ORCID Profile
0000-0002-0355-4178
Current Organisations
University of Sydney School of Public Health
,
University of Cambridge
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Related Links
Publications
When good evidence is not enough: the role of context in bowel cancer screening policy in New Zealand
Publisher: Bristol University Press
Date: 08-2011
Abstract: Bowel cancer is a serious health problem in developed countries. Australia, the United Kingdom (UK) and New Zealand (NZ) reviewed the same randomised controlled trial evidence on the benefits and harms of population-based bowel cancer screening. Yet only NZ, with the highest age standardised rate of bowel cancer mortality, decided against introducing a bowel cancer screening programme. This case study of policy making explores the unique resource, ethical, institutional and political environments in which the evidence was considered. It highlights the centrality of context in assessing the relative worth of evidence in policy making and raises questions about the suitability of knowledge utilisation strategies.
The Referral System between Primary and Secondary Health Care in Saudi Arabia for Patients with Type 2 Diabetes: A Systematic Review
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/4183604
Abstract: Background. In Saudi Arabia, the mortality of diabetes is currently reported at 6%. A well-administered referral system is crucial in aiding the management of this disease. Method. A single reviewer employed a systematic approach to searching the literature databases with regard to the question: what are the attributes of referral systems in Saudi Arabia for patients with type 2 diabetes (T2D)? The results were analysed in order to provide recommendations to improve the Saudi health system. Results. Twelve primary studies were identified from a systematic search. Overall, the 12 studies did not clearly mention any of the factors of a good referral system. The referral problems identified by this study included patients’ unnecessary requests for referral, unstructured referral letters, and unclear dissemination guidelines for referral. Conclusions. This research attempted to identify the efficiency of the referral processes that were implemented for patients with T2D. The majority of the included studies were completely silent on the main referral factors for patients. If this review is representative of the referral system in Saudi Arabia, then, in the context of T2D, current referrals are unsafe. Further research on the quality of the referral system, taking into account at least some of the WHO referral guidelines, is required.
Time's Up. Descriptive Epidemiology of Multi-Morbidity and Time Spent on Health Related Activity by Older Australians: A Time Use Survey
Publisher: Public Library of Science (PLoS)
Date: 04-2013
Implementation and effectiveness of 'care navigation', coordinated management for people with complex chronic illness: Rationale and methods of a randomised controlled
Publisher: Springer Science and Business Media LLC
Date: 03-05-2013
Abstract: Chronic illness is a significant driver of the global burden of disease and associated health care costs. People living with severe chronic illness are heavy users of acute hospital services better coordination of their care could potentially improve health outcomes while reducing hospital use. The Care Navigation trial will evaluate an in-hospital coordinated care intervention on health service use and quality of life in chronically ill patients. A randomised controlled trial in 500 chronically ill patients presenting to the emergency department of a hospital in Western Sydney, Australia. Participants have three or more hospital admissions within a previous 12 month period and either aged ≥70 years or aged ≥45 years and of Aboriginal or Torres Strait Islander descent or aged ≥ 16 with a diagnosis of a respiratory or cardiology related illness. Patients are randomised to either the coordinated care program (Care Navigation), or to usual care. The Care Navigation program consists of dedicated nurses who conduct patient risk assessments, oversee patient nursing while in hospital, and guide development of a care plan for the management of chronic illness after being discharged from hospital. These nurses also book community appointments and liaise with general practitioners. The main outcome variables are the number of emergency department re-presentations and hospital readmissions, and quality of life during a 24 month follow-up. Secondary outcomes are length of hospital stay, mortality, time to first hospital re-admission, time to first emergency department re-presentation, patient satisfaction, adherence to prescribed medications, amount and type of in-hospital referrals made for consultations and diagnostic testing, and the number and type of community health referrals. A process evaluation and economic analysis will be conducted alongside the randomised trial. A trial of in-hospital care coordination may support recent evidence that engaging primary health services in care plans linked to multidisciplinary team support improves patient outcomes and reduces costs to the health system. This will inform local, national and international health policy. Australia New Zealand Clinical Trials Registry ACTRN12609000554268
Galvanizers, Guides, Champions, and Shields: The Many Ways That Policymakers Use Public Health Researchers
Publisher: Wiley
Date: 12-2011
Is the risk from nanomaterials perceived as different from the risk of ‘chemicals’ by the Australian public?
