ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00236.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00237.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:The New South Wales Health Department's initiative on health outcomes promises some important advances in the planning and priority setting of health services. However, the potential to promote better health care will not be realised unless resources are redeployed to the programs where health outcomes (and other benefits) can be purchased most cheaply. The initiative reflects firmly the economic concept of efficiency but leaves less certainty about how concerns for equity are to be handled. This paper proposes that program budgeting and marginal analysis be used to create a framework for redeploying resources to follow the good buys—in terms of health and other outcomes. Additionally, the paper argues for creating the right incentives to promote efficiency, and expressly argues against the use of diagnostic related groups or casemix funding, as such funding is concerned, by definition, with cases and not with health per se. The goal of the initiative of trying to maximise health outcomes implies that there are no other valued gains to be had from health care. This is challenged. In reaching decisions about how best to deploy resources, more account should be taken, in a structured way, of community value

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00238.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:An outbreak of 18 cases of measles in a primary school in the Australian Capital Territory in August and September 1993 provided the opportunity to study measles immunisation status and measles vaccine efficacy. Parents of 384 (78 per cent) of 491 children answered a questionnaire on recent illness consistent with measles and measles immunisation. Parents transcribed details of measles immunisation from the personal health record of the child to the questionnaire. Thirty‐three per cent of cases and 3.4 per cent of the other children had not been immunised. Overall, 95 per cent of children had been immunised. The efficacy for all measles vaccines was estimated to be 90 per cent (95 per cent confidence interval (CI) 75 to 96) and for measles‐mumps vaccine 87 per cent (CI 70 to 95). All of the immunised cases had received measles‐mumps vaccine. There was no increased risk of measles infection in those who had been immunised at under 15 months of age compared with those immunised at 15 months or older, or in those who could not provide a date of immunisation compared with those who could. None of the children who had received two doses of vaccine caught measles. The date of immunisation was provided by 65 per cent of the respondents who said their children had been immunised. Asking parents to provide this date instead of viewing the health record is a less expensive way of assessing immunisation status but this method needs to be evaluated. Measles outbreaks still occur in highly immunised populations when vaccine efficacy appears to be accep

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00239.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:This study compared levels of hepatitis B immunisation in a group of 524 infants in Northland, New Zealand, with levels in the remainder of the country. The Northland sample had specific encouragement from an immunisation coordinator and had been followed from birth. Levels throughout the rest of the country were estimated from four samples totalling 317 infants whose parents were interviewed when the child was at least two years old. The cross‐sectional nationwide sample had fewer children ‘fully immunised’ by two years of age (minimum estimate 61.8 per cent, maximum estimate 69.7 per cent) than the cohort of children (not lost to follow‐up) who were encouraged to have the immunisations in Northland (77.5 per cent) (Z = 4.73,P<0.001 for comparison with the minimum nationwide estimate; Z = 2.45,P= 0.014 for comparison with the maximum estimate). Of the Northland cohort, 13.5 per cent were lost to follow‐up before the scheduled completion of the hepatitis B vaccinations. Assuming that every child lost to follow‐up was not fully immunised, the efforts of the immunisation promotion program operated by a nurse coordinator increased the percentage of children fully immunised by between about 7.8 per cent and 15.7 per cent. A promotion program for hepatitis B immunisation, operated by an immunisation coordinator, is an effective tool for increasing immunisati

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00240.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:An anonymous postal survey of all known general practitioners in the Northern Sydney Health Area (N= 987) examined the provision of immunisation services in general practice. Questions were asked about knowledge of storage of vaccines, the ages of patients administered measles‐mumps‐rubella vaccine, the use of reminder systems for subsequent vaccinations and whether maternal and family health was discussed at immunisation visits. There were 394 (40 per cent) respondents. Only 30 per cent used temperature monitors in their vaccine refrigerators, and 26 per cent correctly identified the period after opening that Sabin may be used (eight hours). Forty‐one percent correctly injected infants in the anterolateral aspect of the thigh and 40 per cent administered measles‐mumps‐rubella vaccine by the recommended age of 12 months. Forty‐one percent of respondents always used visits for immunisation to discuss other issues of maternal and child health and 16 per cent used reminder systems for follow‐up. Sixty‐six per cent of general practitioners stated that they were more likely to review the immunisation status of adolescents routinely, compared to 55 per cent who reviewed adults and 44 per cent who reviewed senior citizens. Routine review of all three groups was carried out by 43 per cent. These results must be interpreted with caution because of low response rates, and cannot necessarily be generalised to all general practitioners providing immunisation services. Nevertheless, important deficiencies in knowledge and practice of immunisation have

