83 research outputs found
Early Childhood Development (ECD) services in the Southern Adelaide Health Service region.
This report documents the findings of a review conducted by the South Australian Community Health Research Unit (SACHRU) at the request of the Southern Adelaide Health Service (SAHS) into the provision of Early Childhood Development services in southern Adelaide. This review was undertaken between June and December 2006 and overseen by a Project Management group consisting of representatives from the SAHS, the primary health services managers, practitioners, an acute service manager and the researchers.
The review examined the early childhood services provided by primary health services across the region, the models used, intake procedures and referral pathways. The findings were to be used for future service planning, implementation and resourcing
Families empowered: a strengths based approach. An evaluation of FEAT, Families Empowered to Act Together.
The South Australian Community Health Research Unit undertook an evaluation of the FEAT program to track the progress of a number of families through the Families Empowered to Act Together (FEAT) program and capture the experiences and perspectives of children, families and stakeholders. Interviews were undertaken with carers and children both currently in the program and those recently exited. The evaluation also documents the development of the FEAT model of service and its aims and objectives; relates the operation of FEAT to understandings in the current literature regarding best practice principles and models for family support programs; and identifies other agencies, programs and services that the FEAT program links with in order to meet the needs of referred families. The evaluation adopted an action research framework employing qualitative and quantitative methods, and has encouraged participation by key stakeholders in the research process
Transformational change in health systems: a road strewn with obstacles.
This research study assesses the impact on primary health care of the reform changes in the South Australian health system from 2005 to 2007. The research follows a pilot study conducted in one of the newly created health regions in 2005 to 2006 and reported in: Governance change in the southern metropolitan Adelaide health region: implications for Primary Health Care (Baum et al. 2006). Both studies were intended as scoping exercises to contribute towards the development of an evaluation framework for primary health care
Developing a good practice model to evaluate the effectiveness of comprehensive primary health care in local communities
This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise statedBackground:
This paper describes the development of a model of Comprehensive Primary Health Care (CPHC)
applicable to the Australian context. CPHC holds promise as an effective model of health system organization able
to improve population health and increase health equity. However, there is little literature that describes and
evaluates CPHC as a whole, with most evaluation focusing on specific programs. The lack of a consensus on what
constitutes CPHC, and the complex and context-sensitive nature of CPHC are all barriers to evaluation.
Methods:
The research was undertaken in partnership with six Australian primary health care services: four state
government funded and managed services, one sexual health non-government organization, and one Aboriginal
community controlled health
service. A draft model was crafted combining program logic and theory-based
approaches, drawing on relevant literature, 68 interview
s with primary health care se
rvice staff, and researcher
experience. The model was then refined through an iterative process involving two to three workshops at each
of the six participating primary health
care services, engaging health service
staff, regional health executives and
central health department staff.
Results:
The resultant Southgate Model of CPHC in Australia model articulates the theory of change of how and
why CPHC service components and activities, based on t
he theory, evidence and values which underpin a CPHC
approach, are likely to lead to indivi
dual and population health outcome
s and increased health equity. The
model captures the importance of context, the mechanisms of CPHC, and the space for action services have to
work within. The process of development engendered
and supported collaborati
ve relationships between
researchers and stakeholders and the product provide
d a description of CPHC as a whole and a framework for
evaluation. The model was endorsed at
a research symposium involving inv
estigators, service staff, and key
stakeholders.
Conclusions:
The development of a theory-based program logi
c model provided a framework for evaluation that
allows the tracking of progress towards desired outcomes and exploration of the particular aspects of context
and mechanisms that produce outcomes. This is important because there are no existing models which enable
the evaluation of CPHC services in their entirety
Governance change in the southern metropolitan Adelaide health region: implications for Primary Health Care.
