摘要:

The most important use of computerised axial tomography (CAT) scanners is in the management of acute head trauma, but inadequately planned diffusion and maldistribution of scanning units and associated medical services limits patient access. Of 19 scanners in New South Wales&Victoria, 9 are publicly owned and located in public hospitals, while 10 are in private hospitals, or in private radiological practices. There is evidence of a “two‐airline policy” with public and private scanners located close together. Only scanners in public hospitals are used for acute head trauma, with a few exceptions.There is gross maldistribution: in Sydney there are 3.2 scanners per million population compared to New South Wales non‐metropolitan areas with only 0.1 scanners per million population. In Melbourne there are 2.3 scanners per million population, compared to only 0.9 per million in Victorian non‐metropolitan areas.Establishment of scanners and supporting services in some non‐metropolitan areas is justifiable, even if projected facility/population ratios exceed norms.The distribution of CAT scanners in Australia can be related to the lobbying power of major hospitals, and the distribution of well‐capitalized private radiological practices, rather than to any assessment of needs or rational planning. Government departments have an important role in the regulation of technol

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00724.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SummaryDoctors are considered by the public to be the main source of information and advice on abortion: the incidence of consultation regarding unwanted pregnancy ranges in Australian practices from 0 to 120 women per year. If a doctor refers a woman on for abortion, the outcome of the referral depends on the referrer's letter (favourable or not) and the referral place used (gynaecologist, hospital or abortion clinic). Two research questions are examined in the present study: is it possible to identify systematic differences between doctors who refer patients to an abortion clinic and those who do not; and, are some regions of Melbourne and Victoria better served than others by doctors who are sympathetic to women requesting abortion?In a 16 week period in a Melbourne clinic, patients presented letters from 470 doctors. Propensity to refer was unrelated to doctor's sex, but was related to poor socio‐economic status of the practice's suburb. Referrers were predominantly general practitioners rather than specialists, and private practitioners rather than salaried doctors. Tasmanians referred more patients than their counterparts in Victoria and New South Wales. Limitations to this indirect method of data collection are describe

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00725.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

AbstractIn this study, the goals of the Australian Community Health Program were identified and operationalised. Measures of the communities' health were obtained before and after the health centres came into operation. A population from a comparison area in which community health centre services were not available is also examined.The findings fail to support the view that Brisbane community health centres influence community symptom levels. Further, there is no evidence that health centre activities have produced a decline in medical service utilisation. Stillbirth and neonatal mortality rates appear unaltered. Hospital admission rates declined in one intervention area but continued to increase in both the comparison and, at a lower rate, in the other intervention area. The apparent lack of impact of community health centres in Brisbane may, in part, be attributed to political and structural factors which have limited the number and range of intervention programs. Thus it cannot be assumed that these findings reflect upon the Community Health Program as a whole, but they do indicate that in some centres the Program may fail to address adequately some community health needs.

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00726.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00727.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

AbstractThe rapid international transfer of medical technologies to the developing countries is in progress, promoting a “high technology” model of medicine mat is reflected in the structure of hospitals and university faculties, and medical education and practice. The resulting growth of specialties and sub‐specialties in hospitals may inhibit the development of appropriate, village‐based primary care services. Postgraduate medical education programs donated by the United States, Australia or Europe may disregard the vital issues of provision of universal primary care and local control of health services, and train doctors to devote resources to high technology urban models of care. Medical graduates emigrate to industrial countries because they find no “market” for their services in villages, where needs are the greatest. Bilateral foreign aid programs, WHO sponsored projects, multinational corporate transactions and medical missions and education have been important sources of technology transfer. While a national pharmacopoeia requires only 200 drugs, with 17 basic drugs in village clinics, most patients are denied suitable drug therapy because of inadequate primary care and the inappropriate transfer and promotion of over 4000 drugs that are expensive, incompletely tested in local conditions, or toxic. The deficiency in basic health services means only about 4 million of the 80 million children born each year in Africa, most of Latin America and South East Asia are effectively immunised with available vaccines.There are some apparently successful examples of appropriate health systems, based on the principles of universal access to primary care by health workers, and a national referral system to secondary and tertiary care. Effective monitoring of technology transfer and the development of appropriate health services involves important roles for the WHO and greater international co‐operation among community h

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00728.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00729.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

AbstractAn effort is made to identify groups of advocates and opponents of the notion that all doctors ought to be put on salary. Three major findings result from the analysis: respondents who are concerned either with cost reduction or equalisation of access to medical service favour fixed remuneration of all doctors: people who favour the remuneration by salary of all doctors appear to be spokesmen for others rather than advocates of their own cause; political party preference is the most important causal factor in determining the support for such a policy. Overall, two out of five respondents endorse the notion of fixed compensation of all doctors but neither political party is able to muster a clear majority for such a proposition suggesting that the present fee‐for‐service arrangement will not be changed in the foreseeable fut

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00730.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SummarySeveral scales that are useful in research concerning patients' experienced (as distinct from observed) quality of life have been developed. They use content analysis and so can be applied to any recorded verbal communication from individual patients. They provide indices of psychoanalysis‐based concepts of anxiety and hostility, as well as of positive feelings. Whether patients experience themselves as helpless or in control of a situation and whether patients experience themselves as having social support—phenomenology‐based concepts—are also measured. Some examples of applications of these scales in health care are given together with data from 381 patients and ex‐patients. Uses of the scales include obtaining information about common patterns of patient experiences, psychologically “at risk” patients, factors which precipitate surgery visits and patients' reaction to specific illnesses and treatments. They can also be employed in evaluations of rehabilitation, treatment and preven

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00731.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

SummaryThe relationship between preventive health care utilisation rates and family social background was examined in a birth cohort of two‐year‐old children. There was a highly significant association between social background and the utilisation of preventive health care. Factors found to reduce preventive health care utilisation included: mother of non‐European ethnic origin; single parent family; low maternal education; high residential mobility and large family size. Maternal age and family income were unrelated to health care utilisation when other variables were taken into account. The theoretical and practical implications of the results are disc

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00732.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1981.tb00733.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY