Choice and preference are fundamental to person-centered care and supporting personal choice at t... more Choice and preference are fundamental to person-centered care and supporting personal choice at the end of life should be a priority. This study analyzed the relationship between a person’s preferred place of death and other individual variables that might influence their actual place of death by examining the activity of 2 specialist community palliative care services in Australia. This was a cross-sectional study of 2353 people who died between 01 August 2016-31 August 2018; 81% died in their preferred place. Sex, type of life-limiting illness, and length of time in care were the only variables significantly related to dying in one’s preferred place. Women were more likely to die in their preferred place than men (84% v 78%) and people with a non-cancer diagnosis were 7% more likely to die in their preferred place than those with cancer, particularly when that place was their private residence (74% v 60%) or Residential Aged Care Facility (98% v 89%). Someone in care for 0-7 days ...
Background: Patients want community-based palliative care, but there was no continuity of care fo... more Background: Patients want community-based palliative care, but there was no continuity of care for patients at the Sydney Adventist Hospital to receive palliative and end-of-life care within a community setting. A nurse practitioner (NP)-led community palliative care service was developed. Aims: To present the background, design, function, and essential elements of the Sydney Adventist Hospital Community Palliative Care Service (SanCPCS). Methods: Semi-structured and cyclical discussions with key informants alongside internal document reviews. Findings: This is the first description of an NP-led community palliative care service model. The NP role ensured specialist training and extended clinical practice within the community setting. The SanCPCS delivers accessible, continuous, community-based palliative care throughout the patient's palliative and end-of-life journey. Conclusion: NP-led models for palliative and end-of-life care in the outpatient or community setting are a log...
BACKGROUND Injury surveillance and workload monitoring are important aspects of professional spor... more BACKGROUND Injury surveillance and workload monitoring are important aspects of professional sports, including cricket. However, at the community level, there is a dearth of accessible and intelligent surveillance tools. Mobile apps are an accessible tool for monitoring cricket-related injuries at all levels. OBJECTIVE The objective of this paper is to share the novel methods associated with the development of the free TeamDoc app and provide evidence from an evaluation of the user experience and perception of the app regarding its functionality, utility, and design. METHODS TeamDoc mobile app for Android and Apple smartphones was developed using 3 languages: C++, Qt Modeling Language, and JavaScript. For the server-side connectivity, Hypertext Preprocessor (PHP) was used as it is a commonly used cross-platform language. PHP includes components that interact with popular database management systems, allowing for secure interaction with databases on a server level. The app was evalua...
This review aimed to assess the evidence to answer the question whether palliative end-of-life ca... more This review aimed to assess the evidence to answer the question whether palliative end-of-life care needs of patients and caregivers in rural and remote communities differs from those of urban dwellers. Peer-reviewed studies from 1996 to the present dealing with the experience of rural and remote patients and caregivers at the end-of-life compared with that of urban people were extracted for narrative synthesis. The eight studies included showed that palliative needs of rural and remote residents are related to context. Diagnosis and treatment are less well managed in rural areas. Rural differences include: people are more accepting of death and less likely to intervene to delay death; caregivers tend to be younger and include friends as well as family and local support networks are important. Rural and remote end-of-life needs are shaped by reduced access and availability of services which has a negative influence on outcomes. This is counterbalanced by an acceptance of death and local support networks. Well-designed longitudinal studies with samples comprised of rural and urban residents for comparison are required to monitor how end-of-life need might change with the approach of death. Clinicians, health services and policy makers need a better understanding of rural attitudes and of how rural community networks mobilise to support end-of-life care in their rural and remote communities.
Rural-remote communities report higher smoking rates and poorer health outcomes than that of metr... more Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high lev...
Journal of Health Services Research & Policy, 2015
Access is defined as the degree of fit between the user and the service; the better the fit, the ... more Access is defined as the degree of fit between the user and the service; the better the fit, the better the access. Using the theory developed by Penchansky and Thomas, access is optimized by accounting for the different dimensions of access: accessibility; availability; acceptability; affordability; and adequacy in service design, implementation and evaluation. These dimensions are independent yet interconnected and each is important to assess the achievement of access. However, I argue that one dimension is missing – awareness. I propose that awareness is integral to access, that it should become a permanent part of the theory, and be applied whenever using the theory to develop, implement, or evaluate health care services and access more generally.
Many rural towns have no resident access to mental health specialist services and local providers... more Many rural towns have no resident access to mental health specialist services and local providers bear the responsibility for mental health care. The Mental Health Emergency Care – Rural Access Program (MHEC-RAP) is a telepsychiatry program established in western NSW to provide specialist emergency mental health care via a freecall number and available 24/7. This presentation will share how MHEC-RAP has impacted on local ED providers; changed their practice and perspective as they are no longer ‘flying blind’. More information is available at: http://www.aci.health.nsw.gov.au/ie/projects/access-changed-emergency-mental-health
See the presentation at: http://webcast.gigtv.com.au/Mediasite/Play/43d4beb4529a44f1862002ae7d034... more See the presentation at: http://webcast.gigtv.com.au/Mediasite/Play/43d4beb4529a44f1862002ae7d034de31d?catalog=53448b5c-b1b3-416c-a5ab-3a11420bffdc Hospital use of the Mental Health Emergency Care—Rural Access Program Emily Saurman1, David Lyle1, Sue Kirby1, David Perkins1, Russell Roberts2 1Broken Hill University Department of Rural Health, 2Western Local Health District Aims: The aim is to examine the use of Mental Health Emergency Care (MHEC) by hospital emergency departments throughout western NSW. Method: A descriptive analysis of routinely collected data reporting MHEC service activity for hospital contacts from its introduction in 2008 to 2011. Relevance: Access to mental health care, including care for patients in crisis, is limited by geographic isolation and workforce shortages. Without specialist assessment and support, clinical decisions made by generalist staff result in the inappropriate transfer of some patients out of community to a mental health inpatient unit (MHIP...
A Centre of Research Excellence (CRE) in Rural and Remote Primary Healthcare was established in 2... more A Centre of Research Excellence (CRE) in Rural and Remote Primary Healthcare was established in 2012 with the goal of providing evidence to inform policy development to increase equity of access to quality health care and the identification of services that should be available to the diverse communities characterising Australia. This article reports on the key findings from seven CRE service evaluations to better understand what made these primary health care (PHC) models work where they worked, and why. We conducted a narrative synthesis of 15 articles reporting on seven CRE service evaluations of different PHC models published between 2012 and 2015. Three different contexts for PHC reform were evaluated: community, regional and clinic based. Themes identified were factors that enabled changes to PHC delivery, processes that supported services to improve access to PHC and requirements for service adaptation to promote sustainability. In both Indigenous and mainstream community sett...
Mental health presentations are considered to be a difficult aspect of emergency care. Although e... more Mental health presentations are considered to be a difficult aspect of emergency care. Although emergency department (ED) staff is qualified to provide emergency mental health care, for some, such presentations pose a challenge to their training, confidence, and time. Providing access to relevant and responsive specialist mental health care can influence care and management for these patients. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telepsychiatry program that was established to improve access to specialist emergency mental health care across rural and remote western NSW, Australia. This study uses interviews with ED providers to understand their experience of managing emergency mental health patients and their use of MHEC-RAP. The lens of access was applied to assess program impact and inform continuing program development. With MHEC-RAP, these ED providers are no longer 'flying blind'. They are also more confident to manage and care for emerge...
Hospital emergency departments (EDs) are common providers of emergency mental health care. Access... more Hospital emergency departments (EDs) are common providers of emergency mental health care. Access to specialist expertise can affect and improve patient outcomes. The Mental Health Emergency Care-Rural Access Programme (MHEC) provides access to mental health specialists for rural and remote communities in western New South Wales. In 2011, 46 of the 48 EDs used the MHEC programme, which provided 1487 clinical services, an average of 29 services per week. This represented 60% of all MHEC activity. A video assessment was conducted during 571 (38%) of these MHEC contacts. Patients attending a non-base hospital (<50 beds) were twice as likely to receive a video assessment as those attending the larger base hospitals, and video was used more with increasing remoteness. Patients from non-base hospitals were also more likely to be admitted locally after a video assessment. When a decision to admit was made, patients from non-base hospital EDs assessed by video were less likely to be tran...
