The Experts below are selected from a list of 60378 Experts worldwide ranked by ideXlab platform
Noel Hayman - One of the best experts on this subject based on the ideXlab platform.
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patients and providers perspectives of a polypill strategy to improve cardiovascular prevention in australian primary Health care a qualitative study set within a pragmatic randomized controlled trial
Circulation-cardiovascular Quality and Outcomes, 2015Co-Authors: Hueiming Liu, Tim Usherwood, David Peiris, Julie Redfern, Tracey Laba, Alan Cass, Anushka Patel, Luciana Massi, Annemarie Eades, Noel HaymanAbstract:Background—This study explores Health provider and patient attitudes toward the use of a cardiovascular polypill as a Health service strategy to improve cardiovascular prevention. Methods and Results—In-depth, semistructured interviews (n=94) were conducted with Health providers and patients from Australian general practice, Aboriginal community-controlled and government-run Indigenous Health Services participating in a pragmatic randomized controlled trial evaluating a polypill-based strategy for high-risk primary and secondary cardiovascular disease prevention. Interview topics included polypill strategy acceptability, factors affecting adherence, and trial implementation. Transcribed interview data were analyzed thematically and interpretively. Polypill patients commented frequently on cost-savings, ease, and convenience of a daily-dosing pill. Most providers considered a polypill strategy to facilitate improved patient medication use. Indigenous Health Services providers and Indigenous patients though...
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household number associated with middle ear disease at an urban Indigenous Health service a cross sectional study
Australian Journal of Primary Health, 2014Co-Authors: Noel Hayman, Geoffrey Spurling, Deborah Askew, Philip J Schluter, Fiona SimpsonAbstract:FewepidemiologicalstudiesofmiddleeardiseasehavebeenconductedinAboriginalandTorresStraitIslander populations, yet the disease is common and causes hearing impairment and poorer educational outcomes. The objective of this study is to identify factors associated with abnormal middle ear appearance, a proxy for middle ear disease. Aboriginal and Torres Strait Islander children aged 0-14 years receiving a Child Health Check (CHC) at an urban Indigenous Health Service,Brisbane,Australiawererecruitedfrom2007to2010.Mixed-effectsmodelswereusedtoexploreassociationsof10 recognisedriskfactorswithabnormalmiddleearappearanceatthetimeoftheCHC.Ethicalapprovalandcommunitysupport for the project were obtained. Four hundred and fifty-three children were included and 54% were male. Participants were Aboriginal (92%), Torres Strait Islander (2%) or both (6%). Abnormal middle ear appearance was observed in 26 (6%) children and was significantly associated with previous ear infection (odds ratio (OR), 8.8; 95% confidence interval (CI), 3.2-24.0)andhouseholdswitheightormorepeople(OR,3.8;95%CI,1.1-14.1)intheimputedmultivariablemixed-effects model. No significant associations were found for the other recognised risk factors investigated. Overcrowding should continue to be a core focus for communities and policy makers in reducing middle ear disease and its consequences in Aboriginal and Torres Strait Islander peoples.
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strategies to improve Indigenous access for urban and regional populations to Health services
Heart Lung and Circulation, 2010Co-Authors: Noel HaymanAbstract:Lack of appropriate Health service provision for Aboriginal and Torres Strait people still remains and important social determinant of ill Health. Historically, Health services have been absent or inappropriate. Cultural factors, financial factors and distance from Health services have been important barriers limiting Indigenous access to mainstream Health services. The Inala Indigenous Health Service, a mainstream Health service has been able to improve Indigenous access from 12 Aboriginal and Torres Strait Islander patients in 1995 to 4000 patients in 2009, and approximately 1200 doctor consultations each month. Community consultation and participation were the main ingredients to improving Indigenous access to the service. With improved access the Inala Indigenous Health Service has been able to analyse 413 Adult Health Checks aged 15–54 years. The Adult Health Checks provide an opportunity to evaluate Health status, identifying chronic disease risk factors and for implementing preventive care. The Inala Indigenous Health Service has access to the Healthy for Life Program, a Commonwealth funded quality improvement program that has improved Health outcomes for patients over the past three years. All primary Health care services working in Aboriginal and Torres Strait Islander Health settings should have access to funded continuous quality improvement activities.
