Sources of stress in impoverished neighbourhoods : insights into links between neighbourhood environments and health

Objective : We consider associations between individual, household and area-level characteristics and self-reported health.Method : Data is taken from baseline surveys undertaken in 13 socio-economically disadvantaged neighbourhoods in Victoria (n=3,944). The neighbourhoods are sites undergoing Neighbourhood Renewal (NR), a State government initiative redressing place-based disadvantage.Analysis :This focused on the relationship between area and compositional factors and self-reported health. Area was coded into three categories; LGA, NR residents living in public housing (NRPU) and NR residents who lived in private housing (NRPR). Compositional factors included age, gender, marital status, identifying as a person with a disability, level of education, unemployment and receipt of pensions/benefits.Results : There was a gradient in socio-economic disadvantage on all measures. People living in NR public housing were more disadvantaged than people living in NR private housing who, in turn, were more disadvantaged than people in the same LGA. NR public housing residents reported the worst health status and LGA residents reported the best.Conclusions : Associations between compositional characteristics of disability, educational achievement and unemployment income and poorer self-reported health were shown. They suggested that area characteristics, with housing policies, may be contributing to differences in self-reported health at the neighbourhood level.Implications : The clustering of socio-economic disadvantage and health outcomes requires the integration of health and social support interventions that address the circumstances of people and places.<br /

Planning, implementation and effectiveness in Indigenous health reform

The Planning, Implementation and Effectiveness in Indigenous Health Reform (PIE) project, funded by the Lowitja Institute and the Australian Research Council, carried out by the University of Melbourne, arose from concerns by Aboriginal and Torres Strait Islander people that despite the importance of participation and investment in collaborative governance, little research focused on capturing current practice and identifying best practice is being done. The advent of the National Indigenous Reform Agreement (NIRA) and the Indigenous Health National Partnership Agreements (IHNPAs) has led to further development/application of collaborative approaches to governance through committees and forums at national, State and regional levels. The activities associated with these committees and forums are referred to throughout this report as collaborative governance. This report focuses on building the evidence base around best practice based on case studies of collaborative governance in relation to the NIRA. A&nbsp;policy brief&nbsp;highlighting the policy recommendations of this report is also available

Differences in primary health care delivery to Australia\u27s Indigenous population : a template for use in economic evaluations

Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia&rsquo;s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting.Methods The &lsquo;Indigenous Health Service Delivery Template&rsquo; has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS.Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly.Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing health inequities is a stated goal.<br /

Impact of standalone and embedded telephone triage systems on after hours primary medical care service utilisation and mix in Australia

BACKGROUND: The Australian government sponsored five local trials aimed at addressing problems in after hours (AH) primary medical care (PMC). The study's objective was to determine if the four trials, where telephone triage was the sole innovation, led to a reduction in AH service utilisation and change in service mix towards AH GP clinics. Changes in utilisation and mix of AH GP clinic and home visits, ED and ambulance use were monitored in the trial areas, and in a national sample to adjust for the effects of secular trend. Pre- and post-trial telephone surveys of two separate random samples of approximately 350 AH PMC user households in each area were conducted. RESULTS: Some types of AH PMC use became more frequent in both of the standalone services using nurse-administered proprietary call centre software, which were aimed at better addressing population need (Statewide call centre; Regional call centre). Service use overall (95%CI: 1.03–1.83) and GP clinic use (95%CI: 1.07–2.00) increased in the metro area of the Statewide call centre and in GP clinic (95%CI: 1.04–2.14) and home visits (95%CI: 1.03–3.91) in the non-metro area of the Regional call centre. Service mix only changed in the non-metro area of the Regional call centre with increased contact in GP home visits (95%CI: 1.02–4.38). Levels of use remained unchanged in both embedded services using other than proprietary software, which were established to support the GP workforce (Deputising service; Local triage centre). Service mix only changed in the Deputising service with a change away from AH GP clinics in both contact (95%CI: 0.39–0.97) and frequency (95% CI: -2.12 – -0.7). CONCLUSION: Bearing in mind limitations in estimating AH PMC utilisation levels and mix, it is concluded that the impacts of telephone triage were generally smaller in Australia than reported elsewhere. There were different impacts on levels of service utilisation and service mix in standalone call centres and embedded services. Impacts of telephone triage on service utilisation and mix are influenced by the type of telephone triage offered, the goals of the agency providing the service, as well as local factors. (345 words

How Significant is Partnership Formation in Area-Based Projects to Increase Parental Attendance at Maternal and Child Health Services?

Objectives: In this study, we assess the importance of area-based partnerships in an initiative to improve access to Maternal and Child Health (MCH) services (known as Best Start) in socially disadvantaged communities in Victoria, Australia. Methods: The study assessed changes in MCH attendance rates, parental attitudes and local partnership formation before and after the introduction of Best Start projects. Partners involved in Best Start projects were surveyed regarding the extent of local partnership formation (before 54; after 84). Data was collected for MCH attendance using routine records for Best Start with MCH projects (before 1,739; after 1437) and the rest of the State (before 45,497; after 45,953). Two cross-sectional surveys of parents of 3-year old children were used to assess changes in parent's knowledge about, and confidence in using relevant services as well as parental confidence more generally (before 1666; after 1838). Results: Best Start was significantly associated with improving: levels of partnership formation (5 of 7 relevant factors) attendance at the 3.5 year MCH visit in Best Start Sites with MCH projects between 2001/02-2004/05. parent's access to information (partnership effect); confidence about attending the 3.5 year MCH visits (partnership effect); and overall parental confidence (project effect only). Conclusion: Best Start improves participation in the MCH attendance. This is related most directly to improving parent's access to information and overall parental confidence either through local partnership or direct project effects