ORCID Profile
0000-0001-5914-1084
Current Organisation
La Trobe University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Sociology | Applied Economics not elsewhere classified | Public Health and Health Services | Public Policy | Health Policy | Psychological Methodology, Design And Analysis | Applied Sociology, Program Evaluation and Social Impact Assessment | Public Health and Health Services not elsewhere classified | Sociological Methodology And Research Methods |
ANZSRC Socio-Economic Objective (SEO)
Behavioural and cognitive sciences | Public Health (excl. Specific Population Health) not elsewhere classified | Health Education and Promotion | Economic Framework not elsewhere classified | Studies in human society | Public Services Policy Advice and Analysis | Political science and public policy | Health Policy Evaluation
Related Links
Publications
A census of economic evaluations in health promotion
Publisher: Oxford University Press (OUP)
Date: 12-2004
DOI: 10.1093/HER/CYG092
How do government health departments in Australia access health economics advice to inform decisions for health? A survey
Publisher: Springer Science and Business Media LLC
Date: 09-04-2009
Abstract: Government anticipates that health economic analysis will contribute to evidence-based policy development. Early ex les in Australia where this expectation has been met include the economic evaluations of breast and cervical screening. However, the level of integration of health economics within health services that require this advice appears uneven. We sought to describe how government health departments in Australia use specialist health economic advice to inform policy and planning and the mechanisms through which they access this advice. Information describing the arrangements for gaining health economics input into health decision-making was sought through interviews with a purposeful s le of economists and non-economists employed by all departments of health in Australia (state, territories and national). The survey was undertaken in August 2004. To aid interpretation of the results eight health economic functions were identified. As a comparison, four other government departments in NSW provided information about their access to economic advice. All health departments except one reported being current users of health economics expertise. A variety of arrangements were described to source this, from building organisational capacity with self-sufficient in-house units to forging links with external sources. However, specialist positions for economists or health economists employed within health were few. A framework mapping these arrangements for sourcing advice with the eight common health economic functions to be met is presented. All other non-health government departments approached accessed economic advice, with three having in-house units. A small health economics capacity in Australia has been established over the past 30 years through a variety of structural and strategic mechanisms. Health departments value health economic advice and use a variety of arrangements to obtain this. These arrangements have strengths and weaknesses depending upon the task to be undertaken. The lack of uniformity of approach suggests that health departments are still seeking the best ways to incorporate this form of specialist advice into mainstream decision-making. Summarises ways that governments source specialist services. Demonstrates how to describe an organisation's need for specialist services as a set of functions. This approach could be applied to assessing need for other specialist areas of advice.
Financial benefits for child health and well-being in low income or socially disadvantaged families in developed world countries
Publisher: Wiley
Date: 23-04-2008
Harnessing advances in computer simulation to inform policy and planning to reduce alcohol-related harms
Publisher: Springer Science and Business Media LLC
Date: 19-10-2017
Public health preparedness in Alberta: A systems-level study
Publisher: Springer Science and Business Media LLC
Date: 12-2006
The value of early discharge: Dispelling some myths
Publisher: Elsevier BV
Date: 12-1993
DOI: 10.1016/0168-8510(93)90111-2
Abstract: Our objective in this paper is to assess the value of early discharge schemes following the economic evaluation of three such schemes in New South Wales, Australia. An early discharge programme for obstetric patients, a fractured hip management programme and a continuing community cancer care programme were evaluated. The results of the economic evaluation of these schemes are discussed in the light of four commonly held beliefs about the value of early discharge: that early discharge schemes succeed in reducing length of stay, that early discharge schemes save money, that the welfare of patients is not reduced by early discharge and that early discharge schemes are cost-effective. The caution expressed by previous authors about the perceived advantages of early discharge schemes is still warranted.
A new model of collaborative research: Experiences from one of Australia's NHMRC Partnership Centres for Better Health
Publisher: The Sax Institute
Date: 15-02-2017
DOI: 10.17061/PHRP2711706
Abstract: There is often a disconnection between the creation of evidence and its use in policy and practice. Cross-sectoral, multidisciplinary partnership research, founded on shared governance and coproduction, is considered to be one of the most effective means of overcoming this research-policy-practice disconnect. Similar to a number of funding bodies internationally, Australia's National Health and Medical Research Council has introduced Partnership Centres for Better Health: a scheme explicitly designed to encourage coproduced partnership research. In this paper, we describe our experiences of The Australian Prevention Partnership Centre, established in June 2013 to explore the systems, strategies and structures that inform decisions about how to prevent lifestyle-related chronic disease. We present our view on how the Partnership Centre model is working in practice. We comment on the unique features of the Partnership Centre funding model, how these features enable ways of working that are different from both investigator-initiated and commissioned research, and how these ways of working can result in unique outcomes that would otherwise not have been possible. Although not without challenges, the Partnership Centre approach addresses a major gap in the Australian research environment, whereby large-scale, research-policy-practice partnerships are established with sufficient time, resources and flexibility to deliver highly innovative, timely and accessible research that is of use to policy and practice.
Satisfaction with postnatal care - the choice of home or hospital
Publisher: Elsevier BV
Date: 09-1993
DOI: 10.1016/0266-6138(93)90021-J
Abstract: This paper reports the findings of a study of client satisfaction with postnatal midwifery care. Women could choose one of two forms of care either domiciliary care following early discharge, or hospital care until discharge. Consumers' perceptions of their postnatal care were examined at the end of the period of care. Women assessed the midwives' interest and caring, education and information provided, their own progress with feeding and baby care, and their own physical and emotional health. They were also asked about their expectations of and gains from postnatal care. The findings indicated that women choosing domiciliary care and women choosing hospital care had different expectations of their postnatal care, but were largely satisfied with the quality of the care they chose. The women who chose domiciliary care rated their postnatal care more highly than the women who stayed in hospital. The findings reinforce the importance of providing women with choices for the maternity care which best suits their needs.
A cost function analysis of residential services for adults with a learning disability
Publisher: Wiley
Date: 10-1993
Abstract: Successive UK governments have pursued a policy of community care for people with learning disabilities which, in the past ten years, has led to a marked change in the nature of residential provision. Research evidence on the costs and quality of alternative forms of community provision is inconclusive and contradictory. It is therefore timely to consider whether or not community residential facilities have delivered the expected quality of service at appropriate cost. The paper presents the results of a cost function analysis of a random stratified s le of staffed community facilities in England excluding London. Both costs and quality of care were found to vary greatly amongst community residential facilities. The most important factors explaining differences in cost were case-mix factors relating to client age, dependency and length of stay. Facility characteristics such as the type of building, the internal layout and the structural quality were not significant. Quality of service measures such as the extent to which care-regimes were client orientated and made use of local community services were positively and significantly associated with costs. Type of provider had no impact on costs independent of differences in case-mix and quality of care with the exception of the private for profit sector which appeared less expensive than other agencies. The shortcomings of the methods and implications of these findings for policy makers are discussed.
Efficiency considerations in the expansion of radiation therapy services
Publisher: Elsevier BV
Date: 1995
A simple guide to chaos and complexity
Publisher: BMJ
Date: 11-2007
The privileging of communitarian ideas: Citation practices and the translation of social capital into public health research
Publisher: American Public Health Association
Date: 08-2005
Abstract: The growing use of social science constructs in public health invites reflection on how public health researchers translate, that is, appropriate and reshape, constructs from the social sciences. To assess how 1 recently popular construct has been translated into public health research, we conducted a citation network and content analysis of public health articles on the topic of social capital. The analyses document empirically how public health researchers have privileged communitarian definitions of social capital and marginalized network definitions in their citation practices. Such practices limit the way public health researchers measure social capital’s effects on health. The application of social science constructs requires that public health scholars be sensitive to how their own citation habits shape research and knowledge.
