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Area Health Service (area + health_service)
Selected AbstractsClient satisfaction and risk behaviours of the users of syringe dispensing machines: a pilot studyDRUG AND ALCOHOL REVIEW, Issue 1 2008MD MOFIZUL ISLAM MSc Abstract Introduction and Aims. The study examines risk behaviours of the users of syringe dispensing machines (SDMs) and evaluates the usefulness of these machines in providing injecting drug users (IDUs) with sterile injecting equipment. Design and Methods. Self-administered questionnaires were used among users of SDMs in an Area Health Service of Sydney. Results. The majority of the 167 participants reported being happy with the quality of the SDM services. Problems identified with machines were that they were often broken or jammed (32.8% respondents), not in the right place (21.9%) or require money (16.7%). Just over half (50.9%) of the IDUs use SDMs only from 5 p.m. to 9 a.m., the time when almost all other outlets for accessing sterile injecting equipment remain closed. Relatively young IDUs (age , 30 years) were more likely to prefer SDMs over staffed needle syringe programmes (NSPs) compared with older users (age > 30) and to identify stigma (a desire to hide their identity or not liking the way people treat them at staffed NSPs or chemists) as a main reason for using these machines. Primary users of SDMs do not differ from primary users of NSP/chemists in terms of sharing of needles. Those users who had shared in the last month were nearly four times as likely to have never used condoms in sexual encounters over that period (95% confidence interval: 1.2,14.5). Discussion and Conclusion. SDMs appear to complement other outlets of NSPs. Providing free-of-cost equipment from SDMs should be considered carefully, as needing money to buy equipment was a reason given for sharing of needles by 35% of those who shared. [source] Process evaluation of an out-patient detoxification serviceDRUG AND ALCOHOL REVIEW, Issue 6 2005Dr CLAUDIA SANNIBALE Abstract This paper describes the process evaluation of an out-patient detoxification service (ODS) established by Drug Health Services (DHS) to increase the supervised withdrawal options for substance users in a Sydney metropolitan Area Health Service. The ODS aimed to provide a safe and effective supervised withdrawal to substance users who were at low risk of severe withdrawal, engage those with severe dependence in further treatment and increase the involvement of general practitioners (GPs) in the medical care of ODS clients. During its first 10 months of operation, the ODS received 199 inquiries, assessed 82 individuals and admitted 76 clients for detoxification. Withdrawal treatment proceeded without complications and within the expected time frames. Fifty-four clients completed withdrawal, 10 ceased treatment, 10 remained in treatment without completing withdrawal and two were transferred elsewhere. Clients who injected substances (mainly heroin) daily at admission, compared to others, were less likely to complete withdrawal and more likely to use a range of non-prescribed substances during withdrawal. One-fifth of clients went on to further treatment with DHS, attending at least once. Overall, the ODS met its goals, providing a safe and effective supervised withdrawal to local residents, especially women, young people and those withdrawing from benzodiazepines who had significant substance dependence, impairment and previous alcohol and other drug (AOD) treatment. Non-injecting substance users benefited most from the ODS in terms of withdrawal completion and ongoing treatment. The level of GP involvement in the conjoint care of ODS clients remained constant over time. The development and expansion of the ODS are discussed. [source] Innovative approach to health promotion for the over 45s: using a health check logINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 4 2008BAppSc (AN), June N. Sheriff CM, MHPEd Objectives., To determine effectiveness of the health check log (HCL) in promoting health-related quality of life and health awareness, health monitoring skills and timely consultation with health professionals for a cohort of community-dwelling people over 45 years, compared with a similar cohort not recording the HCL. Design., An exploratory longitudinal study using a quasi-experimental methodology and data triangulation. Outcome measures included the SF-36 health survey; a semi-structured participant feedback survey and participant focus group discussions. Sample., A convenience sample (n = 309) of community dwellers over the age of 45 living in the South Eastern Sydney/Illawarra Area Health Service, Sydney, Australia. Results., The majority of participants recording the HCL reported health benefits. The SF-36 health survey found younger age is a predictor for positive change in ,social functioning' (, = ,0.14, t = 2.25, P < 0.05), while non-pension income was a predictor of positive ,physical functioning' (, = 0.12, t = 2.02, P < 0.05) and ,general health' (, = 0.13, t = 2.11, P < 0.05). Alternatively, full-time employment (, = ,0.12, t = 2.02, P < 0.05) and not living alone (, = 0.18, t = 3.09, P < 0.01) predicted negative change in ,role , physical'. Participant reactions to recording the HCL via feedback survey and focus group discussions were mostly positive. Conclusions., The majority who maintained the HCL benefited by