Supporting good practice in the provision of services to people with comorbid mental health and alcohol and other drug problems in Australia: describing key elements of good service models

<p>Abstract</p> <p>Background</p> <p>The co-occurrence of mental illness and substance use problems (referred to as "comorbidity" in this paper) is common, and is often reported by service providers as the expectation rather than the exception. Despite this, many different treatment service models are being used in the alcohol and other drugs (AOD) and mental health (MH) sectors to treat this complex client group. While there is abundant literature in the area of comorbidity treatment, no agreed overarching framework to describe the range of service delivery models is apparent internationally or at the national level. The aims of the current research were to identify and describe elements of good practice in current service models of treatment of comorbidity in Australia. The focus of the research was on models of service delivery. The research did not aim to measure the client outcomes achieved by individual treatment services, but sought to identify elements of good practice in services.</p> <p>Methods</p> <p>Australian treatment services were identified to take part in the study through a process of expert consultation. The intent was to look for similarities in the delivery models being implemented across a diverse set of services that were perceived to be providing good quality treatment for people with comorbidity problems.</p> <p>Results</p> <p>A survey was designed based on a concept map of service delivery devised from a literature review. Seventeen Australian treatment services participated in the survey, which explored the context in which services operate, inputs such as organisational philosophy and service structure, policies and procedures that guide the way in which treatment is delivered by the service, practices that reflect the way treatment is provided to clients, and client impacts.</p> <p>Conclusions</p> <p>The treatment of people with comorbidity of mental health and substance use disorders presents complex problems that require strong but flexible service models. While the treatment services included in this study reflected the diversity of settings and approaches described in the literature, the research found that they shared a range of common characteristics. These referred to: service linkages; workforce; policies, procedures and practices; and treatment.</p

Complementary therapy use among people with type 2 diabetes or cardiovascular disease: an Australian cross-sectional study

The popularity of complementary and alternative medicines (CAMs) has been increasing in Australia and high levels of CAM use have been documented among people with chronic conditions. Yet little is known about how people with chronic disease manage their continuing need for medical care and make decisions about using CAM and/or conventional medicines. This thesis describes the use of CAM among people in Victoria, Australia, with two common chronic conditions, type 2 diabetes and cardiovascular disease. Using both qualitative (n=88) and quantitative (n=2,915) data from the CAMELOT study (Complementary and Alternative Medicine, Economics Lifestyle and Other Therapeutic approaches for chronic conditions), new knowledge is provided which contributes to the understanding of care-seeking and health management among people with these conditions. This thesis contains seven articles for publication (and Appendices) which use literature review, descriptive statistics, logistic regression, thematic analysis and discussion to analyse and explore aspects of the use of CAM and conventional healthcare products and services. Areas investigated include: (l) use of CAM products and/or practitioners - prevalence, extent (quantity), modalities used, reasons for and motivators of use, costs, outcomes of CAM practitioner use, factors that would increase the likelihood of visiting a CAM practitioner, disclosure of use to medical doctors and communication between CAM and medical practitioners; (2) use of conventional medical services - frequency of consultations, numbers of doctors visited and pharmaceuticals used, and costs; (3) demographic, health status, quality of life, and care-seeking differences between CAM users and non-users; (4) participants’ perspectives on CAM and conventional medical healthcare services and treatment; and (5) concepts of integration of CAM and conventional medicine. While this study has limitations, many of which are inherent in self-report data and in research of such a diverse and highly pluralistic field as CAM, it highlights the perceived significance and benefits of CAM use for consumers in chronic condition prevention and management, the affordability barrier of access to CAM, the perceived shortfalls of mainstream services, and the potential benefits of greater interaction and communication between CAM and conventional medical providers in Australia. The research brings focus to the multiple ways in which people incorporate CAMs in their lives, often using it to maintain a sense of control or empowerment when faced with living with a chronic condition. Many participants reported improved blood sugar or blood pressure readings and ability to cope, and CAM practitioner use was associated with benefits such as improved confidence in condition management and improved knowledge and understanding of condition(s}. The benefits of CAM use should be viewed at a higher level than solely research on clinical efficacy allows, and further investigation of how the CAM workforce might be incorporated into mainstream pathways for chronic disease prevention and management is warranted. The application of comparable standards and subsidies across conventional and complementary healthcare would help to remove significant barriers currently limiting access to CAM and could encourage a more consumer-centred health system

Complementary therapy use among people with type 2 diabetes or cardiovascular disease: an Australian cross-sectional study