Group model building: A participatory approach to understanding and acting on systems
Publisher: The Sax Institute
Date: 11-2014
DOI: 10.17061/PHRP2511404
Abstract: With mounting appreciation of the complexity of chronic disease, there is a growing need to understand the systemic causes of current health trends. This will support the development of a prevention system and the use of systems thinking to achieve better, more equitable and more sustainable health outcomes. With new language and a need to change our thinking, the push towards systems practice in preventive health is challenging, and calls for a method to support its application. Group model building (GMB) is a participatory approach that is widely used to build the capacity of practitioners to think in a systems way. However, it is a resource-intensive approach that requires high-level buy-in and the investment of time. We discuss the evidence, including a systematic review of the literature examining the effectiveness of GMB approaches across a wide range of contexts. The results of the review are generally positive and suggest that GMB improves problem understanding, increases engagement in systems thinking, builds confidence in the use of systems ideas and develops consensus for action among erse stakeholders.
The cost of hepatitis C and the cost-effectiveness of its prevention
Publisher: Elsevier BV
Date: 11-2001
DOI: 10.1016/S0168-8510(01)00159-2
Abstract: Hepatitis C infection is an emerging problem in public health and is now the most common blood-borne infection. The virus imposes a significant personal and social burden on those infected, as well as substantial costs to the health care system. In this paper we report an estimate of the costs of hepatitis C and consider the role such information might play in determining an appropriate preventive strategy. Preventing a single case of HCV would release resources valued Aus $6000 and Aus $19,000, depending on whether production loses were included. This information can be used to derive cost-effectiveness thresholds for any preventive activity, but is not in itself necessary in determining health priorities. Information on the marginal cost-effectiveness of preventive methods is both necessary and sufficient.
Criteria for evaluating evidence on public health interventions
Publisher: BMJ
Date: 02-2002
Abstract: Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.
Shoe-stiffening inserts for first metatarsophalangeal joint osteoarthritis (the SIMPLE trial): Study protocol for a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 27-04-2017
Sex- and age-specific seasonal variations in physical activity among adults
Publisher: BMJ
Date: 19-10-2010
Abstract: To examine seasonal variations in self-reported physical activity among an urban population of Calgarian adults. Telephone surveys were conducted with two independent random cross-sectional s les of adults in summer and autumn 2007 (n=2199) and in winter and spring 2008 (n=2223). Participation and duration of walking for recreation (WR), walking for transportation (WT), moderate (MODPA) and vigorous physical activity (VIGPA) undertaken in a usual week were captured. Seasonal comparisons of participation related to these activities and sufficient MODPA (≥210 min/week) and VIGPA (≥90 min/week) physical activity were examined using logistic regression. Compared with winter, participation in WR was significantly (p<0.05) more likely in summer (OR 1.42), autumn (OR 1.35) and spring (OR 1.40), WT was more likely in autumn (OR 1.27), and MODPA was more likely in summer (OR 1.42). Achievement of sufficient MODPA was significantly more likely in summer (OR 1.80), autumn (OR 1.31) and spring (OR 1.24). Although there was no seasonal variation in sufficient VIGPA overall, variations in seasonal pattern among sub-populations were observed. Sex- and age-specific seasonal patterns in physical activity were also found. Measuring physical activity throughout the year, rather than at one time point, would more accurately monitor physical activity and assist in developing seasonally appropriate physical activity interventions. Moreover, in countries that experience extreme weather conditions, creating physical activity-friendly environments that help overcome these conditions might contribute to year-long physical activity participation.
A mother's choice: the reasons women choose hospital stay over early discharge
Publisher: Hindawi Limited
Date: 08-06-1994
In search of social value
Publisher: Springer Science and Business Media LLC
Date: 12-2007
The cost-effectiveness of installing sidewalks to increase levels of transport-walking and health
Publisher: Elsevier BV
Date: 10-1970
DOI: 10.1016/J.YPMED.2014.07.041
Abstract: This study investigated the cost-effectiveness of installing sidewalks to increase levels of transport-walking. Secondary analysis using logistic regression established the association of sidewalks with transport-walking using two transport-walking thresholds of 150 and 60 min/week using Western Australian data (n=1394) from 1995 to 2000. Minimum, moderate and maximum interventions were defined, associated respectively with one sidewalk, at least one sidewalk and sidewalks on both sides of the street. Costs, average and incremental cost-effectiveness ratios were calculated for each intervention and expressed as 'the cost per person who walks for transport for more than 150 min/week (60 min/week) after the installation of new sidewalks'. A sensitivity analysis examined the robustness of the incremental cost-effectiveness ratios to varying model inputs. Costs are in 2012 Australian dollars. A positive relationship was found between the presence of sidewalks and transport-walking for both transport-walking thresholds of 150 and 60 min/week. The minimum intervention was found to be the most cost-effective at $2330 erson and $674 erson for the 150 and 60 min/week transport-walking thresholds respectively. Increasing the proportion of people transport-walking and increasing population density by 50% improved the cost-effectiveness of installing side-walks to $346 erson. To increase levels of transport-walking, retrofitting streets with one sidewalk is most cost-effective.
Complex intervention modelling should capture the dynamics of adaptation
Publisher: Springer Science and Business Media LLC
Date: 04-05-2016
Making guidelines for economic evaluations relevant to public health in Australia
Publisher: Elsevier BV
Date: 04-2017
A Review of the User Fees Policy for Primary Healthcare Consultations in Botswana: Problems With Effective Planning, Implementation and Evaluation
Publisher: Maad Rayan Publishing Company
Date: 09-10-2021
Abstract: Background: The Government of Botswana introduced user-fees for primary healthcare consultations in 1975. The policy has remained in place since then, although the fee has remained largely unaltered despite rising inflation. Early reviews of the policy pointed to problems in its implementation, but there has been no evaluation in the past 20 years. The aim of this study was to review the policy to assess whether documented issues with its implementation have been addressed. Methods: This qualitative study involved interviews with 32 key informants: 18 policy-makers and 14 front-line revenue collectors. Data were analysed thematically using a template approach with constructs from an established organizational capacity assessment framework used as predetermined categories to guide data collection and analysis. Results: Limited administrative and management capacity has been a major hindrance to effective implementation of the policy. The lack of infrastructure for effective revenue collection led to misappropriation of funds. Lack of clear guidelines for health facilities on how to implement the policy generated interdepartmental conflicts. Study participants believed the current policy was unlikely to be cost-effective since the cost of collecting fees probably exceeded the revenue it generated. Conclusion: If the Botswana Government persists with the policy then it needs to improve organizational capacity to collect and manage revenues efficiently. However, policy thinking since the turn of the century has turned away from user-charges in healthcare as they impede the move towards universal access. It is timely therefore to consider alternative financing approaches that are more effective and a more equitable means of paying for healthcare.
The health of nations in a global context: Trade, global stratification, and infant mortality rates
Publisher: Elsevier BV
Date: 07-2006
DOI: 10.1016/J.SOCSCIMED.2005.12.009
Abstract: Despite the call for a better understanding of macro-level factors that affect population health, social epidemiological research has tended to focus almost exclusively on national-level factors, such as Gross Domestic Product per capita (GDP/c) or levels of social cohesion. Using a world-systems framework to examine cross-national variations in infant mortality, this paper seeks to emphasize the effects of global trade on national-level population health. Rather than viewing national-level health indicators as autonomous from broader global contexts, the study uses network analysis methods to examine the effects of international trade on infant mortality rates. Network data for countries were derived from international data on the trade of capital-intensive commodities in 2000. Using automorphic equivalence to measure the degree to which actors in a network perform similar roles, countries were assigned into one of six world-system blocks, each with its own pattern of trade. These blocks were dummy-coded and tested using ordinary least squares (OLS) regression. A key finding from this analysis is that after controlling for national-level factors, the two blocks with the lowest density in capital-intensive exchange, i.e., the periphery, are significantly and positively associated with national-level infant mortality rates. Results show the effects of peripherality and stratification on population health, and highlight the influence of broader macro-level factors such as trade and globalization on national health.
