Key Considerations to the Introduction of Intergenerational Practice to Australian Policy.

Intergenerational practice programs provide purposeful interactions between generations. While research reports improved social and behavioral outcomes for cohorts, no study has explored both expert and potential consumer perceptions of the implementation of intergenerational practice programs. This study conducted a Delphi study of expert opinions, as well as a national survey of potential consumers (N = 1020), to provide critical insights into the potential barriers to implementing intergenerational practice programs. Results revealed that 71.3% of potential consumers would participate in intergenerational practice programs if they were available and experts agreed that the program was of benefit to both populations. However, there were shared concerns regarding the transport, safety, and outcomes of the program for participants. Based on our findings we offer several policy considerations in the implementation of intergenerational programs.

An investigation of the health-promoting practices of Australian universities.

Workplace health promotion programmes (WHPPs) are more likely to succeed where design and implementation account for the influence of health's complex, systemic nature. Thus, a greater understanding of how frameworks developed to progress WHPPs are operationalized across different countries and industries is needed. This study investigates health concerns targeted in an underexplored setting-Australian universities, describing how diverse programmes are implemented to target different health issues and health risk factors. Content analysis is used to outline how Australian universities implement WHPPs to target diverse health concerns. Content from 497 website documents is collected and analysed using NVivo software. A framework for examining diverse WHPPs currently used in practice is developed. Based on this framework, it was evident that Australian universities emphasized initiatives targeting health issues focusing on 'mental health' and 'diabetes'. Regarding health risk factors, 'alcohol and other addictions', 'discrimination and harassment', and 'physical activity' were emphasized. Links between different health concerns targeted and corresponding WHPPs implemented, provide workplaces with a benchmark for designing and implementing programmes. University WHPPs targeted a diverse range of health concerns when enough legal and political motivations to do so existed. These findings about the motivations for improving employee health indicate a potential gap between health promotion benefits reported in literature and the appreciation for these benefits in practice.

This study investigates the employee health concerns targeted by the WHPPs of Australian universities. The aim is to identify how Australian universities implement WHPPs to target the different health issues and health risk factors of their employees. Health concerns can differ depending on factors such as the countries, industries or demographics of employees. Therefore, it is important for workplaces to consider the complex nature of health when designing and implementing WHPPs. Content from 497 website documents is analysed in this study and used to outline how Australian universities target diverse health concerns through a range of WHPPs. From this analysis, a framework for examining the different WHPPs currently being used by Australian workplaces is developed. Based on this framework, it was evident that Australian universities emphasized initiatives targeting health issues focusing on 'mental health' and 'diabetes'. Regarding health risk factors, 'alcohol and other addictions', 'discrimination and harassment', and 'physical activity' were emphasized. Links identified in this study, between different health concerns targeted and corresponding WHPPs implemented, provide workplaces with a benchmark for designing and implementing programmes.

Uniting generations: A research protocol examining the impacts of an intergenerational learning program on participants and organisations.

Economic, health and social issues associated with the ageing population and the disconnect between the generations call for novel approaches to care services. Intergenerational programs are known to enhance engagement between generations, improve health and well-being and create a stronger sense of community. While the health and social benefits are well documented, little attention has been given to the operational aspects of intergenerational programs within care facilities. This paper describes the research protocol used to develop, implement and evaluate an intergenerational learning program for preschool-aged children and older people attending care services. The research focuses on five key areas: (a) impact on older people and children; (b) intergenerational learning; (c) workforce development; (d) socio-economic implications and costs; and (e) program fidelity and sustainability. Findings from this research are expected to contribute to building age-friendly communities through the development of practical operational guidelines for intergenerational learning programs to be implemented more broadly across Australia.

The effect of inadequate access to healthcare services on emergency room visits. A comparison between physical and mental health conditions.

