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

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260615
Author(s):  
D. C. Butler ◽  
L. R. Jorm ◽  
S. Larkins ◽  
J. Humphreys ◽  
J. Desborough ◽  
...  
Keyword(s):  
Service Delivery ◽  
Primary Healthcare ◽  
Small Area ◽  
Cervical Screening ◽  
Preventative Care ◽  
Level Variation ◽  
After Hours Care ◽  
Service Organisation ◽  
Small Area Level ◽  
After Hours

Background 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. Methods 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. Results 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). Implications 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.

scholarly journals A multilevel mixed effects analysis of informal carers health in Australia: the role of community participation, social support and trust at small area level

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Itismita Mohanty ◽  
Theo Niyonsenga ◽  
Tom Cochrane ◽  
Debra Rickwood
Keyword(s):  
Health Outcomes ◽  
Community Participation ◽  
General Health ◽  
Small Area ◽  
Positive Influence ◽  
Mixed Effects ◽  
Level Variation ◽  
Individual Level ◽  
Small Area Level ◽  
Informal Carers

Abstract Background Informal carers suffer from worse health outcomes than non-carers due to their caregiving role. Yet, in a society carers health is as important as that of their care recipients. This study investigated the self-assessed mental and general health outcomes of informal carers in Australia. It evaluated the influence of carers’ personal social capital- a logically linked sequence of their social behaviour such as community participation, social support and trust in others- on their health outcomes. The study estimated the magnitude of small area level variation at Statistical Area Level 1 (SA1) along with individual level variation in carers’ health outcomes. Methods The study used a multilevel mixed effects cross-sectional design using data from the Household Income and Labour Dynamics of Australia survey, wave 14. It included Australians aged 15 years and older that were surveyed in the year 2014. The sample consisted of 12,767 individuals and 5004 SA1s. The outcome measures included- mental health, general health and physical functioning, domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life. Results Informal carers suffered from poor mental (Beta = − 0.587, p = 0.003) and general health (Beta = − 0.670, p = 0.001) outcomes compared to non-carers in Australia. These health outcomes exhibited significant variation acrossSA1s in Australia, with 12–13% variation in general and mental health. However, within small local areas, differences at the individual level, accounted for most of the variation in outcomes. Moreover, levels of community participation, personal social connection and trust, as perceived by individuals in the communities, had a positive influence on both mental and general health of carers and non-carers, and were more beneficial for carers compared to non-carers. Conclusion It seems that the positive influence of social capital for carers helps them in coping with the negative impact of their caregiving duty on health outcomes. Findings suggested that some targeted community support programs for carers to build on their personal social cohesion and trust in their community could help in improving their poor health profiles. Moreover, improved informal carers’ health may help the health system in better managing their resources.

Small area-level variation in the incidence of psychotic disorders in an urban area in France: an ecological study

2016 ◽  
Vol 51 (7) ◽  
pp. 951-960 ◽  
Author(s):  
Andrei Szoke ◽  
Baptiste Pignon ◽  
Grégoire Baudin ◽  
Andrea Tortelli ◽  
Jean-Romain Richard ◽  
...  
Keyword(s):  
Urban Area ◽  
Small Area ◽  
Ecological Study ◽  
Psychotic Disorders ◽  
Level Variation ◽  
Small Area Level

scholarly journals A Multilevel Mixed Effects Analysis of Informal Carers Health in Australia: The role of Community Participation, Social Support and Trust at Small Area level.

2020 ◽  
Author(s):  
Itismita Mohanty ◽  
Theo Niyonsenga ◽  
Tom Cochrane ◽  
Debra Rickwood
Keyword(s):  
Health Outcomes ◽  
Community Participation ◽  
General Health ◽  
Small Area ◽  
Positive Influence ◽  
Mixed Effects ◽  
Level Variation ◽  
Individual Level ◽  
Small Area Level ◽  
Informal Carers

Abstract Background: Informal carers suffer from worse health outcomes than non-carers due to their caregiving role. Yet, in a society carers health is as important as that of their care recipients. This study investigated the self-assessed mental and general health outcomes of informal carers in Australia. It evaluated the influence of carers’ personal social capital- a logically linked sequence of their social behaviour such as community participation, social support and trust in others- on their health outcomes. The study estimated the magnitude of small area level variation at Statistical Area Level 1 (SA1) along with individual level variation in carers’ health outcomes.Methods: The study used a multilevel mixed effects cross-sectional design using data from the Household Income and Labour Dynamics of Australia survey, wave 14. It included Australians aged 15 years and older that were surveyed in the year 2014. The sample consisted of 12,767 individuals and 5004 SA1s. The outcome measures included- mental health, general health and physical functioning, domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life.Results: Informal carers suffered from poor mental (Beta = -0.587, p=0.003) and general health (Beta = -0.670, p=0.001) outcomes compared to non-carers in Australia. These health outcomes exhibited significant variation acrossSA1s in Australia, with 12-13% variation in general and mental health. However, within small local areas, differences at the individual level, accounted for most of the variation in outcomes. Moreover, levels of community participation, personal social connection and trust, as perceived by individuals in the communities, had a positive influence on both mental and general health of carers and non-carers, and were more beneficial for carers compared to non-carers. Conclusion: It seems that the positive influence of social capital for carers helps them in coping with the negative impact of their caregiving duty on health outcomes. Findings suggested that some targeted community support programs for carers to build on their personal social cohesion and trust in their community could help in improving their poor health profiles. Moreover, improved informal carers’ health may help the health system in better managing their resources.

