Strengthening primary health care : Building the capacity of rural communities to access health funding
- Authors: McDonald, John , Brown, Leann , Murphy, Angela
- Date: 2002
- Type: Text , Journal article
- Relation: Australian journal of rural health Vol. 10, no. 3 (2002), p. 173-177
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- Description: Present health funding models can place onerous pressures on rural health services. Staff may lack the time, resources, access to data, and the expertise needed to complete complex and lengthy funding submissions. This present study describes an innovative capacity-building approach to working with Victorian rural communities seeking to access health care funding through the Regional Health Services Program. This approach used several strategies: engaging stakeholders in targeted rural communities, developing an information kit and running a workshop on preparing submissions to the Regional Health Services Program, facilitating community consultations, and providing ongoing support with submissions. Six rural communities were supported in this way. Four have been funded to date, with a combined annual recurrent budget for new primary health care services of over $2.5 million. Each community has developed a service delivery model that meets the particular needs of their local area. This capacity-building approach is both effective and replicable to other health funding opportunities. The definitive version of this article is available at www3.interscience.wiley.com
- Description: 2003000079
An exploration of national calls to Lifeline Australia: social support or urgent suicide intervention?
- Authors: Watson, Robert , McDonald, John , Pearce, Dora
- Date: 2006
- Type: Text , Journal article
- Relation: British Journal of Guidance & Counselling Vol. 34, no. 4 (Nov 2006), p. 471-482
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- Description: Lifeline Australia Inc. provides a free 24-hour telephone counselling and referral service to all Australians. The trained telephone counsellors of the service record information on many of their calls in Lifeline's Client Service Management Information System (CSMIS). This paper presents a descriptive summary of a national CSMIS data set, which was compiled during a 3-month period in 2003. The CSMIS data provided a clear national profile of the callers to the service. The results of this study support the hypothesis that callers are generally seeking social support from the service. The discussion explores the implications of this finding for Lifeline and other generalist counselling and referral services and their capacity to offer suicide intervention to the community.
- Description: C1
- Description: 2003001998
Clinical health practice in a remote setting : The impact of local community relationships
- Authors: Murphy, Angela , McDonald, John
- Date: 2004
- Type: Text , Conference paper
- Relation: Paper presented at the 2004 Annual Conference of TASA, Beechworth, Australia : 7th - 8th December, 2004
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- Description: This paper reports on an empirical research about the way in which local community relationships influence clinical health decision-making in a health service in a remote town in Victoria, Australia. Evidence-based practice is now widely promoted as the most effective and efficient basis for making clinical health decisions. However, little is known about its use in rural and remote settings. To date, researchers have assumed that the uptake of evidence-base practice among health care practitioners is primarily a function of the levels of training, resources and support provided to them. Drawing upon qualitative data from individual and group interviews with health care practitioners and managers, this research revealed that strong community relationships profoundly influence clinical decision-making. Community influence was evidenced through the blurring of health practitioner professional and private roles, the extent of community ownership and control of the health services, and the politicisation of health service delivery. The results show how local community relationships can influence clinical practice in a remote town. This advances our understanding of the determinants of the uptake of evidence-based practice. Evidence-based practice may be usefully viewed as a site of political contestation. Introduction
- Description: E1
- Description: 2003001298
The accessibility/remoteness index of Australia (ARIA) and lifeline Australia's calls
- Authors: Watson, Robert , McDonald, John , Pearce, Dora
- Date: 2005
- Type: Text , Conference paper
- Relation: Paper presented at the 8th National Rural Health Conference, Alice Springs : 10th - 13th March, 2005
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- Description: Nationally there are more than 50 member centres and sub-centres of Lifeline Australia’s telephone counselling and referral service, providing an equitable, free, anonymous, and highly accessible primary health resource. The accessibility of this service may mean that it has a particularly important role to play in contributing to the health and well-being of rural and remote Australians. The trained volunteer counsellors of the service receive more than 400 000 calls annually. Information on many of these calls is recorded by telephone counsellors in Lifeline’s Client Service Management Information System (CSMIS). The purpose of this study was to establish if a relationship between the Accessibility/Remoteness Index of Australia (ARIA) and calls to Lifeline Australia could be found. Population standardised areal call rates to Lifeline Ballarat were compiled using Telstra exchange service area to test the hypothesis that a positive relationship between the call rates to the service and the ARIA would be found. 90 128 CSMIS cases from 2003 were examined to explore if any linear relationship between caller characteristics and a centre’s ARIA score were apparent. A number of significant associations with the ARIA scores and CSMIS call variables were observed. However, the hypothesis that a positive relationship between call rates to the service and the ARIA would be found was not supported. An important implication of this exploratory study is that Lifeline’s telephone counselling and referral service may need to be promoted more widely to rural clients and health care providers.