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improving Indigenous patients access to mainstream Health services the inala experience
The Medical Journal of Australia, 2009Co-Authors: Noel Hayman, Geoffrey Spurling, Nola E WhiteAbstract:In 1994, only 12 Indigenous people attended the mainstream general practice in Inala, south-western Brisbane, Queensland. An Indigenous community focus group and telephone interviews revealed deficits such as: few items (eg, artwork) that Indigenous people could identify with; lack of Indigenous staff; staff perceived as unfriendly; inflexibility regarding time; and intolerance of Indigenous children's behaviour. Access to the Inala Indigenous Health Service by Indigenous people improved when these issues were addressed, and has grown significantly every year from 1995 to 2008. Other important factors in improving access include: energetic Indigenous leadership; enabling bulk billing to increase funding; moving to a stand-alone clinic; and engaging with teaching, research and community programs. A Centre of Excellence in Indigenous Primary Health Care is envisaged as the next innovation required to improve access and quality of service, and to close the gap between Indigenous and non-Indigenous Health outcomes.
Hugh R Taylor - One of the best experts on this subject based on the ideXlab platform.
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ethics review of multisite studies the difficult case of community based Indigenous Health research
Social Science Research Network, 2010Co-Authors: David M Studdert, Ian Anderson, Sarah Fox, Jill E Keeffe, Hugh R TaylorAbstract:Researchers have longstanding concerns about the logistical and administrative burdens posed by ethics review of multisite studies involving human participants. Centralised ethics review, in which approval by one committee has authority across multiple sites, is widely touted as a strategy for streamlining the process. Australia is currently developing a national system of ethics review along these lines, following the United Kingdom’s lead. However, it is unclear how centralised review will work for multisite Indigenous Health research, where the views of local stakeholders are important and community consultation is mandatory. This paper describes our recent experience with multisite ethics review in conducting the National Indigenous Eye Health Survey. The experience shows how elaborate the current ethics approval and community consultation processes can be, and points to several lessons and ideas to guide pending reforms.
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ethics review of multisite studies the difficult case of community based Indigenous Health research
The Medical Journal of Australia, 2010Co-Authors: David M Studdert, Ian Anderson, Sarah Fox, Jill E Keeffe, Hugh R TaylorAbstract:Researchers have longstanding concerns about the logistical and administrative burdens posed by ethics review of multisite studies involving human participants. Centralised ethics review, in which approval by one committee has authority across multiple sites, is widely touted as a strategy for streamlining the process. The Harmonisation of Multi-centre Ethical Review (HoMER) project is currently developing such a system for Australia. It is unclear how centralised review will work for multisite Indigenous Health research, where the views of local stakeholders are important and community consultation is mandatory. Our recent experience in conducting the National Indigenous Eye Health Survey (NIEHS) shows how elaborate the current ethics approval and community consultation processes can be, and points to several lessons and ideas to guide pending reforms.
Ian Anderson - One of the best experts on this subject based on the ideXlab platform.
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priority setting in Indigenous Health assessing priority setting process and criteria that should guide the Health system to improve Indigenous australian Health
International Journal for Equity in Health, 2014Co-Authors: Michael E Otim, Margaret Kelaher, Ian Anderson, Christopher M DoranAbstract:Introduction: The Health of Indigenous Australians is worse than that of other Australians. Most of the determinants of Health are preventable and the poor Health outcomes are inequitable. The Australian Government recently pledged to close that Health gap. One possible way is to improve the priority setting process to ensure transparency and the use of evidence such as epidemiology, equity and economic evaluation. The purpose of this research was to elicit the perceptions of Indigenous and non-Indigenous decision-makers on several issues related to priority setting in Indigenous-specific Health care services. Specifically, we aimed to: 1. identify the criteria used to set priorities in Indigenous-specific Health care services; 2. determine the level of uptake of economic evaluation evidence by decision-makers and how to improve its uptake; and 3. identify how the priority setting process can be improved from the perspective of decision-makers. Methods: We used a paper survey instrument, adapted from Mitton and colleagues’ work, and a face-to-face interview approach to elicit decision-makers’ perceptions in Indigenous-specific Health care in Victoria, Australia. We used mixed methods to analyse data from the survey. Responses were summarised using descriptive statistics and content analysis. Results were reported as numbers and percentages. Results: The size of the Health burden; sustainability and acceptability of interventions; historical trends/patterns; and efficiency are key criteria for making choices in Indigenous Health in Victoria. There is a need for an explicit priority setting approach, which is systematic, and is able to use available data/evidence, such as economic evaluation evidence. The involvement of Indigenous Australians in the process would potentially make the process acceptable. Conclusions: An economic approach to priority setting is a potentially acceptable and useful tool for Aboriginal Community Controlled Health Services (ACCHS). It has the ability to use evidence and ensure due process at the same time. The use of evidence can ensure that Health outcomes for Indigenous peoples can be maximised – hence, increase the potential for ‘closing the gap’ between Indigenous and other Australians.
