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Health services administration

Health services administration Research 6 July 2015 Free

Facilitators and barriers to implementation of a pragmatic clinical trial in Aboriginal health services

Patients and providers reflect on a clinical trial in an Indigenous health context

Hueming Liu BA, MB BS, MIPH · Tracey-Lea Laba BSc, BPharm(Hons), PhD · Luciana Massi BBusComm, MIPH · Stephen Jan BEc, MEc, PhD · Tim Usherwood MD, MB BS, FRACGP · Anushka Patel MB BS, PhD, FRACP · Noel E Hayman MB BS, MPH, FRACGP · Alan Cass MB BS, FRACP PhD · Anne-Marie Eades BSc(Nursing), MN · Chris Lawrence PhD, MAppEpidemiol · David P Peiris MIPH, PhD, FRACGP

14 00581
Cardiovascular diseases Research 6 July 2015 Free

Coordinated care versus standard care in hospital admissions of people with chronic illness: a randomised controlled trial

A nurse-led coordinated care intervention was equivalent to standard care for patients with chronic illness

Natalie A Plant MHSc, BSc(Hons) · Patrick J Kelly BMath(Hons), PhD · Stephen R Leeder MD, FRACP, PhD · Mario D’Souza PhD, MSc · Kylie-Ann Mallitt BSc(Hons), MSc · Tim Usherwood MD, FRACGP, FRCP · Stephen Jan PhD, MEc, BEc · Steven C Boyages MB BS, PhD, FRACP · Beverley M Essue MPH, PhD · Justin McNab PhD, MPhil, BSc · James A Gillespie PhD, BA(Hons)

14 01049
Health services administration Supplement 1 June 2015 Open Access

Talking About The Smokes: a large-scale, community-based participatory research project

Objective: To describe the Talking About The Smokes (TATS) project according to the World Health Organization guiding principles for conducting community-based participatory research (PR) involving indigenous peoples, to assist others planning large-scale PR projects. Design, setting and participants: The TATS project was initiated in Australia in 2010 as part of the International Tobacco Control Policy Evaluation Project, and surveyed a representative sample of 2522 Aboriginal and Torres Strait Islander adults to assess the impact of tobacco control policies. The PR process of the TATS project, which aimed to build partnerships to create equitable conditions for knowledge production, was mapped and summarised onto a framework adapted from the WHO principles. Main outcome measures: Processes describing consultation and approval, partnerships and research agreements, communication, funding, ethics and consent, data and benefits of the research. Results: The TATS project involved baseline and follow-up surveys conducted in 34 Aboriginal community-controlled health services and one Torres Strait community. Consistent with the WHO PR principles, the TATS project built on community priorities and strengths through strategic partnerships from project inception, and demonstrated the value of research agreements and trusting relationships to foster shared decision making, capacity building and a commitment to Indigenous data ownership. Conclusions: Community-based PR methodology, by definition, needs adaptation to local settings and priorities. The TATS project demonstrates that large-scale research can be participatory, with strong Indigenous community engagement and benefits.

Sophia Couzos FAFPHM, FACRRM, FRACGP · Anna K Nicholson GDipPH, BPhty(Hons) · Jennifer M Hunt MPH, FAFPHM, PhD · Maureen E Davey MB BS, FAFPHM · Josephine K May · Pele T Bennet BHSc · Darren W Westphal MPH · David P Thomas MB BS, PhD, FAFPHM

Health services administration Supplement 1 June 2015 Open Access

Predictors of wanting to quit in a national sample of Aboriginal and Torres Strait Islander smokers

