Browsing by Author "Larkins S."
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Item Cardiovascular disease risk in young Indigenous Australians: a snapshot of current preventive health care.(2016-11-08) Crinall B.; Boyle J.; Gibson-Helm M.; Esler D.; Larkins S.; Bailie R.Objective: To examine preventive health attendance and recording of type 2 diabetes and cardiovascular disease risk factors and their management in young Aboriginal peoples and Torres Strait Islanders (Indigenous Australians) at primary health care centres (PHCs). Method(s): This descriptive cross-sectional study audited medical records of 1,986 Indigenous people aged 15-34 years attending 93 Australian PHCs. Measurements included blood pressure (BP), blood glucose level (BGL), smoking status, body mass index (BMI) and lipid profile. Result(s): Last attendance was most commonly for acute care (46%); 12% attended for preventive assessment. BP was recorded in 85% (1,686/1,986), BGL 63% (1,244/1,986), smoking status 52% (1,033/1,986), BMI 37% (743/1,986) and lipids 31% (625/1,986). Of those with a recorded assessment, elevated BGL (39%, 479/1,244), smoking (63%, 649/1,033), overweight/obesity (51%, 381/743) and dyslipidaemia (73%, 458/625) were common. Follow-up of abnormal results was documented for elevated BP 28% (34/120), elevated BGL 17% (79/479), smoking 65% (421/649), overweight/obesity 11% (40/381) and abnormal lipids 16% (75/458). Conclusion(s): These findings highlight the importance of raising awareness and assessment of chronic disease risk factors in young Indigenous people and implementing preventive health care strategies. Implications: Strengthening the capacity of PHCs to provide preventive health care may contribute to reducing the chronic disease burden experienced by young Indigenous people. Copyright © 2016 Public Health Association of AustraliaItem Duration of participation in continuous quality improvement: a key factor explaining improved delivery of type 2 diabetes services.(2016-09-29) Matthews V.; Schierhout G.; McBroom J.; Connors C.; Kennedy C.; Kwedza R.; Larkins S.; Moore E.; Thompson S.; Scrimgeour D.; Bailie R.Background: It is generally recognised that continuous quality improvement (CQI) programs support development of high quality primary health care systems. However, there is limited evidence demonstrating their system-wide effectiveness. We examined variation in quality of Type 2 diabetes service delivery in over 100 Aboriginal and Torres Strait Islander primary health care centres participating in a wide-scale CQI project over the past decade, and determined the influence of health centre and patient level factors on quality of care, with specific attention to health centre duration of participation in a CQI program. Method(s): We analysed over 10,000 clinical audit records to assess quality of Type 2 diabetes care of patients in 132 Aboriginal and Torres Strait Islander community health centres in five states/territories participating in the ABCD project for varying periods between 2005 and 2012. Process indicators of quality of care for each patient were calculated by determining the proportion of recommended guideline scheduled services that were documented as delivered. Multilevel regression models were used to quantify the amount of variation in Type 2 diabetes service delivery attributable to health centre or patient level factors and to identify those factors associated with greater adherence to best practice guidelines. Result(s): Health centre factors that were independently associated with adherence to best practice guidelines included longer participation in the CQI program, remoteness of health centres, and regularity of client attendance. Significantly associated patient level variables included greater age, and number of co-morbidities and disease complications. Health centre factors explained 37% of the differences in level of service delivery between jurisdictions with patient factors explaining only a further 1%. Conclusion(s): At the health centre level, Type 2 diabetes service delivery could be improved through long term commitment to CQI, encouraging regular attendance (for example, through patient reminder systems) and improved recording and coordination of patient care in the complex service provider environments that are characteristic of non-remote areas. Copyright © 2014 Matthews et al.Item The patient co-payment and opportunity costs of accessing healthcare for Indigenous Australians with cancer: a whole of population data linkage study.(2019-08-02) Callander E.; Bates N.; Lindsay D.; Larkins S.; Preston R.; Topp S.M.; Cunningham J.; Garvey G.Aim: To quantify the direct out-of-pocket patient co-payments and time opportunity costs (length of hospital stay) incurred by Indigenous and non-Indigenous persons diagnosed with cancer during the first year postdiagnosis. Method(s): CancerCostMod was used, which is a model of cancer costs based upon a whole-of-population data linkage. The base population was a census of all persons diagnosed with cancer in Queensland, Australia between 1 July 2011 and 30 June 2012 (n = 25,553). Individual records were linked to corresponding Queensland Health Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme records between 1 July 2011 and 30 June 2015. Queensland data were weighted to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). Result(s): After adjusting for age, sex, rurality, area-based deprivation, and cancer group, Indigenous Australians accrued significantly less in postdiagnosis patient co-payments at 0-6 months (61% less) and 7-12 months (63% less). Indigenous Australians also had significantly fewer postdiagnosis hospitalizations at 0-6 months (21% fewer) and 7-12 months (27% fewer). Conclusion(s): There is growing concern regarding the financial burden of cancer to the patient. The time spent away from family and their community may also have an important time opportunity cost, which may affect a person's decision to undertake or continue treatment. This is the first study in Australia to identify the financial cost of co-payments for Indigenous people with cancer, as well as the number and length of hospitalizations as drivers of time opportunity costs.Copyright © 2019 John Wiley & Sons Australia, Ltd