Publisher: The Sax Institute
Date: 2016
DOI: 10.17061/PHRP2621618
Abstract: Manufactured nanomaterials in Australia are managed predominantly through existing chemical regulatory frameworks. Many Australian government regulators have suggested the framing of manufactured nanomaterials as 'chemicals' when communicating about manufactured nanomaterials to the general public. This paper aims to determine whether the Australian public perception of manufactured nanomaterials differs to that of 'chemicals', and to examine the relationship between attitudes towards chemicals and perceptions of nanomaterial risk. We undertook a computerised assisted telephone survey of the Australian public. Analysis was undertaken using descriptive, paired tests of proportion, paired t-test and logistic regression techniques. We explored perceptions of nanomaterial risk and their relationship to perceptions of chemical risk and 'chemical attitudes'. We found that the public perceives nanomaterials in a more favourable light than it does chemicals. Perception of risk from chemicals had the greatest association with perceived nanomaterial risk (adjusted odds ratios between 0.1 and 0.2) and that attitudes to chemicals were associated with perception of nanomaterial risk in some cases. Risk communicators and policy makers need to consider the differences and associations between nanomaterials and chemicals when addressing the regulatory aspects of nanomaterials with the public. This is relevant for communication strategies that attempt to normalise the risks from nanomaterials compared with those of chemicals, especially as nanomaterials are perceived to be less risky than chemicals.
Colorectal cancer screening: Why immunochemical fecal occult blood tests may be the best option
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Job satisfaction of urban community health workers after the 2009 healthcare reform in China: a systematic review
Publisher: Oxford University Press (OUP)
Date: 17-12-2015
Abstract: In 2009 China introduced a new round of healthcare reform to strengthen primary care networks through the development of Community Health Services (CHS). This study aimed to measure the degree of overall job satisfaction and also satisfaction dimensions and then find common causes of dissatisfaction among Community Health Workers (CHWs) in urban China by conducting a systematic review of relevant studies on CHWs' job satisfaction. Web of Science, PubMed, Google scholar, Wanfangdata and CNKI were searched. Publications about job satisfaction of CHWs were screened and assessed. Finally 18 Chinese articles and 4 English articles were included. Quantitative and qualitative data were extracted for nine themes concerning job satisfaction. Narrative synthesis was employed to analyze the data. CHWs were generally neither satisfied nor dissatisfied with their work after 2009. Financial rewards and opportunities for professional development were the most important determinants of job dissatisfaction. Workers were generally satisfied with interpersonal relationships in the workplace. The expanded public health services package and human-resources related regulations, e.g. the professional rank promotion system, government-controlled staffing policy (i.e. staff-quota system) and government-controlled budgetary planning (i.e. the Separation of Revenue and Expenditure), were policies that had an effect on job satisfaction. Financial rewards and professional development were the two main predictors of job satisfaction. To improve CHS in China, policy-makers (especially the central government) need to consider the impact of current policies on job satisfaction in order to reduce job dissatisfaction.
Generating Sustained Political Priority for Non‐communicable Diseases: Towards a Suitable Governance Model
Publisher: Wiley
Date: 20-03-2017
Health work by older people with chronic illness: how much time does it take?
Publisher: SAGE Publications
Date: 05-03-2013
Abstract: People living with chronic illness report spending a lot of time managing their health, attempting to balance the demands of their illness/es with other activities. This study was designed to measure the time older people with chronic illness spend on specific health-related activities. Data were collected in 2010 using a national survey of people aged 50 years and over selected from the membership of National Seniors Australia, the Diabetes Services Scheme and The Lung Foundation. Respondents provided recall data on time used for personal health care, non-clinical health activity and health service interactions. While most people with a chronic illness spend on average less than 30 minutes a day on health-related activities, the highest decile of respondents averaged at least 2 hours each day. People with COPD report the highest expenditure of time. The greatest amount of time was spent on daily personal health care activities. For a minority of people with chronic illness, time demands for health-related activities can be so great that other activities must be affected. Some time demands are amenable to system interventions that would result in a more patient-centered organisation of care.
Doing mental health care integration: a qualitative study of a new work role.
Publisher: Springer Science and Business Media LLC
Date: 22-08-2015
Comparative analysis of the labelling of nanotechnologies across four stakeholder groups
Publisher: Springer Science and Business Media LLC
Date: 29-07-2015
Medical Markets and Australian Medical Politics, 1920-45
Publisher: Liverpool University Press
Date: 1988
DOI: 10.2307/27504434
Co-payments for health care: What is their real cost?
Publisher: CSIRO Publishing
Date: 2201
DOI: 10.1071/AH14087
Abstract: Based on the premise that current trends in healthcare spending are unsustainable, the Australian Government has proposed in the recent Budget the introduction of a compulsory $7 co-payment to visit a General Practitioner (GP), alongside increased medication copayments. This paper is based on a recent submission to the Senate Inquiry into the impact of out-of-pocket costs in Australia. It is based on a growing body of evidence highlighting the substantial economic burden faced by in iduals and families as a result of out-of-pocket costs for health care and their flow-on effects on healthcare access, outcomes and long-term healthcare costs. It is argued that a compulsory minimum co-payment for GP consultations will exacerbate these burdens and significantly undermine the tenets of universal access in Medicare. Alternative recommendations are provided that may help harness unsustainable health spending while promoting an equitable and fair health system.
Incorporating evidence and politics in health policy: can institutionalising evidence review make a difference?
