Australian health review : a publication of the Australian Hospital Association
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Diabetes can be effectively managed in general practice (GP). This study used record linkage to explore associations between diabetes care in GP and hospitalisation. ⋯ These data suggest that receipt of processes of care, rather than clinical targets, will prevent admission. One explanation may be that continuity of care in GP provides opportunity for early intervention and treatment. WHAT IS KNOWN ABOUT THE TOPIC? Diabetes is a serious public health problem that is largely managed in primary care. Health care planners use health service use (hospital admissions) for diabetes as an indicator of primary care. Guidelines for diabetes care are known to be effective in reducing diabetes-related complications. WHAT DOES THIS PAPER ADD? This paper created a linked data collection comprising demographic and clinical data from general practice and administrative health records of hospital admissions and emergency department presentations. The paper explores the associations between processes of primary care and control of diabetes and cardiovascular risk factors, and use of health services for a general practice population with diabetes. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? The study suggests that processes of care and not technical control of diabetes and cardiovascular risk factors are important in preventing hospital admission. Continuity of care in general practice that ensures implementation of processes of care provides opportunity for early intervention and treatment.
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This paper provides an analysis of the national Indigenous reform strategy - known as Closing the Gap - in the context of broader health system reforms underway to assess whether current attempts at addressing Indigenous disadvantage are likely to be successful. Drawing upon economic theory and empirical evidence, the paper analyses key structural features necessary for securing system performance gains capable of reducing health disparities. Conceptual and empirical attention is given to the features of comprehensive primary healthcare, which encompasses the social determinants impacting on Indigenous health. ⋯ WHAT DOES THE PAPER ADD? This paper provides a critical analysis of Indigenous health reforms to assess whether such policy initiatives are likely to be successful and outlines key structural changes to primary healthcare system arrangements that are necessary to secure genuine system performance gains and improve health outcomes for Indigenous Australians. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? For policymakers, the need to establish genuine partnership and engagement between Aboriginal people and the Australian government in pursuing a national Indigenous reform agenda is of critical importance. The establishment of the National Congress of Australia's First Peoples provides the opportunity for policy makers to give special status to Indigenous Australians in health policy development and create the institutional breakthrough necessary for effecting primary healthcare system change.
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There are recognised health service inequities in rural communities, including the timely provision of medications, often due to shortages of qualified prescribers. The present paper explores the insights of rural healthcare providers into the prescribing and medication-initiation roles of health professionals for their rural community. ⋯ Rural communities have unique needs that require consideration of multidisciplinary support to assist medical practitioners in coping with prescription demands for timely medical treatment. WHAT IS KNOWN ABOUT THE TOPIC? Extension of prescribing rights to non-medical prescribers has been a topic of considerable debate in Australia for some decades. Several extended-prescribing or medication-initiation roles were established to supplement and support the medical workforce, particularly in rural areas, where health service inequalities and inefficiencies in prescribing and provision of medications are recognised. To date, workforce dynamics and legislative boundaries have restricted the eventual number of rurally located non-medical prescribers. WHAT DOES THIS PAPER ADD? Little research has been conducted to investigate or evaluate the application of prescribing or medication-initiation roles in rural settings from a multidisciplinary approach. This paper provides the perspectives of rural healthcare providers on the prescribing and medication-initiation roles across health professions. Key findings from this rural-engagement exercise are considered valuable for policymakers and health service planners in optimisation of the prescribing or medication-initiation models. The qualitative methods also added richness and depth to the discussion about these roles. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? According to the literature review and other media, extended prescribing roles are not universally accepted. However, some of the roles are being developed and implemented. Hence, it is important for health practitioners to embrace the roles and optimise their application. Specifically in rural settings, it is also important to recognise the value of multidisciplinary support and collaboration within the limited health workforce.
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To examine the hidden cost of medical education at the Sydney Medical School, for which the University of Sydney does not pay. ⋯ The true cost of medical education is the cost of education met by the university plus the value of teaching currently provided by government funded health providers and honorary teachers. In 2010, 38% of the medical education cost at Sydney University was provided at no cost to the University. As government health departments seek to trim rising health expenditure, there is no guarantee that they will continue to contribute to medical education without passing this cost on to universities. WHAT IS KNOWN ABOUT THIS TOPIC? Some medical student teaching is provided by teachers who may be employed by a government health provider or who are honorary teachers. There is no cost to the university for this teaching. WHAT DOES THIS PAPER ADD? An estimate of the total value of teaching provided to students at Sydney Medical School, for which the university does not pay, is approximately $34000 per student per year, compared with the total cost of approximately $56000 per student per year incurred by the university. WHAT ARE THE IMPLICATIONS? Medical education is a partnership between the university, the government health sector and honorary teachers. Without contributions by non-university paid staff, the cost of medical education would be unsustainable.
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Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer. ⋯ It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples' engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health professionals, are necessary to improve lung cancer outcomes and disparities.