This paper estimates the influence of inadequate access to healthcare services on the rate of Emergency Room (ER) hospital visits in Australia. We take micro-data on different types of healthcare shortfalls from the 2012 Australian Survey of Disability, Aging and Carers, and employ Propensity Score Matching (PSM) techniques to identify their effects on ER visits. We find that shortfalls in access to various medical services increases ER visits for individuals with mental and physical conditions by about the same degree. Conversely, inadequate community care services significantly predict ER visits for individuals with physical conditions, but not for persons with mental conditions. The lack of predictive power for inadequate community care for persons with mental health problems is surprising, as "acopia" is thought to be a significant driver of crises that require emergency treatment. We discuss some of the mechanisms that may underpin this finding and address the policy implications of our results. Lastly a number of robustness checks and diagnostics tests are presented which confirm that our modelling assumptions are not violated and that our results are insensitive to the choice of matching algorithms.

Respite service use among caregivers of older people: comparative analysis of family dementia caregivers with musculoskeletal and circulatory system disorder caregivers.

OBJECTIVES: To identify the main drivers of the use of respite services and the need for respite services among caregivers of people experiencing dementia relative to family caregivers of people with other health conditions. METHOD: Based on nationally representative secondary data regression analysis was used to test the association between selected health conditions and the utilisation of and need for respite services. RESULTS: For a person living with dementia the odds of using respite care are higher than for a person with either a musculoskeletal or circulatory condition. Family caregivers of people living with dementia report the odds of the need for more respite as 5.3 times higher than for family caregivers of people with musculoskeletal conditions and 7.7 times higher than for family caregivers of people with circulatory conditions. The main reason for never using respite services is largely driven by the type of health condition, age of care recipient, existence of a spouse, and level of disability. CONCLUSIONS: Respite services that cater to the specific needs of families experiencing dementia at home should become a higher priority within the aged care sector. Alternative models of respite care that focus on prevention and early intervention would be cost effective.

The association between cognitive impairment and community service use patterns in older people living in Australia.

Family plays a vital role in supporting individuals with dementia to reside in the community, thus delaying institutionalisation. Existing research indicates that the burden of care-giving is particularly high for those caring for a person with dementia. Yet, little is known about the uptake of community services by people with a diagnosis of dementia. Therefore, this study aims to better understand the relationship between cognitive impairment and the receipt of community care services. In order to examine the relationship, secondary data collected across Queensland, Australia, from 59,352 home-care clients aged 65 and over during 2007-2008 are analysed. This cross-sectional study uses regression analyses to estimate the relationship between cognitive impairment and service mix, while controlling for socio-demographic characteristics. The dependent variables include formal services, informal care and total home-care service hours during a 12-month period. The findings of this study demonstrate that cognitive impairment is associated with accessing more hours of respite and day centre care but fewer hours of other formal care services. Additionally, the likelihood of support from an informal caregiver increases when a client becomes cognitively impaired. Therefore, this study demonstrates that there is an increased need for respite programmes to support informal caregivers in the future, as the population of people living with dementia increases. These findings support the need for investigations of new and innovative respite models in the future.

How best practices are copied, transferred, or translated between health care facilities: A conceptual framework.

INTRODUCTION: In spite of significant investment in quality programs and activities, there is a persistent struggle to achieve quality outcomes and performance improvements within the constraints and support of sociopolitical parsimonies. Equally, such constraints have intensified the need to better understand the best practice methods for achieving quality improvements in health care organizations over time.This study proposes a conceptual framework to assist with strategies for the copying, transferring, and/or translation of best practice between different health care facilities. PURPOSE: Applying a deductive logic, the conceptual framework was developed by blending selected theoretical lenses drawn from the knowledge management and organizational learning literatures. FINDINGS: The proposed framework highlighted that (a) major constraints need to be addressed to turn best practices into everyday practices and (b) double-loop learning is an adequate learning mode to copy and to transfer best practices and deuteron learning mode is a more suitable learning mode for translating best practice. We also found that, in complex organizations, copying, transferring, and translating new knowledge is more difficult than in smaller, less complex organizations. We also posit that knowledge translation cannot happen without transfer and copy, and transfer cannot happen without copy of best practices. Hence, an integration of all three learning processes is required for knowledge translation (copy best practice-transfer knowledge about best practice-translation of best practice into new context). In addition, the higher the level of complexity of the organization, the more best practice is tacit oriented and, in this case, the higher the level of K&L capabilities are required to successfully copy, transfer, and/or translate best practices between organizations. PRACTICE IMPLICATIONS: The approach provides a framework for assessing organizational context and capabilities to guide copy/transfer/translation of best practices. A roadmap is provided to assist managers and practitioners to select appropriate learning modes for building success and positive systemic change.

