Relationship between body mass index and the use of healthcare services in Australia

Objective: To examine the relationship between body mass index (BMI) and the use of medical and preventive health services. Research Methods and Procedures: This study involved secondary analysis of weighted data from the Australian 1995 National Health Survey. The study was a population survey designed to obtain national benchmark information about a range of health-related issues. Data were available from 17,033 men and 17,174 women, 20 years or age. BMI, based on self-reported weight and height, was analyzed in relation to the use of medical services and preventive health services. Results: A positive relationship was found between BMI and medical service use, such as medication use, visits to hospital accident and emergency departments (for women only); doctor visits, visits to a hospital outpatient clinics; and visits to other health professionals (for women only). A negative relationship was found in women between BMI and preventive health services. Underweight women were found to be significantly less likely to have Papanicolaou smear tests, breast examinations, and mammograms. Discussion: This research shows that people who fall outside the healthy weight range are more likely to use a range of medical services. Given that the BMI of industrialized populations appears to be increasing, this has important ramifications for health service planning and reinforces the need for obesity prevention strategies at a population level.

Economic evaluation of Australian stroke services: a prospective, multicenter study comparing dedicated stroke units with other care modalities

Background and Purpose: Level I evidence from randomized controlled trials demonstrates that the model of hospital care influences stroke outcomes; however, the economic evaluation of such is limited. An economic appraisal of 3 acute stroke care models was facilitated through the Stroke Care Outcomes: Providing Effective Services (SCOPES) study in Melbourne, Australia. The aim was to describe resource use up to 28 weeks poststroke for each model and examine the cost-effectiveness of stroke care units (SCUs). Methods: A prospective, multicenter, cohort study design was used. Costs and outcomes of stroke patients receiving 100% treatment in 1 of 3 inpatient care models (SCUs, mobile service, conventional care) were compared. Health-sector resource use up to 28 weeks was measured in 1999. Outcomes were thorough adherence to a suite of important clinical processes and the number of severe inpatient complications. Results: The sample comprised 395 participants (mean age 73 [SD 14], 77% first-ever strokes, males 53%). When compared with conventional care (n=84), costs for mobile service (n=209) were significantly higher (P=0.024), but borderline for SCU (n=102, P=0.08; $AUD12 251; $AUD15 903; $AUD15 383 respectively). This was primarily explained by the greater use of specialist medical services. The incremental cost-effectiveness of SCUs over conventional care was $AUD9867 per patient achieving thorough adherence to clinical processes and $AUD16 372 per patient with severe complications avoided, based on costs to 28 weeks. Conclusions: Although acute SCU costs are generally higher, they are more cost-effective than either mobile service or conventional care.

The role of dietary choices and medical expenditures on health outcomes when health shocks are endogenous

This paper presents a theoretical framework that incorporates both a role for preventive actions (through food choices) and treatment (through medical services) to improve health outcomes. In particular, we allow for an agent's calorie decision to alter the distribution of future health shocks. Once a shock is realized, medical care can be used to improve health outcomes. Thus this model can help us determine the role of the preventive actions and treatments in producing better health outcomes and study the links between an agent's choice of medical services and her diet. This framework suggests that wealthier individuals, on average, have lower morbidity rates and lead a healthier lifestyle than lower income agents. Finally, our numerical exercise captures U.S. cross-sectional facts regarding the choice of diet, medical expenditures as well as health and non-food expenditures.

Enabling electronic medicine at Kiwicare : the case of video conferencing adoption for psychiatry in New Zealand

Telemedicine emerges as a viable solution to New Zealand health providers in reaching out to rural patients, in offering medical services and conducting administrative meetings and training. No research exists about adoption of telemedicine in New Zealand. The purpose of this case study was to explain factors influencing adoption of telemedicine utilizing video conferencing technology (TMVC) within a New Zealand hospital known as KiwiCare. Since TMVC is part of IT, tackling it from within technological innovation literature may assist in providing an insight into its adoption within KiwiCare and into the literature. Findings indicate weak presence of critical assessment into technological innovation factors prior to the adoption decision, thereby leading to its weak utilization. Factors like complexity, compatibility and trialability were not assessed extensively by KiwiCare and would have hindered TMVC adoption. TMVC was mainly assessed according to its relative advantage and to its cost effectiveness along with other facilitating and accelerating factors. This is essential but should be alongside technological and other influencing factors highlighted in the literature.

An `upside-down` view of rural health care

Access to high quality health care services plays an important part in the health of rural communities and individuals. This fact is reflected in efforts by governments to improve the quality of such services through better targeting of funds and more efficient management of services. In Australia, the difficulties experienced by rural communities in attracting and retaining doctors has long been recognized as a contributing factor to the relatively higher levels of morbidity and mortality in rural areas. However, this paper, based on a study of two small rural communities in Australia, suggests that resolving the health problems of rural communities will require more than simply increasing the quality and accessibility of health services. Health and well-being in such communities relates as much to the sense of community cohesion as it does to the direct provision of medical services. Over recent years, that cohesion has diminished, undermined in part by government policies that have fuelled an exodus from small rural communities to urban areas. Until governments begin to take an 'upside-down' perspective, focusing on building healthy communities rather than simply on building hospitals to make communities healthy, the disadvantages faced by rural people will continue to be exacerbated.

Teledermatology: The Case of Adoption and Diffusion of Telemedicine Health Waikato in New Zealand

Telemedicine emerged as a possible solution to New Zealand health providers in reaching out to rural patients, by offering medical services and conducting administrative meetings and training. However, despite the rapid growth and high visibility of these projects in countries like the United States, relatively few patients are now being seen through telemedicine. Accordingly, this research attempts to investigate telemedicine's effectiveness in New Zealand by using a theoretical framework. Thus, the purpose of this paper is to explain factors influencing the adoption and diffusion of telemedicine utilising the video conferencing technology (TMVC) for dermatology within Health Waikato Ltd. (HW).

Pathways to health through Australian woodlands and forests: `Sign-posts` from recent research and practice

Health is inherently 'ecological' and the natural environment plays a crucial role in human health and well-being. Yet we do not necessarily design, manage or market such areas in ways that acknowledge this link. This paper draws on recent research by a Deakin University team exploring the links between use of and involvement in the maintenance of forests/woodlands, and health and well-being outcomes. Qualitative and quantitative methods have been used to collect data from forest/woodland users and tram volunteers contributing to management and maintenance of such areas, concerning their perceptions of the impacts of the experience
on their health and well-being. In two of the projects, samples of 'users' and 'volunteers' were compared with samples 'non-users' and 'non-volunteers'. Several of the studies included the use of scales of self-rated health, social cohesion, and frequency of use of medical services.The studies have identified a range of perceived physical, mental and social health benefits resulting from use of and/or engagement with forests/woodlands. Study findings have implications for design, management and marketing of such areas, since they identity factors influencing use of and engagement with such areas, and have the potential to promote more widespread recognition of the value of such areas and more commitment to them by individuals, communities and governments. The challenge for us is to build on this research base to more clearly Signpost the mutually beneficial links between forest and woodland ecosystems and human health and well-being, creating new and better pathways to a healthy future.

Health risk behaviours and health care needs among people with psychiatric illness

This paper presents findings from two studies. Study 1 explored differences between people with psychiatric illness (PPI) (N=144) and the general population (N=151) in levels of low-fat diet, exercise and smoking. Study 2 investigated barriers and health care needs of PPI (N=60). The prevalence of overweight, cigarette smoking and sedentary lifestyle were significantly greater among PPI than the general population. Major predictors were limited social support, knowledge of correct dietary principles, lower self-efficacy, psychiatric symptomatology and various psychotropic drugs. The findings demonstrated that PPI over-used medical services but under-used preventive services due to inaccessibility, lower satisfaction and knowledge of services.

Baby boomers and property busts

In the latter half of the 20th century the baby boom generation created an increased demand for many aspects of society including education, housing and medical services. Only now are the negative aspects resulting from this unique demand being fully considered. One of the most important issues is the impact on residential housing values which directly or indirectly affects most residents whether owning, buying or renting.
The relationship between the ageing of the baby boomers and housing values is a current topic of debate throughout the world. Particularly in the U.S.A. warnings have been sounded of a dramatic decrease in property values causing a property bust as the baby boomers move into the older generation.
This paper revisits the baby boom generation and discusses previous research in the worldwide debate concerning their impact on housing values. The status of the Australian baby boomers is examined and the future impact on residential house values in Australia is contemplated.

Paramedic identification of stroke : community validation of the Melbourne ambulance stroke screen

Background: Paramedics require an effective prehospital tool to eliminate stroke mimics and to assist in the identification of suitable candidates for thrombolytic therapy. The Faster Access to Stroke Therapies study combined two validated stroke assessment tools (the Los Angeles Prehospital Stroke Screen, LAPSS, and the Cincinnati Prehospital Stroke Scale, CPSS) to form the Melbourne Ambulance Stroke Screen (MASS), and performed an in-field validation by Australian paramedics.

Methods: Over a 12-month period, 18 paramedics participated in the Faster Access to Stroke Therapies study and prospectively collected data contained in the MASS on all stroke dispatches, and for other patients with a focal neurological deficit. Sensitivity and specificity analysis of the LAPSS, CPSS and MASS was calculated and equivalence analysis performed.

Results: Paramedics completed 100 MASS assessments for 73 (73%) stroke/transient ischemic attack patients and 27 (27%) stroke mimics. The sensitivity of the MASS (90%, 95% CI: 81-96%) showed statistical equivalence to the sensitivity of the CPSS (95%, p = 0.45) and superiority to the LAPSS (78%, p = 0.008). The specificity of the MASS (74%, 95% CI: 53-88%) was equivalent to that of the LAPSS (85%, p = 0.25) and superior to the CPSS (54%, p = 0.007). All patients misidentified by the MASS (7 strokes, 7 mimics) were ineligible for thrombolytic therapy.

