Primary health care for Aboriginal and Torres Strait Islander children

This final report presents the findings from each of the phases of the Engaging Stakeholders in Identifying Priority Evidence-Practice Gaps and Strategies for Improvement in Primary Health Care (ESP) Project. This report is designed for people working in a range of roles including national and jurisdictional policy makers, managers, community-controlled organisations and government health authorities, peak bodies, clinical leaders, researchers, primary health care staff and continuous quality improvement (CQI) practitioners who may have an interest in the interpretation and use of aggregated CQI data to drive decision making. Stakeholders across services and systems that deliver Aboriginal and Torres Strait Islander primary health care (PHC) engaged in a process to analyse and interpret national continuous quality improvement (CQI) data from 132 health centres. We used a consensus process to identify priority evidence-practice gaps in child health care, based on these data. Stakeholders drew on their knowledge and experience working in Aboriginal and Torres Strait Islander PHC to identify barriers and enablers to addressing the priority evidence- practice gaps, and to suggest strategies to overcome barriers and strengthen enablers to addressing the priority evidence-practice gaps. Important messages emerge from these findings

Chronic illness care for Aboriginal and Torres Strait Islander people: final report

This project engage a range of stakeholders across different levels of the primary health care system, including service providers, management, policy-makers and researchers and capture their knowledge on the barriers and enablers to addressing the identified priority-evidence practice gaps and their suggestions on strategies for improvement. Overview The purpose of this project is to engage key stakeholders in the use of aggregate continuous quality improvement (CQI) data to identify and address system-wide evidence-practice gaps in Aboriginal and Torres Strait Islander chronic illness care. We aimed to engage a range of stakeholders across different levels of the primary health care (PHC) system, including service providers, management, policy-makers and researchers and capture their knowledge on the barriers and enablers to addressing the identified priority-evidence practice gaps and their suggestions on strategies for improvement. Our research has highlighted the wide variation in performance between different aspects of care and between health centres. While many aspects of care are being done well in many health centres, there are important gaps between evidence and practice in some aspects of PHC. System-wide gaps are likely to be due to deficiencies in the broader (PHC) system, indicating that system-level action is required to improve performance. Such system-level action should be developed with a deep understanding of the holistic nature of Aboriginal and Torres Strait islander wellbeing beyond just physical health (including healthy connections to culture, community and country), of the impact of Australian colonist history on Aboriginal and Torres Strait Islander people, and of how social systems – including the health system - should be shaped to meet the needs of Aboriginal and Torres Strait Islander people. This project aims to build on the collective strengths within PHC services in order to continue improving the quality of care for Aboriginal and Torres Strait Islander communities

Interim evaluation of lifelong learning networks

The Open University's Centre for Higher Education Research and Information was commissioned in June 2007 to undertake a formative evaluation of Lifelong Learning Networks (LLNs). Research to inform the interim evaluation has been two-fold: desk research of LLN documentation and visits to and interviews with personnel involved in eight LLNs. The report's main conclusion was that LLNs are making progress in terms of encouraging institutions to offer curricula and put in place procedures that, in the fullness of time, could make a significant difference to the coherence, clarity and certainty of progression opportunities for vocational learners. However, it went on to say that it is too soon to be able to make substantive and well-evidenced statements about LLNs' overall progress on meeting this overarching objective of the LLN initiative

The Decentralized Water Market: Assessing and Overcoming the Hurdles to Scale in Kenya

International Financial Corporation and Safe Water Network undertook this assessment to identify options for attracting greater commercial investment in the water sector, in Kenya and elsewhere. This includes an examination of the policy environment and of the populations' ability to pay for water at prices necessary to fund private investment, as well as a review of existing models to determine which are scalable in this context

He wharemoa te rakau, ka mahue. Maori engagement with local government: Knowledge, experiences and recommendations

This report presents the data, analysis and results of focus group research that explored Máori knowledge, experiences and perspectives of local government in Aotearoa New Zealand. Seven focus groups were held with different groups of Máori; 18 – 24 year olds in tertiary study; 18 – 24 year olds in the workforce; people 25 years old and over residing in rural areas, and people 25 years old and over living in urban settings. The purpose of this report is to present the research findings about the knowledge and experiences of Máori in relation to local government, and in particular, their recommendations for the development of the local government sector. It is intended to assist local authorities in their efforts to improve their engagement with Máori, and stimulate further research with Máori about Máori participation in local government decision-making.A research project supported by the Royal Society of New Zealand Marsden Fund (MAU-039

Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care

Networks, Market Structures and Economic Shocks: The structural changes of Innovation Systems in Latin America

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