ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01064.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01065.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01066.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:In 1993, New Zealand implemented radical health sector reform, separating purchaser from provider and creating a competitive market. This paper reports on a 1994 survey of senior managers' perceptions of how well public health services were adapting to this more commercial environment. An initial questionnaire to chief executive officers of Crown health enterprises, the main providers of public health, as well as secondary treatment services, was followed by a telephone survey of managers of public health services. Chief executives expressed generally positive views about the importance of public health, especially health promotion, within their organisations. Public health managers indicated a wide range of negative and positive views about the new system. They were concerned especially about service fragmentation, diminished information‐sharing and decreased collaboration, especially with Maori and general practice providers. Questions were raised about the compatibility of competition with the need for collaboration in public health. The major issue was the inefficient, costly, conflicting and fragmented purchasing arrangements for public health. Managers wanted unified systems and fewer purchasers. More positive views were expressed on an improved focus on outputs and clearer directions, and none wanted to return to the former era of an entirely separate system for public health services. The abolition of the Public Health Commission during 1995 should lead to increased integration of purchasing and policy making, but important questions remain about the place of public health services, especially in their links with primary car

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01067.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The main objective of this study was to see if older people could maintain their quality of life and independence after their homes had been modified and they were using community services as recommended by an occupational therapist. There were 167 study participants aged 69 to 94 years from the Northern Sydney Area. After being assessed at home by an occupational therapist, 105 were randomly allocated to one of two groups, to either have or not have the occupational therapist's recommendations carried out. They were assessed again after six months. A third group did not require any intervention. This group was followed up by telephone and postal questionnaire at six months. The main outcome measures used were the Sickness Impact Profile, the Philadelphia Geriatric Center Morale Scale, the Life Satisfaction Index, assessment of Activities of Daily Living, the Health Assessment Questionnaire and change in residence. After six months there were no difference in outcomes among the three groups. Most study participants remained at a satisfactory level on each measure. Three people had died. One had moved to hostel care and one had moved to a nursing home. A further 14 from the group having no intervention had withdrawn from the study. A secondary objective of this study was to indicate the responsiveness of these outcome measures to change in the short term (over six months) in an elderly population. Twelve‐month assessments are in progress and may indicate what to expect from these outcome measures in the medium ter

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01068.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:The purpose of this study was to describe the rate of permanent placement in aged care institutions (nursing homes and hostels) after hip fracture and to assess whether or not hip fracture is an independent risk factor for institutionalisation. It was a cohort study with median follow‐up time of 14 months. Subjects were 291 people living in the community in western Sydney: 131 with hip fractures and 160 controls. Permanent admission to an aged care institution and/or death during follow‐up was assessed by telephone interview with study subjects or carers. Data on potential confounders were collected with an interviewer‐administered questionnaire at the time of recruitment into the study. During follow‐up, 27 per cent of hip fracture cases and 5 per cent of controls were admitted to an aged care institution. The age‐and sex‐adjusted hazard ratio for hip fracture and institutionalisation was 5.1 (95 per cent confidence interval (CI) 2.2 to 11.9). Adjusting for multiple health‐related factors reduced the strength of association but the hazard ratio remained high at 4.0 (CI 1.7 to 9.5). The risk of institutionalisation after hip fracture is high; this is only partly explained by the poor pre‐fracture health status of many people who frac

