期刊
【作者单位】
="Australian Primary Healthcare Research Institute and Menzies Centre for Health Policy Australian National University Australian Capital Territory"
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Objective: To examine current health policy in Australia and New Zealand and assess the extent to which the policies equip these countries to meet the challenges associated with increasing rates of multi-morbid chronic illnesses.M...
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Objective: To examine current health policy in Australia and New Zealand and assess the extent to which the policies equip these countries to meet the challenges associated with increasing rates of multi-morbid chronic illnesses.Method: We examined reports from agencies holding data relating to chronic illness in both countries, looking at prevalence trends and the frequency of multiple morbidities being recorded. We undertook content analysis of health policy documents from Australian and New Zealand government agencies.Results: The majority of people with chronic illness have multiple morbidities. Multi-morbid chronic illnesses significantly effect the health of people in both Australia and New Zealand and place substantial demands on the health systems of those countries. These consequences are both predicted to increase dramatically in the near future. Despite this, neither country explicitly acknowledges multi-morbidity as a major factor in their policies addressing chronic illness.Conclusion and Implication: In addition to considering policy responses to chronic illness, policy makers should explicitly consider policies shaped to address the needs of people with multi-morbid chronic illness.
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Objective: This study examines measures of psychosocial job quality developed from the Household Income and Labour Dynamics in Australia (HILDA) Survey, and reports on associations with physical and mental health.
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Objective Small Island Developing States (SIDS) struggle with implementing multisectoral tobacco control measures, and health sector actors often lack capacity to forge multisectoral commitment. This study aims to explore the sour...
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Objective Small Island Developing States (SIDS) struggle with implementing multisectoral tobacco control measures, and health sector actors often lack capacity to forge multisectoral commitment. This study aims to explore the sources and dynamics of authority that can enable multisectoral collaboration despite the divergence of policy agendas in tobacco control.Methods We applied a qualitative, explorative case study design, with data collection and analysis guided by an analytical framework that identifies sources and dynamics of authority. Seventy interviews were conducted in Fiji and Vanuatu between 2018 and 2019.Results The key features shaping multisectoral coordination for tobacco control in Fiji and Vanuatu are the expert, institutional, capacity-based and legal authority that state and non-state actors have in tobacco governance. The amount of authority actors can secure from these sources was shown to be influenced by their performance (perceived or real), the discourse around tobacco control, the existing legal tools and their strategic alliances. SIDS vulnerabilities, arising from small size, isolation and developing economies, facilitate an economic growth discourse that reduces health sector actors' authority and empowers protobacco actors to drive tobacco governance.Conclusions Our results highlight the need for terms of engagement with the tobacco industry to enable governments to implement multisectoral tobacco control measures. Expanding assistance on tobacco control among government and civil society actors and increasing messaging about the impact of economic, trade and agricultural practices on health are essential to help SIDS implement the Framework Convention on Tobacco Control.
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The final report of the National Health and Hospital Reform Commission (NHHRC) called for a strengthened consumer voice and empowerment. This has salience for the development of health policy concerning chronic illnesses. This pap...
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The final report of the National Health and Hospital Reform Commission (NHHRC) called for a strengthened consumer voice and empowerment. This has salience for the development of health policy concerning chronic illnesses. This paper compares the recommendations for chronic illness care made in the NHHRC final report with suggestions made by people with chronic illness and family carers of people with chronic illness in a recent Australian study. Sixty-six participants were interviewed in a qualitative research project of the Serious and Continuing Illness Policy and Practice Study (SCIPPS). Participants were people with type II diabetes mellitus, chronic obstructive pulmonary disease or chronic heart failure. Family carers were also interviewed. Content analysis was undertaken and participants' recommendations for improving care were compared with those proposed in the NHHRC final report. Many suggestions from the participants of the SCIPPS qualitative research project appeared in the NHHRC final report, including the need to improve care coordination, health literacy and the experience of Indigenous Australians. The research project also identified important issues of family carers, immigrants and people with multiple illnesses, which were not addressed in the NHHRC final report. More specific attention is needed in health reform to improve the experience of family carers, Indigenous peoples, immigrants to Australia and people with multiple illnesses. To align more closely with their needs, health reform must be explicitly informed by the voices of people with chronic illness and their family carers. The NHHRC recommendations must be supplemented with proposals that address the needs of these people for support and the problems associated with poor care coordination.
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When introduced in 1984 as a universal health insurance scheme, Medicare did not include dental care, which has always been and continues to be a state/territory responsibility. Access to state services has not been a universal en...
