Contribution of university departments of rural health to rural health research: An analysis of outputs.

OBJECTIVE: To assess the research contribution of eleven University Departments of Rural Health (UDRH) which were established as a rural health workforce program in the late 1990s through analysis of peer-reviewed journal output. DESIGN AND SETTINGS: Descriptive study based on validated publications from publication output reported in annual key performance indicator (KPI) reports to the Commonwealth Department of Health, Australia. MAIN OUTCOME MEASURES: In addition to counts and the type of publications, articles were examined to assess fields of research, evidence of research collaboration, and potential for influencing policy. Funding acknowledgement was examined to provide insight into funding sources and research consultancies. RESULTS: Of the 182 peer-reviewed articles, UDRH staff members were the first and corresponding author for 45% (n = 82); most (69%, n = 126) were original research. Most publications examined included Australian data only (80%, n = 101). Over half (56%; n = 102) of the articles addressed rural health issues; Aboriginal health was the main subject in 14% (n = 26). Thirty-three articles (18%) discussed the policy implications of the research and only half (51%, n = 93) of the articles listed sources of funding. Number of authors per article ranged from 1-19, with a mean of 5 (SD = 3.2) authors per article, two-thirds of articles included authors from 2-5 universities/organisations but only 5% of articles included an author from more than one UDRH. CONCLUSIONS: Staff from UDRHs are regularly publishing peer-reviewed articles, and research productivity demonstrated cooperation with external partners. Better collaboration between UDRH staff and others may help increase the quality and value of Australian rural health research.

The (mis)matching of resources and assessed need in remote Aboriginal community aged care.

AIM: To examine processes of aged-care needs assessment for Aboriginal people in remote central Australia to assist development of appropriate models of aged care. METHOD: A qualitative study involving 11 semistructured interviews with aged-care assessors and two focus groups with Aboriginal community members. RESULTS: This paper reports four major themes concerning how needs assessments relate to realities of service delivery: cultural perspectives on aged care, context of service delivery, equity and access to services, and program (mis)alignments. CONCLUSION: Disparities exist between assessment recommendations and service availability, with a potential mismatch between Aboriginal understandings of needs, interpretations by individual assessment staff and program guidelines. Incorporating a conceptual framework, such as the International Classification of Functioning, Disability and Health, into service guidelines to ensure structured consideration of a person's holistic needs may assist, as will building the capacity of communities to provide the level and type of services required.

"People like numbers": a descriptive study of cognitive assessment methods in clinical practice for Aboriginal Australians in the Northern Territory.

BACKGROUND: Achieving culturally fair assessments of cognitive functioning for Aboriginal people is difficult due to a scarcity of appropriately validated tools for use with this group. As a result, some Aboriginal people with cognitive impairments may lack fair and equitable access to services. The objective of this study was to examine current clinical practice in the Northern Territory regarding cognitive assessment for Aboriginal people thereby providing some guidance for clinicians new to this practice setting. METHOD: Qualitative enquiry was used to describe practice context, reasons for assessment, and current practices in assessing cognition for Aboriginal Australians. Semi-structured interviews were conducted with 22 clinicians working with Aboriginal clients in central and northern Australia. Results pertaining to assessment methods are reported. RESULTS: A range of standardised tests were utilised with little consistency across clinical practice. Nevertheless, it was recognised that such tests bear severe limitations, requiring some modification and significant caution in their interpretation. Clinicians relied heavily on informal assessment or observations, contextual information and clinical judgement. CONCLUSIONS: Cognitive tests developed specifically for Aboriginal people are urgently needed. In the absence of appropriate, validated tests, clinicians have relied on and modified a range of standardised and informal assessments, whilst recognising the severe limitations of these. Past clinical training has not prepared clinicians adequately for assessing Aboriginal clients, and experience and clinical judgment were considered crucial for fair interpretation of test scores. Interpretation guidelines may assist inexperienced clinicians to consider whether they are achieving fair assessments of cognition for Aboriginal clients.

Assessment staff in home and community care services: issues of learning and professional identity in Australia.

Home and Community Care (HACC) is a funding programme of the Commonwealth and State governments of Australia which supports the vast majority of community care services. Gaining access to basic community care services is via an assessment process undertaken by workers in roles that may be comprised partially or solely of assessment and care planning tasks. Arguably, the role of assessor in the HACC programme has become increasingly professionalised in recent years, and the complexity and demands of the role have increased. However, to date, little information has been available about the composition of this workforce, making initiatives to improve practice difficult to plan and implement. This paper reports findings of research from Victoria in which interviews were conducted with a range of key informants, and staff employed in client assessment roles. Results indicate considerable diversity on issues such as: the professional backgrounds of HACC assessment staff; the education, training and support they receive; how they learn their role; and what they draw upon to assist decision-making. A significant theme to emerge is that the nature of their practice derives substantially from the local contexts in which they work. In the absence of a single profession or narrative that guides their practice, they draw from a diverse range of knowledge sources. The significance of the workplace as a site of professional learning, which may provide the basis for the development of a new qualification for this workforce, is highlighted, as is the need for a professional body for this group of workers.

Assessment of indigenous older peoples' needs for home and community care in remote Central Australia.

The Home and Community Care (HACC) program in Australia provides services which supports older people to live at home. Individual HACC organisations are generally responsible for initial assessment of eligibility and need of clients presenting for services. This paper reports on a project which aimed to develop an understanding of the various approaches to assessment of client needs in Central Australia. The majority of clients in this geographical area are indigenous. The project was initiated in recognition of the primary importance of assessment in determining service access and service delivery and of the particular challenges faced by service providers in remote areas. This paper discusses key project findings including the client group and services provided, initial needs assessment and care planning processes. Evident inconsistencies in practice reflect a variety of complex contextual factors. Staff in remote areas have an inadequate knowledge base to draw upon to assist them with assessment and care planning decisions, and further research and professional development is required.