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Elizabeth J Comino

Publications and source records attributed to Elizabeth J Comino.

8 recordsLinked to original sources
PubMed2006

Using population health surveys to provide information on access to and use of quality primary health care.

OBJECTIVE: Currently, primary health care (PHC) is under-represented in health statistics due to the lack of a comprehensive PHC data collection. This research explores the utility of population health surveys to address questions relating to access to and use of PHC, using diabetes as an example. METHODS: Drawing on published material relating to diabetes management, we developed a conceptual framework of access to and use of quality PHC. Using this framework we examined three recent population-based health surveys - the 2001 National Health Survey, 2002-03 NSW Health Survey, and AusDiab - to identify relevant information collection. RESULTS: We identified seven domains comprising aspects of quality PHC for people with diabetes. For each domain we proposed associated indicators. In critiquing the three population health surveys in relation to these indicators, we identified strengths and weaknesses of the data collections. CONCLUSION: This approach could inform the development of questions and extension of population health surveys to provide a better understanding of access to and use of quality PHC in Australia. The additional information would complement other data collections with a community-based perspective and contribute to the development of PHC policy.

Health Services Accessibility↗
PubMed2006

The National Health Survey 2001: usefulness to inform a discussion on access to and use of quality primary health care using type 2 diabetes mellitus as an example.

INTRODUCTION: This paper explores the usefulness of the 2001 Australian Bureau of Statistics National Health Survey (2001 NHS) for examining access to and use of quality primary health care (PHC) in Australia, using diabetes as an example. METHODS: Potential indicators of access to and use of quality diabetes care were investigated (diagnosis, preventive pharmacotherapy, complication screening, multidisciplinary care and hospitalisation), and their association with various factors including socioeconomic and diabetes-related health status was assessed. RESULTS: Older Australian-born females were more likely to receive preventive pharmacotherapy, whereas complication screening was associated with duration of disease. Multidisciplinary care was associated with recent hospitalisation and not health need assessed by presence of comorbidity. CONCLUSIONS: This novel use of the 2001 NHS provided information on patterns of access to and use of diabetes-related PHC that were consistent with previous research. It suggests a new role for survey data in monitoring access to and use of PHC over time and complementing other population health data collections in this area.

Aged↗
PubMed2005

General practitioner views on barriers and facilitators to implementation of the Asthma 3+ Visit Plan.

AIM: The Asthma 3+ Visit Plan is an initiative to promote organised asthma care in general practice. This study aimed to identify factors associated with uptake of the plan by general practitioners, and their views on barriers and facilitators to implementation of the plan. DESIGN: Postal survey sent to a random sample of GPs. PARTICIPANTS AND SETTING: 315 GPs in five Divisions of General Practice in metropolitan Sydney, surveyed sequentially between 1 October 2002 and 31 May 2003. OUTCOME MEASURES: Awareness and use of the Asthma 3+ Visit Plan; GP and practice factors associated with use of the plan; and GP views on barriers and facilitators to implementing the plan. RESULTS: The response rate was 55.7%, and 72.1% of participants were male; participants' mean age was 50.5 years. Most GPs (91.2%) were aware of the plan and and 44.9% had used it. GP and practice factors associated with use of the plan were use of the six-step Australian Asthma Management Plan, confidence in aspects of asthma care, practice accreditation, sign-up for asthma incentives, and computerisation. Major barriers to implementing the plan were workload/paperwork and administrative complexities. Patient factors that influenced completion of the plan were their concept of the severity of their asthma, compliance with follow-up, and patient attitudes towards asthma care. CONCLUSION: The perceived workload and administrative complexity of the asthma incentives are barriers to uptake. Factors relating to the illness rather than social factors are seen as the most important influences on completion of the plan by patients.

Aged↗
PubMed2005

Changes in community nursing in Australia: 1995-2000.

AIM: This paper reports a study whose aim was to examine the congruence between community nurses' perceptions and the realities of changes in their work. BACKGROUND: There have been increasing challenges to the delivery of community nursing services in Australia over the past decade. Acute care sector changes and the recent focus on health promotion, prevention, early identification and intervention adds pressure and creates tensions for community nurses, which are well-documented in the literature. There is, however, a lack of empirical evidence of actual changes in community nurses' workloads and the focus of their work. Validation of nurses' perceptions would enable them to have a stronger voice in the future development of community health care. METHODS: Four sources of data were used: community health client administrative data 1995-2000; occasions of service data 1995-2000; staffing numbers 1998-2001; and interviews with 14 community nurses in late 2001. RESULTS: Documentary evidence shows that there has been a large increase in the number of adult clients, and all clients are increasingly receiving a shorter, more intensive, clinically focussed service and are then discharged from care, rather than receiving a lower intensity service over a longer period of time. Staffing numbers have not increased to match this higher acuity and intensity. These changes were echoed by the nurses, who reported that expanded acute care roles were impacting on their workload and resulting in a loss of holistic primary health care focus. There has been a lack of leadership and proactive planning by community nurses in response to these changes. CONCLUSION: Community health care in Australia is shifting from primary to short-term clinical care. Greater opportunities for community nurses to engage proactively in defining and promoting their role in the health care system are needed in order to ensure an appropriate balance of acute clinical and holistic primary health care in the community.

Adolescent↗
PubMed2005

GPs' views of absolute cardiovascular risk and its role in primary prevention.

BACKGROUND: Clinical guidelines recommend using absolute risk to inform clinical decisions in cardiovascular disease prevention. Absolute risk assessment tools have been disseminated to general practitioners, however current use and knowledge of this is approach among GPs is unknown. METHOD: Transcribed audiotapes of focus groups with 36 GPs, analysed for key themes. RESULTS: The GPs said absolute cardiovascular risk assessment tools were used largely as an aid to patient education rather than an influence on management, for which the concept was poorly understood. Barriers to their use included poor computer software, inconsistency with regulations over the use of lipid lowering agents, and fears patients would not understand the concepts. DISCUSSION: To encourage the implementation of absolute risk tools in cardiovascular disease prevention, and GP education. Attitudes and systematic barriers to their use by GPs need to be addressed.

Adult↗
PubMed2003

Relationship between mental health disorders and unemployment status in Australian adults.

OBJECTIVES: To compare the prevalence of anxiety and affective disorders among employed and unemployed patients and to compare the type of treatment received between the two groups for these disorders. METHOD: A secondary analysis of the 1997 National Survey of Mental Health and Wellbeing of Adults cross-sectional study was undertaken. RESULTS: Unemployed adults were more likely to have symptoms of anxiety (OR = 3.09, 95% CI = 2.80-3.41) or an affective disorder (OR = 2.11, 95% CI = 1.95-2.27) or anxiety and/or affective disorders (OR = 2.53, 95% CI = 2.37-2.69). Unemployed participants with symptoms were less likely to have seen a general practitioner for treatment but when they did they received similar care to employed participants. CONCLUSIONS: These results confirm studies reported elsewhere that the prevalence of symptoms of anxiety and/or affective disorders is higher for unemployed people. The data provide further evidence that people with an anxiety and/or affective disorder who are unemployed are not seeking medical treatment. However, unlike previous research undertaken by our group, these results indicate that symptomatic adults who seek help receive comparable treatment in general practice irrespective of their employment status.

Adult↗