Patterns and Characteristics of Ambulance Attendance at Heroin Overdose at a Local-Area Level in Melbourne, Australia: Implications for Service Provision

The monitoring of heroin use and related harms is undertaken in Australia with a view to inform policy responses. Some surveillance data on heroin-related harms is well suited to inform the planning and delivery of heroin-related services, such as needle and syringe provision. This article examines local-area variation in the characteristics of nonfatal heroin overdoses attended by ambulances in Melbourne over the period June 1998 to October 2000 to inform the delivery of services to the heroin-using population in Melbourne.

Service provision factors that affect the health and wellbeing of people living in a lower SES environment: the perspective of service providers

Inequalities in health and wellbeing within low socioeconomic (SES)  environments are well documented. Factors inherent to the health care system itself, such as inaccessible, inflexible or inappropriate seroiceprovision, contribute to the poorer health status ofresidents oflow SES areas. This paper explores the issues ofseroice provision in low SES areas, documenting the perceptions of seroice providers about the seroice needs of residents, in order to understand the systemic factors that negatively impact on health and wellbeing. A total of54 health and welfare seroice providers from two adjacent low SES suburbs within regional Victoria were interoiewed using qualitative research methods. Keyfindings indicate that successful navigation of health care seroices by residents within these low SES environments is being impeded by issues ofaccess, a lack ofappropriate early interoention options or measures, and general resident disempowerment. Central to the improvement of seroice provision is the need for seroices to become economically, geographically and culturally accessible. In particular, the importance of community involvement in health planning and health promoting seroices must be reflected in the ethos ofseroice provision.

An evidence-based approach to podiatry workforce enhancement and service provision in Western Victoria

Aims & rationale/Objectives : The objectives of this workforce and service enhancement project include: (i) establishing the magnitude of podiatry needs; and (ii) developing a model that can be used to enhance podiatry workforce and podiatry services.
Methods : Surveys to podiatrists and health agencies to determine vacancies, waiting lists, work practices and recruitment methods. Desktop analysis of predictive data for burden of disease and population changes per local government area (LGA). Meetings with podiatrists and their professional association, health care agencies, universities, and Local and State Governments.
Principal findings : Results showed
Long podiatry waiting lists (up to 12 months)
Podiatry vacancies and service gaps
Absence of qualified foot assistants
A high chronic disease burden
A population age mix that is predicted to change dramatically over the next 25 years in favour of those who are 60 years of age or older
Ineffective recruitment methods
The workforce enhancement model that emanated from the meetings with the steering group includes podiatrists as well as auxiliaries such as foot-care assistants who work together in an interprofessional model of care that expands across the region. In addition to training foot-care assistants and the development of a podiatry teaching clinic to enhance student placement, the model builds onto a current continuous professional development program for allied health professionals.
Discussion : Although the allied health workforce (including podiatry) is playing an increasingly important role in the prevention and treatment of chronic diseases, rural areas in particular are disadvantaged by recruitment and retention problems. The podiatry workforce shortage is compounded by ageing populations. Age is associated with increased podiatry usage due to chronic diseases such as diabetes, cardiovascular disease and osteoarthritis.
Implications : A strategic plan developed in consultation with stakeholders aims to improve rural podiatry services in a sustainable manner. The project will be implemented when adequate funding is allocated this year and will be evaluated on its impact on services.
Presentation type : Paper

Our health in our hands : building effective community partnerships for rural health service provision

This paper reports findings from a study in two small Tasmanian rural communities that examined the process of developing and sustaining partnerships between health services and their communities. It identifies a generic framework for partnership development that appears to be common to partnerships, regardless of their purpose or of partners involved. The framework comprises ten predictors or indicators of effectiveness, and a sequential nine-stage partnership development process. Integral to the framework are social capital, and the leadership practices of health service and community leaders. The influence of context on the partnership development process is also examined, with reference to historical precedent, age or maturity of the partnership, and community readiness.

Diabetes service provision : a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes

Aims To explore Pakistani and Indian patients' experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services.

Design Qualitative, interview study involving 23 Pakistani and nine Indian patients with Type 2 diabetes recruited from general practices and the local community in Edinburgh, Scotland. Data collection and analysis occurred concurrently and recruitment continued until no new themes emerged from the interviews.

Results Respondents expressed gratitude for the availability of free diabetes services in Britain, as they were used to having to pay to access health care on the Indian subcontinent. Most looked to services for the prompt detection and treatment of complications, rather than the provision of advice about managing their condition. As respondents attached importance to receiving physical examinations, they could be disappointed when these were not offered by health-care professionals. They disliked relying on interpreters and identified a need for bilingual professionals with whom they could discuss their diabetes care directly.

Conclusions Gratitude for free services in Britain may instil a sense of indebtedness which makes it difficult for Pakistanis and Indians to be critical of their diabetes care. Health-care professionals may need to describe their roles carefully, and explain how different diabetes services fit together, to avoid Pakistani and Indian patients perceiving treatment as unsatisfactory. Whilst linkworker schemes may meet patients' need to receive culturally sensitive information in their first language, work is needed to assess their effectiveness and sustainability.