The need for a complex systems model of evidence for public health
Publisher: Elsevier BV
Date: 12-2017
The costs and effects of early discharge in the management of fractured hip-a correction
Publisher: Oxford University Press (OUP)
Date: 1995
Abstract: This paper reports an uncommon location and complication of a cystic lymphangioma. Few cases of infected colonic cystic lymphangioma were described in literature. Symptoms are non-specific and setting the diagnosis on radiological features remain challenging. Urgent open surgery is generally required for therapeutic and diagnostic purposes. We describe a case of a young man who presented with an acute abdomen mimicking bile peritonitis, infected tumor of the colon or even a complicated hydatid disease of the liver, which is endemic in our country. CT-scan was compulsory to suspect the diagnosis of infected cystic lymphangioma but remained insufficient to rule out other more frequent diagnoses. The patient underwent an emergency open surgery consisting in a bowel resection, in whose case an infected cystic lymphangioma was barely suspected preoperatively but confirmed by the pathological examination of the specimen. No postoperative complications were noticed. Setting the diagnosis of an infected cystic lymphangioma of the colon is tough. Many differential diagnoses are more frequently suspected and radiological examinations can be helpful. However, an emergency surgery is mandatory in order to avoid septic shock and resect the lesion, sometimes at the cost of bowel resection. Laparoscopic or endoscopic treatments are feasible but are not the standard in emergency cases. Acute presentation of cystic lymphangioma of the colon is very scarce and can be life-threatening leading to urgent open surgery, although endoscopic or laparoscopic treatment remain feasible. Further studies are needed to select which technique is suitable for this disorder.
Contingent valuation in health care and the persistence of embedding effects without the warm glow
Publisher: Elsevier BV
Date: 04-2002
Resource management in community residential facilities for adults with learning disabilities
Publisher: SAGE Publications
Date: 11-1992
DOI: 10.1177/095148489200500305
Abstract: The trend towards community living for people with learning disabilities puts pressure on traditional hierarchical lines of resource management. A s le of 150 community residential facilities is surveyed in order to describe the systems used to manage resources in the community and to assess the impact they have on the quality of service provided. There are marked differences amongst provider agencies in the degree to which responsibility for resource management is devolved to facility managers and this has a direct effect on the quality of care. Residential homes which operate under centralised management systems are more institutional in their care practices and less responsive to in idual clients' needs. In contrast, homes in which responsibility is delegated to the facility manager provide a service more in keeping with current philosophies of care. The results of this survey suggest that more responsibility for resource management can be delegated to facility managers without losing control of expenditure and with improvements in the efficiency and effectiveness of care.
Quality of life three months and one year after first treatment for early stage breast cancer: Influence of treatment and patient characteristics
Publisher: Springer Science and Business Media LLC
Date: 2000
Abstract: This paper reports the quality of life (QoL) of a large cohort of Australian women three and twelve months after surgery for early stage breast cancer (ESBC), and shows that the impact of disease and treatment on QoL differed by age, education and marital status. Eighty-three percent of eligible patients were recruited 86% had breast conserving surgery and 14% mastectomy. Response rates were 93% (n = 305) at three months and 88% (n = 291) at one year. Quality of life was measured with the EORTC core questionnaire (QLQ-C30) and an ESBC-specific questionnaire. Multilevel analysis was used to estimate the effects and interactions of time, treatment and patient characteristics. Most symptoms declined between three months and one year, but arm and menopausal symptoms persisted. Emotional, social and role functioning improved over time, and fear of disease recurrence diminished. Younger women faired worse than older women on a broad range of QoL dimensions. Single women and those with less education faired worse on a number of dimensions. The negative impact of mastectomy on body image was greatest among married women, particularly young married women. These sociodemographic distinctions are relevant when discussing treatment options with women facing a diagnosis of ESBC.
Complex interventions: How “out of control” can a randomised controlled trial be?
Publisher: BMJ
Date: 24-06-2004
Can willingness to pay capture the value of altruism? An exploration of Sen's notion of commitment
Publisher: Elsevier BV
Date: 12-2003
Neighbourhood type and walkshed size
Publisher: Informa UK Limited
Date: 11-2013
What's in a Name? The Economics of Burden of Illness Studies
Publisher: Wiley
Date: 02-1995
How much does Australia spend on prevention and how would we know whether it is enough?
Publisher: Wiley
Date: 02-05-2018
DOI: 10.1002/HPJA.165
Health economic evaluation
Publisher: BMJ
Date: 02-2002
DOI: 10.1136/JECH.56.2.85
Abstract: A glossary is presented on terms of health economic evaluation. Definitions are suggested for the more common concepts and terms.
Does supplementary prenatal nursing and home visitation reduce healthcare costs in the year after childbirth?
Publisher: Wiley
Date: 20-11-2006
DOI: 10.1111/J.1365-2648.2006.04036.X
Abstract: This paper reports the costs of a programme of supplementary prenatal care, including healthcare costs, in the year following childbirth. Publicly funded healthcare systems have provided pregnant women with adequate medical care, but access to resources to address their non-medical needs is still an issue. To improve women's access to pregnancy-related resources, a community-based, prenatal programme involving consultations with a specialist nurse, or nurse plus a home visitor was evaluated. A s le of 284 women who had participated in a randomized controlled trial of the prenatal care programme participated in this partial economic analysis. Women had been randomized to one of three trial arms: (1) standard care, (2) standard care plus consultations with a specialist prenatal care nurse, or (3) standard care plus nurse consultations and a home visitor. For the economic study, each woman was asked about her and her baby's use of healthcare services in the 12 months after the baby's birth. Health service utilization was multiplied by the unit cost of each service and summed to arrive at the total cost of services used. The study was undertaken in 2004. Supplementary prenatal care neither increased the use of health services nor resulted in savings in health spending. Compared with standard care, women in the two intervention groups made more use of family physicians and less use of paediatricians, but no significant differences in the overall costs of health care were noted. While supplementary prenatal care had no impact on costs, some benefits occurred for those at greatest risk of not accessing services. However, it would be premature to draw widespread recommendations for policy from the results of a single study. Further investment in prenatal care should continue to be accompanied by rigorous evaluation of its costs and the value that women place on the service provided.
Evidence suggests a need to rethink social capital and social capital interventions
Publisher: Elsevier BV
Date: 07-2020
DOI: 10.1016/J.SOCSCIMED.2018.09.006
Abstract: In the 21 years since social capital first appeared in the public health literature, the evidence base has grown enormously, now reaching 28 systematic reviews encompassing more than 850 in idual studies. We summarise this evidence and explain why conclusions relating to both the relationship between social capital and health, and the effectiveness of interventions to promote population health remain elusive and contradictory. A critical factor is the inadequate way that context is treated in the research, and especially how context interacts with efforts to promote health in a dynamic fashion. Of all the different types of interventions one could employ to improve the health of the public, 'social capital' interventions are likely to be the most context specific and especially affected by the boundaries placed around the context. A way forward is offered that requires a combination of insights from systems thinking, community-based participatory research, and intervention and improvement sciences. This requires renewed focus on the specific components of social capital, an understanding of how context interacts dynamically with efforts to improve health, a greater role for practice in the design, implementation, adaptation and evaluation of interventions, and the support of researchers to develop better methods for recognising and classifying the knowledge generated by complex interventions.
Eliciting individual preferences for health care: A case study of perinatal care
Publisher: Wiley
Date: 17-02-2010
Cervical cytology EQA - The northern experience [1]
Publisher: Wiley
Date: 23-10-2001
Preferences for public health insurance: Egotism or altruism?
Publisher: Emerald
Date: 05-2002
DOI: 10.1108/03068290210423505
Abstract: This paper reports the results of a telephone survey to elicit preferences for public or private health insurance. The survey adopted a method described by Hudson and Jones that allows respondents to distinguish between self‐interest and altruistic motivations. A random s le of 403 people drawn from the central Sydney area participated in the survey. The results suggest strong altruistic support for publicly funded health care even among those whose self‐interest is better served by tax‐financed incentives to take out private insurance. This result undermines the assumption in the public choice literature that people will vote for a tax policy only if it is in their self‐interest.
Cost effectiveness of brief interventions for reducing alcohol consumption
Publisher: Elsevier BV
Date: 03-2001
DOI: 10.1016/S0277-9536(00)00189-1
Abstract: The direct costs and health effects of a primary-care-based brief intervention for hazardous alcohol consumption were examined. The total cost of the intervention was calculated from costs associated with: marketing the intervention programme providing training and support in the use of the intervention materials physician time required for providing brief advice for 'at-risk' drinkers. The effect of the intervention on health outcomes was expressed in terms of number of life years saved by preventing alcohol-related deaths. This was derived by combining estimates of the impact of the programme if it were implemented nationally with available evidence on the health effects of excess alcohol consumption. Results are based on international trial evidence showing the physical resources required by the intervention and its effectiveness combined with Australian price data. The costs associated with screening and brief advice using the current intervention programme range from Aus$19.14 to Aus$21.50. The marginal costs per additional life year saved were below Aus$1873. The robustness of the model used is supported by an extensive sensitivity analysis. In comparison with existing health promotion strategies the costs and effects of the current intervention are highly encouraging.
Is general practitioner decision making associated with patient socio-economic status?
Publisher: Elsevier BV
Date: 1996
DOI: 10.1016/0277-9536(95)00063-1
Abstract: This paper presents a preliminary exploration into the relationship between decisions made by general practitioners (GPs) and the socio-economic status (SES) of patients. There is a large literature on the association between SES, health state and the use of health services, but relatively little has been published on the association between SES and decisions by clinicians once a patient is in the health system. The associations between GP decision making and the patient's SES, health status, gender and insurance status are examined using logit analysis. Three sets of binary choices are analysed: the decision to follow up to prescribe and to perform or to order a diagnostic test. Secondary data on consultations for a check up/examination were used to explore these relationships. The results suggest that SES is associated independently with the decision to test and the decision to prescribe but not with the decision to follow up. Patients of high SES are, ceteris paribus, more likely to be tested and less likely to receive a prescription compared with patients of low SES. Women are more likely to be tested and to receive a prescription than men. These findings have implications for the pursuit of equity as a goal of health services policy.
Market failure is bad for your health but social injustice is worse
Publisher: Oxford University Press (OUP)
Date: 24-02-2010
Research review: Economic evidence for interventions in children's social care: Revisiting the what works for children project
Publisher: Wiley
Date: 12-04-2010
Responding to young people's health risks in primary care: A cluster randomised trial of training clinicians in screening and motivational interviewing
Publisher: Public Library of Science (PLoS)
Date: 30-09-2015
The costs of a community-based intervention to promote maternal health
Publisher: Oxford University Press (OUP)
Date: 23-10-2007
DOI: 10.1093/HER/CYL127
Abstract: The costs of community-level interventions are rarely reported, although such insights are needed if intervention research is to be useful to practitioners seeking to understand what might be involved in replicating interventions in different contexts. We report the costs of a 2-year community-based intervention to promote the health of recent mothers in Victoria, Australia. Program of Resources, Information and Support for Mothers was an integrated programme of primary care and community-based strategies. It had health care professional training, health education and community development components as well as an emphasis on creating 'mother-friendly' environments. Costs included the programme costs [primarily the salaries of the community development officers (CDO) in the field] and also 'induced' costs that relate to the CDOs' successes in attracting additional resources to the intervention from the local community. The total cost averaged A$272,490 per rural community and A$313,900 per urban community, equivalent to A$172.40 and A$128.70 per mother, respectively. For every A$10 of public funds initially invested in the project, the CDOs were able to attract a further A$1-2 worth of local resources, predominantly in the form of volunteer time or donated services.
Small area contextual effects on self-reported health: Evidence from riverside, calgary
Publisher: Springer Science and Business Media LLC
Date: 20-05-2010
Reliability of two instruments for critical assessment of economic evaluations
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1111/J.1524-4733.2007.00255.X
Abstract: To assess the reliability of two instruments designed for critical appraisal of economic evaluations: the Quality of Health Economic Studies (QHES) scale and the Pediatric Quality Appraisal Questionnaire (PQAQ). Thirty published articles were chosen at random from a recent bibliography of economic evaluations in health promotion. The quality of each of these studies was assessed independently by two raters using each of the two instruments. Inter-rater reliability and the agreement between the instruments were measured using an intraclass correlation coefficient (ICC). Cronbach's generalizability theory was also used to assess the sources of variation in quality scores of the studies and to indicate where improvements in reliability could best be made. Inter-rater reliability was excellent for both instruments (ICC = 0.81 for the QHES and 0.80 for the PQAQ). Agreement between the instruments varied (ICC = 0.77 for rater 1 and 0.56 for rater 2). The biggest source of variation in the scores assigned to the articles was the quality of the study (56% of total variance). Conventional measurement error explained 31% of the total variance. Variation due to rater (< 0.1%) and measurement instrument (1.8%) was very low. The results suggest that the two instruments perform equally well. Choice of instrument can therefore be based on other criteria--simplicity and speed of application in the case of one, and detail in the information provided in the case of the other. There is little improvement in reliability to be gained from using more than one rater or more than one assessment of quality.
Cervical cytology EQA - The Northern experience
Publisher: Wiley
Date: 04-2001
DOI: 10.1046/J.1365-2303.2001.00306.X
Abstract: The experience of the Northern region using the 1995 draft National Gynaecological Cervical Cytology External Quality Assurance (EQA) Scheme is given. Over three rounds, 390 staff reporting Cervical Cytology took part, and using a cumulative non-numeric marking scheme, five participants were deemed "unacceptable" at the end of three rounds. A total of 3450 responses were given to the 40 test slides used, with an overall false-positive rate of 5.9% and a false-negative rate of 1.4%. Grading was assessed for pathologists, and many appeared to perform badly by accumulating discrepancies for non-clinically-significant grading differences. The problems of slide selection/staining and grading consistency/accuracy are highlighted. This EQA scheme serves its dual function of education and identifying poor performance. It must be seen as a viable EQA scheme, although other options must be considered, given advances in technology.
CONSIDERATION OF THE COST OF INTERFERON ALFA‐2b IN THE TREATMENT OF BASAL CELL CARCINOMA
Publisher: Wiley
Date: 08-1994
DOI: 10.1111/J.1440-0960.1994.TB00899.X
Abstract: Interferon alfa-2b is an effective but expensive way of treating basal cell carcinoma. In this paper, the cost-effectiveness of interferon relative to conventional treatment is considered. Circumstances where surgery is contra-indicated and would not otherwise be performed are not considered. The cost of achieving cure by interferon alfa-2b in the form of Intron A is compared with the cost of conventional treatment in four situations simple lesions, lesions in which protacted healing is expected, lesions in areas where cosmetic result is important and large lesions where hospitalisation for skin grafting may be necessary. For simple lesions, treatment with interferon alfa-2b costs between $500 and $760 more per cure than conventional treatment. However, it is less expensive than conventional methods in cases that would require extensive home nursing or hospitalisation. The difference in cost in simple cases also represents the price which must be paid for the better cosmetic result achieved by interferon alfa-2b. In conclusion, interferon alfa-2b adds another effective option to the treatment of BCC but it is expensive. To exploit its advantages properly, it must be targeted on those who will benefit from it the most.