The popularity of complementary and alternative medicines (CAMs) has been increasing in Australia and high levels of CAM use have been documented among people with chronic conditions. Yet little is known about how people with chronic disease manage their continuing need for medical care and make decisions about using CAM and/or conventional medicines. This thesis describes the use of CAM among people in Victoria, Australia, with two common chronic conditions, type 2 diabetes and cardiovascular disease. Using both qualitative (n=88) and quantitative (n=2,915) data from the CAMELOT study (Complementary and Alternative Medicine, Economics Lifestyle and Other Therapeutic approaches for chronic conditions), new knowledge is provided which contributes to the understanding of care-seeking and health management among people with these conditions. This thesis contains seven articles for publication (and Appendices) which use literature review, descriptive statistics, logistic regression, thematic analysis and discussion to analyse and explore aspects of the use of CAM and conventional healthcare products and services. Areas investigated include: (l) use of CAM products and/or practitioners - prevalence, extent (quantity), modalities used, reasons for and motivators of use, costs, outcomes of CAM practitioner use, factors that would increase the likelihood of visiting a CAM practitioner, disclosure of use to medical doctors and communication between CAM and medical practitioners; (2) use of conventional medical services - frequency of consultations, numbers of doctors visited and pharmaceuticals used, and costs; (3) demographic, health status, quality of life, and care-seeking differences between CAM users and non-users; (4) participants’ perspectives on CAM and conventional medical healthcare services and treatment; and (5) concepts of integration of CAM and conventional medicine. While this study has limitations, many of which are inherent in self-report data and in research of such a diverse and highly pluralistic field as CAM, it highlights the perceived significance and benefits of CAM use for consumers in chronic condition prevention and management, the affordability barrier of access to CAM, the perceived shortfalls of mainstream services, and the potential benefits of greater interaction and communication between CAM and conventional medical providers in Australia. The research brings focus to the multiple ways in which people incorporate CAMs in their lives, often using it to maintain a sense of control or empowerment when faced with living with a chronic condition. Many participants reported improved blood sugar or blood pressure readings and ability to cope, and CAM practitioner use was associated with benefits such as improved confidence in condition management and improved knowledge and understanding of condition(s}. The benefits of CAM use should be viewed at a higher level than solely research on clinical efficacy allows, and further investigation of how the CAM workforce might be incorporated into mainstream pathways for chronic disease prevention and management is warranted. The application of comparable standards and subsidies across conventional and complementary healthcare would help to remove significant barriers currently limiting access to CAM and could encourage a more consumer-centred health system

Evidence based practice in traditional and complementary medicine : an agenda for policy, practice, education and research

Objective: To develop a policy, practice, education and research agenda for evidence-based practice (EBP) in traditional and complementary medicine (T&CM). Methods: The study was a secondary analysis of qualitative data, using the method of roundtable discussion. The sample comprised seventeen experts in EBP and T&CM. The discussion was audio-recorded, and the transcript analysed using thematic analysis. Results: Four central themes emerged from the data; understanding evidence and EBP, drivers of change, interpersonal interaction, and moving forward. Captured within these themes were fifteen sub-themes. These themes/sub-themes translated into three broad calls to action: (1) defining terminology, (2) defining the EBP approach, and (3) fostering social movement. These calls to action formed the framework of the agenda. Conclusions: This analysis presents a potential framework for an agenda to improve EBP implementation in T&CM. The fundamental elements of this action plan seek clarification, leadership and unification on the issue of EBP in T&CM

Chinese Medicine Students' Preparedness for Clinical Practice: An Australian Survey

Background: Little is known about how prepared Chinese medicine (CM) students perceive themselves to enter the workforce. Objective: The objective of this study was to investigate perceptions of preparedness for clinical practice of final-year CM students in Australia. Design: The study design consisted of a written survey focusing on eight dimensions relating to practice: Interpersonal Skills, Confidence/Coping Skills, Professional Networks, Professional Practice Management, Professional Patient Management, Prevention, Holistic Care, and Self-Directed Learning. Part 1 of the survey required participants to choose from six possible responses on how well they believe their CM course has prepared them in relation to 41 statements about aspects of practice (1 = very inadequately through to 6 = very adequately). Part 2 consisted of nine open-ended questions. Study participants: The study participants were final-year Bachelor degree CM and acupuncture students from Australian universities and privately operated educational institutions. Analysis and main outcome measures: Part 1 of survey: mean scores on the eight dimensions of practice. Part 2 of survey: transcribed responses were imported into NVivo8. Each part of the questions was analyzed and grouped into broad themes. Results: Seventy-one (71) of one hundred and seven (71/107) invited students (average age 29.4 years ± 7.4 years) participated in the survey conducted in 2008. Mean scores on eight dimensions of clinical practice were as follows: Interpersonal Skills 3.9 (±1.1), Confidence/Coping Skills 4.0 (±0.8), Professional Networks 4.2 (±0.8), Professional Practice Management 4.2 (±0.8), Professional Patient Management 4.7 (±0.7), Prevention 4.6 (±0.7), Holistic Care 4.4 (±0.7), and Self-Directed Learning 4.6 (±0.6). There was no significant difference in mean scores across gender. Responses to Part 2 indicated a range of suggestions on the strengths of educational courses and how transition to clinical practice could be facilitated. Conclusions: In general, CM students perceived themselves to be “somewhat adequately” or “adequately” prepared for various aspects of clinical practice. Survey results may help inform CM educators about how to better prepare students for entry into the workforce

Perceived barriers to effective implementation of public reporting of hospital performance data in Australia: a qualitative study

