Search PubMed⌕ Search

Biomedical subjects

R B Hays

Publications and source records attributed to R B Hays.

At least 37 records · Page 2Linked to original sources
PubMed1998

Methodological issues in medical workforce analysis: implications for regional Australia.

Medical workforce data have a profound impact on health policy formulation, but derived doctor population ratios (DPR) are often more relevant to plotting national trends than providing a detailed regional or local workforce perspective. Regional workforce data may be more useful if national approaches are augmented by local information. In developing a detailed workforce analysis for one region of Australia, the authors encountered several challenging methodological issues, including the accuracy of medical workforce databases, clarity of definition of community boundaries, interpretation of workforce definitions and the difficulty accounting for local community needs. This paper discusses the implications for regional workforce research.

Health Services Research↗
PubMed1998

Resource allocation in general practice care.

OBJECTIVE: Complexity of care provided by general practitioners (GPs) is poorly addressed by current measures. Resource allocation for health care in inpatient settings utilises complex descriptions of clinical content and process to produce 'casemix' resource units. This pilot project explored the potential application of these concepts to the funding of general practice in Australia. METHOD: Prospective data were collected from three practices in the same community on one day in the same week. GP generated data included reasons for encounter, age and gender of the patient, whether the problems were new or old, what tests and referrals were initiated for each problem and global complexity ratings. Data collected from the patients included problems presented, problems not dealt with and satisfaction ratings. These data were used to explore the determinants of consultation complexity in general practice. RESULTS: There were statistically significant correlations between: global complexity and problem type (coded to ICPC Chapter); global complexity and number of problems seen; and global complexity and consultation billing level. A resource allocation formula which considers broader descriptions than current fee descriptors is suggested. CONCLUSIONS: Aspects of the casemix concept may have some relevance to how resources could be allocated in general practice, but this would require substantial further investigation.

Australia↗
PubMed1997

Actual versus perceived HIV status, sexual behaviors and predictors of unprotected sex among young gay and bisexual men who identify as HIV-negative, HIV-positive and untested.

OBJECTIVES: To compare the prevalence and predictors of HIV sexual risk behavior among young gay and bisexual men who perceived themselves to be HIV-negative, HIV-positive, or who were untested. DESIGN: Population-based sample of young gay and bisexual men. METHODS: Using multi-stage probability sampling, 408 gay and bisexual men aged 18-29 years in San Francisco were recruited and interviewed, and blood samples for HIV-testing from 364 participants were obtained. RESULTS: HIV prevalence was 18.7%, although 25% of the men who were HIV-positive did not know it. Thirty-seven per cent reported engaging in unprotected anal intercourse during the past year, including 59% of the men who knew they were HIV-positive, 35% of the men who perceived themselves HIV-negative and 28% of the untested men. Logistic regressions found similar predictors of unprotected intercourse for HIV-negatives and HIV-positives, including sexual impulsivity, substance use, sexual enjoyment and communication problems. CONCLUSIONS: The high rates of unprotected intercourse, particularly among the HIV-positive men, attest to the urgent need for HIV-prevention interventions for young gay and bisexual men. The findings suggest that many of the important variables to target in interventions are similar for both HIV-positive and HIV-negative men.

Adolescent↗
PubMed1997

Clinical privileges for rural general practitioners.

Improved training programs and registrable qualifications are now available for graduates wishing to pursue a career in rural practice. In the near future, newly established rural doctors will be able to furnish documentation on substantial additional training, which will include competence in a range of procedural skills. In an environment of increasing regulation and litigation awareness, hospitals are developing systems for recognising the skills and experience of medical staff. However, most clinical privileges systems have been developed for larger hospitals and with procedural sub-specialists in mind. This paper proposes an approach to developing clinical privileges systems that are more appropriate to smaller rural hospitals, so that the skills of rural doctors are fully utilised by their communities.

Australia↗
PubMed1997

Why doctors leave rural practice.