This report describes a study aiming to assess the impact of the introduction of regional health structures to metropolitan Adelaide. The study was conducted in 2005 in the southern Adelaide region. Major research questions were: What is the most effective way to organise health service governance in order to promote and strengthen primary health care as a key focus of the health system? How does a change in health service governance affect the position of primary health care in relation to acute care services
The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints
The Commission on the Social Determinants of Health and the World Health Organization have
called for action to address the social determinants of health. This paper considers the extent to which primary
health care services in Australia are able to respond to this call. We report on interview data from an empirical
study of primary health care centres in Adelaide and Alice Springs, Australia.This study was funded by an NH&MRC Project Grant 535041 and FB’s time is
funded by an ARC Federation Fellowship. RL is funded by the Canada
Research Chair program
Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services
Introduction/Background
Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers.
Methods
As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services.
Findings
Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services.
Conclusions
Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully
Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners
This is the accepted version of the following article: [Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S. and Francis, T. (2014), Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Australian and New Zealand Journal of Public Health, 38: 355–361. ], which has been published in final form at doi: 10.1111/1753-6405.12231. This item was under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.Objective. There is little literature on health service level strategies for culturally respectful care to Aboriginal and Torres Strait Islander Australians. We conducted two case studies: , one Aboriginal community controlled, and one state government managed primary health care service to examine cultural respect strategies, client experiences, and barriers to cultural respect.
Methods. Data were drawn from 22 interviews with staff from both services, and four community assessment workshops, with a total of 21 clients.
Results. Staff and clients at both services reported positive appraisals of the achievement of cultural respects. Strategies included being grounded in a social view of health, including advocacy and addressing social determinants, employing Aboriginal staff, creating a welcoming service, supporting access through transport, outreach, and walk-in centres, and integrating cultural protocol. Barriers included communication difficulties, racism and discrimination, and externally developed programs.
Conclusions. Service level strategies were necessary to achieving cultural respect. These strategies have the potential to improve Aboriginal and Torres Strait Islander health and wellbeing.
Implications. Primary health care’s social determinants of health mandate, the community controlled model, and the development of the Aboriginal and Torres Strait Islander health workforce need to be supported to ensure a culturally respectful health system
To What Extent can the Activities of the South Australian Health in All Policies Initiative be Linked to Population Health Outcomes Using a Program Theory-Based Evaluation
This paper reports on a five-year study using a theory-based program logic evaluation, and supportingsurvey and interview data to examine the extent to which the activites of the South Australian Health in All Policiesinitiative can be linked to population health outcomes
Service providers' views of community participation at six Australian primary healthcare services: scope for empowerment and challenges to implementation
This is the peer reviewed version of the following article: [Freeman, T., Baum, F.E., Jolley, G.M., Lawless, A., Edwards, T., Javanparast, S., & Ziersch, A. (2014). Service providers’ views of community participation at six Australian primary health care services: Scope for empowerment and challenges to implementation. International Journal of Health Planning and Management, Early View, DOI: 10.1002/hpm.225], which has been published in final form at DOI:10.1002/hpm.2253. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Community participation is a key principle of comprehensive primary health care
(PHC). There is little literature on how community participation is implemented at Australian PHC services. As part of a wider study conducted in partnership with five South Australian PHC services, and one Aboriginal community controlled health service in the Northern Territory, 68 staff, manager, regional health executives and departmental funders were interviewed about community participation, perceived benefits, and factors that influenced implementation. Additional data was collected through analysis of policy documents, service reports on activity, and a web-based survey completed by 130 staff. A variety of community participation strategies was reported, ranging from consultation and participation as a means to improve service quality and acceptability, through to substantive and structural participation strategies with an emphasis on empowerment. The Aboriginal community controlled health service in our study reported the most comprehensive community participation. Respondents from all were positive about the benefits of participation, but reported that efforts to involve service users had to compete with a centrally directed model of care emphasising individual treatment services, particularly at state-managed services. More empowering substantive and structural participation strategies were less common than consultation or participation used to achieve prescribed goals. The most commonly reported barriers to community participation were budget and lack of flexibility in service delivery. The current central control of the state-managed services needs to be replaced with more local management decision making if empowering community participation is to be strengthened and embedded more effectively in the culture of services
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