health benefits programs for the disabled in Australia. The social and political context of the system is explained in detail, and the potential benefits and risks accruing to the government, health care intermediaries and the community are examined.

Promoting the social and emotional health of primary school-aged children: reviewing the evidence base for school-based interventions

Schools are key settings for promoting the social and emotional health and well-being of children. This study investigated the effectiveness of interventions to improve the social and emotional well-being of primary school-aged children. The protocol development stage of the proposed systematic review identified related and comparable research reviews, indicating a more useful review of reviews. Eight reviews of intervention effectiveness covering 322 primary studies were reviewed. The majority examined classroom-based interventions. Greater effectiveness results from a sustained focus on the promotion of mental health, on self-esteem and coping outcomes within the broad school climate, and on replicating positive impacts rather than the prevention of mental health problems. Conclusions are limited by short duration of studies, lack of detail of interventions, identified outcomes and socio-demographic data, and the relationship between processes and outcomes. This study has clearly shown how crucial carefully designed studies are in understanding strategies with potential to impact on the mental health and well-being of children.

Have the health services reoriented at all?

Recently, I had an opportunity to observe the workings of the health care system from the inside. I was admitted to a mixed surgical ward in an Australian public hospital with a mysterious ailment. My personal health required acute promotion.

My participant observation research demonstrated that the calls for action in the Ottawa Charter are still urgent. The Charter, twenty three years ago, stated

The responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health service institutions and governments. They must work together towards a health care system which contributes to the pursuit of health.

The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services. Health services need to embrace an expanded mandate which is sensitive and respects cultural needs. This mandate should support the needs of individuals and communities for a healthier life, and open channels between the health sector and broader social, political, economic and physical environmental components.

Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization of health services which refocuses on the total needs of the individual as a whole person.

The influence of strategic HRM and sector on perceived performance in health services organizations

In this study, we examine a variety of management characteristics of for-profit and not-for-profit organizations in the health services (HS) industry. Data collected from Australian senior executives are used to test the relationships between managerial constructs such as employee commitment, customer demandingness, strategic HRM orientation and the adoption of human capital-enhancing human resource (HR) practices and perceived overall performance. Data analysis conducted using the Partial Least Square Modeling show a statistically significant path from commitment to employees, customer demandingness and strategic HRM orientation to the adoption of human capital-enhancing HR practices (such as selective staffing, comprehensive training, and performance appraisal) to perceived organizational performance. The results also show that private sector health service organizations have a higher level of perceived performance.

What determines the size of occupational health services in UK universities?

Background There is wide, largely unexplained, variation in occupational health (OH) provision between UK employers.

Aim To explain the variation in OH provision across the UK university sector.

Methods Analyses of data from a survey of university OH services and from the Higher Education Statistics Agency. The outcome variable was clinical (doctor + nurse) staffing of the university's OH service. The explanatory variables examined were university size, income, research activity score and presence or absence of academic disciplines categorized by an expert panel as requiring a high level of OH provision.

Results All 117 UK universities were included and 93 (79%) responded; with exclusions and incomplete data, between 80 and 89 were included in analyses. There was wide variation in clinical OH staffing (range 0–8.4 full-time equivalents). Number of university staff explained 34% of the variation in OH staffing. After adjusting for other factors, neither the research activity nor the presence of high-needs disciplines appeared to be factors currently used by employers to determine their investment in OH.

Conclusions Government or other guidelines for university employers should take organizational size into account. Employers may need guidance on how to provide OH services proportionate to specific occupational hazards or other OH needs.