scholarly journals A Multilevel Mixed Effects Analysis of Informal Carers Health in Australia: The role of Community Participation, Social Support and Trust at Small Area level.

2020 ◽  
Author(s):  
Itismita Mohanty ◽  
Theo Niyonsenga ◽  
Tom Cochrane ◽  
Debra Rickwood
Keyword(s):  
Health Outcomes ◽  
Community Participation ◽  
General Health ◽  
Small Area ◽  
Positive Influence ◽  
Mixed Effects ◽  
Level Variation ◽  
Individual Level ◽  
Small Area Level ◽  
Informal Carers

Abstract Background: Informal carers suffer from worse health outcomes than non-carers due to their caregiving role. Yet, in a society carers health is as important as that of their care recipients. This study investigated the self-assessed mental and general health outcomes of informal carers in Australia. It evaluated the influence of carers’ personal social capital- a logically linked sequence of their social behaviour such as community participation, social support and trust in others- on their health outcomes. The study estimated the magnitude of small area level variation at Statistical Area Level 1 (SA1) along with individual level variation in carers’ health outcomes.Methods: The study used a multilevel mixed effects cross-sectional design using data from the Household Income and Labour Dynamics of Australia survey, wave 14. It included Australians aged 15 years and older that were surveyed in the year 2014. The sample consisted of 12,767 individuals and 5004 SA1s. The outcome measures included- mental health, general health and physical functioning, domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life.Results: Informal carers suffered from poor mental (Beta = -0.587, p=0.003) and general health (Beta = -0.670, p=0.001) outcomes compared to non-carers in Australia. These health outcomes exhibited significant variation acrossSA1s in Australia, with 12-13% variation in general and mental health. However, within small local areas, differences at the individual level, accounted for most of the variation in outcomes. Moreover, levels of community participation, personal social connection and trust, as perceived by individuals in the communities, had a positive influence on both mental and general health of carers and non-carers, and were more beneficial for carers compared to non-carers. Conclusion: It seems that the positive influence of social capital for carers helps them in coping with the negative impact of their caregiving duty on health outcomes. Findings suggested that some targeted community support programs for carers to build on their personal social cohesion and trust in their community could help in improving their poor health profiles. Moreover, improved informal carers’ health may help the health system in better managing their resources.

scholarly journals A Multilevel Mixed Effects Analysis of Informal Carers Health in Australia: The role of Community Participation, Social Support and Trust at Small Area level.

2020 ◽  
Author(s):  
Itismita Mohanty ◽  
Theo Niyonsenga ◽  
Tom Cochrane ◽  
Debra Rickwood
Keyword(s):  
Health Outcomes ◽  
Community Participation ◽  
General Health ◽  
Small Area ◽  
Positive Influence ◽  
Mixed Effects ◽  
Level Variation ◽  
Individual Level ◽  
Small Area Level ◽  
Informal Carers

Abstract Background: Informal carers suffer from worse health outcomes than non-carers due to their caregiving role. Yet, in a society carers health is as important as that of their care recipients. This study investigated the self-assessed mental and general health outcomes of informal carers in Australia. It evaluated the influence of carers’ personal social capital- a logically linked sequence of their social behaviour such as community participation, social support and trust in others- on their health outcomes. The study estimated the magnitude of small area level variation at Statistical Area Level 1 (SA1) along with individual level variation in carers’ health outcomes.Methods: The study used a multilevel mixed effects cross-sectional design using data from the Household Income and Labour Dynamics of Australia survey, wave 14. It included Australians aged 15 years and older that were surveyed in the year 2014. The sample consisted of 12,767 individuals and 5004 SA1s. The outcome measures included- mental health, general health and physical functioning, domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life.Results: Informal carers suffered from poor mental (Beta = -0.587, p=0.003) and general health (Beta = -0.670, p=0.001) outcomes compared to non-carers in Australia. These health outcomes exhibited significant variation acrossSA1s in Australia, with 12-13% variation in general and mental health. However, within small local areas, differences at the individual level, accounted for most of the variation in outcomes. Moreover, levels of community participation, personal social connection and trust, as perceived by individuals in the communities, had a positive influence on both mental and general health of carers and non-carers, and were more beneficial for carers compared to non-carers. Conclusion: It seems that the positive influence of social capital for carers helps them in coping with the negative impact of their caregiving duty on health outcomes. Findings suggested that some targeted community support programs for carers to build on their personal social cohesion and trust in their community could help in improving their poor health profiles. Moreover, improved informal carers’ health may help the health system in better managing their resources.

