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

Briefing to the incoming Minister of Health 2014

Executive summary This briefing provides you, as the incoming Minister, with information on challenges and opportunities facing the New Zealand health and disability system, and how the Ministry can advise and support you to implement your Government’s priorities for health. The Ministry looks forward to discussing with you how to progress your health policies, including: providing high-quality health services; healthy communities; a strong and engaged health workforce; quality aged care and mental health services. The New Zealand health and disability sector provides world-class services, is driven by a trusted, passionate and skilled workforce, across a spectrum of public, NGOs and private providers, and serves a population that can generally access the care it needs, when it needs it. There are, however, many pressures and environmental changes that require both immediate management and longer-term strategic change. As Minister, you have a number of levers at your disposal to guide system change through setting policy direction, legislation and regulations, funding models and performance management, as well as influencing culture and leadership. Every New Zealander will, at some point in their lives, rely on our health and disability system. It is a large and complex system with multiple decision-makers and mixed public and private ownership models. It operates in a dynamic, continually changing environment characterised by well-known global and local challenges, including:   changing population health needs and burden of disease (especially the rising impact of long- term conditions and risk factors, such as diabetes and obesity)   the growing impact of health-care associated infections, antimicrobial resistance and emerging infectious diseases, eg, Ebola   rapid advances in technology, developments in personalised medicine and changing public expectations   an ageing population, and a workforce that is ageing along with the population   a constrained funding environment for the foreseeable future   a growing fiscal sustainability challenge as health consumes an increasing proportion of total government expenditure. These challenges are placing pressure and new demands on the way public health and disability services are currently delivered. Significant gains in the overall health of New Zealanders could be achieved by concentrating on people who have poorer health outcomes, complex health needs or who need a stronger voice. These might include vulnerable children, older people, people with long-term conditions, people with mental health and addiction problems and people with disabilities. Health and disability services need to build on current progress and adapt to future needs. The health system’s ability to provide a sustainable, quality public health service depends on keeping ahead of the challenges. This briefing provides some suggestions for where we could work with you to meet these challenges. There are opportunities to make better use of existing resources, people, facilities and funding, through new ways of delivering services that keep people well with better prevention and early Briefing to the Incoming Minister of Health v intervention. Significant gains could be made by developing a longer-term focus on preventing disability and illness in the first place. There are new opportunities for the health workforce to work in different ways with a broader range of colleagues across the health and wider social sectors, and with partners in the community. To better equip the New Zealand health and disability system for the future, we suggest focusing on four areas. 1  Better integrate services within health and across the social sector: Strengthening integration within health and across government to support the most vulnerable, reduce inequities and address issues outside the health and disability system that impact on health. 2  Improve the way services are purchased and provided: Ensuring funding models support change, building and supporting the key enablers and drivers of change: workforce, health information and capital. 3  Lift quality and performance: Driving performance through measuring and rewarding the right things to improve quality. 4  Support leadership and capability for change: Supporting strong governance, clinical and executive leadership and capability across the health sector.&nbsp

Activity Theory Analysis of Heart Failure Self-Care

The management of chronic health conditions such as heart failure is a complex process emerging from the activity of a network of individuals and artifacts. This article presents an Activity Theory-based secondary analysis of data from a geriatric heart failure management study. Twenty-one patients' interviews and clinic visit observations were analyzed to uncover eight configurations of roles and activities involving patients, clinicians, and others in the sociotechnical network. For each configuration or activity pattern, we identify points of tension and propose guidelines for developing interventions for future computer-supported healthcare systems

A decision support tool for supporting individuals living with long-term conditions make informed choices: LTC-Choices tool for continuous healthcare

An increasing number of individuals are now living with some form of chronic, long-term condition (LTC). The holistic perspective of LTCs makes it important to acknowledge that priorities and decisions are in fluctuation over the course of an individual’s life. The landscape of digital healthcare is full of information systems that capture individuals’ health data, clinical guidelines and/or advice on health conditions, which taken together can help create a comprehensive overview of suitable lifestyle choices to optimise health and well-being. Despite this, there is no evidence of existing frameworks to support individuals living with LTCs from a continuum of care perspective. In this paper, we propose such a multidimensional model for a decision support tool – LTC-Choices. This tool was developed from existing work conducted by the authors around use of multicriteria to support health decisionmaking. We illustrate how LTC-Choices can be implemented using the example of individuals living post-stroke

Curriculum renewal for interprofessional education in health

In this preface we comment on four matters that we think bode well for the future of interprofessional education in Australia. First, there is a growing articulation, nationally and globally, as to the importance of interprofessional education and its contribution to the development of interprofessional and collaborative health practices. These practices are increasingly recognised as central to delivering effective, efficient, safe and sustainable health services. Second, there is a rapidly growing interest and institutional engagement with interprofessional education as part of pre-registration health professional education. This has changed substantially in recent years. Whilst beyond the scope of our current studies, the need for similar developments in continuing professional development (CPD) for health professionals was a consistent topic in our stakeholder consultations. Third, we observe what might be termed a threshold effect occurring in the area of interprofessional education. Projects that address matters relating to IPE are now far more numerous, visible and discussed in terms of their aggregate outcomes. The impact of this momentum is visible across the higher education sector. Finally, we believe that effective collaboration is a critical mediating process through which the rich resources of disciplinary knowledge and capability are joined to add value to existing health service provision. We trust the conceptual and practical contributions and resources presented and discussed in this report contribute to these developments.Office of Learning and Teaching Australi

Researching inequalities: lessons from an ethnographic study

Studies exploring health inequalities have often demonstrated the inappropriateness of service provision in relation to the needs of disadvantaged communities. However, the research methods used to explore these issues have been subject to less scrutiny. This chapter considers whether research methods used for a study of long-term illness in a Pakistani community in the UK were appropriate and sensitive to the needs and priorities of Pakistani people. Findings in relation to fieldwork revealed the value of ethnographic methodology in providing context to data from semi-structured interviews. However, attitudes towards research within the Pakistani community, which formed part of this context, indicated that many Pakistani respondents felt disengaged from and cynical about the research process. They also felt vulnerable to exploitation and to abuse of trust from researchers and other professionals. These findings have implications for the methodological approaches adopted during research and their acceptability to research subjects in marginalised communities. Research methods and designs that engage individuals and offer reciprocity through practical outcomes that meet their needs are suggested as more appropriate than traditional qualitative methods

Towards Empowering People Living with Type-2 Diabetes: A perspective on self-management in the context of a group-based education program

With the exponential rise in chronic disease, Online Health Communities (OHCs) offer opportunities for people to share information and experiences. Type-2 diabetes is one of the most prevalent chronic diseases globally and one that can have a devastating effect on an individuals’ life. This paper aims to investigate the potential for OHCs practices to empower diabetic patients who are participating in a face-to-face Diabetes Group Education Program (DGEP). Using a qualitative content analysis of the three most popular type-2 diabetes communities on Reddit, we identified three salient themes including (1) exchange lifestyle-related advice, (2) experience of commonality, and (3) brainstorm potential solutions for daily challenges. Our findings revealed OHCs could extend the value of the faceto-face DGEP by leveraging online value co-creation behaviour. This paper provides a novel framework for maximising the effectiveness of the DGEP and identifies avenues for future research

The conceptual and practical ethical dilemmas of using health discussion board posts as research data.

Increasing numbers of people living with a long-term health condition are putting personal health information online, including on discussion boards. Many discussion boards contain material of potential use to researchers; however, it is unclear how this information can and should be used by researchers. To date there has been no evaluation of the views of those individuals sharing health information online regarding the use of their shared information for research purposes