Choice and preference are fundamental to person-centered care and supporting personal choice at t... more Choice and preference are fundamental to person-centered care and supporting personal choice at the end of life should be a priority. This study analyzed the relationship between a person’s preferred place of death and other individual variables that might influence their actual place of death by examining the activity of 2 specialist community palliative care services in Australia. This was a cross-sectional study of 2353 people who died between 01 August 2016-31 August 2018; 81% died in their preferred place. Sex, type of life-limiting illness, and length of time in care were the only variables significantly related to dying in one’s preferred place. Women were more likely to die in their preferred place than men (84% v 78%) and people with a non-cancer diagnosis were 7% more likely to die in their preferred place than those with cancer, particularly when that place was their private residence (74% v 60%) or Residential Aged Care Facility (98% v 89%). Someone in care for 0-7 days ...
Background: Patients want community-based palliative care, but there was no continuity of care fo... more Background: Patients want community-based palliative care, but there was no continuity of care for patients at the Sydney Adventist Hospital to receive palliative and end-of-life care within a community setting. A nurse practitioner (NP)-led community palliative care service was developed. Aims: To present the background, design, function, and essential elements of the Sydney Adventist Hospital Community Palliative Care Service (SanCPCS). Methods: Semi-structured and cyclical discussions with key informants alongside internal document reviews. Findings: This is the first description of an NP-led community palliative care service model. The NP role ensured specialist training and extended clinical practice within the community setting. The SanCPCS delivers accessible, continuous, community-based palliative care throughout the patient's palliative and end-of-life journey. Conclusion: NP-led models for palliative and end-of-life care in the outpatient or community setting are a log...
BACKGROUND Injury surveillance and workload monitoring are important aspects of professional spor... more BACKGROUND Injury surveillance and workload monitoring are important aspects of professional sports, including cricket. However, at the community level, there is a dearth of accessible and intelligent surveillance tools. Mobile apps are an accessible tool for monitoring cricket-related injuries at all levels. OBJECTIVE The objective of this paper is to share the novel methods associated with the development of the free TeamDoc app and provide evidence from an evaluation of the user experience and perception of the app regarding its functionality, utility, and design. METHODS TeamDoc mobile app for Android and Apple smartphones was developed using 3 languages: C++, Qt Modeling Language, and JavaScript. For the server-side connectivity, Hypertext Preprocessor (PHP) was used as it is a commonly used cross-platform language. PHP includes components that interact with popular database management systems, allowing for secure interaction with databases on a server level. The app was evalua...
This review aimed to assess the evidence to answer the question whether palliative end-of-life ca... more This review aimed to assess the evidence to answer the question whether palliative end-of-life care needs of patients and caregivers in rural and remote communities differs from those of urban dwellers. Peer-reviewed studies from 1996 to the present dealing with the experience of rural and remote patients and caregivers at the end-of-life compared with that of urban people were extracted for narrative synthesis. The eight studies included showed that palliative needs of rural and remote residents are related to context. Diagnosis and treatment are less well managed in rural areas. Rural differences include: people are more accepting of death and less likely to intervene to delay death; caregivers tend to be younger and include friends as well as family and local support networks are important. Rural and remote end-of-life needs are shaped by reduced access and availability of services which has a negative influence on outcomes. This is counterbalanced by an acceptance of death and local support networks. Well-designed longitudinal studies with samples comprised of rural and urban residents for comparison are required to monitor how end-of-life need might change with the approach of death. Clinicians, health services and policy makers need a better understanding of rural attitudes and of how rural community networks mobilise to support end-of-life care in their rural and remote communities.
Rural-remote communities report higher smoking rates and poorer health outcomes than that of metr... more Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high lev...
Journal of Health Services Research & Policy, 2015
Access is defined as the degree of fit between the user and the service; the better the fit, the ... more Access is defined as the degree of fit between the user and the service; the better the fit, the better the access. Using the theory developed by Penchansky and Thomas, access is optimized by accounting for the different dimensions of access: accessibility; availability; acceptability; affordability; and adequacy in service design, implementation and evaluation. These dimensions are independent yet interconnected and each is important to assess the achievement of access. However, I argue that one dimension is missing – awareness. I propose that awareness is integral to access, that it should become a permanent part of the theory, and be applied whenever using the theory to develop, implement, or evaluate health care services and access more generally.
