PROTECTING BROKEN HILL CHILDREN FROM LEAD IN THE 21ST CENTURY

This thesis uses a translational research approach and combines theoretical, empirical and experiential evidence to explore four key issues that provide further direction to current efforts to reduce lead exposure in Broken Hill, and more generally to improve management of environmental health risks in the community setting. A theoretical review argues for an adaptive response to program development, recognising that the solution to the problem is not straightforward. The review indicated the need for multi-pronged strategies including both population-based approaches and strategies focussing on particular risk groups. Unintended negative consequences must be scanned for and managed so as to ensure a positive benefit : harm ratio is maintained. A qualitative, interview based case study of successful lead exposure reduction programs identified the need for an accurate understanding of sources and pathways of exposure, which may need an iterative approach; effective control of those sources and pathways, adequate funding to undertake the work and active cooperation of relevant stakeholders. A qualitative, interview based case study of the Broken Hill Lead Reference Group found there was broad agreement as to what was required to further reduce lead exposure but that lack of recognition of constraints other organisations faced and overall lack of resources (funding and leadership) within the LRG significantly inhibited collaboration across the group and efforts to reduce lead exposure. Improving collaboration and leadership within this Group is necessary in the long term to reduce lead exposure. A before-after study of changes in participation in blood lead screening found that changing from venous to capillary screening and improving convenience both increased screening, and showed that restructuring services in response to community concern can effectively increase participation. A $13 million, five year program to reduce lead exposure in Broken Hill was established in 2015; considerably more funding is likely to be required

Frequent users of the Royal Flying Doctor Service primary clinic and aeromedical services in remote New South Wales: a quality study

Objective: To examine activity patterns of the Royal Flying Doctor Service of Australia (RFDS) in far western New South Wales and to determine whether frequent use of RFDS services, particularly emergency evacuations, is a useful indicator of patients who may benefit from care planning and review. Design, setting and participants: We conducted a retrospective audit of the RFDS South Eastern Section\u27s Broken Hill patient database. Patients with a residential address in the study area who had accessed at least one RFDS medical service between 1 July 2000 and 30 June 2005 were included in the study. Main outcome measures: Number of evacuations, clinic consultations and remote consultations; clinic usage by frequent evacuees; number of primary diagnoses recorded for frequent evacuees; number of frequent users who might benefit from multidisciplinary care or specialist shared care. Results: Between July 2000 and June 2005, the number of residents requiring evacuation or remote consultations declined by 26% and 19%, respectively, and the number of residents accessing clinics declined by 6%. (Over the same period, the population of the study area fell by about 24%.) Of the 78 patients who were identified as frequent users of the evacuation service (≥3 evacuations/year), 34 had three or more primary diagnoses recorded; 15 were infrequent or non-users of the clinics (≤3 attendances/year); 53 may have benefited from multidisciplinary care, and 41 from specialist shared care. Conclusions: Simple, practical clinical review systems can help health care organisations in rural and remote communities to achieve better outcomes by identifying patients who may benefit from planned care

New South Wales and Australian Capital Territory Researcher Development Program 2005-07: Modest investment, considerable outcomes

This evaluation of the Researcher Development Program (RDP) in NSW and ACT aimed to determine whether the RDP was effective in assisting novice researchers to undertake primary health care research. In mid-2008, 47 participants of the NSW and ACT RDP during 2005-07 were invited to participate in a postal survey. The survey included questions regarding previous research training and experience, outcomes during and after participation in the program, and organisational aspects of the program. Follow-up interviews were conducted with selected participants. Interview questions covered time in the program, supervision, organisational support and placement outcomes. Thirty-seven participants responded to the survey and 23 (62%) participants took part in the semi-structured interviews. Seventy-eight per cent of survey respondents felt that the RDP helped them move from novice to a more experienced researcher with effective supervision identified by participants as a key element in determining the success of the program. Many felt that time allocation was inadequate and 20% thought their capacity to maintain their workload was adversely affected by participating. Outcomes were considerable given the modest nature of the program. Notable outcomes were that most participants published their research and presented their research at a conference. Furthermore, one-fifth of survey respondents had enrolled in higher degrees. Several interviewees reported that their research led to changes in practice. Most respondents found the RDP valuable and considered that undertaking the program increased their research knowledge. 2013 La Trobe University