achieving improved health and knowledge of health monitoring, which was, however, moderated by age, income source, employment status and living arrangements. [source] The essentials of Advance Care Planning for end-of-life care for older peopleJOURNAL OF CLINICAL NURSING, Issue 3-4 2010Sarah Yeun-Sim Jeong Aims and objectives., The aim of the study was to investigate the phenomenon of Advance Care Planning and the use of Advance Care Directives in residential aged care facilities in Australia. The objectives were to: ,,investigate the implementation process of Advance Care Planning and the use of Advance Care Directives; ,,investigate the outcomes of Advance Care Planning and experiences of people involved in Advance Care Planning and Advance Care Directives, including residents, families and nursing staff. Background., Benefits of Advance Care Planning for older residents are considerable given their degenerative health-breakdown and minimal chance of recovery. To date, the use of Advance Care Planning and Advance Care Directives is limited and models of service delivery and processes are needed to enhance best practice with Advance Care Planning and positive outcomes for older Australians. Design., Case study. Methods., The study conducted using multiple sources of evidence to enrich understanding of the phenomenon of Advance Care Planning. The researcher engaged in data collection over six months involving participant observation, field notes, semi-structured interviews and document analysis. The findings contribute to the limited knowledge of options currently available to older adults and their families in their decision-making about end-of-life care options. Permission to conduct the study., Prior to commencement of the data collection, ethics clearances from the University of Newcastle and the regional Area Health Service were achieved. Permission to access the residential aged care facilities to undertake the study was obtained from the relevant residential aged care facility ethics committees or designated authorities. The researcher undertook several strategies to ensure all the ethical principles were considered and adhered to while conducting the project. Results., The research identified the components and factors involved in the Advance Care Planning process and in attaining desired outcomes. The conceptual framework developed elaborates how Advance Care Planning should be implemented and what may constitute successful implementation of Advance Care Planning in residential aged care facilities. The four main elements (input, throughput, output, feedback), and 20 sub-elements were requisites for nurses to initiate and implement the Advance Care Planning. Conclusion., The essential components for end-of-life care are identified in the implementation processes of Advance Care Planning in residential aged care facilities. The study contributes to greater awareness of the processes needed for ,dying well' and highlights the need to explore experiences of ,successful dying' and the way nurses contribute to these events. Relevance to clinical practice., The case study identified four determinative requisites for successful implementation of Advance Care Planning in aged care facilities: the expert nurse, discussion, education and involvement of a multidisciplinary team. Nurses should take these factors into account and use person-centred approach in formalised processes to encourage participation in plans for end-of-life care. [source] Surgical management of colorectal cancer in south-western Sydney 1997,2001: a prospective series of 1293 unselected cases from six public hospitalsANZ JOURNAL OF SURGERY, Issue 9 2005S. K. Cyril Wong Background: The aim of the present study is to provide local data for the management of colorectal cancers in the south-western Sydney health area from 1997 to 2001. Methods: The data were collected prospectively. Follow up was conducted in late 2001 and early 2002. Data were cross-validated with hospital and area databases and with data from the New South Wales Registry of Births, Deaths and Marriages. Results: This was an unselected series of 1293 patients from 36 surgeons; 16.5% of patients presented as emergencies. Only 3% presented as a result of bowel cancer screening. Of the 1293 patients, 1270 received an operation. There were 598 elective colonic resections with the mortality rate of 1.2%, reoperation rate of 2.7% and anastomotic leak rate of 0.8%. For the 410 elective rectal resections, the rates were 2.9%, 2.7% and 1.2%, respectively. For the 290 emergency operations, the rates were much worse at 7.7%, 6.6% and 4.8%, respectively. The corrected overall 3-year survival rate was 64%. For Dukes' A, B, C and D, the figures were 94%, 87%, 61% and 7%, respectively. Conclusions: Colorectal cancer is a major cause of mortality and morbidity in our community. Very few bowel cancers were discovered at the asymptomatic stage. This paper strongly supports community bowel cancer screening and early diagnosis. The local database has provided a rich source of information to benchmark management and outcomes of bowel cancer patients treated in the South Western Sydney Area Health Service. An area-wide computer network with online data input facilities at individual workplaces will improve data integrity and data collection efficiency. [source] A multidisciplinary primary healthcare clinic for newly arrived humanitarian entrants