Exploring the validity of HPQ-based presenteeism measures to estimate productivity losses in the health and education sectors.

BACKGROUND: Illness-related presenteeism (suboptimal work performance) may be a significant factor in worker productivity. Until now, there has been no generally accepted best method of measuring presenteeism across different industries and occupations. This study sought to validate the Health and Work Performance Questionnaire (HPQ)-based measure of presenteeism across occupations and industries and assess the most appropriate method for data analysis. METHODS: . Work performance was measured using the modified version of the HPQ conducted in workforce samples from the education and health workforce in Queensland, Australia (N = 30,870) during 2005 and 2006. Three approaches to data analysis of presenteeism measures were assessed using absolute performance, the ratio of own performance to others' performance, and the difference between others' and own performance. The best measure is judged by its sensitivity to changes in health indicators. RESULTS: . The measure that best correlated to health indicators was absolute presenteeism. For example, in the health sector, correlations between physical health status and absolute presenteeism were 4 to 5 times greater than the ratio or difference approaches, and in the education sector, these correlations were twice as large. Using this approach, the estimated cost of presenteeism in 2006 was $Aus8338 and $Aus8092 per worker per annum for the health and education sectors, respectively. CONCLUSIONS: . The HPQ is a valid measure of presenteeism. Transforming responses by perceived performance of peers is unnecessary as absolute presenteeism correlated best with health indicators. Absolute presenteeism was more insightful for ascertaining the cost of presenteeism.

Gatekeepers to home and community care services: the link between client characteristics and source of referral.

OBJECTIVES: To identify characteristics associated with the likelihood of a client receiving a referral to the Home and Community Care (HACC) program from various sources. METHODS: Data were collected from 73809 home care clients during 2007-08. Binary logistic and multinomial logistic regression were used to investigate the likelihood of a client being referred by health workers v. non-health workers. RESULTS: Females and clients cared for by their parents were less likely to receive referrals from health workers than non-health workers after confounding variables were controlled for. While poorer functional ability of clients increased the probability of receiving a referral from a health worker, the opposite was true for those with behavioural problems. Over 43% of the sample either self-referred or was referred by family or friends. CONCLUSIONS: Eligible individuals may miss out on services unless they or their family take the initiative to refer. There is a need for improved methods and incentives to support and encourage health workers to refer eligible individuals to the program. What is known about the topic? The absence or inappropriate referral to a suitable home care program can place pressure on formalised institutions and increase burdens on family members and the community. Factors largely unrelated to healthcare needs carry significant weight in determining hospital discharge decisions and home care referrals by practitioners. What does this paper add? The effectiveness of the HACC program is dependent on the referrer who acts to inform and facilitate individuals to the program. The purpose of this study is to identify the characteristics associated with the likelihood of individuals receiving a referral to the HACC program from various sources. What are the implications for practitioners? This study will assist policy makers and practitioners in developing effective strategies that transition individuals to suitable home care services in a timely manner. An effective referral process would provide opportunities for implementing preventative strategies that reduce disability rates among individuals and the burden of care for the community. For instance, individuals with unmet needs may be at higher risk from injury at home through inadequate monitoring of nutrient and medication intake and inappropriate home surroundings. Improving knowledge about care options and providing appropriate incentives that encourage health workers to refer individuals would be an effective start in improving the health outcomes of an ageing population.

Differences in wage rates for males and females in the health sector: a consideration of unpaid overtime to decompose the gender wage gap.