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00241.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:In 1982 the National Health and Medical Research Council recommended that every state introduce legislation requiring immunisation certificates at school entry. Victoria was the first state to enact such legislation. This paper explores the process and difficulties encountered in achieving this legal requirement, describes the requirements under the legislation as it was finally introduced, and examines the early data available to the state health department regarding its implementation. Compliance with the legislation and immunisation status of children enrolling in government primary schools were ascertained from mid‐year census data. In 1992 almost 90 per cent of children complied with the legislation, but because 10.2 per cent of children did not present a certificate it was possible to estimate only the lower limit of statewide coverage at 85 per cent against the prescribed diseases. School entry immunisation legislation may provide an important safety net to identify children with incomplete immunisation. However, the effectiveness of the legislation in Victoria remains unproven, and the requirements of the legislation are demanding for parents, local councils, and schools. The failure to document immunisation status in over 10 per cent of children indicates that further efforts to increase compliance are needed. This will require information on the vaccination status of those without certificates and the reasons they have not complied. The impact of the legislation needs further evaluation, although it may be years before its effectiveness can be gauged. Its effectiveness may depend upon enforcement of the requirement to exclude unimmunised children in disease outbreak

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00242.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:We evaluated legislation introduced into Victoria in 1991 requiring that all children enrolling in primary school certify their immunisation status. Information was requested from all local councils. All primary schools in two local government areas were followed up, providing an indication of the validity of the analysis obtained from data collected during the mid‐year census. From 166 of 210 local councils in Victoria, 48 422 documents relating to school entry immunisation certificates were issued for children entering their preparatory year. At least 522 children were enrolled in school on an undertaking to complete immunisation, and were likely to have had their immunisation completed as a result of the legislation. Only 170 statutory declarations of conscientious objection to immunisation were made, indicating that few parents are willing to express firm anti‐vaccine sentiments. Compliance with the immunisation certificate legislation is overestimated by the mid‐year census because many schools have accepted nonstatutory evidence of immunisation. Mobile and immigrant families find it particularly difficult to achieve certification. Local councils are inconsistent in the way in which they issue certificates. Further follow‐up and feedback is essential to better inform schools and parents about the legislation. Such follow‐up can improve the certification rates of children then and in subsequent years. The legislation has imposed a considerable workload on councils, but without efforts to improve compliance with the legislation and to develop practical guidelines for documentation of immunisation and appropriate guidelines regarding transfer, many inadequately immunised children may remain at risk from vaccine‐preventab

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00243.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:A pilot survey by telephone interview, followed by a questionnaire of all rural doctors identified in Queensland, was used develop both a definition of rural practice that distinguishes it from urban general practice and a classification of rural and remote practice which assists in sampling of rural doctors. Questionnaire responses in specific geographic areas were compared using chi‐square and Mantel‐Haenszel chi‐square tests. Several factors were found to differentiate rural from urban general practice consistently, thereby enabling a functional definition of rural practice to be developed. Within the broad group of rural doctors, gradients in practice characteristics were found to differentiate doctors in larger rural centres from those in smaller, more remote communities. These gradients were related to the distance and time of travel from support services. They formed the basis of a complex classification of rural and remote general practice. This functional definition of rural and remote medical practice should be considered by researchers of rural medicine issues when sampling rural and remote doctors. The strategies used in this study could be adapted for use in considering practice characteristics of other rural health profes

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00244.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:The poor nutritional status of Aboriginal Australians is a serious and complex public health concern. We describe an unusually successful health and nutrition project initiated by the people of Minjilang, which was developed, implemented and evaluated with the community. Apparent community dietary intake, assessed by the ‘store‐turnover’ method, and biochemical, anthropometric and haematological indicators of health and nutritional status were measured before intervention and at three‐monthly intervals during the intervention year. Following intervention, there was a significant decrease in dietary intake of sugar and saturated fat, an increase in micronutrient density, corresponding improvements in biochemical indices (for example, a 12 per cent decrease in mean serum cholesterol, increases in serum and red cell folate, serum vitamin B6and plasma ascorbic acid), decrease in mean systolic and diastolic blood pressures, a normalisation of body mass index, and a normalisation of haematologic indices. The success of this project demonstrates that Aboriginal communities can bring about improvements in their generally poor nutritional status, and that the store‐turnover method provides a valid, inexpensive and noninvasive method for evaluating the resultant changes in community diet. Although the project was undoubtedly effective in the short term, further work is in progress to assess individual strategies with respect to sustainability, cost‐effectiveness and gener

ISSN:1035-7319    

DOI:10.1111/j.1753-6405.1994.tb00245.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY