Farm and quarry or Smart State? Queensland's economy since 1989

A generation ago, Queensland's economy relied heavily — as did the standing of the state government — upon a booming resources sector, a bountiful agricultural sector and a still-growing tourist market. ‘Rocks and crops’ (to use a favourite phrase of Peter Beattie's) were mainstays of the state's economic activity, and had long underpinned the government's investment, development and budgetary planning. While to a large extent the same might be said today, critical changes have taken place in the local economy in the intervening period, cultivated by successive state administrations with the express aim of diversifying an economy that was overwhelmingly geared towards primary production. Now it can be argued that Queensland's economy has metamorphosed into a modern, knowledge-based economy that demands greater emphasis on technology, expertise and innovation — what Premier Peter Beattie liked to promote with his catch-all phrase ‘Smart State’. But how effective was this push for diversification in renewing the state's economic foundations? Since the advent of the Goss Labor government in late 1989, has Queensland really moved from a ‘farm and quarry’ to a ‘smart’ economy

Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ)

OBJECTIVE: To develop and validate a new scale to assess treatment burden (the effort of looking after one's health) for patients with multimorbidity. DESIGN: Mixed-methods. SETTING: UK primary care. PARTICIPANTS: Content of the Multimorbidity Treatment Burden Questionnaire (MTBQ) was based on a literature review and views from a patient and public involvement group. Face validity was assessed through cognitive interviews. The scale was piloted and the final version was tested in 1546 adults with multimorbidity (mean age 71 years) who took part in the 3D Study, a cluster randomised controlled trial. For each question, we examined the proportion of missing data and the distribution of responses. Factor analysis, Cronbach's alpha, Spearman's rank correlations and longitudinal regression assessed dimensional structure, internal consistency reliability, construct validity and responsiveness, respectively. We assessed interpretability by grouping the global MTBQ scores into zero and tertiles (>0) and comparing participant characteristics across these categories. RESULTS: Cognitive interviews found good acceptability and content validity. Factor analysis supported a one-factor solution. Cronbach's alpha was 0.83, indicating internal consistency reliability. The MTBQ score had a positive association with a comparator treatment burden scale (rs 0.58, P<0.0001) and with self-reported disease burden (rs 0.43, P<0.0001), and a negative association with quality of life (rs-0.36, P<0.0001) and self-rated health (rs-0.36, P<0.0001). Female participants, younger participants and participants with mental health conditions were more likely to have high treatment burden scores. Changes in MTBQ score over 9-month follow-up were associated, as expected, with changes in measures of quality of life (EuroQol five dimensions, five level questionnaire) and patient-centred care (Patient Assessment of Chronic Illness Care). CONCLUSION: The MTBQ is a 10-item measure of treatment burden for patients with multimorbidity that has demonstrated good content validity, construct validity, reliability and responsiveness. It is a useful research tool for assessing the impact of interventions on treatment burden. TRIAL REGISTRATION NUMBER: ISRCTN06180958

A tale of two parties: contrasting performances of Annastacia Palaszczuk's Labor and the post-Newman LNP in Queensland

Queensland's 2017 state election resulted in Annastacia Palaszczuk's Labor government being returned with a slim majority. While not a resounding victory, the result seemingly vindicated the premier's decision to head to an early election, and reinforced her standing in a succession of opinion polls as ‘preferred premier’ for most voters. The result also halted the short sequence of Queensland governments being voted out of office in no uncertain terms by a supposedly volatile electorate. The extent to which Labor's recent electoral success in Queensland — and the quelling of that volatility — can be attributed to Palaszczuk's leadership is still open to debate. It is instructive, though, to note the differences in leadership and campaigning styles between Palaszczuk and her opponents, which saw her drag a decimated Labor Party back to office after a single term in opposition, then saw it returned with a working parliamentary majority. This article highlights those differences over the last term of government, contrasting the performance of the two major parties in Queensland in terms of their leadership and election campaign approaches. The analysis helps to explain some of the reasons for the respective parties’ recent electoral showings

Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling

Objective To explore whether responses to questions in surveys of patients that purport to assess the performance of general practices or doctors reflect differences between practices, doctors, or the patients themselves

Patient and practitioners' views on the most important outcomes arising from primary care consultations:a qualitative study

BACKGROUND: Primary care clinicians often address multiple patient problems, with a range of possible outcomes. There is currently no patient-reported outcome measure (PROM) which covers this range of outcomes. Consequently, many researchers use PROMs that do not capture the full impact of primary care services. In order to identify what outcomes a PROM for primary care would need to include, we conducted interviews with patients and practitioners. This paper reports these patient and practitioners’ views on the outcomes arising from primary care consultations. METHODS: Semi-structured interviews were held with 30 patients and eight clinicians across five sites in Bristol. Interviews were audio-recorded, transcribed and analysed thematically. We used a broad definition of health outcome as ‘the impacts of healthcare on health, or a patient’s ability to impact health’ to identify outcomes through this process. RESULTS: 10 outcome groups were identified. These occupied 3 domains: Health Empowerment: These are the internal and external resources which enable patients to improve their health. This involves 1) patients’ understanding of their illnesses, 2) ability to self-care and stay healthy, 3) agreeing and adhering to a patient-clinician shared plan, 4) confidence in seeking healthcare and 5) access to support. Health Status: This involves 6) reduction of symptoms and 7) reducing the impact of symptoms on patients’ lives. Health Perceptions: This involves 8) patients’ satisfaction with their health, 9) health concerns, and 10) confidence in their future health. The structure, organisation and nature of primary care means it can affect all 3 domains. CONCLUSIONS: No existing PROM captures all these outcomes. For example, many health empowerment PROMs do not consider patient preference on empowerment. Many health status tools are not responsive to changes resulting from primary care. Health perceptions PROMs have generally been designed for measuring personality traits rather than outcomes. This study provides a platform for designing a new PROM containing outcomes that matter to patients and can be influenced by primary care. Such a PROM would greatly enhance the value of primary care research. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-015-0323-9) contains supplementary material, which is available to authorized users

Identifying possible reasons why female street sex workers have poor drug treatment outcomes:a qualitative study

AIMS: To explore street sex workers (SSWs) views and experiences of drug treatment, in order to understand why this population tend to experience poor drug treatment outcomes. DESIGN: In-depth interviews. SETTING: Bristol, UK. PARTICIPANTS: 24 current and exited SSWs with current or previous experience of problematic use of heroin and/or crack cocaine. FINDINGS: Participants described how feeling unable to discuss their sex work in drug treatment groups undermined their engagement in the treatment process. They outlined how disclosure of sex work resulted in stigma from male and female service users as well as adverse interactions with male service users. Participants highlighted that non-disclosure meant they could not discuss unresolved trauma issues which were common and which emerged or increased when they reduced their drug use. As trauma experiences had usually involved men as perpetrators participants said it was not appropriate to discuss them in mixed treatment groups. SSWs in recovery described how persistent trauma-related symptoms still affected their lives many years after stopping sex work and drug use. Participants suggested SSW-only services and female staff as essential to effective care and highlighted that recent service changes were resulting in loss of trusted staff and SSW-only treatment services. This was reported to be reducing the likelihood of SSWs engaging in drug services, with the resultant loss of continuity of care and reduced time with staff acting as barriers to an effective therapeutic relationship. CONCLUSIONS: SSWs face many barriers to effective drug treatment. SSW-only treatment groups, continuity of care with treatment staff and contact with female staff, particularly individuals who have had similar lived experience, could improve the extent to which SSWs engage and benefit from drug treatment services. Service engagement and outcomes may also be improved by drug services that include identification and treatment of trauma-related symptoms