Abstract Background Public reporting of government funded (public) hospital performance data was mandated in Australia in 2011. Studies suggest some benefit associated with such public reporting, but also considerable scope to improve reporting systems. Methods In 2015, a purposive sample of 41 expert informants were interviewed, representing consumer, provider and purchasers perspectives across Australia’s public and private health sectors, to ascertain expert opinion on the utility and impact of public reporting of health service performance. Qualitative data was thematically analysed with a focus on reporting perceived strengths and barriers to public reporting of hospital performance data (PR). Results Many more weaknesses and barriers to PR were identified than strengths. Barriers were: conceptual (unclear objective, audience and reporting framework); systems-level (including lack of consumer choice, lack of consumer and clinician involvement, jurisdictional barriers, lack of mandate for private sector reporting); technical and resource related (including data complexity, lack of data relevance consistency, rigour); and socio-cultural (including provider resistance to public reporting, poor consumer health literacy, lack of consumer empowerment). Conclusions Perceptions of the Australian experience of PR highlight important issues in its implementation that can provide lessons for Australia and elsewhere. A considerable weakness of PR in Australia is that the public are often not considered its major audience, resulting in information ineffectually framed to meet the objective of PR informing consumer decision-making about treatment options. Greater alignment is needed between the primary objective of PR, its audience and audience needs; more than one system of PR might be necessary to meet different audience needs and objectives. Further research is required to assess objectively the potency of the barriers to PR suggested by our panel of informants

Costs and drivers of complementary and alternative medicine (CAM) use in people with type 2 diabetes or cardiovascular disease

Aim To describe the key drivers and costs to individuals of complementary and alternative medicine (CAM) use in a population with type 2 diabetes and/or cardiovascular disease. Methods Two datasets were utilised. The first derived from a purpose-designed survey of individuals in Australia, all with type 2 diabetes and/or cardiovascular disease (n = 2705). As the vast majority (91%) of the sample had type 2 diabetes, socio-demographic variables were compared to those of people with type 2 diabetes and the general population using the National Health Survey (NHS) of Australia. Step-wise multinomial logit and ordered logit regressions were used for the main analysis. Results People with type 2 diabetes and/or cardiovascular disease appear more likely than the general population to use both CAM products and practitioners. Concurrent chronic conditions appear to be the key motivators of CAM use, however, CAM use is also associated with lower quality of life. Previous attendance at a chronic disease self-management programme and current attendance at a social or health-related support group were also associated with an increased likelihood of CAM use. Median CAM expenditure was estimated at AU$240 per annum for practitioner use, and AU$360 per annum for product use. Conclusions Chronic conditions appear to be strong independent predictors of CAM use in this population, raising many issues for integrative medicine. In particular, health professionals should be aware that this population are more likely to be using both conventional medicine and CAM, highlighting the need for coordination of care and communication between professionals

Type 2 diabetes, cardiovascular disease and the utilisation of primary care in urban and regional settings

INTRODUCTION: There are marked inequities in access to and use of different primary care providers - including GPs, practice nurses, allied health services and complementary and alternative medicine (CAM) providers among populations residing in different geographical areas of Australia. Little research has focused on patterns of primary care health service utilisation according to locality in relation to the management of serious chronic illness, with even less on the use of CAM. In this article geographic similarities and differences in primary care service usage are examined among people with cardiovascular disease and/or type 2 diabetes mellitus residing in regional and urban Victoria, Australia. METHODS: Between April and July 2010, hard-copy questionnaires were sent to a random selection of 10 000 registrants from the National Diabetes Services Scheme, 2162 were distributed via Heart Support Australia and community organisations within the state of Victoria; an online version yielded 290 valid responses. This article draws on data from the 2914 returned survey responses in which people provided their residential postal codes. From this information, geographic location was determined on the basis of the Australian Standard Geographical Classification. Data were subject to inferential analyses using PASW Statistics 18.0 (SPSS; Chicago, IL, USA). A series of contingency table analyses were conducted to evaluate the relationship between primary care service use and respondents' geographical locality. Contingency analyses and χ(2) tests were also conducted to examine the differences between rural and metropolitan frequency of GP use. RESULTS: In comparison with urban respondents, rural respondents reported greater use of allied health practitioners, district or practice nurses, and community health centres. Conversely, use of hospital outpatient services was significantly higher among metropolitan respondents. Use of GP clinics was not related significantly to respondents' locality, nor was use of inpatient hospital services or use of counselling, psychiatry or psychology services. Frequency of GP use, however, varied significantly among geographical categorisations, with urban respondents visiting their GPs more frequently. CONCLUSIONS: While GPs play an important role in chronic disease management in Australia, the rate of GP attendance remains lower among patients living in regional areas. By contrast, the level of patient engagement with nurse practitioners and allied health professionals in this study was significantly higher among rural respondents. Issues related to access appear to play an important role in determining what primary care services people use when managing their chronic conditions and their frequency of consultation

Additional file 1: of Perceived barriers to effective implementation of public reporting of hospital performance data in Australia: a qualitative study

Question guideline for interviews with consumer, provider and purchaser informants: Public reporting of hospital performance data in Australia. Interview questions used as a guide during data collection. (PDF 176 kb