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cost effectiveness of interventions to prevent cardiovascular disease in australia s Indigenous population
Heart Lung and Circulation, 2014Co-Authors: Katherine S Ong, Rob Carter, Theo Vos, Margaret Kelaher, Ian AndersonAbstract:Background: Cardiovascular disease is the leading cause of disease burden in Australia's Indigenous population, and the greatest contributor to the Indigenous 'Health gap'. Economic evidence can help identify interventions that efficiently address this discrepancy. Methods: Five interventions (one community-based and four pharmacological) to prevent cardiovascular disease in Australia's Indigenous population were subject to economic evaluation. Pharmacological interventions were evaluated as delivered either via Aboriginal Community Controlled Health Services or mainstream general practitioner services. Cost-utility analysis methods were used, with Health benefit measured in disability-adjusted life-years saved. Results: All pharmacological interventions produced more Indigenous Health benefit when delivered via Indigenous Health services, but cost-effectiveness ratios were higher due to greater Health service costs. Cost-effectiveness ratios were also higher in remote than in non-remote regions. The polypill was the most cost-effective intervention evaluated, while the community-based intervention produced the most Health gain. Conclusions: Local and decision-making contextual factors are important in the conduct and interpretation of economic evaluations. For Australia's Indigenous population, different models of Health service provision impact on reach and cost-effectiveness results. Both the extent of Health gain and cost-effectiveness are important considerations for policy-makers in light of government objectives to address Health inequities and bridge the Health gap.
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differences in primary Health care delivery to australia s Indigenous population a template for use in economic evaluations
BMC Health Services Research, 2012Co-Authors: Katherine S Ong, Rob Carter, Margaret Kelaher, Ian AndersonAbstract:Background: Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia’s Indigenous population. A template has been developed which can adapt mainstream Health intervention data to the Indigenous setting. Methods: The ‘Indigenous Health Service Delivery Template’ has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary Health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream Health intervention data to allow its economic evaluation as if delivered from an ACCHS. Results: The template indicates that more resources are required in the delivery of Health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved Health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly. Conclusions: The Indigenous Health Service Delivery Template reveals significant differences in the way Health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing Health inequities is a stated goal.
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Indigenous participation in an informal national Indigenous Health policy network
Australian Health Review, 2011Co-Authors: Mark Lock, Ian Anderson, David P Thomas, Philippa PattisonAbstract:Objective. To determine and describe the features of Indigenous participation in an informal national Indigenous Health policy network. Design. A questionnaire was administered during 2003–04. Through a snowball nomination process a total of 227 influential persons were identified. Of these, 173 received surveys of which 44 were returned, a return rate of 25%. Outcome measures. These data were analysed to detect the existence of network groups; measure the degree of group interconnectivity; and measure the characteristics of bonds between influential persons. Demographic information was used to characterise the network and its groups. Results. Indigenous people were integral to the network due to their high representation, their distribution throughout the 16 groups, and the interconnections between the groups. The network was demographically diverse and multiple relational variables were needed to characterise it. Indigenous and non-Indigenous people had strong ties in this network. Conclusion. Social network methods made visible an informal network where Indigenous and non-Indigenous people relate in a complex socio-political environment to influence national Indigenous Health policy. What is known about the topic? The participation of Indigenous people is acknowledged as important in Health, but there is criticism of the lack of real opportunities for Indigenous people to participate in national Indigenous Health policy processes. What does this paper add? This research reveals the presence of an informal network of influential persons. It demonstrates a way to investigate the concept of participation through social network analytic techniques. It reveals that Indigenous people are fundamental to an informal network that influences national Health policy processes. What are the implications for practitioners? Practitioners can become more aware of their place in informal networks of influence and of their capacity to exercise personal influence in national policy decisions based on advice drawn from their informal networks.