- Description: E1
- Description: 2003001236
Simulation training for rural health practitioners : A transformative approach
- Authors: McDonald, John
- Date: 2001
- Type: Text , Conference paper
- Relation: Paper presented at 6th National Rural Health Conference, Canberra : 4th-7th March 2001
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- Description: 2003004322
The emergence of water markets in Australia and implications for rural social work
- Authors: Mason, Robyn , McDonald, John , Ollerenshaw, Alison
- Date: 2006
- Type: Text , Journal article
- Relation: Rural Social Work and Community Practice Vol. 11, no. (2006), p. 6- 17
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- Description: The aim of this paper is to consider the implications for rural social work practice of the widespread and severe drought coupled with the emergence of water markets in Australia. The National Water Initiative was signed at the June 2004 Council of Australian Governments meeting with the aim of producing a nationally-compatible, market, regulatory and planning-based system of managing water resources to optimise economic, social and environmental outcomes. The National Water Commission and the National Competition Council have since assessed progress on the implementation of the initiative: none of their reports gives adequate consideration to the impact of water reform on rural communities. In this paper, we draw upon previous research and written submissions made to the Commission and the Council to examine the social and political consequences of the drought and the emergence of water markets. We discuss the implications for rural practice, and conclude by proposing seven recommendations to assert the role of rural social workers as change agents. This role could encompass community education and advocacy, piloting schemes such as community water banks, reinstating community development in social work curriculum, and facilitating collaborative rural partnerships.
- Description: C1
- Description: 2003001997
A review of mathematical models used to determine sperm donor limits for infertility treatment
- Authors: Sawyer, Neroli , McDonald, John
- Date: 2008
- Type: Text , Journal article
- Relation: Fertility and Sterility Vol. 90, no. 2 (2008), p. 265-271
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- Description: Objective: To review mathematical models used to determine sperm donor limits for infertility treatment and to consider the need to develop a new, internationally recognized and applicable model for calculating limits. Design: Literature review. Setting: Models for determining sperm donor limits were identified through bibliographic databases. Patient(s): Published models. Intervention(s): Variables used in the models were defined, evaluated, and assessed for relevancy and applicability. Main Outcome Measure(s): Relevance and applicability of model variables used to predict the number of consanguineous matings, probability of unwitting sibling mating and contribution to F (coefficient of inbreeding). Result(s): Models found to be outdated and inadequate for the present-day. Conclusion(s): Many countries have introduced limits to the number of offspring each anonymous sperm donor can father but these limits vary considerably. Published models for calculating sperm donor limits are in need of improvement and it is recommended that an enhanced, internationally applicable formula be developed for calculating acceptable limits. Moreover, it is recommended that further research be undertaken into the social and familial consequences of the revocation of sperm donor anonymity and the implications for the setting of sperm donor limits. © 2008 American Society for Reproductive Medicine.
