Coordinated Primary Health Care for Refugees: A Best Practice Framework for Australia

Australia permanently resettles over 20,000 refugees each year. Our team reviewed the international evidence and conducted new research to develop a framework for the delivery of accessible and coordinated primary health care to this vulnerable group.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

Context: A key aim of reforms to primary health care (PHC) in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood.Objective: To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices.Design: Collaborative synthesis of 12 mixed methods studies.Setting: Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec).Methods: We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they were influenced by local context.Results: There was a diverse range of complex reforms seeking to foster interprofessional teamwork in the care of patients with chronic disease. The impact on communication and relationships between different professional groups, the roles of nursing and allied health services, and the expressed satisfaction of PHC providers with their work varied more within than between jurisdictions. These variations were associated with local contextual factors such as the size, power dynamics, leadership, and physical environment of the practice. Unintended consequences included deterioration of the work satisfaction of some team members and conflict between medical and nonmedical professional groups.Conclusion: The variation in impacts can be understood to have arisen from the complexity of interprofessional dynamics at the practice level. The same characteristic could have both positive and negative influence on different aspects (eg, larger practice may have less capacity for adoption but more capacity to support interprofessional practice). Thus, the impacts are not entirely predictable and need to be monitored, and so that interventions can be adapted at the local level

Dimensions and intensity of inter-professional teamwork in primary care: Evidence from five international jurisdictions

Background. Inter-professional teamwork in primary care settings offers potential benefits for responding to the increasing complexity of patients' needs. While it is a central element in many reforms to primary care delivery, implementing inter-professional teamwork has proven to be more challenging than anticipated. Objective. The objective of this study was to better understand the dimensions and intensity of teamwork and the developmental process involved in creating fully integrated teams. Methods. Secondary analyses of qualitative and quantitative data from completed studies conducted in Australia, Canada and USA. Case studies and matrices were used, along with faceto- face group retreats, using a Collaborative Reflexive Deliberative Approach. Results. Four dimensions of teamwork were identified. The structural dimension relates to human resources and mechanisms implemented to create the foundations for teamwork. The operational dimension relates to the activities and programs conducted as part of the team's production of services. The relational dimension relates to the relationships and interactions occurring in the team. Finally, the functional dimension relates to definitions of roles and responsibilities aimed at coordinating the team's activities as well as to the shared vision, objectives and developmental activities aimed at ensuring the long-term cohesion of the team. There was a high degree of variation in the way the dimensions were addressed by reforms across the national contexts. Conclusion. The framework enables a clearer understanding of the incremental and iterative aspects that relate to higher achievement of teamwork. Future reforms of primary care need to address higher-level dimensions of teamwork to achieve its expected outcomes

Internet-based trials and the creation of health consumers

In this paper we document the experience of participating in novel randomised controlled trials for panic disorder - where face-to-face and Internet delivery of cognitive behavioural therapy are compared. Our analysis is based on 18 months of observation and in-depth interviews with 10 trial participants and 8 trialists in Victoria, Australia. We argue that the participants are positioned as active health consumers and approach the trial as they would other self-help practices. High levels of individual responsibility are assumed of participants in these trials, which they accept by approaching the trials reflexively and searching for information and strategies they can employ while building their health literacy on panic disorder. Although the researchers set the parameters of the treatment and interaction, increasingly the participants choose the extent to which they will comply with their defined role. For the participants the trial is one of the 'pick and mix' options of available treatment and we suggest it is a compelling example of contemporary health consumption.Australia Randomised controlled trials Panic disorder Therapy culture Internet Health consumption Cognitive behavioural therapy (CBT)

Smashed! : the many meanings of intoxication and drunkenness

Everyone knows what intoxication and drunkenness are, what they look like, how to define and measure them and what their consequences are. At least we might assume so given the ways these words are used by the media, by politicians and policy makers and by various medical, educational and legal experts in Australia and around the world. A whole variety of concerns about young people, individual and public health, road safety, sexual assault and violence are connected to these taken-for-granted understandings of intoxication and drunkenness. Drawing on an extensive review of research from biomedicine, psychology, sociology and legal studies, and from news media reporting, the authors reveal a far more complex picture. This is a picture marked by little agreement on how to define intoxication and drunkenness, how to measure intoxication, what getting drunk means to those who drink (including young people, men and women and people from different cultural and national backgrounds), and where responsibility lies for many of the individual, social, medical and legal consequences of intoxication and drunkenness. Smashed! presents an overview of the history of these concerns and an extensive account of the many meanings of intoxication and drunkenness at the start of the 21st century. It provides a valuable resource for researchers, policy makers, the media and members of the community who are involved in these ongoing, often emotive, debate

It\u27s my time to shine : young Australians reflect on past, present and imagined future alcohol consumption

Drawing on interviews about the drinking trajectories of sixty young Victorian drinkers (aged 20-24), this paper outlines patterns of change over time and explores two drinking biographies in depth. For most research participants, drinking alcohol was an enjoyable and integral part of their social lives, but its role changed as they made other transitions in their lives. Most participants considered their early twenties to be a time for heavy alcohol consumption, and most imagined that they would drink less when they were middle-aged.<br /

I don\u27t know anyone that has two drinks a day : young people, alcohol and the government of pleasure

Problematic alcohol consumption is a major public health, health education and health promotion issue in Australia and internationally. In an effort to better understand young people\u27s drinking patterns and motivations we investigated the cultural drivers of drinking in 14&ndash;24 year-old Australians. We interviewed 60 young people in the state of Victoria aged 20&ndash;24 about their drinking biographies. At the time of interviewing, the draft guidelines on low-risk drinking were released by the National Health and Medical Research Council, Australia, and we asked our participants what they knew about them and if they thought they would affect their drinking patterns. Their responses indicate that pleasure and sociability are central to young people\u27s drinking cultures which is supported by a range of research. However, O&rsquo;Malley and Valverde claim that pleasure is silenced and/or deployed strategically in neo-liberal governance discourses about drugs and alcohol such as these guidelines which raises questions about the limits of such discourses to affect changes in drinking patterns.<br /