A glossary of terms for navigating the field of social network analysis
Publisher: BMJ
Date: 12-2004
Resource implications of medical interventions
Publisher: Wiley
Date: 06-1994
The association between sidewalk length and walking for different purposes in established neighborhoods
Publisher: Springer Science and Business Media LLC
Date: 2012
The worldview of hospital security staff: Implications for health promotion policy implementation
Publisher: SAGE Publications
Date: 19-05-2009
Abstract: Interventions to encourage compliance with smoking control policies often rely on intermediaries for implementation, and the culture of the intermediary group might affect policy implementation. The authors present an ethnography of security staff involved in enforcing restrictive smoking policies in a large hospital in Canada. They find strong norms associated with control, mutuality, and deference to authority. Common sense interpretation rather than strict enforcement of rules prevails. To be enforced effectively, smoking policy would have to compete with other duties and elevate the security staff's perceived status in the eyes of visitors, staff, and patients.
Test-retest reliability of willingness to pay
Publisher: Springer Science and Business Media LLC
Date: 09-2006
DOI: 10.1007/S10198-006-0349-Y
Abstract: We describe the results of a survey designed to assess the test-retest reliability of a method of establishing willingness to pay. Willingness to pay values for a hypothetical intervention were elicited from a randomly selected, population s le by face-to-face interview on three occasions over a period of 5 weeks. Test-retest reliability was assessed by intraclass correlation and by generalizability analysis. Reliability was acceptable but not substantial, and there was a statistically significant shift in mean value between first and second assessments. The greatest source of variation in values was the participants. There was also a substantial interaction between time and participants, suggesting that some respondents changed their answers at follow-up. The results were sensitive to the high valuations provided by four of the participants, however.
Convergent validity between a discrete choice experiment and a direct, open-ended method: Comparison of preferred attribute levels and willingness to pay estimates
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.SOCSCIMED.2008.09.058
Abstract: The Discrete Choice Experiment (DCE) has become increasingly popular as a method for eliciting patient or population preferences. If DCE estimates are to inform health policy, it is crucial that the answers they provide are valid. Convergent validity is tested in this paper by comparing the results of a DCE exercise with the answers obtained from direct, open-ended questions. The two methods are compared in terms of preferred attribute levels and willingness to pay (WTP) values. Face-to-face interviews were held with 292 women in Calgary, Canada. Similar values were found between the two methods with respect to preferred levels for two out of three of the attributes examined. The DCE predicted less well for levels outside the range than for levels inside the range reaffirming the importance of extensive piloting to ensure appropriate level range in DCEs. The mean WTP derived from the open-ended question was substantially lower than the mean derived from the DCE. However, the two sets of willingness to pay estimates were consistent with each other in that in iduals who were willing to pay more in the open-ended question were also willing to pay more in the DCE. The difference in mean WTP values between the two approaches (direct versus DCE) demonstrates the importance of continuing research into the different biases present across elicitation methods.
The inertia of self-regulation: A game-theoretic approach to reducing passive smoking in restaurants
Publisher: Elsevier BV
Date: 10-2000
DOI: 10.1016/S0277-9536(00)00018-6
Abstract: Two alternate regulatory approaches can be used to reduce exposure to environmental tobacco smoke in workplaces. The first is voluntary, self-regulation introduced by management, which is supported by common law and occupational health legislation that emphasises the employers' 'duty of care'. The second is public health legislation that bans smoking outright in enclosed places. In Australia, self-regulation has succeeded in restricting tobacco smoking in most indoor workplaces but has been a relative failure in the hospitality industry. Claims that this reflects consumer preference by diners, club and hotel patrons are not backed by survey evidence, typically showing large majority support for non-smoking establishments. Insights from game theory show why reliance on the duty of care is unlikely to succeed even when establishment operators collectively support a non-smoking policy. Using plausible assumptions about the net costs of unilaterally introducing smoking restrictions, what makes good sense for society as a whole is likely to be the least profitable option for an in idual operator acting alone. Operators find themselves in the classic prisoner's dilemma. If the aim of policy is to restrict smoking in public places in order to protect the health of employees then game-theory predicts that public health legislation banning smoking in enclosed places will be more effective than self-regulation and reliance on the duty of care.
Assessing the cost-effectiveness of treating chronic hepatitis C virus in people who inject drugs in Australia
Publisher: Wiley
Date: 25-03-2013
DOI: 10.1111/JGH.12041
Abstract: To assess the cost-effectiveness of hepatitis C virus treatment with pegylated interferon alfa-2a and ribavirin in current and former people who inject drugs (PWID). A decision analytic model simulated the lifetime costs and outcomes of four treatment options: early treatment with mild fibrosis, standard treatment with moderate fibrosis, late treatment with compensated cirrhosis, and no treatment. Treatment modalities were simulated across current, former, and never-injector cohorts of 1000 hypothetical patients with chronic hepatitis C virus. The main outcome measures were incremental costs ($AUD) per quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) were calculated for each cohort. Treatment of current PWID during mild fibrosis resulted in a discounted average gain of 1.60 QALYs (95% confidence interval 0.93-2.26) for an added cost of $12,723 ($11,153-$14,396) compared with no treatment, yielding an ICER of $7941 per QALY gained ($6347-$12,017). Former PWID gained 1.80 QALYs (1.29-2.33) for $10,441 ($8843-$12,074) for early treatment compared with no treatment, resulting in an ICER of $5808 per QALY gained ($5189-$6849). Never-injectors gained 2.33 QALYs (1.87-2.80) for $9290 ($7642-$10,912) compared with no treatment-an ICER of $3985 per QALY gained ($3896-$4080). Early treatment was more cost-effective than late treatment in all cohorts. Despite comorbidities, increased mortality, and reduced adherence, treatment of both current and former PWID is cost-effective. Our estimates fall below the unofficial Australian cost-effectiveness threshold of $AUD 50,000 per QALY for public subsidies. Scaling up treatment for PWID can be justified on purely economic grounds.
If the price is right: Vagueness and values clarification in contigent valuation
Publisher: Wiley
Date: 2003
DOI: 10.1002/HEC.777
Abstract: The use of willingness to pay to value the benefits of health care is increasing. Much of this work assumes that health preferences are well formed or 'complete' and readily revealed if the right question is asked in the right way. We examined this assumption, seeking evidence in a mixed-methods study that explored the meaning and implications of vague responses to a payment-scale based willingness to pay exercise.One-half of the s le said that their vagueness meant that their maximum willingness to pay was actually greater than the amount that they had previously said it was. Thirty percent agreed that they would probably pay pound 10 more than a sum that they had previously said they would most definitely not pay, if they found this to be the cost of the vaccine. Interview data supported the view that the payment scale had failed to elicit the maximum willingness to pay and that some participants used the information on cost to help clarify their values, in contrast to the theory underpinning willingness to pay. The results suggest a need to consider values-clarification in health economic evaluations.
A longitudinal study of the cost of food in Victoria influenced by geography and nutritional quality
Publisher: Elsevier BV
Date: 06-2016
Abstract: To monitor the cost and affordability of a nutritious diet and to assess the influence of distance from the capital city and socioeconomic status on the cost of nutritious food in Victoria. Twenty-six of Victoria's 79 local government areas (33%) were randomly chosen for inclusion in the study. A random s le of stores was selected for inclusion from each local government area. The cost of the 44 'healthy' and 10 'discretionary' food and drinks in the healthy food basket for a family of four for a fortnight was collected during the winter and summer of 2012, 2013 and 2014. The mean cost of the basket increased from $424.06 ± 38.22 in winter 2012 to $451.19 ± 33.83 in summer 2014 (p<0.001), representing about 31% of government benefit household income. Fruit and vegetables prices were the most varied over time. Distance of the store from state capital city centre predicted difference in food cost. These findings show that a healthy diet may be unaffordable for some Victorians. The cost of food is a key factor influencing intake. Public health strategies may need to consider strategies to make healthy food more affordable for some.
Socioeconomic disadvantage within a neighborhood, perceived financial security and self-rated health
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.HEALTHPLACE.2008.01.011
Abstract: We examine whether perceived financial security mediates the association between social deprivation and self-rated health, using data from a 2004 survey of residents of one neighborhood in Calgary (N=441) and 2001 Census data on the 26 Census Dissemination Areas (DAs) that make up this neighborhood. Net of sociodemographic characteristics of residents, DA disadvantage had significant associations with being in fair oor or very good health as compared to excellent health. Perceived financial security explained part of this association and influenced health over and above in idual- and DA-level sociodemographic characteristics. These findings suggest social deprivation and perceptions of financial security are potentially useful intervention targets.
Participation in treatment decision-making by women with early stage breast cancer
Publisher: Wiley
Date: 09-1999
DOI: 10.1046/J.1369-6513.1999.00050.X
Abstract: OBJECTIVE: This study aimed to assess the way women treated for early stage breast cancer perceived the treatment selection process. The purpose was to understand more fully patients' experiences of the decision process and their preferences for participation in treatment decisions. SETTING AND PARTICIPANTS: The study informants were 40 women, treated at a teaching hospital in Sydney Australia, who were interviewed face to face 1 year after their first treatment for stage I or stage II breast cancer. METHODS: This study used a qualitative approach, based on the analysis of interview transcripts. The main areas covered were how the informants' treatment decisions were made and their preferences for participation in treatment decisions. Content and thematic analyses were conducted with findings presented using verbatim quotations for illustration. RESULTS AND CONCLUSIONS: Many of the informants who preferred not to participate in decisions also failed to recognize the need for value judgements (as well as medical expertise) in the decision-making process. Some informants believed they ought to be responsible for the consequences whilst others did not. Difficulties were identified in patient utilization of medical information for treatment decision-making, and also in establishing preferences for the risks and benefits of treatments where few patients had prior experience of the potential outcomes. The findings indicate that patient participation in treatment decision-making is a more complex issue than simply giving patients information and choices. Ways of enhancing patients' involvement in the treatment selection process are discussed.
Do taboo trade-offs explain the difficulty in valuing health and social interventions?
Publisher: Elsevier BV
Date: 12-2009
The relationship between cluster-analysis derived walkability and local recreational and transportation walking among Canadian adults
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.HEALTHPLACE.2012.04.014
Abstract: We investigated the association between objectively-assessed neighborhood walkability and local walking among adults. Two independent random cross-sectional s les of Calgary (Canada) residents were recruited. Neighborhood-based walking, attitude towards walking, neighborhood self-selection, and socio-demographic characteristics were captured. Built environmental attributes underwent a two-staged cluster analysis which identified three neighborhood types (HW: high walkable MW: medium walkable LW: low walkable). Adjusting for all other characteristics, MW (OR 1.40, p < 0.05) and HW (OR 1.34, approached p < 0.05) neighborhood residents were more likely than LW neighborhood residents to participate in neighborhood-based transportation walking. HW neighborhood residents spent 30-min/wk more on neighborhood-based transportation walking than both LW and MW neighborhood residents. MW neighborhood residents spent 14-min/wk more on neighborhood-based recreational walking than LW neighborhood residents. Neighborhoods with a highly connected pedestrian network, large mix of businesses, high population density, high access to sidewalks and pathways, and many bus stops support local walking.
Contested ground: How should qualitative evidence inform the conduct of a community intervention trial?
Publisher: SAGE Publications
Date: 04-2005
Abstract: This paper presents issues which arose in the conduct of qualitative evaluation research within a cluster-randomized, community-level, preventive intervention trial. The research involved the collection of narratives of practice regarding the intervention by community development officers working in eight communities over a two-year period. The community development officers were largely responsible for implementing the intervention. We discuss the challenges associated with the collection of data as the intervention unfolded, in particular, the disputes over cues to revise and adjust the intervention (i.e. to use the early data formatively). We explore the ethical uncertainties that arise when multiple parties have different views on the legitimacy of types of knowledge and the appropriate role of research and theory in various trial stages. These issues are discussed drawing on the fields of ethnography, community psychology, epidemiology, qualitative methodology and notions of research reflexivity. We conclude by arguing that, in addition to the usual practice of having an outcome data-monitoring committee, community intervention trials also require a process data-monitoring committee as a forum for debate and decision-making. Without such a forum, the relevance, ethics and position of qualitative evaluation research within randomized controlled trials are destined to be a point of contention rather than a source of insight.
Still waiting for the great leap forward
Publisher: Cambridge University Press (CUP)
Date: 04-2009
Reliability of health utility measures and a test of values clarification
Publisher: Elsevier BV
Date: 04-2003
DOI: 10.1016/S0277-9536(02)00154-5
Abstract: This study examines the test-retest reliability of two methods of establishing health preference weights and assesses the effectiveness of a brief values-clarification exercise. Survey participants were randomly allocated to one of two groups and received either a standard protocol for eliciting health preferences (comparison group) or an augmented protocol designed to encourage reflection and deliberation (intervention group). Preferences were elicited on three occasions over 5 weeks. The results show that the two valuation methods each had acceptable levels of test-retest reliability. No significant differences were found in preference weights over time or between intervention and comparison groups. The values-clarification exercise had some impact on in idual answers, but the changes cancelled each other out at the group level. There was no discernable intervention effect at the group level. It is premature to draw conclusions from one study about why, or even how, a person's valuations might change over time, but our results support the use of current valuation techniques for group-level analyses.
The costs and effects of early discharge in the management of fractured hip
Publisher: Oxford University Press (OUP)
Date: 1994
Abstract: The cost-effectiveness of a Fractured Hip Management Programme (FHMP) was evaluated by considering available measures of patient outcome and comparing the cost of the programme with the value of resources freed by reductions in length of hospital stay. The FHMP adopted a multidisciplinary team approach to care for elderly patients with hip fracture. The aims of the programme were to reduce delays before surgery provide specialist geriatric medical supervision improve early post-operative mobility plan for hospital discharge with rehabilitation in the patient's normal environment and provide continuity of care by a small number of staff. The cost of managing patients with fractured hip averaged $Aus11,060 per patient before the programme was introduced and $Aus9280 per patient after the FHMP was in place. This reduction in cost was achieved without impairing health outcomes. Patients treated by the programme were no worse off compared with those treated conventionally. In conclusion, the FHMP provided a cost-effective alternative in the management of fractured hip in elderly people.
Extrinsic goals and time tradeoff
Publisher: SAGE Publications
Date: 07-2007
Abstract: Background. The aim of this article is to investigate the extrinsic goals hypothesis in time tradeoff (TTO). The extrinsic goal of interest here is seeing children through to maturity. In TTO, the time it takes to attain this goal becomes a target life expectancy, with no trades happening below the critical value implied by the target, no matter how severe the health state. Methods. A combined quantitative and qualitative approach was used to elicit values for 4 EQ-5D states from 30 recent mothers. The qualitative analysis allowed the researchers to explore with participants whether a target life expectancy was being used. Results. The differences in the visual analogue scale and TTO scores of the mothers compared with the general population suggest that the mothers value life-years differently than the general population does. The finding was also consistent with the target life expectancy hypothesis. However, the interview data were not so strongly supportive of the target life expectancy hypothesis. Although some women suggested this had motivated their responses to the TTO, the interviews paint a more complicated and nuanced picture of what drives a person's responses to health valuation surveys. Conclusions. A higher value was assigned to life-years relative to quality of life by recent parents, but there was no reduction in the willingness to trade per se. Parenthood affects how much one will trade for better health but not whether one will trade in the 1st place. This conclusion became apparent only when the qualitative and quantitative data were combined.
Cost of illness studies: An aid to decision-making?