- Description: C1
Place matters! Rural as an ‘enabling culture’ for female GPs
- Authors: Schwarz, Imogen , McDonald, John
- Date: 2007
- Type: Text , Conference paper
- Relation: Paper presented at 9th National rural health conference: Standing up for rural health., Albury, Australia : March, 2007 p. 1-9
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- Description: E1
- Description: 2003005837
The regional research framework : Balancing national imperatives, institutional structures and regional interests
- Authors: McDonald, John , Haynes, Carmel
- Date: 2004
- Type: Text , Conference paper
- Relation: Paper presented at 1st Australian Universities Community Engagement Alliance National Conference, Bathurst : 14th-16th July 2004
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- Description: 2003004265
Power and politics : A case study of the failure of an evidence-based practice project in two rural communities
- Authors: McDonald, John
- Date: 2003
- Type: Text , Conference paper
- Relation: Paper presented at the 7th National Rural Health Conference, Canberra : 1st - 4th March, 2003
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- Description: This paper reports on an evaluation of a two-year project aimed at implementing a multi-disciplinary, evidence-based approach to the management of back pain in two rural communities. The project attempted to address the significantly above-average rates of back pain admissions to the local hospitals
- Description: E1
- Description: 2003000518
Markets, outsourcing and the welfare state : Reconciling welfare policies in state education
- Authors: McDonald, John
- Date: 2001
- Type: Text , Journal article
- Relation: Just Policy: A Journal of Australian Social Policy Vol. 22, no. (2001), p. 36-42
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Contestability and social justice : The limits of competitive tendering of welfare services
- Authors: McDonald, John
- Date: 2002
- Type: Text , Journal article
- Relation: Australian Social Work Vol. 55 , no. 2 (2002), p. 99-108
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- Description: This paper critically analyses competitive tendering as a model for the provision of welfare services. Competitive tendering, driven by National Competition Policy and other imperatives for greater efficiency and a smaller public sector, is now used extensively by governments to fund welfare services. However, the suitability of this funding model to welfare services generally, and specifically welfare services in non·metropolitan areas, can be criticised on both theoretical and empirical grounds. Competitive tendering is grounded in economic rationalist, urbo-centric assumptions that are largely inappropriate for welfare provision, and have limited validity in rural areas. There is lillie rigorous empirical evidence of improved efficiency and effectiveness of service delivery under this model. Conversely, there is mounting evidence about the negative impacts. In rural areas this includes the erosion of community service obligations, less collaboration and greater secrecy between agencies, the reduction of choice, limited opportunities for local planning, cost shifting, and threats to continuity of care. This paper concludes with a call for greater application of the 'public benefit' test under the provisions of the National Competition Policy, and the development of more sophisticated frameworks for assessing the contestability of welfare services. Social workers have a leading role to play in challenging the dominant ideology of competition·orientated welfare reforms.
- Description: C1
- Description: 2003000195
Patriarchy and resistance to change in rural general practice : Progress by female activists in revisioning a male institution
- Authors: Schwarz, Imogen , McDonald, John
- Date: 2004
- Type: Text , Conference paper
- Relation: Paper presented at the The 2004 Annual TASA Conference, Beechworth, Australia : 7th-8th December, 2004
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- Description: Females now outnumber males as medical graduates and general practice trainees in Australia. However, women are significantly less likely than men to take up full-time general practice in rural and remote areas. The organisation of medicine remains strongly patriarchal. Over the past decade, female doctors, educationalists, researchers and bureaucrats have been pushing for change. This empirical study investigates how women – at an institutional level – are challenging these entrenched interests and how change is resisted. Drawing upon data from in-depth interviews with seventeen women activists, the five main barriers are: the dominant cultural view that male, full-time, procedural doctors are the ‘norm’; the professional socialisation of doctors as amorphous, genderless persons; the occupation by men of, and the exclusion of women from, powerful positions in formal organisations; the threat to conform to professional standards; and the resource intensiveness of being an activist. These results indicate that, after ten years’ struggle, medicine has progressed beyond the denial of women’s issues. Female doctors are now seen as ‘the problem.’ Marginal adjustments are being made to accommodate their needs. Generally, however, women’s interests continue to be subordinated; exclusionary practices allow the men who control the organisation of rural general practice to maintain their privileges.
- Description: E1
- Description: 2003001299
Implementing evidence-based health care : A new model for rural areas
- Authors: McDonald, John
- Date: 2001
- Type: Text , Conference paper
- Relation: Paper presented at 6th National Rural Health Conference, Canberra : 4th-7th March 2001
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- Description: 2003004316
Legitimating private interests: Hegemonic control over 'the public interest' in national competition policy
- Authors: McDonald, John
- Date: 2007
- Type: Text , Journal article
- Relation: Journal of Sociology Vol. 43, no. 4 (2007), p. 349-366
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- Description: National Competition Policy (NCP), legislated in Australia in 1995, has arguably been the single most consequential economic policy over the past decade. Yet it has largely escaped sociological analysis. This article investigates how the concept of the public interest in NCP has actually had the effect of legitimizing neo-liberal ideologies concerning private, individual, economic interests. Using critical policy analysis, this article examines how this legitimization has occurred through: (1) the policy language of the public interest, and how this discourse has shifted over time; (2) the implementation of NCP, particularly the application of the public interest test; and (3) evidence proffered by dominant institutions about the social and economic distributional outcomes of NCP. This analysis demonstrates that the policy language and public discourse of the public interest has been used to secure hegemonic control to legitimate the interests of dominant groups. © 2007 the Australian Sociological Association.
- Description: C1
- Description: 2003005831
Ballarat health consortium : A case study of influential factors in the development and maintenance of a health partnership
- Authors: McDonald, John , Murphy, Angela , Payne, Warren
- Date: 2001
- Type: Text , Journal article
- Relation: Australian Journal of Primary Health Vol. 7, no. 2 (2001), p. 75-82
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- Description: Intersectoral partnerships in health have a central role in current policy and programs. Partnerships are seen to be an effective strategy for maximising health outcomes. However, theoretical models of health partnerships are underdeveloped. Moreover, the research literature contains inconsistent findings about their effectiveness, and there has been very little evaluative research on health partnerships in this country. This paper reports on a case study of an intersectoral consortium using a health promotion approach to cardiovascular disease. A model of partnership formation and development is presented. From this, a research strategy was devised and carried out. Results indicate that the health consortium was formed inresponse to a critical health issue, and as a separate legal entity without recurrent funding, it has been sustained through the commitment of individual members. Project funding has, in large part, dictated its operations. The case study reveals the strengths, vulnnerabilities and achievements of this consortium over five years. To produce sustainable health outcomes, the researchers conclude, partnerships require strategic management to capitalise on individual endeavours, organisational alignments, and government or funder priorities. Ideological zeal for intersectoral health partnerships must be balanced by rigorous evaluation; together with more sophisticated indicators for measuring success in partnerships in health promotion. Theoretical development of models of health partnerships will also contribute to their enhanced effectiveness.
- Description: 2003004325
Recruiting and retaining rural general practitioners : A mismatch between research evidence and current initiatives?
- Authors: McDonald, John , Bibby, Louise , Carroll, Steve
- Date: 2003
- Type: Text , Conference paper
- Relation: Paper presented at Seventh National Rural Health Conference, Hobart : 1st - 4th March , 2003
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- Description: This paper investigates the possible mismatch between current initiatives to attract and retain general practitioners (GPs) to rural areas, and Australian research evidence about the most significant factors affecting recruitment and retention. The results reported here are part of a broader project that aims to use evidence-based research to enhance rural GP workforce planning and management. This phase of the project analysed research reports evaluating the outcome of programs and services aimed at improving rural recruitment and retention. The search strategies for this review included: key word searches of electronic database publications over the last 15 years; hand searching of relevant journals; trawling websites of relevant organisations; and direct contact with relevant organisations to request copies of “grey” literature such as unpublished reports. A total of 22 Australian studies were identified that met these criteria. (It is acknowledged that many other initiatives have been tried, but evaluation reports for these do not exist or were not obtainable. Similarly, many other studies have examined recruitment or retention without evaluating workforce initiatives.) The 22 studies evaluated nine major recruitment and retention initiatives including: medical course admission criteria (2 studies); rural placements (7); student scholarships (1); financial incentives (2); continuing medical education (5); universitylinked rural practices (1); case management (1); and overseas-trained doctors (2); an community capacity-building (1). Demonstrating “causation” requires strong internal and external validity. Overall, however, there is not yet strong empirical evidence for the efficacy of the any of these initiatives. The methodological problems consistently identified in our analysis were: no use of comparison or control groups; an overreliance on surveys of GPs’ attitudes or intentions rather than actual behaviours; inconsistent definitions of key variables including “rural” and “retention”; inadequate sample sizes or unrepresentative samples and selection biases; inconsistent use of definitions of key variables including “rural” and “retention”; cross-sectional and retrospective designs; insufficient information on statistical analyses; and qualitative studies that did not formally and systematically apply techniques for strengthening credibility and transferability. Moreover, many of these initiatives do not appear to be closely aligned with the factors usually thought to influence recruitment or retention. The learnings from this project support the strategic and accessible use of evidencebased health care for rural workforce issues. Government departments and agencies should invest in rigorous evaluations that are then made publicly available. Policy and program development can benefit by drawing upon sound research knowledge. Rural communities can also become more informed and discerning consumers of this information.