BACKGROUND: In Australia a persistent and sizable gender wage gap exists. In recent years this gap has been steadily widening. The negative impact of gender wage differentials is the disincentive to work more hours. This implies a substantial cost on the Australian health sector. This study aimed to identify the magnitude of gender wage differentials within the health sector. The investigation accounts for unpaid overtime. Given the limited availability of information, little empirical evidence exists that accounts for unpaid overtime. METHODS: Information was collected from a sample of 10,066 Australian full-time employees within the health sector. Initially, ordinary least-squares regression was used to identify the gender wage gap when unpaid overtime was included and then excluded from the model. The sample was also stratified by gender and then by occupation to allow for comparisons. Later the Blinder-Oaxaca decomposition method was employed to identify and quantify the contribution of individual endowments to wage differentials between males and females. RESULTS: The analyses of data revealed a gender wage gap that varied across occupations. The inclusion of unpaid overtime in the analysis led to a slight reduction in the wage differential. The results showed an adjusted wage gap of 16.7%. CONCLUSIONS: Unpaid overtime made a significant but small contribution to wage differentials. Being female remained the major contributing factor to the wage gap. Given that wage differentials provide a disincentive to work more hours, serious attempts to deal with the skilled labour shortage in the health sector need to address the gender wage gap.

Health-related productivity losses increase when the health condition is co-morbid with psychological distress: findings from a large cross-sectional sample of working Australians.

BACKGROUND: The health condition of workers is known to impact on productivity outcomes. The relationship between health and productivity is of increasing interest amid the need to increase productivity to meet global financial challenges. Prevalence of psychological distress is also of growing concern in Australia with a two-fold increase in the prevalence of psychological distress in Australia from 1997-2005. METHODS: We used the cross-sectional data set from the Australian Work Outcomes Research Cost-benefit (WORC) study to explore the impacts of health conditions with and without co-morbid psychological distress, compared to those with neither condition, in a sample of approximately 78,000 working Australians. The World Health Organisation Health and Performance Questionnaire was used which provided data on demographic characteristics, health condition and working conditions. Data were analysed using negative binomial logistic regression and multinomial logistic regression models for absenteeism and presenteeism respectively. RESULTS: For both absenteeism and presenteeism productivity measures there was a greater risk of productivity loss associated when health conditions were co-morbid with psychological distress. For some conditions this risk was much greater for those with co-morbid psychological distress compared to those without. CONCLUSIONS: Co-morbid psychological distress demonstrates an increased risk of productivity loss for a range of health conditions. These findings highlight the need for further research to determine whether co-morbid psychological distress potentially exacerbates lost productivity.

Which health conditions impact on productivity in working Australians?

OBJECTIVE: To identify health conditions associated with productivity loss in working Australians, adjusting for comorbidity, demographics, and work-related characteristics. METHODS: The Australian Work Outcomes Research Cost-benefit study cross-sectional screening data set was used to identify health-related productivity losses in a sample of approximately 78,000 working Australians. Data collected with the World Health Organisation Health and Productivity Questionnaire were analyzed using negative binomial logistic regression and multinomial logistic regression models for absenteeism and presenteeism, respectively. RESULTS: Health conditions impacted on both presenteeism and absenteeism. Drug and alcohol problems and psychological distress had a greater impact on absenteeism and presenteeism than other investigated health conditions. Demographic characteristics, health status (comorbidity), and work-related characteristics all impacted significantly on both absenteeism and presenteeism. CONCLUSION: Mental health conditions contributed more strongly to productivity loss than other investigated health conditions.

Work-related injury in the nursing profession: an investigation of modifiable factors.

AIM: This paper is a report of a correlational study of the relationships between work-related injury-risk events and modifiable risk factors in a nursing population after controlling for socioeconomic factors. BACKGROUND: Nurses are at high risk for work-related injury. Work-related injury is strongly influenced by psychosocial factors and physical job-related exposures, but the magnitude of effect from modifiable factors remains unclear. METHOD: Data were based on the Work Outcomes Research Cost-benefit survey conducted in Australia during 2005 and 2006. The study sample of 5724 represented ~14% of nurses in Queensland, Australia. Logistic regression was used to determine the magnitude of association of psychological distress (represented by the Kessler 6 score: six-item scale of psychological distress), the number of health conditions and various socioeconomic factors with work place injury. RESULTS: High psychological distress was associated with a 5% probability of injury. As the number of health conditions increased, the probability of injury increased; 3 and ≥ 6 health conditions increased the chance of injury by 5% and 15% compared with no health conditions. Compared with the total sample, nurses who reported high levels of psychological distress demonstrated greater sensitivity to the number of health conditions. Computation of the marginal effects showed little difference in the likelihood of injury when the total sample was compared with nurses with < 5 years of work experience. CONCLUSION: Effective occupational health and safety workplace programmes that target modifiable factors such as psychological distress and physical health conditions may improve the health capital of nurses and productivity levels within the profession.