Objective: To describe factors that predict wanting to quit smoking in a national sample of Aboriginal and Torres Strait Islander people. Design, setting and participants: The Talking About The Smokes (TATS) project used a quota sampling design to recruit participants from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. Baseline survey data were collected from 1643 current smokers between April 2012 and October 2013. Main outcome measure: Wanting to quit smoking. Results: More than two-thirds of smokers (70%) said they want to quit. Many factors were associated with wanting to quit, including past quitting activity. Interest in quitting was lower among men and smokers from economically disadvantaged areas, but there was no difference by age, remoteness or other measures of economic disadvantage. Attitudes and beliefs negatively associated with wanting to quit included enjoying smoking and believing quitting to be very difficult, and those positively associated included regretting ever starting to smoke, perceiving that local Aboriginal and Torres Strait Islander community leaders disapprove of smoking, believing non-smokers set a good example to children, worrying about future smoking-related health effects and believing quitting to be beneficial. Reporting support from family and friends was predictive of wanting to quit, but factors related to smoking in the social network were not. Associations with health and wellbeing were mixed. While most tobacco control policy exposure variables were positively associated with wanting to quit, two — receiving advice to quit from a health professional, and recall of targeted anti-tobacco advertising — appeared to have an effect that extended beyond influencing relevant attitudes and beliefs. Conclusion: Interest in quitting among Aboriginal and Torres Strait Islander smokers appears to be influenced by a broad range of factors, highlighting the importance of taking a comprehensive approach to tobacco control. Advice from health professionals and targeted advertising appear to be important intervention strategies.

Anna K Nicholson GDipPH, BPhty(Hons) · Ron Borland PhD · Maureen E Davey MB BS, FAFPHM · Matthew Stevens PhD, BSc(Hons) · David P Thomas MB BS, PhD, FAFPHM

Health services administration Perspectives 1 June 2015 Free

Response - The Royal Australasian College of Physicians: a 21st century college

This article is a response by the Royal Australasian College of Physicians (RACP) to an article in this issue of the Journal: Komesaroff PA, Kerridge IA, Isaacs D, Brooks PM. The scourge of managerialism and the Royal Australasian College of Physicians. Med J Aust 2015; 202: 519-521. The RACP was made aware only recently of the article, which was submitted to the Journal some time ago. Due to this unique circumstance, a rapid and simultaneous response to the article is provided in this issue of the MJA. Publication of this response should not be taken as creating a precedent at the MJA. Editorial Advisory Committee: Charles Guest MPH, PhD, FAFPHM Bruce Waxman FRACS, FRCS, MRACMA Jeffrey Zajac PhD, FRACP Charles Guest and Jeffrey Zajac declare that they are members of the RACP. A statement from the Royal Australasian College of Physicians One of the great lessons of the 20th century was the danger of ideologies that attempted to squeeze the complexity of the world into their frameworks. The authors of “The scourge of managerialism and the Royal Australasian College of Physicians”1 have fallen into this trap by attempting to portray as a “corporatisation” framework a series of structural changes being undertaken to make the Royal Australasian College of Physicians (RACP) more focused on the needs of its members. Komesaroff and colleagues argue that the College is victim to a takeover from a faceless class of managers and technocrats. Proposals for a more streamlined Board and a College Council that bring our disparate specialties together are characterised as markers on the road to a neoliberal dystopia. The fundamental flaw in the article is that it provides little attention to facts that do not fit in with its argument. In portraying the College's role as “providing a forum for physicians to communicate with each other”, it largely overlooks the objectives of the College that demand it be and remain an outward-looking institution committed to maintaining the highest professional standards, delivering robust training to its 6000 trainees and publicly advocating for the health of the public. How does the authors' analysis that the College has been captured by faceless managers account for the Australian Medical Council's recent decision to award the College 6 years' accreditation as the sole trainee of specialist physicians in Australia and New Zealand? Why would these supposed disciples of Thatcher and Reagan be allowing such a progressive advocacy agenda? At our recent Congress, the RACP adopted a progressive and controversial policy on asylum seekers; embraced the complexity of medicinal marijuana and end-of-life care; and grappled with confronting issues like gender identity and Indigenous health. The Board recently voted to divest investments identified as being directly and materially involved in fossil fuel activities. And how does an analysis about managerial control account for the many Fellow committees that directly shape the College, or the current proposal to create an influential and representative College Council that will provide a forum to bring together our disparate specialties to share insights, collaborate and drive our broader agenda? The article's portrayal of reforms championed by the Board needs to be challenged. While a minority resisted the constitutional changes proposed in 2013, a two-thirds majority supported the proposals. These facts are paid little attention because they get in the way of what appears to be an ideological critique of the College, its Board and its dedicated and professional staff. The reality is that this College, far from embracing “corporatism”, is following the lead of member-based non-for-profit associations around the world and rethinking the way it is run — focusing on the needs of our members, especially those entering the profession, harnessing technology, reviewing our committees and services to ensure they remain relevant. We cannot work to a collective vision if we do not empower a democratically elected Board to set a strategy and implement it. Change upsets people, but the risk of not changing is that an organisation will become irrelevant because of pressing external challenges. If the College were to be accused of pursuing any ideological theory or agenda it would be that of “empowerment”. Empowerment is how we engage our more than 22 000 members to train the next generation of physicians, nurture their careers and make a difference as leaders in our communities. That may not be as dramatic a story as a sinister corporate takeover of the College, but it's one that the College believes in for the benefit of our current and future Fellows and trainees, and for the communities they serve.