Retention of rural doctors remains difficult because of complex factors that influence decisions of medical families. This study explores the reasons why Queensland rural doctors left their communities during 1995. Semi-structured interviews were conducted with contactable former rural doctors who claimed that they had entered rural practice with the intention to stay for a substantial period of time. The interviews were audiotaped, transcribed and analysed using NUD.IST software. Participants appeared to be subject to a dynamic balance between opposing pressures to stay and pressures to leave. In time, they became susceptible to 'triggers' to leave. These triggers were sometimes locality-specific and could be difficult to address, particularly without early intervention. We believe that it should be possible to develop strategies that address specific concerns of rural doctors, particularly if they are identified early. The optimum period of stay in rural practice should be reconsidered, such that moderate stays should be rewarded in a way that retains the doctors in some form of rural, or near-rural practice.

Family Practice↗
PubMed1997

Integration of undergraduate and postgraduate general practice education--does it work?

Academic general practice remains a small part of most medical schools. One topical method of creating larger units is to integrate the undergraduate and postgraduate education roles. This paper describes the structure of the General Practice and Rural Health Unit at the North Queensland Clinical School, where education, clinical service and policy development roles are combined to create one of Australia's larger academic general practice centres. Issues which have facilitated and challenged the development are discussed in this reflective paper describing the first 3 years of operation.

Education, Medical, Continuing↗
PubMed1997

Unprotected sex and HIV risk taking among young gay men within boyfriend relationships.

A growing body of research shows that gay men in primary relationships engage in higher rates of unprotected anal intercourse than single gay men. We sought to (a) describe patterns of HIV risk taking among young gay men in boyfriend relationships and (b) identify characteristics of relationships that were most associated with engaging in unprotected intercourse. The data come from the Young Men's Survey, an ongoing longitudinal survey of 416 gay men aged 18 to 27 in three medium-sized West Coast communities. Fifty-one percent of the men with boyfriends had engaged in unprotected anal intercourse in the past 2 months, compared with 21% of the single men. Forty-two percent of the respondents who had unprotected intercourse with their boyfriend did not know their own and their partners' HIV status. Factors associated with unprotected intercourse included greater relationship involvement and time spent together, sexual behavior patterns, less involvement with the gay community, poor sexual communication skills, and misperceptions about safe sex. The findings highlight the need for HIV risk reduction interventions designed specifically for young gay men with boyfriends and identify critical areas to target in such interventions.

Adolescent↗
PubMed1996

Language background and communication skills of medical students.

OBJECTIVE: The increasing proportion of medical students whose primary language is other than English and recent reports of poor communication skills of medical graduates has generated community concern about the methods of selection of students and their communication skills training. This paper examines the relationship between language background and examination performance in oral communication skills in Year 5 medical students. METHOD: Questionnaire data from all Year 5 students in the 1992 general practice terms were matched to examination results. RESULTS: Seventy percent of students responded. Most students whose primary language was not English passed, although some required remedial communication skills tuition. The most powerful predictors of poor performance were recent arrival in Australia and living in an environment where English was not spoken at home. CONCLUSION: Students with poor English oral communication skills should be encouraged to speak English away from the medical school and should be offered additional tuition so that their skills in other languages are not lost to the health-care system.

Adult↗
PubMed1996

Ruralising the undergraduate medical curriculum through consultation with key stake holders.

This paper describes the approach taken at the University of Queensland to broaden the scope of curriculum design to involve rural general practitioners, medical students and rural health care consumers. A form of nominal group process in serial telephone teleconferences was used, with a group of rural general practitioners, to develop and pilot curriculum content, learning strategies and assessment methods. Medical students assisted in the evaluation of the curriculum and representatives of rural organisations were consulted about the value of hosting medical students in rural communities. The three groups made significant contributions to the project. The results will be trialed for the entire year 6 cohort (240 students) in 1995 and will form the basis of the planned rural practice term in the new graduate course.

Community Participation↗
PubMed1996

The Mpowerment Project: a community-level HIV prevention intervention for young gay men.