scholarly journals Forecasting of Lung Cancer Incident Cases at the Small-Area Level in Victoria, Australia

2021 ◽  
Vol 18 (10) ◽  
pp. 5069
Author(s):  
Win Wah ◽  
Rob G. Stirling ◽  
Susannah Ahern ◽  
Arul Earnest
Keyword(s):  
Lung Cancer ◽  
Small Area ◽  
Health Planning ◽  
Temporal Trends ◽  
State Level ◽  
The Elderly ◽  
Ageing Population ◽  
Temporal Models ◽  
Small Area Level ◽  
Incident Cases

Predicting lung cancer cases at the small-area level is helpful to quantify the lung cancer burden for health planning purposes at the local geographic level. Using Victorian Cancer Registry (2001–2018) data, this study aims to forecast lung cancer counts at the local government area (LGA) level over the next ten years (2019–2028) in Victoria, Australia. We used the Age-Period-Cohort approach to estimate the annual age-specific incidence and utilised Bayesian spatio-temporal models that account for non-linear temporal trends and area-level risk factors. Compared to 2001, lung cancer incidence increased by 28.82% from 1353 to 1743 cases for men and 78.79% from 759 to 1357 cases for women in 2018. Lung cancer counts are expected to reach 2515 cases for men and 1909 cases for women in 2028, with a corresponding 44% and 41% increase. The majority of LGAs are projected to have an increasing trend for both men and women by 2028. Unexplained area-level spatial variation substantially reduced after adjusting for the elderly population in the model. Male and female lung cancer cases are projected to rise at the state level and in each LGA in the next ten years. Population growth and an ageing population largely contributed to this rise.

scholarly journals Perceptions of registered nurses regarding factors influencing service delivery in expanding programmes in a primary healthcare setting

2012 ◽  
Vol 17 (1) ◽  
Author(s):  
Nnoi. A. Xaba ◽  
Mmapheko D. Peu ◽  
Salaminah S. Phiri
Keyword(s):  
Service Delivery ◽  
Registered Nurses ◽  
Primary Healthcare ◽  
Healthcare Setting ◽  
Qualitative Approach ◽  
Focus Group Interviews ◽  
Enabling Factors ◽  
Related Factors ◽  
Factors Influencing ◽  
Group Interviews

The aim of this study was to explore and describe the perceptions of registered nurses regarding factors influencing service delivery regarding expansion programmes in a primary healthcare setting, using a qualitative approach. The registered nurses, who have been working in the clinics for more than two years and have been exposed to the expansion programmes there, were purposively sampled. Two focus group interviews were conducted in a neutral place and the data collected by the researcher Nnoi A. Xaba (N.A.X.). Data were analysed by the researcher and an independent co-coder using the Tesch method. Categories, subcategories and themes were identified; those that formed the basis of discussion were disabling factors, enabling factors, client-related factors, service-related factors and solutions to problems. It is recommended that integration of programmes and coordination be done at a provincial level and planned together with the training centres in order to alleviate problems in service delivery. Training on expansion programmes in the form of in-service education should be carried out continually in the region.Die doel van die studie was om die persepsie van geregistreerde verpleegkundiges met betrekking tot die  faktore wat dienslewering van die uitbreidingsprogramme in ‘n primêre gesondheid opset beinvloed; te eksploreer en te beskryf. ‘n Kwalitatiewe benadering is gevolg in die iutvoering van die studie. ‘n Doelgerigte steekproef is uitgevoer vanuit geregistreerde verpleegkundiges wat vir langer as twee jaar in die klinieke werksaam was en blootgestel is aan die uitbreiding programme. Twee fokus groep onderhoude is deur die navorser Nnoi A. Xaba (N.A.X.) in ‘n neutrale opset uitgevoer. Data is deur die navorser en ʼn onafhanklike kodeerder ontleed volgens Tesch se metode van analise. Kategorieë, sub-kategorieë en temas was geidentifiseer. Die kategorieë fundamenteel tot die bespreking behels: remmende faktore, bydraende faktore, kliënt-verwante faktore, diens-verwante faktore, en oplossing van probleme. Daar word aanbeveel dat die integrasie en koordinasie van programme op provisiale vlak beplan word in samewerking met opleidings instansies om die dienslewerings probleem te verlig. In die streek behoort opleiding met betrekking tot die uitbreidingsprogramme deurlopend deur middel van indiensopleiding gedoen word.

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