Royal Australasian College of Physicians

15 00609
Health services administration Supplement 1 June 2015 Open Access

Personal attitudes towards smoking in a national sample of Aboriginal and Torres Strait Islander smokers and recent quitters

Objectives: To describe attitudes towards smoking in a national sample of Aboriginal and Torres Strait Islander smokers and recent quitters and assess how they are associated with quitting, and to compare these attitudes with those of smokers in the general Australian population. Design, setting and participants: The Talking About The Smokes project used a quota sampling design to recruit participants from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. We surveyed 1392 daily smokers, 251 non-daily smokers and 78 recent quitters from April 2012 to October 2013. Main outcome measures: Personal attitudes towards smoking and quitting, wanting to quit, and attempting to quit in the past year. Results: Aboriginal and Torres Strait Islander daily smokers were less likely than daily smokers in the general Australian population to report enjoying smoking (65% v 81%) and more likely to disagree that smoking is an important part of their life (49% v 38%); other attitudes were similar between the two groups. In the Aboriginal and Torres Strait Islander sample, non-daily smokers generally held less positive attitudes towards smoking compared with daily smokers, and ex-smokers who had quit within the past year reported positive views about quitting. Among the daily smokers, 78% reported regretting starting to smoke and 81% reported spending too much money on cigarettes, both of which were positively associated with wanting and attempting to quit; 32% perceived smoking to be an important part of their life, which was negatively associated with both quit outcomes; and 83% agreed that smoking calms them down when stressed, which was not associated with the quitting outcomes. Conclusions: Aboriginal and Torres Strait Islander smokers were less likely than those in the general population to report positive reasons to smoke and held similar views about the negative aspects, suggesting that factors other than personal attitudes may be responsible for the high continuing smoking rate in this population.

Anna K Nicholson GDipPH, BPhty(Hons) · Ron Borland PhD · Pele T Bennet BHSc · Anke E van der Sterren MPH, MA, BA · Matthew Stevens PhD, BSc(Hons) · David P Thomas MB BS, PhD, FAFPHM

Social determinants of health Supplement 1 June 2015 Open Access

Social acceptability and desirability of smoking in a national sample of Aboriginal and Torres Strait Islander people

Objectives: To describe social normative beliefs about smoking in a national sample of Aboriginal and Torres Strait Islander people, and to assess the relationship of these beliefs with quitting. Design, setting and participants: The Talking About The Smokes project used a quota sampling design to recruit participants from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. We surveyed 1392 daily smokers, 251 non-daily smokers, 311 ex-smokers and 568 never-smokers from April 2012 to October 2013. Main outcome measures: Eight normative beliefs about smoking; wanting and attempting to quit. Results: Compared with daily smokers in the general Australian population, Aboriginal and Torres Strait Islander daily smokers were less likely to report that mainstream society disapproves of smoking (78.5% v 62%). Among Aboriginal and Torres Strait Islander daily smokers, 40% agreed that Aboriginal and Torres Strait Islander community leaders where they live disapprove of smoking, 70% said there are increasingly fewer places they feel comfortable smoking, and most (90%) believed non-smokers set a good example to children. Support for the government to do more to tackle the harm caused by smoking was much higher than in the general Australian population (80% v 47.2%). These five normative beliefs were all associated with wanting to quit. Non-smokers reported low levels of pressure to take up smoking. Conclusion: Tobacco control strategies that involve the leadership and participation of local Aboriginal and Torres Strait Islander community leaders, particularly strategies that emphasise protection of others, may be an important means of reinforcing beliefs that smoking is socially unacceptable, thus boosting motivation to quit.

Anna K Nicholson GDipPH, BPhty(Hons) · Ron Borland PhD · Anke E van der Sterren MPH, MA, BA · Pele T Bennet BHSc · Matthew Stevens PhD, BSc(Hons) · David P Thomas MB BS, PhD, FAFPHM

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