Australian Institute of Health and Welfare eBooks, 2001
Monitoring the Incidence of Cardiovascular Disease in Australia examines the feasibility of monit... more Monitoring the Incidence of Cardiovascular Disease in Australia examines the feasibility of monitoring the incidence of selected cardiovascular diseases using existing national datasets. Methods for estimating the national incidence of acute myocardial infarction, stroke, unstable angina pectoris, and congestive heart failure are recommended. This report is part of the Cardiovascular Disease Series, which covers mortality, risk factors, morbidity and medical procedures. It is a valuable resource for health planners, practitioners and researchers interested in the occurrence of cardiovascular conditions
AimsTo focus on the needs, challenges and opportunities to improve access to cardiac rehabilitati... more AimsTo focus on the needs, challenges and opportunities to improve access to cardiac rehabilitation (CR) (Heart: Road to health [HRH]) for Aboriginal and Torres Strait Islander peoples in rural and remote (R&R) areas of North Queensland.ContextIt is known that there is insufficient access to HRH for Aboriginal and Torres Strait Islander peoples in R&R areas of NQ, who have the highest rates of heart disease and socioeconomic disadvantage mainly due to poor social determinants of health. However, at least in part due to the impact of colonialism and predominantly western medicalised approach to health care, few gains have been made.ApproachThis commentary draws on recent research and literature and reflects on cultural issues that impact on improving access to an HRH for Aboriginal and Torres Strait Islander peoples in R&R areas. The underutilisation of the skills of Aboriginal and Torres Strait Islander Health Workers (ATSIHW) and a lack of a defined process to ensure access to culturally responsive HRH are discussed. Finally, a way forward is proposed that includes the development of policies, pathways and guidelines to ensure that appropriate support is available in the client's home community.ConclusionIt is proposed that culturally responsive, accessible and effective HRH is achievable through the reorientation of current health systems that include a continuous client‐centred pathway from hospital to home. In this model, ATSIHW will take a lead or partnership role in which their clinical, cultural brokerage and health promotion skills are fully utilised.
A controlled intervention trial was set up in 1976 to evaluate a program to lower risk factors fo... more A controlled intervention trial was set up in 1976 to evaluate a program to lower risk factors for coronary heart disease. The 3,401 persons who attended a voluntary screening program at their place of work, became the subjects. All subjects in the treatment group were given their results; those with a high blood pressure reading were referred to their doctor, while those with increases in other risk factor levels were offered educational group programs and literature. For control subjects, the only intervention was the sending of screening results, with advice to consult a doctor, for the 10 per cent at highest risk. Repeat screening after one year showed that similar changes in risk factor levels had occurred in both the treatment and the control groups, although changes in blood pressure favoured the control group. This program of screening and intervention had little effect on the level of coronary disease risk factors.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Lags between policy and outcomes mean it is important to have good metrics and the right expectat... more Lags between policy and outcomes mean it is important to have good metrics and the right expectations about timelines I t is well known that the health of Australia's Aboriginal and Torres Strait Islander people is considerably poorer than that of their non-Indigenous counterparts. 1 Strategies, policies, programs and funding over many years have been targeted toward improving the health of Indigenous Australians and closing the gap in health status between Indigenous and non-Indigenous Australians. In this article, we review trends in key mortality rates for both populations and two complementary indices of the gap between them, both of which are essential to understanding progress or otherwise in closing the mortality gaps. Importantly, we also discuss the time required until the impact of policy changes can be assessed. Measures of "the gap" An understanding of changes in mortality over time requires: (i) graphing the non-Indigenous and Indigenous rates to see whether they are declining, remaining stable or increasing; (ii) showing trends in the rate difference (obtained by subtracting the non-Indigenous rate from the Indigenous rate) to indicate movement in the absolute size of the difference and the magnitude of improvement required for the gap to close; and (iii) showing trends in the rate ratio (obtained by dividing the Indigenous rate by the non-Indigenous rate) to indicate whether the relative rate of improvement in Indigenous mortality is faster than for non-Indigenous mortalitythe fundamental requirement for the "gap" to finally close. Are the gaps closing? Analysis of data from the Aboriginal and Torres Strait Islander Health Performance Framework 2014 report shows that the overall difference in death rates between Indigenous and non-Indigenous Australians during 2008 to 2012 was 389 deaths per 100 000, with a rate ratio of 1.7. 2 The Box shows rate differences and rate ratios for mortality from all causes, child mortality and infant mortality among Indigenous and non-Indigenous Australians from 1998 to 2012.
The authors argue for the use of validated questionnaires whenever possible to improve the qualit... more The authors argue for the use of validated questionnaires whenever possible to improve the quality of epidemiological research. (non- author abstract)
In February 1976, a conference on the Rationalisation and Development of Health Data Collection a... more In February 1976, a conference on the Rationalisation and Development of Health Data Collection and Analysis Activities was convened in Canberra. This conference was attended by representatives of Commonwealth and State Governments and private organisations. Considerable concern was expressed by delegates to that conference, and also subsequent to it, regarding the lack of sufficient timely, comprehensive and appropriate data necessary for the effective planning, administration and evaluation of health services and facilities. Basic national epidemiological data and information on matters such as health care facilities, the use of health services, health personnel and health
The present report is a comprehensive study of statistical data on mortality, morbidity and costs... more The present report is a comprehensive study of statistical data on mortality, morbidity and costs to the community of the effects of cranio-cerebral, spinal and peripheral nerve injury from all causes in New South Wales in 1977. This epidemiological overview of neurotrauma is designed to serve as a detailed reference book for planning of various aspects of, and improvements in, our preventive and first aid services; for monitoring trends and changes occurring over the years; for planning and distribution of manpower and facilities; and for improvement of patient care and cost efficiency. An important though not unexpected finding of this study is that road accidents are the dominant cause of neurotauma, leading to two-thirds of the mortality and probably in excess of one half of the permanent disability. The consequent recommendations stemming from this fall into two categories: prevention and initial care. Considering that human error is responsible for the majority of accidents and that almost half the drivers dying from neurotrauma sustained in road accidents had high blood alcohol levels, appropriate preventive measures might have considerably reduced the road toll in 1977. The mortality survey revealed that two-thirds of all neurotrauma victims were dead before they were admitted to hospital. This draws immediate attention to our organisation of first aid at the accident site and two separate aspects of quality of care: quality of care at hospital and first aid, emergency and transport services. The study was initiated and sponsored by the Neurosurgical Society of Australasia, conducted by its Trauma Subcommittee, in collaboration wth the Division of Health Services Research, Health Commission of New South Wales.
OBJECTIVE To assess implementation of in-patient cardiac rehabilitation (Phase-1-cardiac rehabili... more OBJECTIVE To assess implementation of in-patient cardiac rehabilitation (Phase-1-cardiac rehabilitation), impact on people in rural and remote areas of Australia and potential methods for addressing identified weaknesses. DESIGN Exploratory case study methodology using qualitative and quantitative methods. Qualitative data collection via semi-structured interviews, using thematic analysis, augmented by quantitative data collection via a medical record audit. SETTING Four regional hospitals (2 Queensland Health and 2 private) providing tertiary health care. PARTICIPANTS (a) Hospital in-patients with heart disease ≥18 years. (b) Staff responsible for their care. OUTCOME MEASURES Implementation of Phase-1-cardiac rehabilitation in tertiary hosptials in North Queensland and the impact on in-patients discharge planning and post discharge care. Recommentations and implications for practice are proposed to address deficits. RESULTS Phase-1-cardiac rehabilitation implementation rates, in-patient understanding and multidisciplinary team involvement were low. The highest rates of Phase-1-cardiac rehabilitation were for in-patients with a length of stay three days or more in cardiac units with cardiac educators. Rates were lower in cardiac units with no cardiac educators, and lowest for in-patients in all areas of all hospitals with length of stay of two days or less days. Low Phase-1-cardiac rehabilitation implementation rates resulted in poor in-patient understanding about their disease, treatment and post-discharge care. Further, medical discharge summaries rarely mentioned cardiac rehabilitation/secondary prevention or risk factor management resulting in a lack of information for health care providers on cardiac rehabilitation and holistic health care. CONCLUSION Implementation of Phase-1-cardiac rehabilitation in regional hospitals in this study fell short of recommended best practice, resulting in patients' poor preparation for discharge, and insufficient information on holistic care for health care providers in rural and remote areas. These factors potentially impact on holistic care for people returning home following treatment for heart disease.
A method for estimating the incidence of acute myocardial infarctions (AMI) from routinely collec... more A method for estimating the incidence of acute myocardial infarctions (AMI) from routinely collected hospital morbidity records is presented. The method is based on a review of a sample of routinely collected statistics on hospital diagnoses and the subsequent estimation of the "sensitivity" and "positive predictive value" of hospital diagnoses of AMI. The incidence estimate of AMI is a function of the total number of hospital diagnoses of AMI, the "sensitivity", the "positive predictive value", the proportion of cases of AM1 treated at home, and the proportion dying prior to hospital admission. Such estimates may be a practical alternative to community registers for monitoring the incidence of AMI.
In the 10 years 1990-2000, despite improvements in some conditions, there has been little or no o... more In the 10 years 1990-2000, despite improvements in some conditions, there has been little or no overall progress in the health of the Aboriginal and Torres Strait Islander populations of Australia. This is in stark contrast to the gains made in Indigenous health in other countries. The issue is one of lack of commitment to and implementation of already existing policies. We need to (i) fully and adequately fund the Primary Health Care Access Program to provide the out-of-hospital services for prevention and early treatment required to break the cycle of ill-health; (ii) implement a National Training Plan to train the necessary health workforce; and (iii) introduce a National Infrastructure Plan to rectify the continuing deficiencies in water supply, sanitation, education and other basic services. (MJA 2002; 177: 629-631) THE RECENT PIONEERING Public Report Card 2002-Aboriginal and Torres Strait Islander health, entitled No more excuses, 1 outlines where we are today and how the health of our Indigenous population compares with that of other similar countries-New Zealand, Canada and the United States. Produced by the Australian Medical Association, it is a "warts-and-all" assessment which is designed to show what is working and where we need to do better.
International Journal of Environmental Research and Public Health, Sep 29, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Australian Institute of Health and Welfare eBooks, 2001
Monitoring the Incidence of Cardiovascular Disease in Australia examines the feasibility of monit... more Monitoring the Incidence of Cardiovascular Disease in Australia examines the feasibility of monitoring the incidence of selected cardiovascular diseases using existing national datasets. Methods for estimating the national incidence of acute myocardial infarction, stroke, unstable angina pectoris, and congestive heart failure are recommended. This report is part of the Cardiovascular Disease Series, which covers mortality, risk factors, morbidity and medical procedures. It is a valuable resource for health planners, practitioners and researchers interested in the occurrence of cardiovascular conditions
AimsTo focus on the needs, challenges and opportunities to improve access to cardiac rehabilitati... more AimsTo focus on the needs, challenges and opportunities to improve access to cardiac rehabilitation (CR) (Heart: Road to health [HRH]) for Aboriginal and Torres Strait Islander peoples in rural and remote (R&R) areas of North Queensland.ContextIt is known that there is insufficient access to HRH for Aboriginal and Torres Strait Islander peoples in R&R areas of NQ, who have the highest rates of heart disease and socioeconomic disadvantage mainly due to poor social determinants of health. However, at least in part due to the impact of colonialism and predominantly western medicalised approach to health care, few gains have been made.ApproachThis commentary draws on recent research and literature and reflects on cultural issues that impact on improving access to an HRH for Aboriginal and Torres Strait Islander peoples in R&R areas. The underutilisation of the skills of Aboriginal and Torres Strait Islander Health Workers (ATSIHW) and a lack of a defined process to ensure access to culturally responsive HRH are discussed. Finally, a way forward is proposed that includes the development of policies, pathways and guidelines to ensure that appropriate support is available in the client's home community.ConclusionIt is proposed that culturally responsive, accessible and effective HRH is achievable through the reorientation of current health systems that include a continuous client‐centred pathway from hospital to home. In this model, ATSIHW will take a lead or partnership role in which their clinical, cultural brokerage and health promotion skills are fully utilised.
A controlled intervention trial was set up in 1976 to evaluate a program to lower risk factors fo... more A controlled intervention trial was set up in 1976 to evaluate a program to lower risk factors for coronary heart disease. The 3,401 persons who attended a voluntary screening program at their place of work, became the subjects. All subjects in the treatment group were given their results; those with a high blood pressure reading were referred to their doctor, while those with increases in other risk factor levels were offered educational group programs and literature. For control subjects, the only intervention was the sending of screening results, with advice to consult a doctor, for the 10 per cent at highest risk. Repeat screening after one year showed that similar changes in risk factor levels had occurred in both the treatment and the control groups, although changes in blood pressure favoured the control group. This program of screening and intervention had little effect on the level of coronary disease risk factors.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Lags between policy and outcomes mean it is important to have good metrics and the right expectat... more Lags between policy and outcomes mean it is important to have good metrics and the right expectations about timelines I t is well known that the health of Australia's Aboriginal and Torres Strait Islander people is considerably poorer than that of their non-Indigenous counterparts. 1 Strategies, policies, programs and funding over many years have been targeted toward improving the health of Indigenous Australians and closing the gap in health status between Indigenous and non-Indigenous Australians. In this article, we review trends in key mortality rates for both populations and two complementary indices of the gap between them, both of which are essential to understanding progress or otherwise in closing the mortality gaps. Importantly, we also discuss the time required until the impact of policy changes can be assessed. Measures of "the gap" An understanding of changes in mortality over time requires: (i) graphing the non-Indigenous and Indigenous rates to see whether they are declining, remaining stable or increasing; (ii) showing trends in the rate difference (obtained by subtracting the non-Indigenous rate from the Indigenous rate) to indicate movement in the absolute size of the difference and the magnitude of improvement required for the gap to close; and (iii) showing trends in the rate ratio (obtained by dividing the Indigenous rate by the non-Indigenous rate) to indicate whether the relative rate of improvement in Indigenous mortality is faster than for non-Indigenous mortalitythe fundamental requirement for the "gap" to finally close. Are the gaps closing? Analysis of data from the Aboriginal and Torres Strait Islander Health Performance Framework 2014 report shows that the overall difference in death rates between Indigenous and non-Indigenous Australians during 2008 to 2012 was 389 deaths per 100 000, with a rate ratio of 1.7. 2 The Box shows rate differences and rate ratios for mortality from all causes, child mortality and infant mortality among Indigenous and non-Indigenous Australians from 1998 to 2012.
The authors argue for the use of validated questionnaires whenever possible to improve the qualit... more The authors argue for the use of validated questionnaires whenever possible to improve the quality of epidemiological research. (non- author abstract)
In February 1976, a conference on the Rationalisation and Development of Health Data Collection a... more In February 1976, a conference on the Rationalisation and Development of Health Data Collection and Analysis Activities was convened in Canberra. This conference was attended by representatives of Commonwealth and State Governments and private organisations. Considerable concern was expressed by delegates to that conference, and also subsequent to it, regarding the lack of sufficient timely, comprehensive and appropriate data necessary for the effective planning, administration and evaluation of health services and facilities. Basic national epidemiological data and information on matters such as health care facilities, the use of health services, health personnel and health
The present report is a comprehensive study of statistical data on mortality, morbidity and costs... more The present report is a comprehensive study of statistical data on mortality, morbidity and costs to the community of the effects of cranio-cerebral, spinal and peripheral nerve injury from all causes in New South Wales in 1977. This epidemiological overview of neurotrauma is designed to serve as a detailed reference book for planning of various aspects of, and improvements in, our preventive and first aid services; for monitoring trends and changes occurring over the years; for planning and distribution of manpower and facilities; and for improvement of patient care and cost efficiency. An important though not unexpected finding of this study is that road accidents are the dominant cause of neurotauma, leading to two-thirds of the mortality and probably in excess of one half of the permanent disability. The consequent recommendations stemming from this fall into two categories: prevention and initial care. Considering that human error is responsible for the majority of accidents and that almost half the drivers dying from neurotrauma sustained in road accidents had high blood alcohol levels, appropriate preventive measures might have considerably reduced the road toll in 1977. The mortality survey revealed that two-thirds of all neurotrauma victims were dead before they were admitted to hospital. This draws immediate attention to our organisation of first aid at the accident site and two separate aspects of quality of care: quality of care at hospital and first aid, emergency and transport services. The study was initiated and sponsored by the Neurosurgical Society of Australasia, conducted by its Trauma Subcommittee, in collaboration wth the Division of Health Services Research, Health Commission of New South Wales.
OBJECTIVE To assess implementation of in-patient cardiac rehabilitation (Phase-1-cardiac rehabili... more OBJECTIVE To assess implementation of in-patient cardiac rehabilitation (Phase-1-cardiac rehabilitation), impact on people in rural and remote areas of Australia and potential methods for addressing identified weaknesses. DESIGN Exploratory case study methodology using qualitative and quantitative methods. Qualitative data collection via semi-structured interviews, using thematic analysis, augmented by quantitative data collection via a medical record audit. SETTING Four regional hospitals (2 Queensland Health and 2 private) providing tertiary health care. PARTICIPANTS (a) Hospital in-patients with heart disease ≥18 years. (b) Staff responsible for their care. OUTCOME MEASURES Implementation of Phase-1-cardiac rehabilitation in tertiary hosptials in North Queensland and the impact on in-patients discharge planning and post discharge care. Recommentations and implications for practice are proposed to address deficits. RESULTS Phase-1-cardiac rehabilitation implementation rates, in-patient understanding and multidisciplinary team involvement were low. The highest rates of Phase-1-cardiac rehabilitation were for in-patients with a length of stay three days or more in cardiac units with cardiac educators. Rates were lower in cardiac units with no cardiac educators, and lowest for in-patients in all areas of all hospitals with length of stay of two days or less days. Low Phase-1-cardiac rehabilitation implementation rates resulted in poor in-patient understanding about their disease, treatment and post-discharge care. Further, medical discharge summaries rarely mentioned cardiac rehabilitation/secondary prevention or risk factor management resulting in a lack of information for health care providers on cardiac rehabilitation and holistic health care. CONCLUSION Implementation of Phase-1-cardiac rehabilitation in regional hospitals in this study fell short of recommended best practice, resulting in patients' poor preparation for discharge, and insufficient information on holistic care for health care providers in rural and remote areas. These factors potentially impact on holistic care for people returning home following treatment for heart disease.
A method for estimating the incidence of acute myocardial infarctions (AMI) from routinely collec... more A method for estimating the incidence of acute myocardial infarctions (AMI) from routinely collected hospital morbidity records is presented. The method is based on a review of a sample of routinely collected statistics on hospital diagnoses and the subsequent estimation of the "sensitivity" and "positive predictive value" of hospital diagnoses of AMI. The incidence estimate of AMI is a function of the total number of hospital diagnoses of AMI, the "sensitivity", the "positive predictive value", the proportion of cases of AM1 treated at home, and the proportion dying prior to hospital admission. Such estimates may be a practical alternative to community registers for monitoring the incidence of AMI.
In the 10 years 1990-2000, despite improvements in some conditions, there has been little or no o... more In the 10 years 1990-2000, despite improvements in some conditions, there has been little or no overall progress in the health of the Aboriginal and Torres Strait Islander populations of Australia. This is in stark contrast to the gains made in Indigenous health in other countries. The issue is one of lack of commitment to and implementation of already existing policies. We need to (i) fully and adequately fund the Primary Health Care Access Program to provide the out-of-hospital services for prevention and early treatment required to break the cycle of ill-health; (ii) implement a National Training Plan to train the necessary health workforce; and (iii) introduce a National Infrastructure Plan to rectify the continuing deficiencies in water supply, sanitation, education and other basic services. (MJA 2002; 177: 629-631) THE RECENT PIONEERING Public Report Card 2002-Aboriginal and Torres Strait Islander health, entitled No more excuses, 1 outlines where we are today and how the health of our Indigenous population compares with that of other similar countries-New Zealand, Canada and the United States. Produced by the Australian Medical Association, it is a "warts-and-all" assessment which is designed to show what is working and where we need to do better.
International Journal of Environmental Research and Public Health, Sep 29, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
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