Publisher: Elsevier BV
Date: 12-1987
The cost-effectiveness of a law banning the use of cellular phones by drivers
Publisher: Wiley
Date: 17-09-2010
DOI: 10.1002/HEC.1546
Abstract: To assess the cost-effectiveness of a law banning the use of cellular phones by drivers in the Canadian province of Alberta. Cost-effectiveness analysis using a probabilistic decision-analytic model and publicly available data. We adopted a societal perspective. Health gains were measured in terms of quality-adjusted life-years. Costs include those associated with awareness raising, enforcement and the welfare loss associated with the reduction in cellular phone use, less savings in health care and other costs associated with automobile accidents. A ban promotes health and releases resources worth more than the costs. There is an 80% chance that a ban will be 'cost saving', and a 94% chance that a ban will cost less than Can$50,000/QALY. The results are sensitive to the additional risk posed by cellular phone use while driving, and the rate and pattern with which drivers comply with a ban. Under our base line assumptions a cellular phone ban is likely to be cost saving from a societal perspective. The results are sensitive to parameters for which there is very little information or for which the available information is contradictory.
Use evidence to expose the unequal distribution of problems and the unequal distribution of solutions
Publisher: Oxford University Press (OUP)
Date: 10-2007
In search of causality: A systematic review of the relationship between the built environment and physical activity among adults
Publisher: Springer Science and Business Media LLC
Date: 2011
How health managers think about risk and the implications for portfolio theory in health systems
Publisher: Informa UK Limited
Date: 02-2009
Early stage breast cancer: Costs and quality of life one year after treatment by mastectomy or conservative surgery and radiation therapy
Publisher: Elsevier BV
Date: 02-2000
Abstract: This paper reports a descriptive study of the costs and quality of life (QoL) outcome of treatments for early stage breast cancer in a cohort of Australian women, one year after initial surgical treatment. Mastectomy without breast reconstruction is compared to breast conserving surgery and radiotherapy (breast conservation). Of the 397 women eligible for the study, costing data were collected for 81% and quality of life data for 73%. The cost differences between treatment groups were mainly accounted for by adjuvant therapies, the more expensive being radiotherapy. When compared to women treated by mastectomy, those treated by breast conservation reported better body image but worse physical function. The negative impact of breast cancer and its treatment was greater for younger women, across a number of dimensions of quality of life (regardless of treatment type). While this study shows that breast conservation is more expensive than mastectomy, the QoL results reinforce the importance of patient participation in treatment decisions.
Understanding place and health: A heuristic for using administrative data
Publisher: Elsevier BV
Date: 06-2007
DOI: 10.1016/J.HEALTHPLACE.2006.01.007
Abstract: The increasing availability, use and limitations of administrative data for place-based population health research, and a lack of theory development, created the context for the current paper. We developed a heuristic to interrogate administrative data sets and to help us develop explanatory pathways for linking place and health. Guided by a worked ex le, we argue that some items in administrative data sets lend themselves to multiple theories, creating problems of inference owing to the implications of using inductive versus deductive reasoning during the research process, and that certain types of theories are privileged when used administrative data bases.
Competing hospitals: Assessing the impact of self-governing status in the United Kingdom
Publisher: Elsevier BV
Date: 12-1991
DOI: 10.1016/0168-8510(91)90003-G
Abstract: The proposals contained in the White Paper 'Working for Patients' have been described as an attempt to introduce competition into a non-competitive situation. Together with the introduction of practice budgets for family practitioners, the granting of self-governing status to NHS hospitals is the principal mechanism by which this aim will be achieved. Very little is known about the effects of competition on the delivery of health care. Evidence from the United Kingdom is non-existent and from the United States of America is inadequate and contradictory. Yet, despite the inconclusive nature of this evidence, the U.K. Government is implementing the most radical reforms of the NHS since its inception without any systematic attempt to monitor the extent to which the reforms achieve the desired ends. In the absence of any systematic evaluation the responsibility for monitoring the effects of self-governing status will fall to the managers and public health specialists in the purchasing authorities. A variety of methods are described which would enable the reforms to be evaluated without holding back their implementation. No radical reform of the NHS can be expected to have an unambiguously beneficial impact on the delivery of health care. If the U.K. Government is genuine in its desire to improve health services, it should be prepared to subject its proposals to the sort of evaluation described in this paper.
The role of the clinical nurse co‐ordinator in the provision of cost‐effective orthopaedic services for elderly people
Publisher: Wiley
Date: 09-1993
DOI: 10.1046/J.1365-2648.1993.18091424.X
Abstract: Positions for nurses as coordinators and case managers have developed in response to demands for increased efficiency in the provision of hospital care. The Fractured Hip Management Programme in Western Sydney is one ex le of this development. The programme was introduced in response to mounting concern about the demands on hospital resources from elderly patients with hip fracture. A central feature of the programme is the pivotal role given to the nurse coordinator working within a multi-disciplinary team. This is not a new nursing role rather it explicitly recognizes skills developed as part of the traditional nursing role. Evaluation of the programme found that patients received surgery sooner and spent less time in hospital, without adverse affects on outcome. The results show that recognition of the role of the nurse as patient advocate and care manager can lead to more cost-effective and higher-quality care.
Social capital and health promotion: A review
Publisher: Elsevier BV
Date: 09-2000
DOI: 10.1016/S0277-9536(00)00067-8
Abstract: Interest in social capital and health has emerged at an exciting time. In public health, there is a renewed interest in mechanisms that link social inequalities and health. In epidemiology, there has been a critical interrogation of methods and a call for a more explicit use of theory. In health promotion over the last 20-30 years, social health interventions have been somewhat marginalised in an era dominated by interest in traditional cardiovascular disease risk factors. Now that social hypotheses are being reborn in health, there is a risk that the sophistication that has developed in social health promotion and the literatures that have informed it could be overlooked. In this paper, we present a brief history of social capital and how it has come into recent prominence through the debate linking income inequality and health. We present the background to this, the earlier literatures on social environmental influences on health and the possible processes thought to underlie this relationship. Social capital has relational, material and political aspects. We suggest that, although the relational properties of social capital are important (eg, trust, networks), the political aspects of social capital are perhaps under recognised. The paper also reviews how complex social processes at the community level have come to be operationalised by social theorists and intervention agents in other fields. We suggest that social capital research so far has inadequately captured the underlying constructs, in particular the qualitative difference between the macro/context level and the micro/in idual level. While being cautious about the science, we conclude that social capital's power as rhetoric and as a metaphor may be of value. We conclude by suggesting that the coalescence of interests in context-level influences on health now invites a revitalisation of theories and interventions inspired by erse fields, such as geography and ecological community psychology.
A tentative cost—utility analysis of road safety education
Publisher: Wiley
Date: 12-02-1993
DOI: 10.1111/J.1753-6405.1993.TB00120.X
Abstract: This paper sets road safety education in a health promotion context and describes the application of cost-utility analysis to the economic evaluation of road safety education in New South Wales. The application is tentative and designed to illustrate the advantages of the approach rather than to demonstrate the cost-effectiveness of road safety education.
Subject variation more than values clarification explains the reliability of willingness to pay estimates
Publisher: Wiley
Date: 2008
DOI: 10.1002/HEC.1261
Abstract: In a recent article in this journal, Smith offers additional evidence to support his claim that the test-retest reliability of willingness to pay measures increases along with willingness to pay because people take more time to consider their answers for the more highly valued (and therefore more 'expensive') goods. Unfortunately, by repeating a common misconception about what reliability actually measures, he overlooks an alternative explanation for the relationship he observed namely, that subject variation increases with willingness to pay and that it is this, rather than any reduction in measurement error, that explains his findings. We show that 75% of the increase in reliability comes from increases in subject variation (that is different views about the value of good health), and that the relationship between measurement error and willingness to pay is not as simple as Smith suggests. However, our critique of Smith's paper should not be construed as criticism of the ideas being explored. We need to better understand the responses people give to contingent valuation exercises. Such understanding has to be based on a better appreciation of what reliability is and on more robust testing of alternative hypotheses.
