ORCID Profile
0000-0002-0996-8128
Current Organisations
Cairns and Hinterland Hospital and Health Service
,
James Cook University
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Publisher: Informa UK Limited
Date: 25-08-2022
DOI: 10.1080/09638288.2021.1962992
Abstract: The aim of this systematic review was to identify models of community disability, rehabilitation and lifestyle service delivery in non-metropolitan areas of Australia, and to describe these models through an Integrated People-Centred Health Services (IPCHS) lens. We identified peer-reviewed studies published between 2000 and June 2021 that met the following criteria: described or evaluated a community service delivery model, intervention or program in regional, rural or remote Australia provided for people with a disability or a potentially disabling health condition. A scoring rubric was developed covering the five IPCHS strategies. Nineteen studies were included in the review. We identified a range of service delivery models providing support to people with a range of disabilities or conditions. We report evidence of the use of the IPCHS strategies in ways relevant to the local context. Several strengths emerged, with many services tailored to in idual need, and significant community engagement. Innovative rural service delivery approaches were also identified. Key areas requiring action included improved coordination or integration within and across professions and sectors. There was limited evidence of co-production of solutions or participatory governance. While people-centred approaches show promise to improve community-based services, large-scale fundamental change is required.IMPLICATIONS FOR REHABILITATIONCommunity-based disability and rehabilitation services in rural and remote Australia performed well at delivering tailored care and engaging in community consultation.These services must urgently implement strategies to enhance community ownership of solutions and participatory governance.Services must place a greater focus on explicit strategies to integrate and coordinate across services and professions, and to create an enabling environment, to deliver people-centred care.The World Health Organisation Integrated People-Centred Health Services framework provides an important roadmap to improving service delivery in rural and remote Australian communities.
Publisher: CSIRO Publishing
Date: 2021
DOI: 10.1071/AH19210
Abstract: ObjectiveTo explore measures of potentially avoidable general practitioner (PAGP)-type presentations to the emergency department (ED) of a large regional hospital in northern Queensland. MethodsLinkage of an ED administrative dataset to a face-to-face patient survey of local residents (n=1000) calculation of Australian Institute of Health and Welfare (AIHW) and Australasian College of Emergency Medicine (ACEM) measures of PAGP-type presentations to the ED and exploration of these measures with patient-perspective linked data. ResultsPAGP-type presenters to the ED were younger in age (median age in years: total cohort: 49 AIHW 38, P& .001 ACEM 36, P& .001) with the odds of having a chronic condition being less likely for AIHW PAGP-type presenters than other ED presenters (OR (95% CI) 0.54 (0.38–0.77): P=0.001)) after adjustment for age. PAGP-type presenters nominated reasons of convenience rather than urgency as their rationale for attending the ED, irrespective of measure. The number of PAGP-type presentations to the ED identified by the AIHW measure was more than three-fold higher than the ACEM measure (AIHW: n=227 ACEM: n=67). Influencing factors include the low proportion of ED attendees who had a medical consultation time of & h at this hospital site (1-month survey period: 17.8%) and differences between the patient self-report and ED administrative record for ‘self-referral to the ED’ (Self-referred: Survey 71% vs EDIS 93%, P& .001). ConclusionsIdentification of PAGP-type presentations to the ED could be enhanced with improvements to the quality of administrative processes when recording patient ‘self-referral to the ED’, along with further consideration of hospital site variation for the length of medical consultation time. What is known about the topic?PAGP-type presentations to the ED are an Australian National Healthcare Agreement progress indicator. Methods of measuring this indicator have been under review since 2012 and debate remains on how to accurately determine the measure. What does this paper add?By using patient perspective-linked data to explore different measures of PAGP-type presentations to EDs, this paper identifies issues with measure elements and suggests ways to improve these measures. What are the implications for practitioners?Measure elements of patient ‘self-referral to the ED’ and ‘medical consultation time’ require further consideration if they are to be used to measure PAGP-type presentations to the ED.
Publisher: Informa UK Limited
Date: 25-08-2019
Publisher: Informa UK Limited
Date: 05-03-2019
DOI: 10.1080/10253890.2019.1572745
Abstract: Chronic stress and adversity are associated with poor mental health and are thought to contribute to the existing mental health gap between Aboriginal and Torres Strait Islander people and other Australians. Hair cortisol and allostatic load (AL) are indices of sustained stress and may be mediators of the effects of stress on health. The aim of this study was to examine the relationship between hair cortisol, AL, and depressive symptoms. This cross-sectional study comprised 329 Aboriginal and Torres Strait Islander adolescents and adults recruited at two health screening programs operating in three communities in north Queensland. We measured hair cortisol and calculated an AL index from 10 biomarkers. We assessed depressive symptoms with a version of the Patient Health Questionnaire-9 adapted for Aboriginal and Torres Strait Islander people (aPHQ-9). We found differences in cortisol and AL between the screening programs and communities, which were not explained by depressive symptoms. Overall aPHQ-9 scores were unrelated to hair cortisol (p = .25 and p = .94) and AL (p = .30 and p = .88) when age, gender and smoking were taken into account. However, anhedonia (p = .007) and insomnia (p = .006) sub-scores were each significantly associated with AL in one study site. Our present data did not demonstrate overall associations of stress biomarkers and multisystem dysregulation with depressive symptoms, which suggests that the relationship between cumulative stress and depression may be better explained by other factors in this population. The specific association between anhedonia and insomnia with AL indicates that chronic multisystem dysregulation plays a role in these features of depression in this population. Lay summary Our study investigated the relationship between symptoms of depression and two biological pathways thought to mediate depression risk - the stress hormone cortisol and allostatic load (AL) - in an Australian Aboriginal and Torres Strait Islander population. Overall, cortisol and AL were unrelated to depression. However, AL was selectively associated with anhedonia (lack of motivation or drive) and sleep disturbances. These results suggest that metabolic dysregulation measured as AL may be relevant to the depression risk in this population.
Publisher: Informa UK Limited
Date: 03-08-2018
Location: Australia
No related grants have been discovered for Linton Harriss.