Publisher: Bristol University Press
Date: 08-2014
Abstract: Much of the evidence translation literature focuses narrowly on the use of evidence in the initial policy formulation stages, and downplays the crucial role of institutions and the inherently political nature of policy making. More recent approaches acknowledge the importance of institutional and political factors, but make no attempt to incorporate their influence into new models of evidence translation. To address this issue, this article uses data from a comparative case study of bowel cancer screening policy in Australia, the United Kingdom and New Zealand, to propose alternative models of evidence incorporation which apply to all stages of the policy process.
Perceptions of risk from nanotechnologies and trust in stakeholders: a cross sectional study of public, academic, government and business attitudes
Publisher: Springer Science and Business Media LLC
Date: 26-04-2015
Intergovernmental policy opportunities for childhood obesity prevention in Australia: Perspectives from senior officials
Publisher: Public Library of Science (PLoS)
Date: 28-04-2022
DOI: 10.1371/JOURNAL.PONE.0267701
Abstract: Early childhood (from conception to five years) is a key life stage for interventions to prevent obesity. In the Australian Federation, policy responsibility for obesity prevention sits across all levels of government and several intergovernmental institutions, rendering a complicated policy space. There is a gap in our understanding of the role of intergovernmentalism in developing obesity prevention policy in Australia. Given the complexity of intergovernmental structures and initiatives influencing childhood obesity prevention policy, it is important to understand the perspectives of senior health officials within the bureaucracy of government who through their roles may be able to influence processes or new strategies. Document analysis relating to obesity prevention in the intergovernmental context provided material support to the study. This analysis informed the interview guides for nine interviews with ten senior health department officials (one interview per jurisdiction). Several opportunities exist to support nutrition and obesity prevention in early childhood including marketing regulation (discretionary choices, breastmilk substitutes, commercial complementary foods and ‘toddler milks’) and supporting the early childhood education and care sector. This study found a widening structural gap to support national obesity policy in Australia. New public management strategies limit the ability of intergovernmental institutions to support coordination within and between governments to address complex issues such as obesity. Subnational informants perceived a gap in national leadership for obesity prevention, while a Commonwealth informant noted the commitment of the national government to partner with industry under a self-regulation model. In this gap, subnational leaders have pursued nationally consistent action to address obesity, including the development of a national obesity strategy as a bipartisan endeavour across jurisdictions. Public officials calculate the strategic possibilities of pursuing opportunities within state agendas but note the limited chances of structural change in the absence of national leadership and funding.
Integrated Care for Multimorbidity Population in Asian Countries: A Scoping Review
Publisher: Ubiquity Press, Ltd.
Date: 2022
DOI: 10.5334/IJIC.6009
Covid 19 Vaccines and the Australian health care state
Publisher: Elsevier BV
Date: 06-2022
Coordination of care in Australian mental health policy
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/AH11049
Abstract: Objective. To review Australian mental health initiatives involving coordination of care. Methods. Commonwealth government websites were systematically searched for mental health policy documents. Database searches were also conducted using the terms ‘coordination’ or ‘integration’ and ‘mental health’ or ‘mental illness’ and ‘Australia’. We assessed the extent to which informational, relational and management continuity have been addressed in three ex le programs. Results. The lack of definition of coordination at the policy level reduces opportunities for developing actionable and measurable programs. Of the 51 mental health initiatives identified, the three ex les studied all demonstrated some use of the dimensions of continuity to facilitate coordination. However, problems with funding, implementation, evaluation and competing agendas between key stakeholders were barriers to improving coordination. Conclusions. Coordination is possible and can improve both relationships between providers and care provided. However, clear leadership, governance and funding structures are needed to manage the challenges encountered, and evaluation using appropriate outcome measures, structured to assess the elements of continuity, is necessary to detect improvements in coordination. What is known about the topic? The issues of integration of services and coordination of care have been a part of the National Mental Health Strategy documents for almost 20 years, but reports and evaluations continually note a lack of solid progress on these reforms. What does this paper add? This paper examines how the key elements of continuity that underpin coordination have been addressed in three ex les of Australian mental health initiatives aimed at improving integration and coordination. What are the implications for practitioners? Coordination of care for mental health is possible and can improve both relationships between providers and care provided, but attention should be paid to the role of informational, relationship and management continuity in program design and implementation.
Is the Partners in Recovery program connecting with the intended population of people living with severe and persistent mental illness? What are their prioritised needs?