Many rural towns have no resident access to mental health specialist services and local providers... more Many rural towns have no resident access to mental health specialist services and local providers bear the responsibility for mental health care. The Mental Health Emergency Care – Rural Access Program (MHEC-RAP) is a telepsychiatry program established in western NSW to provide specialist emergency mental health care via a freecall number and available 24/7. This presentation will share how MHEC-RAP has impacted on local ED providers; changed their practice and perspective as they are no longer ‘flying blind’. More information is available at: http://www.aci.health.nsw.gov.au/ie/projects/access-changed-emergency-mental-health
See the presentation at: http://webcast.gigtv.com.au/Mediasite/Play/43d4beb4529a44f1862002ae7d034... more See the presentation at: http://webcast.gigtv.com.au/Mediasite/Play/43d4beb4529a44f1862002ae7d034de31d?catalog=53448b5c-b1b3-416c-a5ab-3a11420bffdc Hospital use of the Mental Health Emergency Care—Rural Access Program Emily Saurman1, David Lyle1, Sue Kirby1, David Perkins1, Russell Roberts2 1Broken Hill University Department of Rural Health, 2Western Local Health District Aims: The aim is to examine the use of Mental Health Emergency Care (MHEC) by hospital emergency departments throughout western NSW. Method: A descriptive analysis of routinely collected data reporting MHEC service activity for hospital contacts from its introduction in 2008 to 2011. Relevance: Access to mental health care, including care for patients in crisis, is limited by geographic isolation and workforce shortages. Without specialist assessment and support, clinical decisions made by generalist staff result in the inappropriate transfer of some patients out of community to a mental health inpatient unit (MHIP...
A Centre of Research Excellence (CRE) in Rural and Remote Primary Healthcare was established in 2... more A Centre of Research Excellence (CRE) in Rural and Remote Primary Healthcare was established in 2012 with the goal of providing evidence to inform policy development to increase equity of access to quality health care and the identification of services that should be available to the diverse communities characterising Australia. This article reports on the key findings from seven CRE service evaluations to better understand what made these primary health care (PHC) models work where they worked, and why. We conducted a narrative synthesis of 15 articles reporting on seven CRE service evaluations of different PHC models published between 2012 and 2015. Three different contexts for PHC reform were evaluated: community, regional and clinic based. Themes identified were factors that enabled changes to PHC delivery, processes that supported services to improve access to PHC and requirements for service adaptation to promote sustainability. In both Indigenous and mainstream community sett...
Mental health presentations are considered to be a difficult aspect of emergency care. Although e... more Mental health presentations are considered to be a difficult aspect of emergency care. Although emergency department (ED) staff is qualified to provide emergency mental health care, for some, such presentations pose a challenge to their training, confidence, and time. Providing access to relevant and responsive specialist mental health care can influence care and management for these patients. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telepsychiatry program that was established to improve access to specialist emergency mental health care across rural and remote western NSW, Australia. This study uses interviews with ED providers to understand their experience of managing emergency mental health patients and their use of MHEC-RAP. The lens of access was applied to assess program impact and inform continuing program development. With MHEC-RAP, these ED providers are no longer 'flying blind'. They are also more confident to manage and care for emerge...
Hospital emergency departments (EDs) are common providers of emergency mental health care. Access... more Hospital emergency departments (EDs) are common providers of emergency mental health care. Access to specialist expertise can affect and improve patient outcomes. The Mental Health Emergency Care-Rural Access Programme (MHEC) provides access to mental health specialists for rural and remote communities in western New South Wales. In 2011, 46 of the 48 EDs used the MHEC programme, which provided 1487 clinical services, an average of 29 services per week. This represented 60% of all MHEC activity. A video assessment was conducted during 571 (38%) of these MHEC contacts. Patients attending a non-base hospital (<50 beds) were twice as likely to receive a video assessment as those attending the larger base hospitals, and video was used more with increasing remoteness. Patients from non-base hospitals were also more likely to be admitted locally after a video assessment. When a decision to admit was made, patients from non-base hospital EDs assessed by video were less likely to be tran...
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