in regional NSW: model of service delivery and summary of preliminary findingsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Gillian Gould Abstract Objective: To describe a multidisciplinary primary healthcare clinic for newly arrived humanitarian entrants in regional New South Wales and report health problems and issues encountered during the initial period of operation. Methods: A quality assurance study of the Coffs Harbour Refugee Health Clinic (a collaboration between the Area Health Service and general practitioners) was undertaken from February to December 2006. Results: Seventy-six patients received a comprehensive health assessment: 69 of these within 12 months of arrival. The median time from arrival in Australia to the first clinic visit was five days. Problems detected were categorised according to their management options. GP clinic providers expressed concern about referring patients to GPs in the community for ongoing care. Conclusions: The Coffs Harbour Refugee Health Clinic represents a successful collaboration between relevant stakeholders. It was well utilised by the target community. Implications: The service delivery model used in the clinic could be replicated in other areas in regional Australia, provided financial and human resources are available. [source] Socio-economic status and patterns of care in lung cancerAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2005Andrew C. Hui Objective: This retrospective study aims to explore the associations between socio-economic factors and lung cancer management and outcomes in the Australian setting. Methods: The study population consisted of patients who were living in the Northern Sydney Area Health Service (NSAHS) or South Western Sydney Area Health Service (SWSAHS) at the time of their lung cancer diagnosis in 1996. Data on patient demographics, tumour characteristics, management details, recurrence and survival were collected and compared between the two areas. Socio-economic status indicators of the two Area Health Services were obtained from the Australian Bureau of Statistics. Results: There were 270 and 256 new cases of lung cancer identified in NSAHS and SWSAHS respectively. Patients in NSAHS were slightly older and there were more women. Based on the 1996 Census data, the population of NSAHS is more affluent, better educated and more likely to be employed compared with SWSAHS. The stage distributions and performance status of the two areas were similar. The utilisation rates of different treatment modalities in the two areas were similar except for chemotherapy. The five-year overall survival rate was 10.5% in NSAHS and 7.2% in SWSAHS (p=0.08). Comparison based on the SEIFA Index of Relative Socio-economic Disadvantage did not reveal significant differences. Conclusion: Patients with lung cancer had similar patterns of care and survival despite differences in socio-economic profiles between the two Area Health Services. Implication: There seems to be equity of access to lung cancer services between the two Area Health Services. [source] Co-morbid drug and alcohol and mental health issues in a rural New South Wales Area Health ServiceAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2006Bryan Hoolahan Abstract Objective:,In 2003 the New South Wales (NSW) Centre for Rural and Remote Mental Health (CRRMH) conducted an analysis of co-morbid drug and alcohol (D&A) and mental health issues for service providers and consumers in a rural NSW Area Health Service. This paper will discuss concerns raised by rural service providers and consumers regarding the care of people with co-morbid D&A and mental health disorders. Design:,Current literature on co-morbidity was reviewed, and local area clinical data were examined to estimate the prevalence of D&A disorders within the mental health service. Focus groups were held with service providers and consumer support groups regarding strengths and gaps in service provision. Setting:,A rural Area Health Service in NSW. Participants:,Rural health and welfare service providers, consumers with co-morbid D&A and mental health disorders. Results:,Data for the rural area showed that 43% of inpatient and 20% of ambulatory mental health admissions had problem drinking or drug-taking. Information gathered from the focus groups indicated a reasonable level of awareness of co-morbidity, and change underway to better meet client needs; however, the results indicated a lack of formalised care coordination, unclear treatment pathways, and a lack of specialist care and resources. Discussion:,Significant gaps in the provision of appropriate care for people with co-morbid D&A and mental health disorders were identified. Allocation of service responsibly for these clients was unclear. It is recommended that D&A, mental health and primary care services collaborate to address the needs of clients so that a coordinated and systematic approach to co-morbid care can be provided. [source] CANCER INPATIENTS MORPHINE USAGE: A NEW ENGLAND AREA SURVEYAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2003John Trollor ABSTRACT:,This is a one year study of the use of morphine in cancer patients in 10 inpatient facilities in the New England Area Health Service in the north-west of New South Wales. The study explored 170 admissions relating to 122 patients, most of whom were cared for by their general practitioners. The use of morphine in these cancer patients was compared with the recommendations made by the expert working group of the European Association of Palliative Care.1 Those items which matched the recommendations included the initial doses for new users of morphine and the subcutaneous route being the preferred parenteral route. The data in this study differed from the recommendations in that only half of the patients received the immediate release morphine when first given oral morphine, only 43% had orders for immediate release oral morphine for breakthrough pain (with a variable frequency) and a significant number of orders for parenteral and immediate release oral morphine for breakthrough pain were outside the recommended doses (100% and 86.2%, respectively). Written orders for immediate release oral and parenteral morphine involved a dose range in significant numbers while only 30% of patients had orders for parenteral morphine for breakthrough pain. There was a low use of fixed interval variable dose (FIVD) morphine charts despite these being available in most facilities. (See summary Appendix A.) [source] Recruitment and retention issues for occupational therapists in mental health: Balancing the pull and the pushAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 2 2010Justin Newton Scanlan Background/aim:,Recruitment and retention issues for mental health occupational therapists have been the subject of significant concern for many years. This paper describes recruitment and retention issues as reported by mental health occupational therapists employed by a large Area Health Service in metropolitan Sydney. Method:,Thirty-eight mental health occupational therapists (response rate 84%) completed a survey in the first half of 2008. Key themes investigated were: overall satisfaction; attractive elements of positions; positive aspects of positions; constraints of positions; factors associated with leaving positions; supervision; professional development; career pathways; and interest in and access to management positions. Results:,Key elements that kept respondents in positions included the nature of the work, being in a supportive team and the opportunity to use occupational therapy skills. Elements that prompted people to consider leaving positions were the desire for new and different types of work, a desire to work closer to home, insufficient time or high workloads, feeling ,bored' or ,stale', organisational change or juggling multiple demands, working in unsupportive or dysfunctional teams and family or other personal factors. Conclusions:,The results supported the development of a ,push and pull' conceptualisation of recruitment and retention issues, including job-related (intrinsic) and non-job-related (extrinsic) issues. This conceptualisation allows organisations to closely examine factors that attract practitioners to positions and those that support or damage staff tenure. [source] The communication challenges faced in adopting a palliative care approach in advanced dementiaINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2009Amanda Johnson RN DipT(Ng) MHScEd This paper discusses one aspect from the findings of an Australian study aimed at understanding the needs of people with advanced dementia. Specifically, this paper focuses on the communication issues that might potentially inhibit the implementation of a palliative care approach for a person with advanced dementia in a residential aged care facility (RACF). Six focus groups consisting of 34 participants and 24 semistructured interviews were conducted. Participants were drawn from palliative care specialty staff, palliative care volunteers, designated aged or dementia specialist staff from an area health service, general practitioners, RACF staff and family carers. The findings show communication issues identified by the participants were a significant factor impacting on their capacity to adopt a palliative care approach in caring for people with advanced dementia. The findings support the need for education, skill development and networking to occur among the key providers of care in RACFs to ensure the provision of ,best practice' palliative care to residents with advanced dementia and their families. [source] The role and scope of the clinical nurse consultant in Wentworth area health service, New South Wales, AustraliaJOURNAL OF NURSING MANAGEMENT, Issue 1 2007GradDipClinNsg, JENNY O'BAUGH RN, OncNsgCert Aims, This paper reports phase one of a two-part study in a New South Wales area health service, which aimed to evaluate the grading system for clinical nurse consultants. Background, Since its inception in 1986, the role and scope of practice of clinical nurse consultants in New South Wales has been viewed with differing expectations leading to role conflict from the nurse consultants themselves and others in health care including managers and other clinicians. Method, A quantitative approach was used for this study. A survey comprising of open and closed questions was mailed to all clinical nurse consultants (n = 42) employed in the area. Results, The data presented suggest that ambiguity continues about the role, the scope and the differences within the grading system of clinical nurse consultants. Conclusions, Clinical nurse consultants need leadership training and support from their managers to fulfil their role. More work is required to clarify the role of clinical nurse consultants. [source] | ||||||||||