Do adults in contact with Australia's public sector mental health services get better?

This paper describes the outcomes of episodes of care for adults in public sector mental health services across Australia, with a view to informing the debate on service quality. Health of the Nation Outcome Scales (HoNOS) change scores and effect sizes were calculated for 14,659 acute inpatient episodes and 23,692 community episodes. The results showed that people in contact with public sector mental health services generally do get better, although the magnitude of improvement depends on the setting and episode type. This confirmatory finding is particularly positive, given current community concerns about the quality and effectiveness of mental health services

Disparities in Cancer Care in Australia and the Pacific

Disparities in cancer care across populations in Australia and the Pacific become apparent only when there is a cancer registry to record the cancer incidence and mortality statistics and data capture is comprehensive. The reasons are not just poorer access to screening and treatment but lifestyle and occupational factors which encompass increased cancer risk factors compared with urban counterparts. More research is needed to identify preventable causes of these disparities

Cardiovascular disease prevention via a nurse-facilitated intervention clinic in a regional setting: The Protecting Healthy Hearts Program

Aims: To determine the potential benefits of a nurse-led, self-management intervention program to reduce CVD and diabetes risk

Learning from an epidemiological, Population-based study on prescribed medicine use in adults

ObjectiveThe aim of this study was to examine changes in the prevalence of use of prescribed medicines in Australian community samples.Study design and settingIn this study, face-to-face interviews were carried out with random, representative samples of South Australian adults, aged ≥15 years. Data on self-reported use of prescribed medicines, most commonly reported categories of prescribed medicines and use of multiple medicines for common body systems were collected. It was not possible to distinguish between medicines prescribed for acute and chronic use.ResultsA total of 3015 respondents were interviewed in 2004 and 3034 in 2008, representing participation rates of 76% and 73%. There was no significant increase in the prevalence of use of ≥1 (46.8% vs 47.3%, p = 0.6) or ≥6 medicines (5.7% vs 5.5%, p = 0.7). In both years, the use of medicines was higher in women (56.7% vs 57.5%). On subgroup analyses, a significant reduction in the use of medicines was observed in respondents aged 15-24 (25.0% vs 18.5%, p = 0.01) and ≥65 years (87.7% vs 82.5%, p = 0.01), whereas use in those aged 35-44 years increased significantly (26.4% vs 33.6%, p = 0.01). The number of cardiovascular system agents (23.1% vs 24.6%, p = 0.20) and psychotropic medicines (9.8% vs 10.6%, p = 0.35) used by respondents remained unchanged while use of respiratory (7.2% vs 5.7%, p = 0.01) and musculoskeletal system medicines (8.7% vs 5.6% p= ConclusionsIn presenting what we believe is the first Australian population-based study to compare changes in prescribed medicines across the adult age spectrum, we highlight some key questions to ensure the quality use of medicines. Our findings identify a need to discuss de-prescribing, monitor practices to minimise adverse events and challenge if consumers and prescribers need to consider the costs to governments of medicines.Kerena A. Eckert, Zumin Shi, Anne W. Taylor, Gary Wittert, Kay Price and Robert D. Goldne

Carers' perspectives on an effective Indigenous health model for childhood asthma in the Torres Strait

ObjectiveTo describe parents'/carers' views of the characteristics of a clinical service model shown to improve asthma outcomes

Individual and district-level predictors of alcohol use: cross sectional findings from a rural mental health survey in Australia

Background: Excessive alcohol use is a significant problem in rural and remote Australia. The factors contributing to patterns of alcohol use have not been adequately explained, yet the geographic variation in rates suggests a potential contribution of district-level factors, such as socio-economic disadvantage, rates of population change, environmental adversity, and remoteness from services/population centres. This paper aims to investigate individual-level and district-level predictors of alcohol use in a sample of rural adults. Methods: Using baseline survey data (N = 1,981) from the population-based Australian Rural Mental Health Study of community dwelling residents randomly selected from the Australia electoral roll, hierarchal logistic regression models were fitted for three outcomes: 1) at-risk alcohol use, indicated by Alcohol Use Disorders Identification Test scores ≥8; 2) high alcohol consumption (> 40 drinks per month); and 3) lifetime consequences of alcohol use. Predictor variables included demographic factors, pre-dispositional factors, recent difficulties and support, mental health, rural exposure and district-level contextual factors. Results: Gender, age, marital status, and personality made the largest contribution to at-risk alcohol use. Five or more adverse life events in the past 12 months were also independently associated with at-risk alcohol use (Adjusted Odds Ratio [AOR] 3.3, 99%CI 1.2, 8.9). When these individual-level factors were controlled for, at-risk alcohol use was associated with having spent a lower proportion of time living in a rural district (AOR 1.7, 99%CI 1.3, 2.9). Higher alcohol consumption per month was associated with higher district-level socio-economic ranking, indicating less disadvantage (AOR 1.2, 99%CI 1.02, 1.4). Rural exposure and district-level contextual factors were not significantly associated with lifetime consequences of alcohol use. Conclusions: Although recent attention has been directed towards the potential adverse health effects of district or community level adversity across rural regions, our study found relatively few district-level factors contributing to at-risk alcohol consumption after controlling for individual-level factors. Population-based prevention strategies may be most beneficial in rural areas with a higher socio-economic ranking, while individual attention should be focused towards rural residents with multiple recent adverse life events, and people who have spent less time residing in a rural area