Health Services Research :: Northern Rivers Department of Rural Health

Northern Rivers Department of Rural Health - Australia

Health Services Research

Evaluation of the Integrated Care Trial for Drug Dependent Women and their Families (WRAP)
Passey M, Sheldrake

This trial is piloting a number of innovative approaches to meeting the needs of drug dependent women, including, improving integration of services. The study addresses two main research questions:

Have service models adopted led to better integration of care/service delivery for drug-dependant women in this rural area?
Has the integration of care affected quality of life, health and social circumstances of drug dependant women?
The trial is being funded by the Drugs Program Bureau and arose from the New South Wales Drug Summit.

Contact: Michelle Sheldrake, Evaluation Researcher on 61 2 6620 7564 or email michellesh@nrahs.nsw.gov.au.

Evaluation of the Lismore Magistrates Early Referral Into Treatment Pilot Program (MERIT)

Passey M.

The Lismore Magistrates Early Referral into Treatment (MERIT) Pilot Program, a pre-plea early court intervention, was planned by the New South Wales Government in response to recommendations from the Drug Summit held at the New South Wales Parliament House in May 1999. The target population was adult defendants at Lismore and surrounding Local Courts, who had demonstrable drug problem, were eligible for bail, and who were motivated to engage in treatment for their illicit drug problems.

The evaluation incorporated: a review of legal issues; a cost-benefit analysis; statistical monitoring of the program; an implementation review; evaluation of social functioning and health outcomes and of recidivism. A copy of the final report is available on request. Further analyses are in progress.

Contact: Dr Megan Passey, Director, Clinical Health Service Research on 61 2 6620 7516 or email MPASSEY@nrahs.nsw.gov.au.

Priority Health Care Program Evaluation

Passey M, Holden L

The Priority Health Care Program, an initiative of New South Wales Health targets the health care needs of patients with chronic and complex health problems. It aims to:

Improve the quality of life of people with cardiovascular, cancer and respiratory diseases;
Improve the quality of life of their carers and families; and
Prevent crisis situations and unplanned and unnecessary hospital admissions.
The Northern Rivers program is being evaluated to determine the effect of the program on utilisation of services, patient carer quality of life and satisfaction with care. Impact on services and service providers' perceptions of the program and also being assessed.

Contact: Dr Megan Passey, Director, Clinical Health Service Research on 61 2 6620 7516 or email MPASSEY@nrahs.nsw.gov.au.

Cardiac Rehabilitation Program - Support and Research

Passey M, Clark J

A database to support management of the Northern Rivers Area Health Service (NRAHS) Cardiac Rehabilitation Program and follow-up of clients has been developed. It provides numberous reports, including some focussing on process indicators and health outcomes for the clients. It also allows collection of data to support the evaluation.

The evaluation assesses:

Provision of services and evidence-based practice;
Utilisation of Phase 2 programs;
Health outcomes (risk factor profiles, re-admissions and quality of life); and
compares theses between the following groups:

A historical cohort - patients with ischaemic heart disease (IHD) admitted prior to development of the area-wide program;
Phase 2 cohort - patients admitted with IHD who enroll in the Phase 2 program; and
Contemporary cohort - patients admitted with IHD since the program started, but who don't enroll in the Phase 2 program.

Contact: Dr Megan Passey, Director, Clinical Health Service Research on 61 2 6620 7516 or email MPASSEY@nrahs.nsw.gov.au.

Injury Prevention and Control Australia - Injury Prevention in Older People

McClure R, Nixon J, Pitt R, Sheehan M, Stevenson M, Williamson A, Parker T, Beard J, Newman B, Hunter E, McDermott R, Murdoch B, Oldenburg B

Injury Prevention and Control (Australia) was one of the two National Health and Medical Research Council (NHMRC) funded partnerships in injury involving researchers from across Australia. The program has a budget of over $10 million focusing on five (5) injury domains: children injury, risk taking behaviours, occupational injury, falls and Indigenous injury. The NRUDRH is co-leader of the falls prevention stream and is currenly examining the long-term impact, sustainability and cost-benefit analysis of Stay of Your Feet (SOYF), a large community based falls prevention program.

SOYF was a multi-strategic community-based intervention to reduce falls in older people undertaken in the North Coast region of New South Wales between 1992 and 1996 by the North Coast Public Health Unit. SOYF was the focus of a comprehensive evaluation including the follow-up of a large cohort of older people within the intervention region and comparison with a cohort from a similar region in Queensland that was not the subject of a falls prevention program. A number of cross-sectional telephone surveys were also undertaken examining factors such as awareness and behaviour change. The original evaluation found significant changes in awareness and self-reported behaviour within 18 months of the program commencing. This was maintained throughout the life of the program and was followed by a reduction in self-reported falls, and a significant 20% reduction in falls related hospital admissions across the region.

Curent research is examining the long-term health and economic impact of SOYF. Time series analysis demonstrates a sustained reduction in falls related hospital admission rates in the intervention region compared to the state of New South Wales as a whole, continuing beyond the completion of the program. This pattern is not mirrored in non-intervention regions. A large telephone survey of residents in the intervention and a control region suggests this may result from North Coast residents remaining more aware of the risk of falling and undertaking related behavioural changes such as increased rates of moderate physical activity. Health economic analysis suggests the direct and indirect benefits of this program significantly outweigh its costs.

Contact: Professor John Beard, Head of Department on 61 2 6620 7231 or email jbeard@med.usyd.edu.au.

Investigation of General Practice/Hospital Integration Issues in Rural and Remote Australia

Webber K

The NRUDRH leads an eleven-department research team spanning each State and the Northern Territory of Australia.

The aim of the project is to identify 'good practice' in transitions of care between the primary health care and hospital sectors, looking at issues such as continuity of care, health outcomes, patient experience and satisfaction, adherence to existing clinical guidelines, communication between all players, patient transport, and financing issues. It should then be possible to share information about models that are working well, to help improve transitions of care in areas that are currently having difficulty.

The project team, made up of rural health researchers from across Australia, will work with local communities and service providers to undertake detailed case studies in eleven rural communities. These case studies are the most important part of the project, and will be complemented by a literature review and by national and state/territory level consultations.

The case studies will focus on transitions of care from the patient's point of view. They will follow the patient's 'journey' from primary care to hospital and back. A major source of information will be patients carers, as they are in an ideal position to describe what works well and what needs to be improved. Health care providers such as general practioners, nurses, allied health professionals, Aboriginal health workers, and district and base hospital staff in rural and remote areas will be the other major source of information and will be interviewed about how they see the systems around them working, and what they identify as options for improvement.

Contact: Dr Kim Webber, Director of Rural Programs on 61 3 9810 6109 or email kimw@med.usyd.edu.au