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15248
Abstract: Objective The Partners in Recovery (PIR) program is an Australian government initiative designed to make the mental health and social care sectors work in more coordinated ways to meet the needs of those with severe and complex mental illness. Herein we reflect on demographic data collected during evaluation of PIR implementation in two Western Sydney sites. The aims of the present study were to: (1) explore whether two Sydney-based PIR programs had recruited their intended population, namely people living with severe and persistent mental illness and (2) learn more about this relatively unknown population and their self-identified need priorities. Methods Routinely collected initial client assessment data were analysed descriptively. Results The data suggest that the two programs are engaging the intended population. The highest unmet needs identified included psychological distress, lack of daytime activities and company, poor physical health and inadequate accommodation. Some groups remain hard to connect, including people from Aboriginal and other culturally erse communities. Conclusions The data confirm that the PIR program, at least in the two regions evaluated, is mostly reaching its intended audience. Some data were being collected inconsistently, limiting the usefulness of the data and the ability to build on PIR findings to develop ongoing support for this population. What is known about the topic? PIR is a unique national program funded to engage with and address the needs of Australians living with severe and persistent mental illness by facilitating service access. What does this paper add? This paper reports on recruitment of people living with severe and persistent mental illness, their need priorities and data collection. These are three central elements to successful roll-out of the much anticipated mental health component of the National Disability Insurance Scheme, as well as ongoing PIR operation. What are the implications for practitioners? Active recruitment, exploration of self-reported need priorities and routine outcome measurement are essential yet challenging work practices when working with people living with severe and persistent mental illness.
Flexible funding for effective, individualised, integrated care.
Publisher: Ubiquity Press, Ltd.
Date: 11-07-2017
DOI: 10.5334/IJIC.3174
Time to care? Health of informal older carers and time spent on health related activities: an Australian survey
Publisher: Springer Science and Business Media LLC
Date: 22-04-2013
Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report
Publisher: Elsevier BV
Date: 04-2018
Coordinated care versus standard care in hospital admissions of people with chronic illness: A randomised controlled trial
Publisher: AMPCo
Date: 07-2015
DOI: 10.5694/MJA14.01049
Abstract: To determine whether Care Navigation (CN), a nurse-led hospital-based coordinated care intervention, reduced the use of hospital services and improved quality of life for patients with chronic illness. Randomised controlled trial participants were allocated to CN or standard care. Patients with chronic illness presenting to the emergency department of Nepean Hospital, Sydney, New South Wales. High-risk status for an unplanned admission was defined as i) three or more unplanned hospital admissions in 12 months for patients aged ≥ 70 or at least one admission for cardiac or respiratory disease in patients aged 16-69 years or ii) judged by a CN nurse to be high risk and likely to benefit. Numbers of re-presentations or readmissions, quality of life, time to re-presentation, readmission or death, length of stay, and access to hospital and community health services. 500 participants were randomised between May 2010 and February 2011 359 by previous unplanned admission and 141 by clinical impression. The CN group received more community health services (rate ratio, 1.94 95% CI, 1.35-2.81 P < 0.001) than participants receiving standard care however, this did not result in statistically significant differences in number of re-presentations (rate ratio, 0.83 95% CI, 0.68-1.01 P = 0.07), number of readmissions (rate ratio, 0.85 95% CI, 0.70-1.04 P = 0.11), quality of life at 24 months (mean difference, 0 95% CI, - 0.10 to 0.09, P = 0.93), or other measures. CN did not improve quality of life or reduce unplanned hospital presentations or admissions despite community health services almost doubling. Future service development should explore potential benefits of linking navigated intrahospital care to ongoing, proactive care planning and delivery in the community. ACTRN12609000554268.
Improving coordination through information continuity: a framework for translational research
Publisher: Springer Science and Business Media LLC
Date: 25-11-2014
Searching for Truth: Internet Search Patterns as a Method of Investigating Online Responses to a Russian Illicit Drug Policy Debate
Publisher: JMIR Publications Inc.
Date: 13-12-2012
DOI: 10.2196/JMIR.2270
COVID-19: The need for an Australian economic pandemic response plan
Publisher: Elsevier BV
Date: 12-2020
Deconstructing unemployment: developments in Britain in the interwar years
Publisher: Wiley
Date: 11-1991
Internet Search Patterns of Human Immunodeficiency Virus and the Digital Divide in the Russian Federation: Infoveillance Study
Publisher: JMIR Publications Inc.
Date: 12-11-2013
DOI: 10.2196/JMIR.2936
Health professionals, patients and chronic illness policy: A qualitative study
Publisher: Wiley
Date: 09-06-2011
National Health Workforce Regulation: Contextualising the Australian scheme
Publisher: Emerald
Date: 06-03-2017
DOI: 10.1108/IJHG-01-2016-0005
Abstract: In 2010, Australia introduced the National Registration and Accreditation Scheme for the health professions (the Australian scheme) creating a legislative framework for a national system of health workforce regulation, delivering a model of collective (and multi-level) government involvement in regulatory activities. The purpose of this paper is to examine how its governance arrangement compares to different national systems and other health regulatory bodies in Australia. This qualitative case study is informed by documentary analysis in conjunction with policy mapping. This is part of a larger project investigating the policy pathway which led to establishment of the Scheme. The authors compare the Scheme with other Australian health standard setting and regulatory bodies. The Australian scheme’s governance model supported existing constitutional arrangements, and enabled local variations. This facilitated the enduring interest of ministers (and governments) on matters of health workforce and articulated the activities of the new regulatory player. It maintains involvement of the six states and two territories, with the Commonwealth Government, and profession-specific boards and accreditation agencies. This resulted in a unique governance framework delivering a new model of collective ministerial responsibility. The governance design is complex, but forges a new way to embed existing constitutional arrangements within a tripartite arrangement that also delivers National Boards specific to in idual health professions and an organisation to administer regulatory activities. This study demonstrates that effective design of governance arrangements for regulatory bodies needs to address regulatory tasks to be undertaken as well as the existing roles, and ongoing interests of governments in participating in those regulatory activities. It highlights that a unique arrangement, while appearing problematic in theory may in practice deliver intended regulatory outcomes.
The Price of Health
Publisher: Cambridge University Press
Date: 28-11-1991
Abstract: No area of social welfare in Australia has seen as much conflict as health policy. Clashes have involved the medical profession, bureaucrats, friendly societies and political parties, often to the detriment of the patient. This 1991 book provides background to the current debate by studying the political conflict over health policy in Australia from 1910–60. It looks at both state and national levels for the origins of the system of publicly subsidized private practice epitomized in the fee-for-service scheme. The different currents within state policy are analysed along with the various obstructions to the development of the national health insurance policy. The role of the British Medical Association, which in its indigenous form continues to have a hostile relationship with the government because of its determination to maintain its independence and fee-for-service practices, is closely examined. The Price of Health will be of particular interest to health policy makers.
Policy Stringency, Handwashing and COVID-19 cases: Evidence from Global dataset
Publisher: Elsevier BV
Date: 06-2021
From “our world” to the “real world”: Exploring the views and behaviour of policy-influential Australian public health researchers
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.SOCSCIMED.2011.02.004
Abstract: Research and researchers influence the genesis and development of public health policy in limited but essential ways. Surveys and interviews with 36 peer-nominated "highly influential" Australian public health researchers found they engaged in a breadth of strategies that included rigorous but targeted research design, multilateral collaboration, multiple methods of research dissemination and promotion (including tactical use of the media), and purposeful development of bridging relationships. Researchers' ability to understand the worlds of research, policy and the media and to speak their languages (or to work with others who fulfilled this role) was a key factor. Advocacy was seen as fundamental by some but was disparaged by others. Influential behaviours were guided by values and beliefs about the principles underlying traditional science and the contrasting ethos of contemporary research. This study may help researchers consider their own policy-related roles, strategies and relationships in the context of increasing calls for research that serves economic and/or social goals.
Implementing system-wide risk stratification approaches: A review of critical success and failure factors
Publisher: SAGE Publications
Date: 28-03-2017
Abstract: Risk stratification has become a widely used tool for linking people identified at risk of health deterioration to the most appropriate evidence-based care. This article systematically reviews recent literature to determine key factors that have been identified as critical enablers and/or barriers to successful implementation of risk stratification tools at a system level. A systematic search found 23 articles and four promising protocols for inclusion in the review, covering the use to 20 different risk stratification tools. These articles reported on only a small fraction of the risk stratification tools used in health systems suggesting that while the development and statistical validation of risk stratification algorithms is widely reported, there has been little published evaluation of how they are implemented in real-world settings. Controlled studies provided some evidence that the use of risk stratification tools in combination with a care management plan offer patient benefits and that the use of a risk stratification tool to determine components of a care management plan may contribute to reductions in hospital readmissions, patient satisfaction and improved patient outcomes. Studies with the strongest focus on implementation used qualitative and case study methods. Among these, the literature converged on four key areas of implementation that were found to be critical for overcoming barriers to success: the engagement of clinicians and safeguarding equity, both of which address barriers of acceptance the health system context to address administrative, political and system design barriers and data management and integration to address logistical barriers.
The Papua New Guinea cholera outbreak: implications for PNG, Australia and the Torres Strait
Publisher: AMPCo
Date: 11-2013
DOI: 10.5694/MJA13.10516
Effective communication is crucial to self-management: the experiences of immigrants to Australia living with diabetes
Publisher: SAGE Publications
Date: 15-11-2010
Abstract: Objectives: Ageing immigrant populations now pose problems for the management of chronic illness in Australia. This article asks questions about the experiences of immigrants in Australia with type II diabetes mellitus (DM). What impact, if any, have health policies had on the lives of immigrants? How do their experiences of living with DM compare with those of people with DM who were born in Australia? Methods: Semi-structured interviews were conducted with 32 participants who had DM (n = 25) or cared for someone with DM (n = 7). Fifteen participants had migrated to Australia and English was not their first language. Participants were asked to describe their experience of managing diabetes. Results: Immigrants to Australia confront linguistic and cultural barriers that create an extra layer of problems not experienced by Australian-born people. Older people who were born overseas face obstacles to effective engagement with the health system that weaken their ability to take an active part in the management of their conditions. Conclusions: Chronic disease policy is failing immigrants to Australia. Health professionals and services must recognize the central role that cultural ersity plays in self-management and the impact that this can have on health outcomes for immigrants with chronic illness.
A spatial analysis of referrals to a primary mental health programme in Western Sydney from 2012 to 2015
Publisher: PAGEPress Publications
Date: 06-11-2019
DOI: 10.4081/GH.2019.773
Abstract: Access to Allied Psychological Services is a primary mental health programme targeting hard-to-reach populations throughout Australia. This research aims to identify patterns of referrals to the programme in the Western Sydney Primary Health Network region from 2012 to 2015. The referral rates were analysed by using spatial autocorrelation indexes and spatial regression. The study area was described through the identification of the most disadvantaged areas and through consideration of three socio-economic indicators: percentage of Aboriginal and Torres Strait Islander Australians, low educational attainment and low weekly incomes. A large hot spot (identifying high referral rates) was located across the duration of the study in the south-western urban area that partially covered a disadvantaged area. The main cold spot (identifying low referral rates) was located in the south-eastern urban area, covering another disadvantaged area, however critically this association disappeared over time. Our modelling showed that the referral rates had a direct association with the percentage of Aboriginal and Torres Strait Islander peoples with low incomes, and an indirect association with low educational attainment. The results and technique are useful in monitoring and addressing inequality in health planning and policy.
From coordinated care trials to medicare locals: what difference does changing the policy driver from efficiency to quality make for coordinating care?
Publisher: Oxford University Press (OUP)
Date: 21-11-2012
Abstract: The terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for in iduals to organizational and system interventions such as managed care, which contract medical and support services. Ongoing debate about whether financial and organizational integration are needed to achieve clinical integration is evident in policy debates over several decades, from a focus through the 1990s on improving coordination through structural reform and the use of market mechanisms to achieve allocative efficiencies (better overall service mix) to more recent attention on system performance to improve coordination and quality. We examine this shift in Australia and ask how has changing the policy driver affected efforts to achieve coordination? Care planning, fund pooling and purchasing are still important planks in coordination. Evidence suggests that financial strategies can be used to drive improvements for particular patient groups, but these are unlikely to improve outcomes without being linked to clinical strategies that support coordination through multidisciplinary teamwork, IT, disease management guidelines and audit and feedback. Meso level organizational strategies might align the various elements to improve coordination. Changing the policy driver has refocused research and policy over the last two decades from a focus on achieving allocative efficiencies to achieving quality and value for money. Research is yet to develop theoretical approaches that can deal with the implications for assessing effectiveness. Efforts need to identify intervention mechanisms, plausible relationships between these and their measurable outcomes and the components of contexts that support the emergence of intervention attributes.
Improving integrated care for chronic non-communicable diseases: A focus on quality referral factors
Publisher: Informa UK Limited
Date: 19-01-2019
Getting evidence into policy: The need for deliberative strategies?
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.SOCSCIMED.2011.01.034
Abstract: Getting evidence into policy is notoriously difficult. In this empirical case study we used document analysis and key informant interviews to explore the Australian federal government's policy to implement a national bowel cancer screening programme, and the role of evidence in this policy. Our analysis revealed a range of institutional limitations at three levels of national government: within the health department, between government departments, and across the whole of government. These limitations were lified by the pressures of the 2004 Australian federal election c aign. Traditional knowledge utilisation approaches, which rely principally on voluntarist strategies and focus on the in idual, rather than the institutional level, are often insufficient to ensure evidence-based implementation. We propose three alternative models, based on deliberative strategies which have been shown to work in other settings: review of the evidence by a select group of experts whose independence is enshrined in legislation and whose imprimatur is required before policy can proceed use of an advisory group of experts who consult widely with stakeholders and publish their review findings or public discussion of the evidence by the media and community groups who act as more direct conduits to the decision-makers than researchers. Such deliberative models could help overcome the limitations on the use of evidence by embedding public review of evidence as the first step in the institutional decision-making processes.
Are Australians concerned about nanoparticles? A comparative analysis with established and emerging environmental health issues
Publisher: Elsevier BV
Date: 02-2015
Abstract: Introducing new technologies into society raises considerable public concern. We determine the public concern about nanoparticles, and compare this concern to other environmental health issues such as wind farms and coal seam gas production. A repeat cross sectional survey examining views on environmental health issues, risk, chemicals and trust was undertaken in more than 1,300 Australian residents in 2000 and 2013. Logistic regression and principal component analysis was used to investigate predictors of nanoparticle concern and identify a component structure for environmental health issues that could explain a trend of future nanoparticle concern. Australians have a relatively low level of concern about the risks of nanoparticles to health when compared to their concerns about other environmental health issues. Items associated with concern included gender, a general wish to avoid chemicals and possibly trust in politicians. Concern over nanoparticles clustered with similar views on technological risks. Current public concern over the risks of nanoparticles is low. However, a reframing of the issue towards 'chemicals' is likely to have a negative effect on risk perceptions. This paper raises questions about appropriate channels for the effective communication of risk.
