Examining area-level variation in service organisation and delivery across the breadth of primary healthcare. Usefulness of measures constructed from routine data

Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effective PHC systems. Using a suite of measures constructed at the area-level, this study explored their application in assessing area-level variation in PHC organisation and delivery. Routinely collected data from New South Wales, Australia were used to construct 13 small area-level measures of PHC service organisation and delivery that best approximated access (availability, affordability, accommodation) comprehensiveness and coordination. Regression analyses and pairwise Pearson’s correlations were used to examine variation by area, and by remoteness and area disadvantage. PHC service delivery varied geographically at the small-area level–within cities and more remote locations. Areas in major cities were more accessible (all measures), while in remote areas, services were more comprehensive and coordinated. In disadvantaged areas of major cities, there were fewer GPs (most disadvantaged quintile 0.9[SD 0.1] vs least 1.0[SD 0.2]), services were more affordable (97.4%[1.6] bulk-billed vs 75.7[11.3]), a greater proportion were after-hours (10.3%[3.0] vs 6.2[2.9]) and for chronic disease care (28%[3.4] vs 17.6[8.0]) but fewer for preventive care (50.7%[3.8] had cervical screening vs 62.5[4.9]). Patterns were similar in regional locations, other than disadvantaged areas had less after-hours care (1.3%[0.7] vs 6.1%[3.9]). Measures were positively correlated, except GP supply and affordability in major cities (-0.41, p < .01). Application of constructed measures revealed inequity in PHC service delivery amenable to policy intervention. Initiatives should consider the maldistribution of GPs not only by remoteness but also by area disadvantage. Avenues for improvement in disadvantaged areas include preventative care across all regions and after-hours care in regional locations

Masculinities, affect and the (re)place(ment) of stardom in Formula One fan leisure practices

Writing from an autoethnographic perspective, this article explores male leisure practices via the mediated relationships fans enter into with stars. More specifically, my own fandom for Formula One driver Jacques Villeneuve is the locus of study, revealing how this affective investment shapes and furnishes my corresponding leisure practices. Notions of gendered 'performativity' come to the fore, with my own displays evoking, enacting and revealing oscillating performances of masculinity. Moreover, there are interesting gendered dynamics that such fan leisure practices flag in terms of the intersection of female/male relationships and the potential 'fantasy' and/or narcissistic readings that a male fan identifying with and performing as another male sport star afford. Finally, my research reveals paradoxes for contemporary masculinities, with fans reliant upon mediation and commodification to facilitate and sustain their performative roles. © 2011 Taylor & Francis