OBJECTIVES: Since young gay men are engaging in alarmingly high rates of unsafe sex and few seek help for changing risky behaviors, community-level programs to prevent infection with the human immunodeficiency virus (HIV) among them are urgently needed. METHODS: We developed and implemented a community-level HIV prevention program in a midsized Oregon community. The peer-led program had three components: out-reach, small groups, and a publicity campaign. Independently from the prevention program, a cohort of young gay men (n = 300) was surveyed in this and in a similar comparison community pre- and postintervention. RESULTS: Following intervention, the proportion of men engaging in any unprotected anal intercourse decreased from 41.0% to 30.0% (-27% from baseline), decreased from 20.2% to 11.1% (-45% from baseline) with nonprimary partners, and decreased from 58.9% to 44.7% (-24% from baseline) with boyfriends. No significant changes occurred in the comparison community over the same period. CONCLUSIONS: This prevention approach effectively led to HIV risk reduction. To reach risk-taking young gay men, HIV prevention activities must be embedded in social activities and community life.

Adult↗
PubMed1996

Options in education for advanced trainees in isolated general practice.

BACKGROUND: Only a small number of remote solo doctors are needed each year to provide health care to remote communities. However, despite advances in the provision of appropriate training for intending rural doctors, the preparation of graduates for this kind of medical practice has received little attention. OBJECTIVE: To develop and evaluate an optional training unit within the Royal Australian College of General Practitioners Training Program, which provides trainee GPs with an opportunity to learn about remote medicine during training with the distant support of an experienced rural doctor. METHOD: A program of intensive educational support was developed and piloted with a group of nine GP in solo rural practices and compared to that provided to four GP trainees in standard advanced GP terms. Comparison was based on data collected in trainee logbooks and in questionnaires completed by trainees and supervisors. RESULTS: The solo trainees received equivalent duration of educational support through the use of communications technology and other distance education methods. The training unit will be trialed further and may remain an option within the Training Program.

Career Choice↗
PubMed1995

Longitudinal reliability of the Royal Australian College of General Practitioners certification examination.

The examination for Fellowship of the Royal Australian College of General Practitioners is a long-standing examination that is regarded as a valid and comprehensive assessment of competence for general practice in Australia. Income and employment opportunities now depend on passing this battery of eight subtests. This paper describes the structures of the examination and reports an analysis of the reliability and efficiency of the examinations, based on data from five consecutive examinations. Results indicate that the examination achieves acceptable overall reliability, although suggestions for changes to improve reliability are made. A decision on implementing any changes must take into consideration any consequent changes in validity.

Australia↗
PubMed1995

Developing group practices: a management challenge.

The advantages and disadvantages of forming larger professional practices are often debated. This paper reports an exploration of the issues through three case studies involving clusters of Sydney general medical practitioners who had expressed a desire to amalgamate their solo or small group practices. Their most frequently stated goals were to reduce financial overheads, to improve the range of services offered to their patients and to improve the opportunities for recreational and study leave. Several barriers to successful amalgamation were identified, and methods of overcoming these were explored. Practices can successfully amalgamate, but only where there is a group of like-minded general practitioners who are willing to invest time to achieve mutually agreed objectives. Amalgamation will not be appropriate in all circumstances. Larger group practices should benefit from the employment of a professional practice manager. These findings may be relevant to veterinary and dental practices.

Animals↗
PubMed1994

Forming large group practices: is it worth it?

OBJECTIVE: To investigate means of successful general practice amalgamation. PARTICIPANTS: Three clusters of Sydney general practitioners who wished to amalgamate their solo or small group practices. DESIGN: Structured interviews were conducted with individual general practitioners and group meetings were held with members of each cluster. RESULT: Successful amalgamation of solo/small practices starts with choosing compatible participants. Next, aims must be agreed upon and clearly spelt out. Commonly expressed goals of amalgamation were to reduce financial overheads, improve the range of patient services and increase opportunities for recreational and study leave. Financial and legal aid is essential for intending amalgamators. "Trial amalgamation" may be a safe option for those uncertain as to whether to commit themselves and their practices. CONCLUSIONS: Practices can successfully amalgamate, but only with a group of like-minded general practitioners who are willing to invest time to achieve mutually agreed objectives. Amalgamation is not always appropriate.

Attitude of Health Personnel↗