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When introduced in 1984 as a universal health insurance scheme, Medicare did not include dental care, which has always been and continues to be a state/territory responsibility. Access to state services has not been a universal entitlement and continues to be provided on a means-tested basis. For a brief period in the 1990s the Commonwealth provided support funding for state dental services under the Commonwealth Dental Health Program (CDHP), which was discontinued in 1996.The National Health and Hospitals Reform Commission (the Commission), established by the Rudd Government in 2007 to review the Australian health system, concluded that there was a pressing need for a national dental health scheme.
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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 condu...
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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 example 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 examples 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 examples 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.
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Objective: Evidence-based policy depends on the availability of high-quality research that is relevant to the population. This study aimed to identify the available data on the health of older Indigenous Australians in population-...
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Objective: Evidence-based policy depends on the availability of high-quality research that is relevant to the population. This study aimed to identify the available data on the health of older Indigenous Australians in population-based longitudinal studies of ageing. Approach: Evaluation of the Dynamic Analyses to Optimise Ageing Project (DYNOPTA) dataset that has pooled nine Australian longitudinal ageing studies, six of which were analysed here. Main outcome measures: Proportions of the DYNOPTA sample identified as Indigenous. Results: Indigenous participants made up 0.7% of males and 0.5% of females in the weighted sample, compared with 0.8% of both sexes in the Australian population. Indigenous under-representation is greater at ages 45-54 than at older ages, despite overall greater participation in this age range. Conclusions and implications: Within the existing Australian longitudinal ageing studies, Indigenous Australians are under-represented. This means there is a significant gap in the evidence base relating to the health of older Indigenous Australians. Research approaches specifically designed to address the health and wellbeing of older Indigenous Australians are urgently required.
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Disparities in electricity retail regulatory protections will see someconsumers approaching energy transition from an uneven footing. Herewe examine the spatial organization of regulatory inequities in Australiaby mapping electric...
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Disparities in electricity retail regulatory protections will see someconsumers approaching energy transition from an uneven footing. Herewe examine the spatial organization of regulatory inequities in Australiaby mapping electricity legal protections for settlements nationwide.Multiple logistic regression (n = 2,996) identifies the geographic andsocio-demographic characteristics of settlements likely to be underservedby regulations to: protect life-support customers, guarantee service levels,clarify connection requirements for rooftop solar, require disconnectionreporting and set clear and independent complaints processes. Assessingwhether communities receive fewer than four of five protections, wefind that Indigenous communities are 15% more likely to be underservedacross multiple metrics and remote communities are 18% more likely to beunderserved. These groups overlap. Those communities whose lands arerich in resources necessary for energy transition are simultaneously at riskof non-recognition of their own energy needs under current regulation,requiring policy remedies for a just transition.
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The terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for individuals to organizational and system interventions such as managed care, which contract med...
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The terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for individuals to organizational and system interventions such as managed care, which contract medical and support ser-vices. 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.
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Introduction. The Australian federal government is developing a policy response to chronic disease in Australia. The Serious and Continuing Illness Policy and Practice Study examined the experience of individuals with chronic hear...
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Introduction. The Australian federal government is developing a policy response to chronic disease in Australia. The Serious and Continuing Illness Policy and Practice Study examined the experience of individuals with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or type 2 diabetes mellitus (diabetes) in the Australian Capital Territory (ACT) and Western Sydney. This paper describes the disease-specific experiences of people interviewed. Methods. We conducted semi-structured interviews with 40 individuals aged 45-85 years with CHF, COPD or diabetes in 2008. Interviews were recorded and transcribed. Qualitative content analysis was performed, assisted by QSR Nvivo 8 qualitative data software. Results. Participants with CHF (n≤9) came to terms with the prospect of unpredictable sudden death. Participants with COPD (n≤15) were angry about limitations it imposed on their lives. Participants with diabetes (n≤16) experienced a steep learning curve in self-management of their condition surrounded by high levels of uncertainty. Conclusion. Although people with chronic illness share many experiences, a person's overall experience of living with chronic illness is significantly shaped by the nature of their specific dominant disease. Policies for patient-centred care must take account of both generic and disease-specific elements. What is known about the topic? There is a large qualitative literature relating to the disease-specific experiences and needs of individuals with diabetes, and a growing literature on CHF and COPD . However, the extent to which patient experiences and responses are specific to one condition rather than generic to all is not clear. What does this paper add? This study identified that pushing one's limits is central to the experience of living with COPD; this has not been reported elsewhere but is critical to our understanding of the behaviours and needs of people living with COPD. Such characteristics, when specific to a condition, are reported in this paper. What are the implications for practitioners? Understanding the different experiences associated with specific chronic diseases can enable healthcare services to tailor programs and services to people with those problems. This finding is particularly relevant where interactions are time limited, such as in general practice settings.
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