Assuntos
Sistemas de Informação em Saúde/economia , Política de Saúde/economia , Investimentos em Saúde , Saúde Pública/economia , Austrália , Tomada de Decisões Gerenciais , Difusão de Inovações , Reforma dos Serviços de Saúde/economia , Sistemas de Informação em Saúde/organização & administração , Humanos , Objetivos OrganizacionaisRESUMO
OBJECTIVE: To review Australian mental health initiatives involving coordination of care. METHODS: Commonwealth government websites were systematically searched for mental health policy documents. Database searches were also conducted using the terms 'coordination' or 'integration' and 'mental health' or 'mental illness' and 'Australia'. We assessed the extent to which informational, relational and management continuity have been addressed in three example programs. RESULTS: The lack of definition of coordination at the policy level reduces opportunities for developing actionable and measurable programs. Of the 51 mental health initiatives identified, the three examples studied all demonstrated some use of the dimensions of continuity to facilitate coordination. However, problems with funding, implementation, evaluation and competing agendas between key stakeholders were barriers to improving coordination. CONCLUSIONS: Coordination is possible and can improve both relationships between providers and care provided. However, clear leadership, governance and funding structures are needed to manage the challenges encountered, and evaluation using appropriate outcome measures, structured to assess the elements of continuity, is necessary to detect improvements in coordination.
Assuntos
Continuidade da Assistência ao Paciente/normas , Prestação Integrada de Cuidados de Saúde/organização & administração , Política de Saúde , Serviços de Saúde Mental/normas , Austrália , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/normas , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Publicações Governamentais como Assunto , Humanos , Internet , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/estatística & dados numéricosRESUMO
The social mission, or accepted social responsibility of Australian medical schools, was assessed at a time of rapid expansion and resulting pressure on staff and facilities. Nine new schools have been established in 2005-10 and there has been particular concern about adequacy of clinical training places. Discussions with most of the deans revealed their strong social commitments. We consider two of these in depth - raising the status and thus the involvement of students in general and especially rural practice; and increasing the numbers of Indigenous students and the knowledge of Indigenous health and culture among all students. We examine a system by which medical schools in the USA have been ranked for social mission achievements and suggest this approach might be used in Australia to measure the response of medical schools to Government initiatives and policies.
Assuntos
Faculdades de Medicina , Responsabilidade Social , Austrália , Serviços de Saúde do Indígena/normas , Objetivos Organizacionais , Qualidade da Assistência à SaúdeRESUMO
Multidisciplinary approaches to primary health care improve outcomes for individuals living with chronic conditions. However, emerging evidence suggests access to allied health professionals in Australia is problematic. This paper reports findings of a telephone survey of allied health professionals' billing practices in one urban area. The survey was undertaken as a quality improvement project in response to the affordability queries raised by patients and carers in the clinical setting. The aim was to determine financial cost of access to allied health professionals in one urban primary health care setting. Participant practices included: physiotherapy (n=21), podiatry (n=8) and dietitians (n=3). Fees were variable, with cost of the initial (assessment) appointment higher than subsequent (follow-up) appointments in 92% of practices. The average out of pocket expenses for assessment and three follow-up appointments ranged from $258 to $302. When available, the Medicare rebate reduced this to $58-106. Bulk billing was not offered. Variable costs, minimal concessions and absence of bulk billing in this confined geographical area creates a cost barrier to access for patients from lower socioeconomic groups and has implications for access to multidisciplinary care in Australian primary health care.
Assuntos
Honorários e Preços/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Atenção Primária à Saúde/economia , Austrália , Humanos , Entrevistas como Assunto , Programas Nacionais de Saúde/estatística & dados numéricos , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/estatística & dados numéricosRESUMO
In 2008, the Australian Primary Health Care Research Institute (APHCRI) held a Primary Health Care Workforce Roundtable with practising clinicians, policymakers and researchers, which drew on Australian evidence in health care policy, systematic reviews, and expertise and experience of participants. Key recommendations for an adequate, sustainable and effective primary health care workforce that arose from the meeting included: simplifying the Medicare Benefits Schedule, which is unnecessarily complex and inflexible; effectively funding undergraduate and prevocational medical and nursing education and training in primary health care; developing career structure and training pathways for general practitioners and primary health care nurses; developing of functional primary health care teams; and using a blended funding model, comprising fee-for-service as well as capitation for patients with chronic or complex needs. A report from the meeting, detailing these policy options, was submitted to the National Health and Hospitals Reform Commission for inclusion in their deliberations.
Assuntos
Atenção Primária à Saúde/legislação & jurisprudência , Austrália , Educação em Enfermagem , Medicina de Família e Comunidade/educação , Programas Nacionais de Saúde/organização & administração , Política Pública , Recursos HumanosAssuntos
Médicos de Família/provisão & distribuição , Serviços de Saúde Rural/organização & administração , População Rural , Austrália , Necessidades e Demandas de Serviços de Saúde , Humanos , Área Carente de Assistência Médica , Modelos Organizacionais , Médicos de Família/estatística & dados numéricosAssuntos
Inovação Organizacional , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Austrália , Agentes Comunitários de Saúde , Infecções por HIV/prevenção & controle , Reforma dos Serviços de Saúde , Prioridades em Saúde , Promoção da Saúde , Humanos , Saúde Mental , Grupos Populacionais , Atenção Primária à Saúde/economia , Avaliação de Programas e Projetos de Saúde/economiaRESUMO
A synthesis of the findings of the five studies of sustainability of primary health care innovation across six domains (political, institutional, financial, economic, client and workforce) yielded three main themes. These were: the importance of social relationships, networks and champions; the effect of political, financial and societal forces; and the motivation and capacity of agents within the system. The need for routine assessment of the sustainability of primary health care innovations is discussed. Given the dearth of literature on the sustainability of primary health care innovation, there is potential to develop a program of research directed towards a future synthesis of evidence.