Do rural consumers expect a prescription from their GP visit? Investigation of patients' expectations for a prescription and doctors' prescribing decisions in rural Australia

Objective: To assess patients’ expectation for receiving a prescription and GPs’ perceptions of patient expectation for a prescription. Design: Matched questionnaire study completed by patients and GPs. Setting: Seven general practices in rural Queensland, Australia. Subjects: The subjects were 481 patients consulting 17 GPs. Main outcome measures: Patients’ expectation for receiving a prescription and GPs’ perceptions of patients’ expectation. Results: Ideal expectation (hope) for a prescription was expressed by 57% (274/481) of patients. Sixty-six per cent (313/481) thought it was likely that the doctor would actually give them a prescription. Doctors accurately predicted hope or lack of hope for a prescription in 65% (314/481) of consultations, but were inaccurate in 19% (93/481). A prescription was written in 55% of consultations. No increase in patients’ expectation, doctors’ perceptions of expectation, or decision to prescribe were detected for patients living a greater distance from the doctors. Conclusions: Rural patients demonstrated similar rates of hope for a prescription to those found in previous urban studies. Rural doctors seem to be similarly ‘accurate’ and ‘inaccurate’ in determining patients’ expectations. Rates of prescribing were comparable to urban rates. Distance was not found to increase the level of patient expectation, affect the doctors’ perception or to influence the decision to prescribe.

Preventive social health programs : are they Australia's answer to rising health care costs in rural communities?

Although we have good evidence to support the notion that early intervention, prevention and community education programs can mitigate the impact of preventable disease, expanded primary health care is also being promoted by Australian governments as a panacea for reducing growth in demand generally. While preventive programs do reduce acute demand, they may not do so the extent that resources, currently allocated to the acute sector, can be substituted to provide the additional primary care services necessary to reduce acute demand permanently. These developments have particular relevance for rural and isolated communities where access to acute services is already very limited. What appears to be occurring, in rural South Australia at least, is that traditional acute services are being reduced and replaced with lower level care and social intervention programs. This is well and good, but eventually the acute care being provided in rural health units now will still need to be provided by other units elsewhere and probably at much higher cost to the system and to consumers. Where rural communities have previously managed much of their own acute service demand, they may now be forced to send patients to more distant centres for care but at much greater social and economic cost to individuals and the system.

Energy and communication infrastructure for disaster resilience in rural and regional Australia

Energy and communication infrastructure for disaster resilience in rural and regional Australia, Regional Studies. Australia's rural and regional areas are prone to frequent natural disasters with extensive socio-economic impacts. Resultant damage to large-grid energy and communication networks can lead to widespread, lengthy outages, signalling the need for alternative infrastructure developments to aid disaster risk reduction and resilience-building (DRRR). Distributed smart renewable energy micro-grid systems can mitigate adverse impacts through outage prevention and rapid service restoration, increase rural and regional resilience, and offer communities opportunities for socio-economic development. However, renewable energy and digital communications policy uncertainty currently adversely affects disaster preparedness and investment in alternative infrastructure, undermining rural and regional futures.

Reinvigorating the rural

Presents information on the projects underway by Melbourne landscape architects, Urban Initiatives, in Shepparton, Victoria. Comparison of the Urban Initiatives design policies in Melbourne with those in Shepparton; Importance of design to public space; Quality of the design of the Shepparton projects.

Enhancing digital road map with lane details extracted from large-scale stereo aerial imagery using object-oriented image analysis

Precise, up-to-date and increasingly detailed road maps are crucial for various advanced road applications, such as lane-level vehicle navigation, and advanced driver assistant systems. With the very high resolution (VHR) imagery from digital airborne sources, it will greatly facilitate the data acquisition, data collection and updates if the road details can be automatically extracted from the aerial images. In this paper, we proposed an effective approach to detect road lane information from aerial images with employment of the object-oriented image analysis method. Our proposed algorithm starts with constructing the DSM and true orthophotos from the stereo images. The road lane details are detected using an object-oriented rule based image classification approach. Due to the affection of other objects with similar spectral and geometrical attributes, the extracted road lanes are filtered with the road surface obtained by a progressive two-class decision classifier. The generated road network is evaluated using the datasets provided by Queensland department of Main Roads. The evaluation shows completeness values that range between 76% and 98% and correctness values that range between 82% and 97%.

Survey of novice motorcycle riders and their riding experience before licensing

Graduated licensing schemes have been found to reduce the crash risk of young novice drivers, but there is less evidence of their success with novice motorcycle riders. This study examined the riding experience of a sample of Australian learner-riders to establish the extent and variety of their riding practice during the learner stage. Riders completed an anonymous questionnaire at a compulsory rider-training course for the licensing test. The majority of participants were male (81%) with an average age of 33 years. They worked full time (81%), held an unrestricted driver's license (81%), and owned the motorcycle that they rode (79%). These riders had held their learner's license for an average of 6 months. On average, they rode 6.4 h/week. By the time they attempted the rider-licensing test, they had ridden a total of 101 h. Their total hours of on-road practice were comparable to those of learner-drivers at the same stage of licensing, but they had less experience in adverse or challenging road conditions. A substantial proportion had little or no experience of riding in the rain (57%), at night (36%), in heavy traffic (22%), on winding rural roads (52%), or on high-speed roads (51%). These findings highlight the differences in the learning processes between unsupervised novice motorcycle riders and supervised novice drivers. Further research is necessary to clarify whether specifying the conditions under which riders should practice during the graduated licensing process would likely reduce or increase their crash risk.

Evaluation of the cost-effectiveness of strategies claiming to reduce the risk of surgical site infections following primary total hip arthroplasty

Background Total hip arthroplasty (THA) is a commonly performed procedure and numbers are increasing with ageing populations. One of the most serious complications in THA are surgical site infections (SSIs), caused by pathogens entering the wound during the procedure. SSIs are associated with a substantial burden for health services, increased mortality and reduced functional outcomes in patients. Numerous approaches to preventing these infections exist but there is no gold standard in practice and the cost-effectiveness of alternate strategies is largely unknown. Objectives The aim of this project was to evaluate the cost-effectiveness of strategies claiming to reduce deep surgical site infections following total hip arthroplasty in Australia. The objectives were: 1. Identification of competing strategies or combinations of strategies that are clinically relevant to the control of SSI related to hip arthroplasty 2. Evidence synthesis and pooling of results to assess the volume and quality of evidence claiming to reduce the risk of SSI following total hip arthroplasty 3. Construction of an economic decision model incorporating cost and health outcomes for each of the identified strategies 4. Quantification of the effect of uncertainty in the model 5. Assessment of the value of perfect information among model parameters to inform future data collection Methods The literature relating to SSI in THA was reviewed, in particular to establish definitions of these concepts, understand mechanisms of aetiology and microbiology, risk factors, diagnosis and consequences as well as to give an overview of existing infection prevention measures. Published economic evaluations on this topic were also reviewed and limitations for Australian decision-makers identified. A Markov state-transition model was developed for the Australian context and subsequently validated by clinicians. The model was designed to capture key events related to deep SSI occurring within the first 12 months following primary THA. Relevant infection prevention measures were selected by reviewing clinical guideline recommendations combined with expert elicitation. Strategies selected for evaluation were the routine use of pre-operative antibiotic prophylaxis (AP) versus no use of antibiotic prophylaxis (No AP) or in combination with antibiotic-impregnated cement (AP & ABC) or laminar air operating rooms (AP & LOR). The best available evidence for clinical effect size and utility parameters was harvested from the medical literature using reproducible methods. Queensland hospital data were extracted to inform patients’ transitions between model health states and related costs captured in assigned treatment codes. Costs related to infection prevention were derived from reliable hospital records and expert opinion. Uncertainty of model input parameters was explored in probabilistic sensitivity analyses and scenario analyses and the value of perfect information was estimated. Results The cost-effectiveness analysis was performed from a health services perspective using a hypothetical cohort of 30,000 THA patients aged 65 years. The baseline rate of deep SSI was 0.96% within one year of a primary THA. The routine use of antibiotic prophylaxis (AP) was highly cost-effective and resulted in cost savings of over $1.6m whilst generating an extra 163 QALYs (without consideration of uncertainty). Deterministic and probabilistic analysis (considering uncertainty) identified antibiotic prophylaxis combined with antibiotic-impregnated cement (AP & ABC) to be the most cost-effective strategy. Using AP & ABC generated the highest net monetary benefit (NMB) and an incremental $3.1m NMB compared to only using antibiotic prophylaxis. There was a very low error probability that this strategy might not have the largest NMB (<5%). Not using antibiotic prophylaxis (No AP) or using both antibiotic prophylaxis combined with laminar air operating rooms (AP & LOR) resulted in worse health outcomes and higher costs. Sensitivity analyses showed that the model was sensitive to the initial cohort starting age and the additional costs of ABC but the best strategy did not change, even for extreme values. The cost-effectiveness improved for a higher proportion of cemented primary THAs and higher baseline rates of deep SSI. The value of perfect information indicated that no additional research is required to support the model conclusions. Conclusions Preventing deep SSI with antibiotic prophylaxis and antibiotic-impregnated cement has shown to improve health outcomes among hospitalised patients, save lives and enhance resource allocation. By implementing a more beneficial infection control strategy, scarce health care resources can be used more efficiently to the benefit of all members of society. The results of this project provide Australian policy makers with key information about how to efficiently manage risks of infection in THA.

A qualitative investigation into the different health experiences of people living with type II diabetes, in the rural environments

Study Rationale The objective of the study was to explore if and how rural culture influences type II diabetes management and to better understand the social processes that rural people construct in coping with diabetes and its complications. In particular, the study aimed to analyse the interface and interactions between rural people with type II diabetes and the Australian health care system. Theoretical framework and methods The research applied constructivist grounded theory methods within an interpretive interactionist framework. Data from 39 semi-structured interviews with rural and urban people with type II diabetes plus a mix of rural health care providers were analysed to develop a theoretical understanding of the social processes that define diabetes management in that context. Results The analysis suggests that although type II diabetes imposes limitations that require adjustment and adaptation these processes are actively negotiated by rural people within the environmental context to fit the salient social understandings of autonomy and self-reliance. Thus people normalised self-reliant diabetes management behaviours because this was congruent with the rural culture. Factors that informed the actions of normalisation were the relationships between participants and health care professions, support and access to individual resources. Conclusions The findings point to ways in which rural self-reliance is conceived as the primary strategy of diabetic management. People face the paradox of engaging with a health care system that at the same time maximises individual responsibility for health and minimises the social support by which individuals manage the condition. The emphasis on self-reliance gives some legitimacy to a lack of prevention and chronic care services. Success of diabetic management behaviours is contingent on relative resources. Where there is good primary care there develop a number of downstream effects including a sense of empowerment to manage difficult rural environmental circumstances. This has particular bearing on health outcomes for people with fewer resources.

Evaluation of the Suchey-Brooks method for aging Australian Caucasian Populations using multislice Computed Tomography reconstructions of the Pubic Symphyseal Surface

Establishing age-at-death for skeletal remains is a vital component of forensic anthropology. The Suchey-Brooks (S-B) method of age estimation has been widely utilised since 1986 and relies on a visual assessment of the pubic symphyseal surface in comparison to a series of casts. Inter-population studies (Kimmerle et al., 2005; Djuric et al., 2007; Sakaue, 2006) demonstrate limitations of the S-B method, however, no assessment of this technique specific to Australian populations has been published. Aim: This investigation assessed the accuracy and applicability of the S-B method to an adult Australian Caucasian population by highlighting error rates associated with this technique. Methods: Computed tomography (CT) and contact scans of the S-B casts were performed; each geometrically modelled surface was extracted and quantified for reference purposes. A Queensland skeletal database for Caucasian remains aged 15 – 70 years was initiated at the Queensland Health Forensic and Scientific Services – Forensic Pathology Mortuary (n=350). Three-dimensional reconstruction of the bone surface using innovative volume visualisation protocols in Amira® and Rapidform® platforms was performed. Samples were allocated into 11 sub-sets of 5-year age intervals and changes associated with the surface geometry were quantified in relation to age, gender and asymmetry. Results: Preliminary results indicate that computational analysis was successfully applied to model morphological surface changes. Significant differences in observed versus actual ages were noted. Furthermore, initial morphological assessment demonstrates significant bilateral asymmetry of the pubic symphysis, which is unaccounted for in the S-B method. These results propose refinements to the S-B method, when applied to Australian casework. Conclusion: This investigation promises to transform anthropological analysis to be more quantitative and less invasive using CT imaging. The overarching goal contributes to improving skeletal identification and medico-legal death investigation in the coronial process by narrowing the range of age-at-death estimation in a biological profile.