The National Health Service: A Political History
Publisher: JSTOR
Date: 1998
DOI: 10.2307/40111330
Living with economic hardship at the end of life
Publisher: BMJ
Date: 16-08-2013
DOI: 10.1136/BMJSPCARE-2013-000460
Abstract: Dying patients and their families often face an added burden of economic hardship, especially if they have become ill in the years before expected retirement. In Australia, patients can fall through the cracks of the national system of social protection because there are gaps in the access to and provision of healthcare and social assistance at the end of life. A mixed-method, prospective case study of in iduals and their family carers, recruited from a specialist palliative care service in Melbourne, Australia, is presented. Participants were interviewed and followed up over 6 months and completed a 2-week diary of all services used and out-of-pocket costs. Mean out-of-pocket spending was $A369 per month (median: $A176, IQR: 356) ($A1=US$1=€0.73=£0.62 January 2011). Households with economic hardship were more likely to have a patient who was male, had ceased paid employment earlier than expected due to illness, reported a reduction in income due to illness, had less access to financial resources and used significantly fewer health-related community services. Three factors shaped the participants' experience of hardship: (1) the premature loss of employment capacity and income (2) the affordability of care and (3) a welfare system that could not accommodate their complex needs. These results demonstrate the multidimensional nature of the economic burden experienced at the end of life and imply the need for nuanced solutions to better support patients and their families. If terminally ill people wish to die at home and are to be supported to do so, policies must take account of the shift in economic burden from the health system onto families.
Patient affiliation with GPs in Australia—Who is and who is not and does it matter?
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.HEALTHPOL.2010.09.002
Abstract: AIMS AND RATIONALE: Recent government reports have proposed voluntary enrolment with general practitioners for certain groups of patients to enhance their continuity of care. We examine which groups of patients are presently "de facto" affiliated with GPs, and whether affiliated patients are more likely to receive advice from their GPs on primary preventative matters such as weight, exercise and smoking. A nationally representative cross sectional survey of Australian residents aged 18 years or over was conducted via telephone in 2008. Data from 1146 participants were analysed in both tabular forms and with logistic regression. Most Australian adults are affiliated, de facto, with an in idual GP or a GP practice (11% often go to different GPs). Factors associated with affiliation were patient age, education, satisfaction with their GP and urban or rural location. Patients with poor or fair self assessed health are relatively unlikely to be affiliated with a GP. Weak support was found for the hypothesis that affiliated patients were more likely to receive primary preventative advice on weight and diet and no support found in relation to exercise, smoking or alcohol consumption. The study suggests policy on voluntary patient enrolment should focus on providing continuity of care to those with poor health. If further studies confirm affiliation does not enhance preventive health advice, further policy interventions may be appropriate.
The Radical Left in Britain, 1931-1941
Publisher: Liverpool University Press
Date: 1985
DOI: 10.2307/27508737
Engagement with healthcare providers and healthcare system navigation among Australians with chronic conditions: a descriptive survey study
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2022-061623
Abstract: With the rate of chronic conditions increasing globally, it is important to understand whether people with chronic conditions have the capacity to find the right care and to effectively engage with healthcare providers to optimise health outcomes. We aimed to examine associations between care navigation, engagement with health providers and having a chronic health condition among Australian adults. This is a cross-sectional, 39-item online survey including the navigation and engagement subscales of the Health Literacy Questionnaire, completed in December 2018, in Australia. Binary variables (low/high health literacy) were created for each item and navigation and engagement subscale scores. Logistic regression analyses (estimating ORs) determined the associations between having a chronic condition and the navigation and engagement scores, while controlling for age, gender, level of education and income. 1024 Australians aged 18–88 years (mean=46.6 years 51% female) recruited from the general population. Over half (n=605, 59.0%) of the respondents had a chronic condition, mostly back pain, mental disorders, arthritis and asthma. A greater proportion of respondents with chronic conditions had difficulty ensuring that healthcare providers understood their problems (32.2% vs 23.8%, p=0.003), having good discussions with their doctors (29.1% vs 23.5%, p=0.05), discussing things with healthcare providers until they understand all they needed (30.5% vs 24.5%, p=0.04), accessing needed healthcare providers (35.7% vs 29.7%, p=0.05), finding the right place to get healthcare services (36.3% vs 29.2%, p=0.02) and services they were entitled to (48.3% vs 40.6%, p=0.02), and working out what is the best healthcare for themselves (34.2% vs 27.7%, p=0.03). Participants with chronic conditions were 1.5 times more likely to have low scores on the engagement (adjusted OR=1.48, p=0.03, 95% CI 1.05 to 2.08) and navigation (adjusted OR=1.43, p=0.026, 95% CI 1.043 to 1.970) subscales after adjusting for age, gender, income and education. Upskilling in engagement and communication for healthcare providers and people with chronic conditions is needed. Codesigned, clearly articulated and accessible information about service entitlements and pathways through care should be made available to people with chronic conditions. Greater integration across health services, accessible shared health records and access to care coordinators may improve navigation and engagement.