Do fee descriptors influence treatment choices in general practice? A multilevel discrete choice model
Publisher: Elsevier BV
Date: 06-1997
DOI: 10.1016/S0167-6296(96)00520-6
Abstract: Before 1990 Australian general practitioners (GPs) were remunerated according to consultation length. This was assumed to encourage GPs to prescribe more, counsel less and provide fewer treatments than were 'appropriate'. In an attempt to change this behaviour, the remuneration system was altered to reflect the content of consultations. This paper analyses, through the use of multilevel modelling, the effect of content-based descriptors on the discrete choice behaviour of GPs while controlling for patient, GP and practice characteristics. GPs who used content-based descriptors were just as likely to prescribe, counsel and treat compared to GPs who used time-based descriptors.
THE COSTS OF COMMUNITY RESIDENTIAL FACILITIES FOR ADULTS WITH A MENTAL HANDICAP IN ENGLAND
Publisher: Wiley
Date: 07-1992
The influence of organizational jurisdiction, organizational attributes, and training measures on perceptions of public health preparedness in Alberta
Publisher: Springer Science and Business Media LLC
Date: 04-05-2012
Lost in translation: A genealogy of the social capital concept in public health
Publisher: BMJ
Date: 08-2006
Theorising interventions as events in systems
Publisher: Wiley
Date: 24-04-2009
DOI: 10.1007/S10464-009-9229-9
Abstract: Conventional thinking about preventive interventions focuses over simplistically on the "package" of activities and/or their educational messages. An alternative is to focus on the dynamic properties of the context into which the intervention is introduced. Schools, communities and worksites can be thought of as complex ecological systems. They can be theorised on three dimensions: (1) their constituent activity settings (e.g., clubs, festivals, assemblies, classrooms) (2) the social networks that connect the people and the settings and (3) time. An intervention may then be seen as a critical event in the history of a system, leading to the evolution of new structures of interaction and new shared meanings. Interventions impact on evolving networks of person-time-place interaction, changing relationships, displacing existing activities and redistributing and transforming resources. This alternative view has significant implications for how interventions should be evaluated and how they could be made more effective. We explore this idea, drawing on social network analysis and complex systems theory.
In response to Spillane V., Byrne M.C., Byrne M., Leathem C.S., O'Malley M. & Cupples M.E. (2007) Monitoring treatment fidelity in a randomized trial of a complex intervention. Journal of Advanced Nursing 60(3), 343-352. Important considerations for standardizing complex interventions.
Publisher: Wiley
Date: 04-2008
Subpopulation differences in the association between neighborhood urban form and neighborhood-based physical activity
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.HEALTHPLACE.2014.04.001
Abstract: This study investigated whether associations between the neighborhood built environment and neighborhood-based physical activity (PA) varied by sociodemographic and health-related characteristics. A random s le of adults (n=2006) completed telephone- and self-administered questionnaires. Questionnaires captured PA, sociodemographic, and health-related characteristics. Neighborhood-based PA (MET-minutes/week) was compared across low, medium, and high walkable neighborhoods for each sociodemographic (sex, age, dependents, education, income, motor vehicle access, and dog ownership) and health-status (general health and weight status) subpopulation. With few exceptions, subpopulations residing in high walkable neighborhoods undertook more (p<0.05) neighborhood-based PA than their counterparts in less walkable neighborhoods. Improving neighborhood walkability is a potentially effective population health intervention for increasing neighborhood-based PA.
Public health preparedness: A systems-level approach
Publisher: BMJ
Date: 04-2007
Health outcomes are about choices and values: An economic perspective on the health outcomes movement
Publisher: Elsevier BV
Date: 1997
DOI: 10.1016/S0168-8510(96)00845-7
Abstract: The aim of the health outcomes movement is to reorientate health services so that the spotlight shines less on what is done and more on what is achieved. The health outcomes movement, thus far, has been most successful in addressing what appear to be technical questions relating to the measurement and analysis of health outcomes and in placing their routine use on the agenda of clinical practice and health services planning. If there is one lesson to be drawn from an economic perspective, however, it is that health outcomes are about values and not just technicalities. The need to make choices forces one to consider whether what is achieved is also what is most valued. The success of health service delivery, be it at a clinical, planning or systems level, must therefore be measured against agreed objectives. It follows that time must be taken to establish what patients and the community want from their health services and what each is prepared to give up to achieve its ends. Value judgements are unavoidable. The challenge lies not in measuring the outcomes of health interventions but in deciding what the objectives of the health system ought to be.
The prevalence of psychiatric morbidity on a coronary care ward
Publisher: Wiley
Date: 09-1991
DOI: 10.1111/J.1365-2648.1991.TB03368.X
Abstract: Numerous studies have documented the high prevalence of psychological and emotional disorders in patients seen in general medical settings. However, despite the emphasis placed on holistic approaches to nursing care in all professional models of nursing practice, much of this distress is still missed by nursing staff. The Hospital Anxiety and Depression (HAD) scale is an easy-to-use self-administered screening instrument purportedly designed to detect psychological distress amongst hospitalized patients with physical illnesses. On using the HAD scale on patients admitted to a coronary care ward of a district general hospital, 44% were found to be suffering high levels of anxiety or depression. This figure is consistent with the results of similar studies in other cardiac wards and out-patient clinics. In most cases, the levels of distress found were not sufficiently severe to warrant seeking specialist psychiatric support. Instead, there is much that the general nurse can do to alleviate the understandable fears and worries of patients being treated for cardiac disease. However, to respond appropriately, nursing staff must be able to identify psychological distress in patients. The HAD scale, if it can be validated in cardiac in-patient settings, provides an instrument which could easily become part of the routine assessment of patients' nursing needs.
Contextualizing and assessing the social capital of seniors in congregate housing residences: Study design and methods
Publisher: Springer Science and Business Media LLC
Date: 18-04-2005
Abstract: This article discusses the study design and methods used to contextualize and assess the social capital of seniors living in congregate housing residences in Calgary, Alberta. The project is being funded as a pilot project under the Institute of Aging, Canadian Institutes for Health Research. Working with seniors living in 5 congregate housing residencies in Calgary, the project uses a mixed method approach to develop grounded measures of the social capital of seniors. The project integrates both qualitative and quantitative methods in a 3-phase research design: 1) qualitative, 2) quantitative, and 3) qualitative. Phase 1 uses gender-specific focus groups phase 2 involves the administration of in idual surveys that include a social network module and phase 3 uses anamolous-case interviews. Not only does the study design allow us to develop grounded measures of social capital but it also permits us to test how well the three methods work separately, and how well they fit together to achieve project goals. This article describes the selection of the study population, the multiple methods used in the research and a brief discussion of our conceptualization and measurement of social capital.
Methods for exploring implementation variation and local context within a cluster randomised community intervention trial
Publisher: BMJ
Date: 09-2004
Paying for efficiency: what price the quality of hospital care?
Publisher: Wiley
Date: 12-02-1992
DOI: 10.1111/J.1753-6405.1992.TB00069.X
Abstract: Economic recession prompts governments and health service ministers to seek increased efficiency in the production of hospital services in order to reconcile increasing demands with scarce resources. As one approach to the problem, the National Health Strategy is recommending pilot schemes, similar to those which have been introduced in both the United Kingdom and the Netherlands, which involve the separation of purchaser from the provider of hospital services. It is argued that such separation, with the introduction of competition between providers of hospital services for contracts placed by publicly funded Area Health Boards, will increase efficiency and accountability in the use of resources. However, this argument ignores the hospital management's ability to keep costs down by altering the quality of hospital care in ways which are difficult to monitor by purchasing agencies. The article considers the effects the introduction of managed competition is likely to have on the quality of hospital services. The outcome is uncertain and competition may improve some dimensions of quality while jeopardizing others. If managed competition is tried in Australia, the opportunity should also be taken to examine its impact on the quality and outcomes of hospital care.
Assessing the congruence between perceived connectivity and network centrality measures specific to pandemic influenza preparedness in Alberta
Publisher: Springer Science and Business Media LLC
Date: 10-03-2010
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