Psychological distress is associated with a range of high-priority health conditions affecting working Australians.

BACKGROUND: Psychological distress is growing in prevalence in Australia. Comorbid psychological distress and/or depressive symptoms are often associated with poorer health, higher healthcare utilisation and decreased adherence to medical treatments. METHODS: The Australian Work Outcomes Research Cost-benefit (WORC) study cross-sectional screening dataset was used to explore the association between psychological distress and a range of health conditions in a sample of approximately 78,000 working Australians. The study uses the World Health Organization Health and Productivity Questionnaire (HPQ), to identify self-reported health status. Within the HPQ is the Kessler 6 (K6), a six-item scale of psychological distress which strongly discriminates between those with and without a mental disorder. Potential confounders of age, sex, marital status, number of children, education level and annual income were included in multivariate logistic regression models. RESULTS: Psychological distress was significantly associated with all investigated health conditions in both crude and adjusted estimates. The conditions with the strongest adjusted association were, in order from highest: drug and alcohol problems, fatigue, migraine, CVD, COPD, injury and obesity. CONCLUSIONS: Psychological distress is strongly associated with all 14 health conditions or risk factors investigated in this study. Comorbid psychological distress is a growing public health issue affecting Australian workers.

Work performance decrements are associated with Australian working conditions, particularly the demand to work longer hours.

OBJECTIVES: To demonstrate the importance of including a range of working conditions in models exploring the association between health- and work-related performance. METHODS: The Australian Work Outcomes Research Cost-benefit study cross-sectional screening data set was used to explore health-related absenteeism and work performance losses on a sample of approximately 78,000 working Australians, including available demographic and working condition factors. Data collected using the World Health Organization Health and Productivity Questionnaire were analyzed with negative binomial logistic regression and multinomial logistic regressions for absenteeism and work performance, respectively. RESULTS: Hours expected to work, annual wage, and job insecurity play a vital role in the association between health- and work-related performance for both work attendance and self-reported work performance. CONCLUSIONS: Australian working conditions are contributing to both absenteeism and low work performance, regardless of health status.

Using the interaction of mental health symptoms and treatment status to estimate lost employee productivity.

OBJECTIVE: In Australia it has been estimated that mental health symptoms result in a loss of $ AU2.7 billion in employee productivity. To date, however, there has been only one study quantifying employee productivity decrements due to mental disorders when treatment-seeking behaviours are considered. The aim of the current paper was to estimate employee work productivity by mental health symptoms while considering different treatment-seeking behaviours. METHOD: A total of 60 556 full-time employees responded to the World Health Organization Health and Work Performance Questionnaire. This questionnaire is designed to monitor the work productivity of employees for chronic and acute physical and mental health conditions. Contained within the questionnaire is the Kessler 6, a scale measuring psychological distress along with an evaluation of employee treatment-seeking behaviours for depression, anxiety and any other emotional problems. A univariate analysis of variance was performed for employee productivity using the interaction between Kessler 6 severity categories and treatment-seeking behaviours. RESULTS: A total of 9.6% of employees have moderate psychological distress and a further 4.5% have high psychological distress. Increasing psychological distress from low to moderate then to high levels is associated with increasing productivity decrements (6.4%, 9.4% and 20.9% decrements, respectively) for employees in current treatment. Combining the prevalence of Kessler 6 categories with treatment-seeking behaviours, mean 2009 salaries and number of Australian employees in 2009, it is estimated that psychological distress produces an $ AU5.9 billion reduction in Australian employee productivity per annum. CONCLUSIONS: The estimated loss of $ AU5.9 billion in employee productivity due to mental health problems is substantially higher than previous estimates. This finding is especially pertinent given the global economic crisis, when psychological distress among employees is likely to be increasing. Effective treatment for mental health problems yields substantial increases in employee productivity and would be a sound economic investment for employers.