Conclusion: The MASS is simple to use, with accurate prehospital identification of stroke. It distinguishes stroke mimics, with good recognition of suitable patients for thrombolytic therapy.

Cardiovascular health behaviours and health needs among people with psychiatric disabilities

Recent research in Australia has found that people with a mental illness experience higher mortality rates from preventable illnesses, such as cardiovascular disease, respiratory disease and diabetes compared to the general population. Lifestyle and other behavioural factors contribute significantly to these illnesses. Lifestyle behaviours that affect these illnesses include lack of physical activity, consumption of a poor diet and cigarette smoking. Research on the influence of these factors has been mainly directed towards the mainstream population in Australia. Consequently, there remains limited understanding of health behaviours among individuals with psychiatric disabilities, their health needs, or factors influencing their participation in protective health behaviours. This thesis presents findings from two studies. Study 1 evaluated the utility of the main components of Roger’s (1983) Protection Motivation Theory (PMT) to explain health behaviours among people with a mental illness. A clinical population of individuals with schizophrenia (N=83), Major Depressive Disorder (MDD) (N=70) and individuals without a mental illness (N=147) participated in the study. Respondents provided information on intentions and self-reported behaviour of engaging in physical activity, following a low-fat diet, and stopping smoking. Study 2 investigated the health care service needs of people with psychiatric disabilities (N=20). Results indicated that the prevalence of overweight, cigarette smoking and a sedentary lifestyle were significantly greater among people with a mental illness compared to that reported for individuals without a mental illness. Major predictors of the lack of intentions to adopt health behaviours among individuals with schizophrenia and MDD were high levels of fear of cardiovascular disease, lack of knowledge of correct dietary principles, lower self-efficacy, a limited social support network and a high level of psychiatric symptoms. In addition, findings demonstrated that psychiatric patients are disproportionately higher users of medical services, but they are under-users of preventive medical care services. These differences are primarily due to a lack of focus on preventive health, feelings of disempowerment and lower satisfaction of patient-doctor relationships. Implications of these results are discussed in terms of designing education and preventive programs for individuals with schizophrenia and MDD.

Health system expenditure on disease and injury in Australia, 2000–01

This publication presents estimates of health expenditure on disease and injury in Australia in 2000-01, classified by disease or injury group, age and sex. The estimates are available by area of expenditure - hospitals, high-level residential aged care, medical services, other professional services, pharmaceuticals and research.The 2000-01 disease expenditure estimates were based on the 176 disease and injury conditions used in the first Australian burden of disease study (AIHW: Mathers et al. 1999), with the inclusion of some additional sub-categories. This report aggregates these conditions into the 19 broad disease groups used by the burden of disease study. Disease expenditure estimates are also presented for selected conditions in the seven National Health Priority Areas and by age and sex.

The rural and regional ambulance paramedic : moving beyond emergency response - report to the Council of Ambulance Authorities Inc. March 2006

Serious long-term recruitment and retention problems amongst rural health workers in Australiacontribute to inequitable health service access for rural Australians. In response, new healthcaremodels with flexible workforce roles are emerging including expanded-scope paramedic roles.

This research project was born from the view that expanding ambulance paramedics’ scope ofpractice offers the potential to improve patient care and the general health of the community.New healthcare models with flexible workforce roles are clearly needed in rural Australia andexpanded-scope paramedic roles are valuable innovations.

Three phases of the Pacific Islands Project (1995–2010)

The Pacific Islands Project (PIP), funded by AusAid and managed by the Royal Australasian College of Surgeons (RACS), has progressed through three phases from 1995 to 2010. During this time, it has sent over 520 teams to 11 Pacific Island Countries, providing over 60 000 consultations and some 16 000 procedures. In addition to this delivery of specialist medical and surgical services that were not previously available in-country, the project has contributed as a partner in capacity building with the Fiji School of Medicine and Ministries of Health of the individual nations. By 2011, Fiji School of Medicine, which began postgraduate specialist training in 1998, had awarded 51 doctors a diploma in surgery (1 year), 20 of whom had completed their Masters in Medicine (4 years). PIP was independently evaluated on completion of every phase, including the bridging Phase III (2006–2010). The project delivered on its design, to deliver services, and also helped build capacity. The relationship established with the RACS throughout the project allowed Pacific Island graduates to access the Rowan Nicks scholarship, and the majority of MMed graduates received International Travel Grants to attend the Annual Scientific Meeting. PIP has been a highly successful partnership in delivering and building specialist medical services. Although AusAid contributed some $20 million over 16 years, the value added from pro bono contributions by Specialist Teams, Specialty Coordinators and the Project Directors amounted to an equivalent amount. With the emergence of Pacific Island-trained specialists, PIP is ready to move into a new phase where the agendas are set, monitored and managed within the Pacific, and RACS fulfils the role of a service provider. A critical mass of Pacific Island surgeons has been trained, so that sub-specialization will be an option for the general surgeons of the larger island nations.

Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approach

Aim.  To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. Background.  Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management. Design.  Systematic review. Method.  The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage). Results.  Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase. Conclusions.  Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design. Relevance to clinical practice.  To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high-level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family.