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- Description: 2003000516
Moorabool Shire project : Stage 1 - Local area planning
- Authors: Blaskett, Beverley , Marshall, Craig , McDonald, John , Ollerenshaw, Alison
- Date: 2006
- Type: Text , Report
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- Description: This project was funded by the Victorian Government Department of Human Services and the Moorabool Shire Council and is currently being used to inform future health and welfare service provision in the Moorabool Shire.
- Description: K1
- Description: 2003002861
Promoting resilience in young people : Progress in implementing a framework in schools
- Authors: McDonald, John , Hayes, Louise
- Date: 2001
- Type: Text , Journal article
- Relation: Health Promotion Journal of Australia Vol. 12, no. 3 (2001), p. 261-264
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- Description: Issue addressed: The Framework for Student Support Services (FSSS) in Victoria aims to foster resiliency among young people through an emphasis on prevention and early intervention. This study examined the implementation of the first 18 months of the Framework in a rural region. Methods: A process evaluation was conducted involving eight focus groups with student welfare staff and a survey of 79 schools. Results: Participants reported frustration with delays in professional development, a perceived lack of resources and difficulty engaging the community welfare and health sectors. The survey revealed that schools were targeting primary prevention activities. Conclusion: The student welfare system is successfully introducing some early intervention services. However, the system is still largely constrained to work clinically with individual high risk students. Staff are attempting to introduce a whole-school approach to promoting resiliency. There is significant variation between schools in their efforts and successes. So what?: The Framework is an ambitious, long term program. It presents major challenges for reorienting the priorities and activities of the student support system. Implementation could be improved through a statewide evaluation and learning from research on the delivery of other whole-school approaches to student support. (author abstract)
- Description: 2003004328
Areal call rates to a rural Lifeline centre
- Authors: Watson, Robert , McDonald, John , Pearce, Dora
- Date: 2004
- Type: Text , Conference paper
- Relation: Paper presented at TASA '04 Refereed Conference Proceedings: Revisioning institutions: Change in the 21st century, Beechworth, Victoria : 8th November, 2004
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- Description: This study investigated the relationship between areal call rates to Lifeline Ballarat’s telephone counselling service and the Socio-economic Indexes for Australia. Successful calls for the period of January, February, March, and April 2002 (N=3767) were geospatially referenced to small areas. It was hypothesised that call rates would increase with greater socio-economic disadvantage as measured by the Socio-economic Indexes for Australia. Population adjusted call rates in each exchange service area in the study region were produced and their relationship with the corresponding Socio-economic Indexes for Australia scores were investigated. Significant correlations were observed for the call rate indicator, named the Lifeline Indicator of Social Need, and the Socio-economic Indexes for Australia advantage/disadvantage, disadvantage, and education/occupation indices. The results support Johnston’s (1979) finding of a relationship between socio-economic status of an area and local utilization of telephone counselling. The results support the idea that social factors such as the socio-economic climate of the area can have a significant association with seeking support from telephone counselling services such as the Lifeline service. An implication of the study may be that the calls to telephone counselling and referral centres could be used as a functional social indicator of the expressed need for psychosocial support or as a contributor to other social indices.
- Description: E1
- Description: 2003000971