Unlocking information for coordination of care in Australia: a qualitative study of information continuity in four primary health care models
Publisher: Springer Science and Business Media LLC
Date: 13-03-2013
Identifying Trustworthy Experts: How Do Policymakers Find and Assess Public Health Researchers Worth Consulting or Collaborating With?
Publisher: Public Library of Science (PLoS)
Date: 05-03-2012
Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15154
Abstract: Objective Australian mental health care remains hospital centric and fragmented it is riddled with gaps and does little to promote recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparison with other regions and jurisdictions, but must be based on a rigorous classification of services. The main aim of this study is to create an integrated mental health atlas of the Western Sydney LHD in order to help decision makers to better plan informed by local evidence. Methods The standard classification system, namely the Description and Evaluation of Services and Directories in Europe for Long-term Care model, was used to describe and classify adult mental health services in the Western Sydney Local Health District (LHD). This information provided the foundation for accessibility maps and the analysis of the provision of care for people with a lived experience of mental illness in Western Sydney LHD. All this data was used to create the Integrated Mental Health Atlas of Western Sydney LHD. Results The atlas identified four major gaps in mental health care in Western Sydney LHD: (1) a lack of acute and sub-acute community residential care (2) an absence of services providing acute day care and non-acute day care (3) low availability of specific employment services for people with a lived experience of mental ill-health and (4) a lack of comprehensive data on the availability of supported housing. Conclusions The integrated mental health atlas of the Western Sydney LHD provides a tool for evidence-informed planning and critical analysis of the pattern of adult mental health care. What is known about the topic? Several reports have highlighted that the Australian mental health system is hospital based and fragmented. However, this knowledge has had little effect on actually changing the system. What does this paper add? This paper provides a critical analysis of the pattern of adult mental health care provided within the boundaries of the Western Sydney LHD using a standard, internationally validated tool to describe and classify the services. This provides a good picture of the availability of adult mental health care at the local level that was hitherto lacking. What are the implications for practitioners? The data presented herein provide a better understanding of the context in which mental health practitioners work. Managers and planners of services providing care for people with a lived experience of mental illness can use the information herein for better planning informed by local evidence.
Changes in public perceptions and experiences of the Australian health‐care system: A decade of change
Publisher: Wiley
Date: 20-11-2020
DOI: 10.1111/HEX.13154
Class in Urban History. A Review Article
Publisher: Cambridge University Press (CUP)
Date: 1984
Controlling equine influenza: policy networks and decision-making during the 2007 Australian equine influenza outbreak.
Publisher: Hindawi Limited
Date: 28-12-2014
DOI: 10.1111/TBED.12046
Abstract: Rapid, evidence-based decision-making is critical during a disease outbreak response however, compliance by stakeholders is necessary to ensure that such decisions are effective - especially if the response depends on voluntary action. This mixed method study evaluated technical policy decision-making processes during the 2007 outbreak of equine influenza in Australia by identifying and analysing the stakeholder network involved and the factors driving policy decision-making. The study started with a review of the outbreak literature and published policy documents. This identified six policy issues regarding policy modifications or differing interpretations by different state agencies. Data on factors influencing the decision-making process for these six issues and on stakeholder interaction were collected using a pre-tested, semi-structured questionnaire. Face-to-face interviews were conducted with 24 in iduals representing 12 industry and government organizations. Quantitative data were analysed using social network analysis. Qualitative data were coded and patterns matched to test a pre-determined general theory using a method called theory-oriented process-tracing. Results revealed that technical policy decisions were framed by social, political, financial, strategic and operational considerations. Industry stakeholders had influence through formal pre-existing channels, yet specific gaps in stakeholder interaction were overcome by reactive alliances formed during the outbreak response but outside the established system. Overall, the crisis management system and response were seen as positive, and 75-100% of in iduals interviewed were supportive of, had interest in and considered the outcome as good for the majority of policy decisions, yet only 46-75% of those interviewed considered that they had influence on these decisions. Training to increase awareness and knowledge of emergency animal diseases (EADs) and response systems will improve stakeholder participation in emergency disease management and preparedness for future EAD incursions.
Demographic and clinical predictors of unplanned hospital utilisation among chronically ill patients: a prospective cohort study.
Publisher: Springer Science and Business Media LLC
Date: 03-04-2015
Deadly Enemies: Tobacco and Its Opponents in Australia
Publisher: Liverpool University Press
Date: 2001
DOI: 10.2307/27516824
Embodying policy-making in mental health: the implementation of Partners in Recovery
Publisher: Informa UK Limited
Date: 28-04-2016
Navigating public health chemicals policy in Australia: a policy maker?s and practitioner?s guide
Publisher: The Sax Institute
Date: 2012
DOI: 10.1071/NB12110
Related Organisations
University Of Cambridge
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for James Gillespie.