Study protocol: Evaluating the impact of a rural Australian primary health care service on rural health

BACKGROUND: Rural communities throughout Australia are experiencing demographic ageing, increasing burden of chronic diseases, and de-population. Many are struggling to maintain viable health care services due to lack of infrastructure and workforce shortages. Hence, they face significant health disadvantages compared with urban regions. Primary health care yields the best health outcomes in situations characterised by limited resources. However, few rigorous longitudinal evaluations have been conducted to systematise them; assess their transferability; or assess sustainability amidst dynamic health policy environments. This paper describes the study protocol of a comprehensive longitudinal evaluation of a successful primary health care service in a small rural Australian community to assess its performance, sustainability, and responsiveness to changing community needs and health system requirements. METHODS/DESIGN: The evaluation framework aims to examine the health service over a six-year period in terms of: (a) Structural domains (health service performance; sustainability; and quality of care); (b) Process domains (health service utilisation and satisfaction); and (c) Outcome domains (health behaviours, health outcomes and community viability). Significant international research guided the development of unambiguous reliable indicators for each domain that can be routinely and unobtrusively collected. Data are to be collected and analysed for trends from a range of sources: audits, community surveys, interviews and focus group discussions. DISCUSSION: This iterative evaluation framework and methodology aims to ensure the ongoing monitoring of service activity and health outcomes that allows researchers, providers and administrators to assess the extent to which health service objectives are met; the factors that helped or hindered achievements; what worked or did not work well and why; what aspects of the service could be improved and how; what benefits have been realised and for whom; the level of community satisfaction with the service; and the impact of a health service on community viability. While the need to reduce the rural-urban health service disparity in Australia is pressing, the evidence regarding how to move forward is inadequate. This comprehensive evaluation will add significant new knowledge regarding the characteristics associated with a sustainable rural primary health care service

Staff perceptions of primary healthcare service change: influences on staff satisfaction

Abstract. Strong primary healthcare (PHC) services are efficient, cost-effective and associated with better population health outcomes. However, little is known about the role and perspectives of PHC staff in creating a sustainable service. Staff from a single-point-of-entry primary health care service in Elmore, a small rural community in north-west Victoria, were surveyed. Qualitative methods were used to collect data to show how the key factors associated with the evolution of a once-struggling medical service into a successful and sustainable PHC service have influenced staff satisfaction. The success of the service was linked to visionary leadership, teamwork and community involvement while service sustainability was described in terms of inter-professional linkages and the role of the service in contributing to the broader community. These factors were reported to have a positive impact on staff satisfaction. The contribution of service delivery change and ongoing service sustainability to staff satisfaction in this rural setting has implications for planning service change in other primary health care settings. What is known about this topic? Integrated PHC services have an important role to play in achieving equitable population health outcomes. Many rural communities struggle to maintain viable PHC services. Innovative PHC models are needed to ensure equitable access to care and reduce the health differential between rural and metropolitan people. What does this paper add? Multidisciplinary teams, visionary leadership, strong community engagement combined with service partnerships are important factors in the building of a rural PHC service that substantially contributes to enhanced staff satisfaction and service sustainability. What are the implications for practitioners? Understanding and engaging local community members is a key driver in the success of service delivery changes in rural PHC services

Owner-Reported Pica in Domestic Cats Enrolled onto a Birth Cohort Study

The prevalence and cooccurrence of pica towards different target materials were investigated using prospective data from three questionnaires completed by owners participating in a longitudinal study of UK pet cats. Pica towards one or more material types was reported in 42.9% (229/534), 32.0% (171/534), and 30.9% (165/534) of cats aged approximately 6, 12, and 18 months, respectively. At all timepoints, it was most common for only one material type to be targeted. Associations between potential explanatory variables and “chronic pica” (pica exhibited at all three timepoints) were also explored. Multivariable logistic regression revealed moving to a new house when the cat was aged approximately 6–12 months, renting rather than owning a home, and living in a household without a dog(s) when the cat was aged 2–4 months increased the odds of chronic pica occurrence. This study provides novel data from a cohort of UK pet cats and it is hoped this will increase the understanding of pica and provide direction for areas for future research