Australia’s rural youth, online storytelling and identity performance

Online storytelling spaces provide young people who live in rural and remote parts of Australia with an opportunity to develop their personal identities and connect and communicate with other young people. The Australian Broadcasting Corporation’s (ABC’s) rural and regional youth network, Heywire, is such a space (http://www.abc.net.au/heywire/). Heywire invites 16-22 year old Australians who identify as ‘rural’ or ‘regional’ to create an online profile and upload stories about their lives in the form of text, audio, video or photographs. Emerging from my PhD project, this paper describes how rural and regional youth perform their identities through creating stories for the Heywire website, addressing notions of individual and social identities as a sub-theme. Compared with their city counterparts, the youth who live in regional towns or isolated properties have fewer opportunities to socialise with other people their own age. Subsequently computer mediated technologies, particularly the internet, can enable this group of people to connect with each other and develop a sense of community. In this paper I outline how these possibilities exist within an online storytelling space. I describe a number of reasons for young people’s story-sharing on the Heywire website in order to demonstrate the potential for spaces such as this to enable isolated youth to experience a sense of connection and belonging, despite geographical dispersion and physical isolation.

Evaluation framework for green procurement in road construction

Purpose Most barriers and enablers of sustainable projects are related to procurement. This study proposes a framework for evaluating green procurement practices throughout the lifecycle of road construction projects and demonstrates its application through an Australian case study. Design/methodology/approach The study is based on linking the phases of road construction with incentive mechanisms for proactively motivating behavioural change. A holistic view on utilised and potential incentives is attempted with a literature review and a state-of-practice review. The latter is based on interviews and 90 policy and procurement documents across five Australian states. Findings An evaluation framework with seven procurement stages is suggested to describe current state green procurement incentives throughout the delivery lifecycle of road construction projects. The Australian case study was found to provide useful data to identify gaps and strong points of the different states regarding their level of integration of sustainability and greenhouse gas emissions GHG) reduction elements in their procurement practices. This understanding was used to draw recommendations on future advancement of green procurement. Originality/value: Government entities across the globe can impact considerably the achievement of sustainability and GHG targets, by using their procurement practices and requirements to create incentives for contractors and suppliers to engage in more GHG conscious practices. The present study provides a systematic account of how green procurement practices can be underpinned using the Australian road construction industry as a case study, and distinguish between strong and weak links in the green procurement chain to draw recommendations for future initiatives.

“Scary” heterosexualities in a rural Australian mining town

This paper draws upon Hubbard's (1999, p. 57) term ‘scary heterosexualities,’ that is non-normative heterosexuality, in the context of the rural drawing on data from fieldwork in the remote Western Australian mining town of Kalgoorlie. Our focus is ‘the skimpie’ – a female barmaid who serves in her underwear and who, in both historical and contemporary times, is strongly associated with rural mining communities. Interviews with skimpies and local residents as well as participant observation reveal how potential fears and anxieties about skimpies are managed. We identify the discursive and spatial processes by which skimpie work is contained in Kalgoorlie so that the potential scariness ‘the skimpie’ represents to the rural is muted and buttressed in terms of a more conventional and less threatening rural heterosexuality.

Methodology to predict the safety performance of rural multilane highways [Final Report for NCHRP Project 17-29]

The objective of this research is to develop a methodology that predicts the safety performance of various elements considered in the planning, design, and operation of nonlimited- access rural multilane highways.