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ethics review of multisite studies the difficult case of community based Indigenous Health research
Social Science Research Network, 2010Co-Authors: David M Studdert, Ian Anderson, Sarah Fox, Jill E Keeffe, Hugh R TaylorAbstract:Researchers have longstanding concerns about the logistical and administrative burdens posed by ethics review of multisite studies involving human participants. Centralised ethics review, in which approval by one committee has authority across multiple sites, is widely touted as a strategy for streamlining the process. Australia is currently developing a national system of ethics review along these lines, following the United Kingdom’s lead. However, it is unclear how centralised review will work for multisite Indigenous Health research, where the views of local stakeholders are important and community consultation is mandatory. This paper describes our recent experience with multisite ethics review in conducting the National Indigenous Eye Health Survey. The experience shows how elaborate the current ethics approval and community consultation processes can be, and points to several lessons and ideas to guide pending reforms.
Geoffrey Spurling - One of the best experts on this subject based on the ideXlab platform.
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household number associated with middle ear disease at an urban Indigenous Health service a cross sectional study
Australian Journal of Primary Health, 2014Co-Authors: Noel Hayman, Geoffrey Spurling, Deborah Askew, Philip J Schluter, Fiona SimpsonAbstract:FewepidemiologicalstudiesofmiddleeardiseasehavebeenconductedinAboriginalandTorresStraitIslander populations, yet the disease is common and causes hearing impairment and poorer educational outcomes. The objective of this study is to identify factors associated with abnormal middle ear appearance, a proxy for middle ear disease. Aboriginal and Torres Strait Islander children aged 0-14 years receiving a Child Health Check (CHC) at an urban Indigenous Health Service,Brisbane,Australiawererecruitedfrom2007to2010.Mixed-effectsmodelswereusedtoexploreassociationsof10 recognisedriskfactorswithabnormalmiddleearappearanceatthetimeoftheCHC.Ethicalapprovalandcommunitysupport for the project were obtained. Four hundred and fifty-three children were included and 54% were male. Participants were Aboriginal (92%), Torres Strait Islander (2%) or both (6%). Abnormal middle ear appearance was observed in 26 (6%) children and was significantly associated with previous ear infection (odds ratio (OR), 8.8; 95% confidence interval (CI), 3.2-24.0)andhouseholdswitheightormorepeople(OR,3.8;95%CI,1.1-14.1)intheimputedmultivariablemixed-effects model. No significant associations were found for the other recognised risk factors investigated. Overcrowding should continue to be a core focus for communities and policy makers in reducing middle ear disease and its consequences in Aboriginal and Torres Strait Islander peoples.
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improving Indigenous patients access to mainstream Health services the inala experience
The Medical Journal of Australia, 2009Co-Authors: Noel Hayman, Geoffrey Spurling, Nola E WhiteAbstract:In 1994, only 12 Indigenous people attended the mainstream general practice in Inala, south-western Brisbane, Queensland. An Indigenous community focus group and telephone interviews revealed deficits such as: few items (eg, artwork) that Indigenous people could identify with; lack of Indigenous staff; staff perceived as unfriendly; inflexibility regarding time; and intolerance of Indigenous children's behaviour. Access to the Inala Indigenous Health Service by Indigenous people improved when these issues were addressed, and has grown significantly every year from 1995 to 2008. Other important factors in improving access include: energetic Indigenous leadership; enabling bulk billing to increase funding; moving to a stand-alone clinic; and engaging with teaching, research and community programs. A Centre of Excellence in Indigenous Primary Health Care is envisaged as the next innovation required to improve access and quality of service, and to close the gap between Indigenous and non-Indigenous Health outcomes.
Christopher M Doran - One of the best experts on this subject based on the ideXlab platform.