Laughing lesbians: Camp, spectatorship, and citizenship

xi, 158 p. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number.This study, set in the context of the feminist sex wars, explores the performances of Holly Hughes, Carmelita Tropicana, and Split Britches throughout the 1980s and early 1990s. The purpose of this study is to better understand the implications of a specific style of lesbian comedic performance, found at the WOW Café and defined here as lesbian camp, throughout a contentious era in feminist politics. The motivating questions for this study are: How can a performance inspire an activated spectatorship? How have lesbian comedic performance practices provoked feminist theory and practice? Chapter II defines lesbian camp and attempts to trace a dialogue among lesbian performance critics and academics ruminating over lesbian camp and its existence. It also explores lesbian camp's relationship to drag and butch-femme as well as how lesbian camp functions within specific performances of Holly Hughes, Split Britches, and Carmelita Tropicana. Chapter III argues that it is the very element of lesbian camp that brings forth the potential for an activated spectatorship. It is a chaotic, unstable environment that exposes and disassembles deep-seated fears, ideals, and practices seemingly inherent, although pragmatically constructed, to our communities and cultures throughout the 1980s and early 1990s. It presents a climate of resistance through the disruption of identificatory practices. This, in turn, provokes an activated spectatorship. Chapter IV examines the effects these artists had on the larger stage of the feminist sex wars and culture wars. Holly Hughes, for example, became a national figure, defunded from the National Endowment for the Arts due to her subject of the queer body, then deemed obscene and pornographic. Split Britches were popularized by feminists in the academy not only for their creative techniques but also for their (de)construction of butch-femme coupling. Carmelita Tropicana brought drag to a whole new level with incorporation of male and female drag into her hybrid performances.Committee in charge: John Schmor, Chairperson, Theater Arts; Sara Freeman, Member, Theater Arts; Theresa May, Member, Theater Arts; Ellen Scott, Outside Member, Sociolog

Prevention of cardiovascular disease in rural Australian primary care : an exploratory study of the perspectives of clinicians and high-risk men

Rural primary care services have the potential to play a major role in reducing the gap in cardiovascular disease (CVD) outcomes between rural and metropolitan Australians, particularly in men at high risk of CVD. The aim of this study was to explore the self-reported behaviours and satisfaction with their general practice/practitioner of men at high risk of CVD, and attitudes of rural primary care clinicians regarding the role of primary care in CVD prevention. This observational research was addressed through survey questionnaires with rural men at high risk of CVD and semi-structured interviews with rural primary care clinicians. Fourteen rural primary care practices from towns with populations less than 25000 participated. One hundred and fifty-eight high-risk men completed the questionnaire. Their responses demonstrated poorly controlled risk factors despite a willingness to change. Alternatively, rural primary care clinicians (n≤20) reported that patients were unlikely to change and that illness-based funding models inhibited cardiovascular preventive activities. Australians living in rural areas have worse CVD outcomes. In addition, there is a disparity in the assumptions of health providers and male patients at high risk of CVD in rural areas. This necessitates innovative rural primary care models that include a blended payment system that incentivises or funds preventive care alongside an emphasis on lifestyle advice, as well as an explicit strategy to influence clinician and patient behaviour to help address the disparity.7 page(s

Study protocol: Evaluating the impact of a rural Australian primary health care service on rural health

Abstract Background Rural communities throughout Australia are experiencing demographic ageing, increasing burden of chronic diseases, and de-population. Many are struggling to maintain viable health care services due to lack of infrastructure and workforce shortages. Hence, they face significant health disadvantages compared with urban regions. Primary health care yields the best health outcomes in situations characterised by limited resources. However, few rigorous longitudinal evaluations have been conducted to systematise them; assess their transferability; or assess sustainability amidst dynamic health policy environments. This paper describes the study protocol of a comprehensive longitudinal evaluation of a successful primary health care service in a small rural Australian community to assess its performance, sustainability, and responsiveness to changing community needs and health system requirements. Methods/Design The evaluation framework aims to examine the health service over a six-year period in terms of: (a) Structural domains (health service performance; sustainability; and quality of care); (b) Process domains (health service utilisation and satisfaction); and (c) Outcome domains (health behaviours, health outcomes and community viability). Significant international research guided the development of unambiguous reliable indicators for each domain that can be routinely and unobtrusively collected. Data are to be collected and analysed for trends from a range of sources: audits, community surveys, interviews and focus group discussions. Discussion This iterative evaluation framework and methodology aims to ensure the ongoing monitoring of service activity and health outcomes that allows researchers, providers and administrators to assess the extent to which health service objectives are met; the factors that helped or hindered achievements; what worked or did not work well and why; what aspects of the service could be improved and how; what benefits have been realised and for whom; the level of community satisfaction with the service; and the impact of a health service on community viability. While the need to reduce the rural-urban health service disparity in Australia is pressing, the evidence regarding how to move forward is inadequate. This comprehensive evaluation will add significant new knowledge regarding the characteristics associated with a sustainable rural primary health care service.</p