Self-reported access to and quality of healthcare for diabetes : Do the severely obese experience equal access?

Background: Given reported pejorative views that health professionals have about patients who are severely obese, we examined the self-reported views of the quality and availability of diabetes care from the perspective of adults with type 2 diabetes (T2DM), stratified by body mass index (BMI). Methods: 1795 respondents to the Diabetes MILES - Australia national survey had T2DM. Of these, 530 (30%) were severely obese (BMI ≥35 kg/m2) and these participants were matched with 530 controls (BMI <35 kg/m2). Data regarding participants' self-reported interactions with health practitioners and services were compared. Results: Over 70% of participants reported that their general practitioner was the professional they relied on most for diabetes care. There were no betweengroup differences in patient-reported availability of health services, quality of interaction with health practitioners, resources and support for selfmanagement, or access to almost all diabetes services. Discussion: Participants who were severely obese did not generally report greater difficulty in accessing diabetes care.

Considering the ways in which anti-oppressive practice principles can inform health research

All research that investigates therapeutic practice should be conducted with the aim to develop and support good procedures of inquiry. An anti-oppressive practice approach within health research provides a way to systematically examine research procedures and motivations to increase the potential that the resultant research will yield ethical and just results. In this paper two music therapy researchers consider how anti-oppressive practices can address real life problems and be applicable to real life situations; from questions of participation, to developing the research question, recruitment, consent, and further steps of the research process. The goal of this paper is to examine issues arising when considering anti-oppressive practices and healthcare research practices from the perspective of the authors’ experience of music therapy research.

An evaluation framework for the qualitative investigation of a physical activity prescription program in rural Victoria

Physical activity (PA) has consistently been shown to improve ones' physical, social and mental health. Hence, the rationale for promoting regular physical activity is relatively straightforward. However, what is less clear from the literature is the mix of strategies, (i.e. 'what is working and why?'), to increase in physical activity levels within a population. Of particular interest to primary care is the concept of Physical Activity Prescription Programs (PAPPs) delivered by general practitioners (GPs).

Several examples of a PAPP exist within England, America, New Zealand and Australia. These all aim to encourage GPs to deliver physical activity advice to their patients effectively and in a timely manner. Notwithstanding, the authors of a recent review of published literature on PAPPs, reveal a deficit of evidence regarding the components for successful PA interventions.

This research through an ethnographic enquiry aims to build on the evidence formulated to date. Through a case study research design, the researcher has developed a methodology to define what is/is not working within this recent trend.

In two rural Divisions of GP, participants have been identified as key stakeholders in the implementation of a PAPPs. They are categorised according to three theoretical paradigms, namely, Policy Makers, Linkers and Adaptors. Following this the three paradigms will be studied on the contextual factors, the characteristics and behaviours of members within all three paradigms. The study has also further defined certain elements for investigation, these include the:
intention of the players
effort undertaken by players, and
effect of parties within.

Primarily qualitative data will be collected; through Desk Analysis (Policies, Strategic and Business plans), Site Visits (Participant Observation) and semi-structured interviews. This presentation defines a qualitative framework and methodology for investigating the outcome of programs that historically has been evaluated using quantitative measures. Hence, the author of this study aims to present a qualitative investigation and subsequent results, defining aspects of a PAPP that allow for successful and sustainable implementation.

A rural model for delivering regional continuing nurse education by videoconference : a pilot project

Background : The South West Alliance of Rural Health (SWARH) is an alliance of 33 health care agencies scattered across South West Victoria over a total area of approximately 46 000 square kilometres. SWARH was established to develop and install information technology (IT) infrastructure, hardware and software for all acute public hospitals in the region. The Rural Intercampus Learning Environment Project (March 2003-March 2004) piloted the use of the SWARH regional area IT network to deliver a program of continuing education to Division 1 registered nurses, utilising the expertise of local health professionals. The study was funded by the Department of Human Services, Victoria.

Aims & rationale/Objectives : Establish partnerships for multi-site delivery of programs.
Develop existing educational programs and resources for video and intranet delivery (including IT training and change management).
Collaboratively deliver educational programs utilising SWARHnet to six rural sites.
Explore issues related to the use of the technology in continuing education for rural nurses and the implications for practice.

Methods : Key informant interviews, paper-based audits, and focus groups informed the development of the schedule of the program. Session participants completed a 2-page evaluation questionnaire.

Principal findings : Participants must own the process.
Videoconferencing should be considered an adjunct to traditional education programs.
Videoconferencing most suitable for short education sessions as opposed to full-day workshops.
IT problems are unpredictable and frustrating for all concerned.
IT awareness/training of staff is essential.

Implications : The project proposes a model for coordinating and delivering regional continuing education which has been shown to improve access to education programs across multiple sites. It provides a sustainable organisational framework for the program, which could be applied in continuing professional education programs of other rural health professions, such as dentistry, medicine, allied health and pharmacy.

Presentation type : Poster

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.

Global priority setting for Cochrane systematic reviews of health promotion and public health research

Background: Systematic reviews of health promotion and public health interventions are increasingly being conducted to assist public policy decision making. Many intra-country initiatives have been established to conduct systematic reviews in their relevant public health areas. The Cochrane Collaboration, an international organisation established to conduct and publish systematic reviews of healthcare interventions, is committed to high quality reviews that are regularly updated, published electronically, and meeting the needs of the consumers.

Aims: To identify global priorities for Cochrane systematic reviews of public health topics.

Methods: Systematic reviews of public health interventions were identified and mapped against global health risks. Global health organisations were engaged and nominated policy-urgent titles, evidence based selection criteria were applied to set priorities.

Results: 26 priority systematic review titles were identified, addressing interventions such as community building activities, pre-natal and early infancy psychosocial outcomes, and improving the nutrition status of refugee and displaced populations.

Discussion: The 26 priority titles provide an opportunity for potential reviewers and indeed, the Cochrane Collaboration as a whole, to address the previously unmet needs of global health policy and research agencies.

Object-oriented security modelling for healthcare

With the convergence of paper to electronic, the health industry is relying more on technology to maintain and update the well-being of patients. This reliance on technology requires an acute level of protection from unwanted technological disasters and/or human threats. Research shows insufficiencies with the implementation and use of security controls; as well as current analysis methods lacking the techniques to analyse technical and social aspects of security. The aim of this paper is to introduce an information security evaluation methodology for health information systems based on UML.

Managing complex medication regimens: perspectives of consumers with osteoarthritis and healthcare professionals

BACKGROUND: Managing medications is complex, particularly for consumers with multiple coexisting conditions for whom benefits and adverse effects are unpredictable and health priorities may be variable.

OBJECTIVE: To investigate perceptions of and experiences with managing drug regimens from the perspectives of consumers with osteoarthritis and coexisting chronic conditions and of healthcare professionals from diverse backgrounds.

METHODS: Using an exploratory research design, focus groups were formed with 34 consumers and 19 healthcare professionals. Individual interviews were undertaken with 3 community medical practitioners.

RESULTS: Consumers' management of medications was explored in terms of 3 themes: administration of medications, provision of information, and the perceived role of healthcare professionals. In general, consumers lacked understanding regarding the reason that they were prescribed certain medications. Since all consumer participants had at least 2 chronic conditions, they were taking many drugs to relieve undesirable symptoms. Some consumers were unable to achieve improved pain relief and were reluctant to take analgesics prescribed on an as - needed basis. Healthcare professionals discussed the importance of using non-pharmacologic measures to improve symptoms; however, consumers stated that physicians encourage them to continue using medications, often for prolonged periods, even when these agents are not helpful.

CONCLUSIONS: Consumers were dissatisfied about the complexity of their medication regimens and also lacked understanding as to how to take their drugs effectively. Dedicated time should be devoted during medical consultations to facilitate verbal exchange of information about medications. Pharmacists must communicate regularly with physicians about consumers' medication needs to help preempt any problems that may arise. Instructions need to be revised through collaboration between physicians and pharmacists so that "as needed" directions provide more explicit advice about when and how to use such drugs. Future research, using large, generalizable samples, should examine trends related to consumers' experiences of symptomatic relief from chronic conditions and their understandings about medications.

Managing FM (support services): business risks in the healthcare sector

This paper presents research findings of 365 NHS Trust executives in the UK and builds on work carried out on risk perceptions and treatment in facilities management operations and business support activities in the NHS Trusts. The research utilises a business approach of viewing healthcare facilities not only as fixed “assets” occupying hospital sites and space, but it also considers them as that “tangible” part of the service chain process underpinning the provision of clinical services to both internal (departments or directorates) and external customers. The research found that customer satisfaction, service delivery certainty, customer involvement, service quality reliability, health and safety are highly rated by the NHS executives. The paper classifies healthcare related risk constructs into seven elements namely: customer care, corporate, legal, commercial finance and economics, business transfer, and facilities transmitted

Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.