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does evidence influence policy resource allocation and the Indigenous burden of disease study
Australian Health Review, 2016Co-Authors: Christopher M Doran, Rod Ling, Andrew Searles, Peter S HillAbstract:Objective The Indigenous Burden of Disease (IBoD) report is the most comprehensive assessment of Indigenous disease burden in Australia. The aim of the present study was to investigate the potential effect of the IBoD report on Australian Indigenous Health policy, service expenditure and research funding. Findings have significance for understanding factors that may influence Indigenous Health policy. Methods The potential effect of the IBoD report was considered by: (1) conducting a text search of pertinent documents published by the federal government, Council of Australian Governments and the National Health and Medical Research Council of Australia (NHMRC) and observing the quantity and quality of references to IBoD; (2) examining data on government Indigenous Healthcare expenditure for trends consistent with the findings and policy implications of the IBoD report; and (3) examining NHMRC Indigenous grant allocation trends consistent with the findings and policy implications of the IBoD report. Results Of 110 government and NHMRC documents found, IBoD was cited in 27. Immediately after publication of the IBoD report, federal and state governments increased Indigenous Health spending (relative to non-Indigenous), notably for community Health and public Health at the state level. Expenditure on Indigenous hospital separations for chronic diseases also increased. These changes are broadly consistent with the findings of the IBoD report on the significance of chronic disease and the need to address certain risk factors. However, there is no evidence that such changes had a causal connection with the IBoD study. After publication of the IBoD report, changes in NHMRC Indigenous research funding showed little consistency with the findings of the IBoD report. Conclusions The present study found only indirect and inconsistent correlational evidence of the potential influence of the IBoD report on Indigenous Health expenditure and research funding. Further assessment of the potential influence of the IBoD report on Indigenous Health policy will require more targeted research, including interviews with key informants involved in developing Health policy. What is known about the topic? There are currently no publications that consider the potential effed of the IBoD study on Indigenous Health expenditure and research funding. What does this paper add? This paper offers the first consideration of the potential effect of the IBoD report. It contains analyses of data from readily available sources, examining national expenditures on Indigenous Health and NHMRC Indigenous research, before and after the publication of the IBoD report. What are the implications for practitioners? The paper is relevant to analysts interested in drivers of Indigenous Health policy. Although it finds correlations between the release of the IBoD report and some subsequent Health spending decisions, other factors should be investigated to better understand the complexity of processes that drive government efforts to improve Indigenous Health.
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priority setting in Indigenous Health assessing priority setting process and criteria that should guide the Health system to improve Indigenous australian Health
International Journal for Equity in Health, 2014Co-Authors: Michael E Otim, Margaret Kelaher, Ian Anderson, Christopher M DoranAbstract:Introduction: The Health of Indigenous Australians is worse than that of other Australians. Most of the determinants of Health are preventable and the poor Health outcomes are inequitable. The Australian Government recently pledged to close that Health gap. One possible way is to improve the priority setting process to ensure transparency and the use of evidence such as epidemiology, equity and economic evaluation. The purpose of this research was to elicit the perceptions of Indigenous and non-Indigenous decision-makers on several issues related to priority setting in Indigenous-specific Health care services. Specifically, we aimed to: 1. identify the criteria used to set priorities in Indigenous-specific Health care services; 2. determine the level of uptake of economic evaluation evidence by decision-makers and how to improve its uptake; and 3. identify how the priority setting process can be improved from the perspective of decision-makers. Methods: We used a paper survey instrument, adapted from Mitton and colleagues’ work, and a face-to-face interview approach to elicit decision-makers’ perceptions in Indigenous-specific Health care in Victoria, Australia. We used mixed methods to analyse data from the survey. Responses were summarised using descriptive statistics and content analysis. Results were reported as numbers and percentages. Results: The size of the Health burden; sustainability and acceptability of interventions; historical trends/patterns; and efficiency are key criteria for making choices in Indigenous Health in Victoria. There is a need for an explicit priority setting approach, which is systematic, and is able to use available data/evidence, such as economic evaluation evidence. The involvement of Indigenous Australians in the process would potentially make the process acceptable. Conclusions: An economic approach to priority setting is a potentially acceptable and useful tool for Aboriginal Community Controlled Health Services (ACCHS). It has the ability to use evidence and ensure due process at the same time. The use of evidence can ensure that Health outcomes for Indigenous peoples can be maximised – hence, increase the potential for ‘closing the gap’ between Indigenous and other Australians.