Dual disability : the inherent difficulties in service provision and client management

Dual disability is a particularly important area of study, as the co-occurence of intellectual and psychiatric disability presents signficant challenges to professionals within the health and disability services. Four case studies are presented.

Violent offender rehabilitation and the therapeutic community model of treatment : towards integrated service provision?

Rehabilitation programs for violent offenders are at an early stage in their development, and there is currently only a very limited empirical base from which to draw any conclusions about treatment effectiveness (Jolliffe and Farrington, 2007). Therapeutic communities for offender populations have a much longer history, although the effects of applying this model of treatment to violent offenders have not been systematically investigated. This paper reviews the content and evidence supporting both violent offender treatment programs and therapeutic community models, concluding that approaches to treatment which combine features of both may prove to be most successful, and warrant further development and evaluation.

Rural and regional Australian public accounting firm services : service provision, concerns and tensions

Public accounting firms provide a necessary and important service for rural and regional areas. However, the provision of high-quality services is hindered by a number of factors. This paper reports the findings from a large-scale survey of professional accounting firm practitioners located in rural and regional Australia, identifying factors causing concerns and tensions and quantifying their scope and importance. Prominent concerns and tensions identified include adverse effects arising from the employment market, communications technology developments and legislation such as the Corporate Law Economic Reform Program (Audit Reform and Corporate Disclosure) Act 2004 and the Financial Services Reform Act 2001.

Optimising health literacy and access of service provision to community dwelling older people with diabetes receiving home nursing support

Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS).

Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method.

Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice.

Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

Diabetes care provision: barriers, enablers and service needs of young adults with Type 1 diabetes from a region of social disadvantage

AIMS:
To determine the barriers to and enablers of engaging with specialist diabetes care and the service requirements of young adults with Type 1 diabetes mellitus from a low socio-economic, multicultural region.

METHODS:
A cross-sectional survey targeted 357 young adults with Type 1 diabetes, aged 18-30 years. Participants completed questions about barriers/enablers to accessing diabetes care and service preferences, self-reported HbA(1c), plus measures of diabetes-related distress (Problem Areas in Diabetes), depression/anxiety (Hospital Anxiety and Depression Scale), and illness perceptions (Brief Illness Perceptions Questionnaire).

RESULTS:
Eighty-six (24%) responses were received [55 (64%) female; mean ± sd age 24 ± 4 years; diabetes duration 12 ± 7 years; HbA(1c) 68 ± 16 mmol/mol (8.4 ± 1.5%)]. Logistical barriers to attending diabetes care were reported; for example, time constraints (30%), transportation (26%) and cost (21%). However, 'a previous unsatisfactory diabetes health experience' was cited as a barrier by 27%. Enablers were largely matched to overcoming these barriers. Over 90% preferred a multidisciplinary team environment, close to home, with after-hours appointment times. Forty per cent reported severe diabetes-related distress, 19% reported moderate-to-severe depressive symptoms and 50% reported moderate-to-severe anxiety.

CONCLUSIONS:
Among these young adults with Type 1 diabetes, glycaemic control was suboptimal and emotional distress common. They had identifiable logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with flexible service provision. A substantial minority were discouraged by previous unsatisfactory experiences, suggesting health providers need to improve their interactions with young adults. This research will inform the design of life-stage-appropriate diabetes services targeting optimal engagement, access, attendance and ultimately improved healthcare outcomes in this vulnerable population.

Access to breast prostheses via a government-funded service in Victoria, Australia

For many women, the only alternative to breast reconstruction following a mastectomy is to use external prostheses, which need replacing regularly at a cost of up to $395 per prosthesis. Commonwealth and state governments across Australia have responded to this need by providing subsidies to assist in the purchase of breast prostheses. However, current arrangements have been highly variable and sometimes difficult to access. As part of a larger review of breast pros-thesis services in Victoria, Australia, the aim of this research was to evaluate client satisfaction among Victorian women who accessed funds through the State Government's Aids and Equipment Program, compare the responses of the program service providers with the experiences of clients accessing funding, and identify opportunities to improve service provision.

eCommerce in service industries : extending the socio-technical paradigm

The socio-technical framework (STF) is useful for describing how technologies are embedded in social systems and how people, groups and technologies are interrelated. This perspective, however, lacks theoretical specificity and has limited usefulness in explaining the dynamics of actual situations. In this paper we address the question of how to extend the STF to better analyse technologies in their social context. We build on the STF by including the concept of ‘information ecology’ and research on service provision to suggest a more empirically focussed way of analysing the relationships between people and technologies. In particular, we examine changes that have occurred as B2C eCommerce technologies have been implemented in service organisations, using case study findings from retail banking to introduce the concept of ‘Coactive Commerce Systems’. This concept provides a theoretically based descriptor for understanding the technologically-mediated interrelationships between organisations and their customers.