The association between mental disorders and productivity in treated and untreated employees.

OBJECTIVES: In a large cross-sectional study, this article investigates associations between employee work productivity, psychological distress, and the treatment of mental disorders. METHODS: Sixty thousand five hundred fifty-six Australian employees completed the Health and Work Performance Questionnaire (HPQ). The HPQ quantified treatment seeking behavior for depression, anxiety, or other mental disorders. The HPQ also evaluated the level of psychological distress (Kessler 6 [K6]) and employee productivity measures. RESULTS: The productivity of employees without psychological distress and who have not been in treatment of a mental disorder was 20% (SE = 0.3%). The productivity of a successfully treated employee (low K6) for a mental disorder was 17% (SE = 0.6%). CONCLUSIONS: Treatment of mental disorders resulting in normalization of symptoms is associated with employees' productivity returning to values approaching those of employees without a history of a mental disorder.

Substitution across professions within the home care sector: an investigation of nursing and allied health services.

OBJECTIVE: The service type offered by a home care agency contracted by the Queensland government is not based on the qualifications of the worker providing the service, but the service itself. This allows agencies to substitute certain levels and categories of labour in order to provide a service to meet their contract obligations. This study investigated evidence of labour substitution between nursing and allied health services. METHODS: Correlation and regression analysis was performed on the data collected from 218 clients of a branch of a community-based service agency operating nationally in Brisbane, Australia, during April, May and June 2005. RESULTS: The results of the regression analysis revealed that when either allied health or nursing time rose by 10%, all else held constant, it was predicted that the other would fall by 4%. The subcategories, registered/enrolled nursing and physiotherapy, appeared to drive the inverse relationship between nursing and allied health service time. Registered/enrolled nursing service time was more sensitive to changes in physiotherapy rather than the other way around. CONCLUSIONS: The higher labour turnover among allied health staff compared with the nursing staff reported by the agency implies a substitution of labour between the two professions to ensure that the needs of clients are met. Health policy makers and health care professional educators need to acknowledge that workforce shortages will inevitably reshape professional boundaries. Leaving labour-force substitution undiscussed and unplanned may compromise the quality and safety of care.

Understanding the use of respite services among informal carers.

OBJECTIVE: To examine the use of respite services among carers of non-institutionalised individuals aged 15 and over with either profound or severe disabilities. METHODS: Based on data collected from the Australian Survey of Disability, Ageing and Carers in 2003, the investigation evaluated the statistical significance of a number of carer and recipient characteristics on the likelihood of the use of respite services. Further analysis assisted in identifying the support most desired by the majority of carers (88.6%, n = 243 690) who have never used respite. RESULTS: The results revealed that social and cultural factors played a critical role in the receipt of respite services. Family relationships were important. Just under one-fifth of all primary carers most preferred more financial assistance in their role as caregiver. After controlling for confounding variables it was found that, compared with other forms of assistance, the desire for an improvement in the primary carers' own health was more likely among non-respite users. This may reflect the carers' preference to improve their own capacity to service the recipient rather than rely on others outside the household. CONCLUSIONS: Since the recipients under investigation typically possess core communication restrictions and highly individualised needs, it is speculated that carers perceive family members as better able to interpret and meet the sporadic and individualised care demands of recipients. IMPLICATIONS: Given the low usage of respite services among primary informal carers, policy makers and health organisations need to dispel the "one size fits all" approach to support services for households.

Caring for people with a mental disability at home: Australian carers' perceptions of service provision.

This study investigates carer perceptions of the adequacy of assistance received by comparing two populations: those with a mental disability and those with a physical disability in Australia by using data representing 12.5% of the total population. This very large sample provides robust evidence for the study's findings. Of those caring for individuals with severe core disabilities, 21.6% of those with a mental disability compared to only 8.3% of carers of those with a physical disability reported inadequate service assistance. Greater involvement of consumers and their families in health care service planning will provide opportunities to deliver more appropriate services and enhance equities within this sector.