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01069.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Cholecystectomies in Victorian public hospitals were evaluated by analysis of hospital morbidity data. The Victorian Inpatient Minimum Dataset (VIMD) contains data on postoperative complications from all cholecystectomies in Victorian public hospitals. Hospital separations associated with cholecystectomy were identified according to Australian national diagnosis‐related groups and the procedures were grouped as open, laparoscopic or conversion from laparoscopic to open cholecystectomy (conversion). Postoperative complications were identified by ICD9‐CM external‐cause codes (E‐codes) in the VIMD. The 35 593 cholecystectomies performed between 1987–88 and 1993–94 were analysed. A further detailed analysis of all cholecystectomies performed in 1993 was based on logistic regression. This identified the adjusted odds (AOR) of occurrence of complications and included covariates of age, sex, admission type, diagnosis‐related group and hospital identification code. The annual frequency of cholecystectomy increased after introduction of laparoscopic cholecystectomy in 1990, and was associated with an increase in rates of separations having adverse events, but laparoscopic cholecystectomy had the lowest rate (66.7 per 1000 separations). Adverse‐event rates for open procedures increased to 157.5 per 1000 in 1993‐94, and for conversions to 290.0 per 1000. Of 5627 cholecystectomies in 1993, 74.4 per cent were laparoscopic, 21.5 per cent open and 4.1 per cent conversions. Postoperative complications were more likely in males (AOR 1.67, 95 per cent confidence interval (CI) 1.38 to 2.04), in patients admitted as an emergency (1.27, CI 1.01 to 1.60), and in those having open cholecystectomies (2.25, 1.78 to 2.85) or conversions (4.29, 3.05 to 6.03). Analysis of the VIMD has provided information for the evaluation of cholecystectomy. The VIMD is a useful tool for monitoring postoperative complications and the quality of care in Vi

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01070.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:One of the stated aims of Australia's health care system is to achieve equity of access to health care according to need for all Australians, with the ultimate goal of moving toward statistical equality of good health for all. This paper examines how, using routinely collected population health data, we might answer the question of whether access to hospital care for Aborigines in the Northern Territory (NT) improved in relation to access for non‐Aborigines during the period 1979 to 1988. Some of the advantages and shortfalls of this approach are discussed and an ‘index of access’ is postulated. This index is shown to be moving towards 1 during the period, suggesting that access to hospitals has improved for Aborigines compared with non‐Aborigines, but that a substantial shortfall still exists. While this index can be useful for measuring progress toward achieving the horizontal equity goal of equal access for equal need, the more difficult task of defining and measuring progress toward vertical equity goals with respect to the persistent and gross inequalities in health status between Aboriginal and non‐Aboriginal Australians deserves

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01071.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:A local study of consumer views of maternity services was initiated because of major shifts in the patterns of maternity service provision and use in a metropolitan region. Women who had given birth to a live infant at one of four hospitals in and near the region in the 1991 calendar year were surveyed about their satisfaction with their antenatal and postnatal care. Questionnaires were sent to 866 women and 519 responded, for an overall response rate of 62 per cent; in the second stage of the study, in‐depth interviews were conducted with 50 of the women. Analyses were conducted according to the hospital and to individual sociodemographic characteristics. There were statistically significant differences in satisfaction according to women's sociodemographic characteristics and the type of hospital at which they gave birth. Women who were best off in terms of economic, educational and other social resources reported the highest levels of satisfaction. Analyses by hospital revealed important differences between different types of public hospital, and between public and private hospitals. The results suggest that changing some of the organisational features of antenatal and postnatal care provision may make a significant difference to women's experience of, and satisfaction with, maternity services; most of the organisational changes identified suggest an enhanced or extended role for midwives in the provision of antenatal and postnatal service

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01072.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Reviews of the effects of smoking on health have concluded that older smokers can experience considerable health benefits from giving up smoking. In a representative population survey of people aged 15 years and over in South Australia, the percentage of people aged 60 years and over who were smokers was 13.5 per cent (95 per cent confidence interval 10.9 to 16.2 per cent). Compared with smokers aged under 60 years (n=727), older smokers (n=88) were significantly more likely: to be less convinced of the effects of smoking on health; to perceive that they were not personally at risk from their smoking in the future; to believe that smoking had not affected their own health so far; and to believe there was a daily level of cigarette consumption that was safe. Strategies to encourage older people to consider more objectively how smoking impairs daily living, including personal disclosure of smoking‐related damage through lung‐function testing, deserve further resea

ISSN:1326-0200    

DOI:10.1111/j.1467-842X.1996.tb01073.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY