Search PubMed⌕ Search

Biomedical subjects

R S Bailie

Publications and source records attributed to R S Bailie.

14 recordsLinked to original sources
PubMed2004

Specialist outreach clinics in primary care and rural hospital settings.

BACKGROUND: Specialist medical practitioners have conducted clinics in primary care and rural hospital settings for a variety of reasons in many different countries. Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services. OBJECTIVES: To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access, quality, health outcomes, patient satisfaction, use of services, and costs. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialised register (March 2002), the Cochrane Controlled Trials Register (CCTR) (Cochrane Library Issue 1, 2002), MEDLINE (including HealthStar) (1966 to May 2002), EMBASE (1988 to March 2002), CINAHL (1982 to March 2002), the Primary-Secondary Care Database previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester, a collection of studies from the UK collated in "Specialist Outreach Clinics in General Practice" (Roland 1998), and the reference lists of all retrieved articles. SELECTION CRITERIA: Randomised trials, controlled before and after studies and interrupted time series analyses of visiting specialist outreach clinics in primary care or rural hospital settings, either providing simple consultations or as part of complex multifaceted interventions. The participants were patients, specialists, and primary care providers. The outcomes included objective measures of access, quality, health outcomes, satisfaction, service use, and cost. DATA COLLECTION AND ANALYSIS: Four reviewers working in pairs independently extracted data and assessed study quality. MAIN RESULTS: 73 outreach interventions were identified covering many specialties, countries and settings. Nine studies met the inclusion criteria. Most comparative studies came from urban non-disadvantaged populations in developed countries. Simple 'shifted outpatients' styles of specialist outreach were shown to improve access, but there was no evidence of impact on health outcomes. Specialist outreach as part of more complex multifaceted interventions involving collaboration with primary care, education or other services was associated with improved health outcomes, more efficient and guideline-consistent care, and less use of inpatient services. The additional costs of outreach may be balanced by improved health outcomes. REVIEWER'S CONCLUSIONS: This review supports the hypothesis that specialist outreach can improve access, outcomes and service use, especially when delivered as part of a multifaceted intervention. The benefits of simple outreach models in urban non-disadvantaged settings seem small. There is a need for good comparative studies of outreach in rural and disadvantaged settings where outreach may confer most benefit to access and health outcomes.

Community-Institutional Relations↗
PubMed2003

Case-control study of the association between kava use and pneumonia in eastern Arnhem and Aboriginal communities (Northern Territory, Australia).

Pneumonia causes significant morbidity and mortality in Aboriginal populations in Australia's Northern Territory (NT). Kava, consumed in Arnhem Land since 1982, may be a risk factor for infectious disease including pneumonia. A case-control study (n = 115 cases; n = 415 controls) was conducted in 7001 Aboriginal people (4217 over 15 years). Odds ratios (OR) were calculated by conditional logistic regression with substance use and social factors as confounders. Pneumonia was not associated with kava use. Crude OR = 1.26 (0.74-2.14, P = 0.386), increased after controlling for confounders (OR = 1.98, 0.63-6.23, P = 0.237) but was not significant. Adjusted OR for pneumonia cases involving kava and alcohol users was 1.19 (0.39-3.62, P = 0.756). In communities with longer kava-using histories, adjusted OR was 2.19 (0.67-7.14, P = 0.187). There was no kava dose-response relationship. Crude ORs for associations between pneumonia and cannabis use (OR = 2.27, 1 18-4.37, P = 0.014) and alcohol use (OR = 1.95, 1.07-3.53, P = 0.026) were statistically significant and approached significance for petrol sniffing (OR = 1.98, 0.99-3.95, P = 0.056).

Adult↗
PubMed2003

Health effects of kava use in an eastern Arnhem Land Aboriginal community.

BACKGROUND: Heavy kava use in Aboriginal communities has been linked to various health effects, including anecdotes of sudden cardiac deaths. AIMS: To examine associations between kava use and potential health effects. METHODS: A cross-sectional study was carried out within a kava-using east Arnhem Land Aboriginal community in tropical northern Australia. One-hundred-and-one adults who were current, recent or non-users of kava were enrolled in March 2000. Main outcome measures were physical, anthropometric, biochemical, haematological, immunological and neurocognitive assessments. RESULTS: Kava users more frequently showed a characteristic dermopathy (P<0.001). They had increased levels of gamma-glutamyl transferase and alkaline phosphatase (P<0.001). Lymphocyte counts were significantly lower in kava users (P<0.001). Fibrinogen, plasminogen activator inhibitor-1 and neurocognitive tests were not different between kava use categories. IgE and IgG antibodies were elevated across the whole group, as were C-reactive protein and homocysteine. CONCLUSIONS: Kava use was associated with dermopathy, liver function abnormalities and decreased lymphocytes. If kava continues to be used by Aboriginal populations, monitoring should focus on the health consequences of these findings, including a possible increase in serious infections. The interaction between kava, alcohol and other substances requires further study. Although markers of cardiovascular risk are increased across the population, these were not higher in kava users, and this increase may be linked to the large infectious pathogen burden reflective of the socioeconomic disadvantage seen in many remote Aboriginal communities.

Adult↗
PubMed2002

Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability.

STUDY OBJECTIVE: To examine the role of specialist outreach in supporting primary health care and overcoming the barriers to health care faced by the indigenous population in remote areas of Australia, and to examine issues affecting its sustainability. DESIGN: A process evaluation of a specialist outreach service, using health service utilisation data and interviews with health professionals and patients. SETTING: The Top End of Australia's Northern Territory, where Darwin is the capital city and the major base for hospital and specialist services. In the rural and remote areas outside Darwin there are many small, predominantly indigenous communities, which are greatly disadvantaged by a severe burden of disease and limited access to medical care. PARTICIPANTS: Seventeen remote health practitioners, five specialists undertaking outreach, five regional health administrators, and three patients from remote communities. MAIN RESULTS: The barriers faced by many remote indigenous people in accessing specialist and hospital care are substantial. Outreach delivery of specialist services has overcome some of the barriers relating to distance, communication, and cultural inappropriateness of services and has enabled an over fourfold increase in the number of consultations with people from remote communities. Key issues affecting sustainability include: an adequate specialist base; an unmet demand from primary care; integration with, accountability to and capacity building for a multidisciplinary framework centred in primary care; good communication; visits that are regular and predictable; funding and coordination that recognises responsibilities to both hospitals and the primary care sector; and regular evaluation. CONCLUSIONS: In a setting where there is a disadvantaged population with inadequate access to medical care, specialist outreach from a regional centre can provide a more equitable means of service delivery than hospital based services alone. A sustainable outreach service that is organised appropriately, responsive to local community needs, and has an adequate regional specialist base can effectively integrate with and support primary health care processes. Poorly planned and conducted outreach, however, can draw resources away and detract from primary health care.

Community-Institutional Relations↗
PubMed2001

Household infrastructure in aboriginal communities and the implications for health improvement.

OBJECTIVE: To evaluate housing survey data, describe the state of household infrastructure in Aboriginal communities in the Northern Territory (NT), and to discuss implications for health improvement for people in these communities. DESIGN: Quantitative analysis of survey data and qualitative analysis of the survey process. SETTING: All NT houses funded for repairs and maintenance through the Indigenous Housing Authority of the Northern Territory (IHANT). MAIN OUTCOME MEASURE: Status of infrastructure necessary for four key "healthy living practices" (washing people, washing clothes and bedding, waste removal, and food storage and preparation). RESULTS: 3906 houses (79% of all houses funded by IHANT) were surveyed. Infrastructure components most frequently identified as not functional or not present were those required for the storage and preparation of food (62% not functional). The facilities required for personal hygiene and safe removal of human waste were not functional in 45%-46% of houses. CONCLUSIONS: These findings highlight the significance of absent or non-functioning household infrastructure as a potential contributory factor in the poor nutritional status and high rates of respiratory, skin and gastrointestinal infections in Indigenous communities. The environmental health and housing survey in the NT is an important tool for monitoring progress on addressing a key underlying determinant of the health of Indigenous people, and potentially for facilitating research aimed at gaining an improved understanding of the relationship of the household environment to health in Indigenous communities.

Attitude to Health↗
PubMed2001

Improving access to specialist care for remote Aboriginal communities: evaluation of a specialist outreach service.

OBJECTIVE: To identify barriers faced by Aboriginal people from remote communities in the Northern Territory (NT) when accessing hospital-based specialist medical services, and to evaluate the impact of the Specialist Outreach Service (SOS) on these barriers. DESIGN: Combined quantitative and qualitative study. SETTING: Remote Aboriginal communities in the "Top End" of the NT, 1993-1999 (spanning the introduction of the SOS in 1997). PARTICIPANTS: 25 remote health practitioners, patients and SOS specialists. MAIN OUTCOME MEASURES: Numbers of consultations with specialists; average cost per consultation; perceived barriers to accessing hospital-based outpatient care; and perceived impact of specialist outreach on these barriers. RESULTS: Perceived barriers included geographic remoteness, poor doctor-patient communication, poverty, cultural differences, and the structure of the health service. Between 1993 and 1999, there were 5,184 SOS and non-SOS outreach consultations in surgical specialties. Intensive outreach practice (as in gynaecology and ophthalmology) increased total consultations by up to 441% and significantly reduced the number of transfers to hospital outpatient clinics (P< 0.001). Average cost per consultation was $277 for SOS consultations, compared with $450 at Royal Darwin Hospital and $357 at the closest regional hospital. Outreach has reduced barriers relating to distance, communication and cultural differences, and potentially bolsters existing primary healthcare services. CONCLUSIONS: When compared with hospital-based outpatient services alone, outreach is a more accessible, appropriate and efficient method of providing specialist medical services to remote Aboriginal communities in the NT.

Attitude of Health Personnel↗
PubMed2000

Cervical cancer mortality in Australia: contrasting risk by Aboriginality, age and rurality.

BACKGROUND: The poor health status of Australia's indigenous population is reflected in relatively high mortality rates from almost all causes, including preventable causes such as cervical cancer, where the rate is six to eight times that of non-Aboriginal women. However, there is little information on the geographical distribution of risk, an important issue for service deployment. This study examined the risk of death from cervical cancer in relation to Indigenous status, age and rurality. METHODS: Data from death registers from Australian states and territories who have identified Aboriginal people were examined for 1986-1997 to obtain a list of all deaths where the primary cause was cancer of the cervix. The data categorized females by 5-year age group, by metropolitan, rural or remote category and by Indigenous status. Mean age at death and standardized mortality ratios for deaths from cervical cancer were calculated for Aboriginal compared with non-Aboriginal women in metropolitan, rural and remote areas. RESULTS: The risk of death from cervical cancer for Aboriginal women compared with non-Aboriginal women increased by 4.3-fold for metropolitan areas, 9.7-fold for rural areas and 18.3-fold for remote areas. CONCLUSIONS: Aboriginal women in rural and remote areas of Australia are at significantly higher risk of death from cancer of the cervix than either Aboriginal women in metropolitan areas or non-Aboriginal women in any area. This result raises questions about access to services for prevention and early diagnosis and other factors that might impact on the incidence and natural history of the disease.

Adult↗
PubMed1997

General practitioners' perceptions regarding coordinated care.

OBJECTIVE: To explore the attitudes of general practitioners to the changing roles in the coordination of complex patient care. METHOD: A questionnaire survey was distributed with Australian Doctor. RESULTS: GPs were found to fall into four broad groups in relation to care coordination: those who do not want to expand their role in coordination of care (30%); those who would like to expand their role in coordination of care, but do not want to take costs into account when making decisions about patient care (34%); those who would like to expand their role in coordination of care, do think costs should be taken into account, but do not wish to be involved in budget management (21%); and those who would like to expand their role in coordination of care and be involved in budget management (22%). CONCLUSION: In the context of the introduction of managed care in Australia, this survey highlights the potential for GPs to take on a range of roles and responsibilities under these arrangements.

Adult↗
PubMed1996

Surveillance for equity in cervical cytology screening.

BACKGROUND: The opportunistic basis on which screening has been conducted in South Africa has resulted in multiple rescreening of a small proportion of the population (which excludes most women at high risk) and low population coverage. There has consequently been a failure of screening to impact on the incidence of cervical cancer in most of the population. AIM: To propose the use of the ratio of smears showing cervical intra-epithelial neoplasia (CIN)III: smears showing signs of malignancy as an indicator for the surveillance of equity in cervical cytology screening, and to apply this indicator to an area of the Western Cape of South Africa. RESULTS: Marked inequity in screening is demonstrated between metropolitan and non-metropolitan area, and between different non-metropolitan districts. Inequity in screening between different age groups of women is also found, and this is associated with an inappropriately young age distribution of screening activity. CONCLUSIONS: The application of this indicator in the routine surveillance of screening activity may be useful in monitoring progress towards the implementation of more equitable screening programmes, and the validity of the indicator should be tested in other settings.

Adolescent↗
PubMed1996

Trends in cervical cancer mortality in South Africa.

BACKGROUND: Cervical cancer is an important cause of death throughout the world, especially in less developed countries. Reports of trends in cervical cancer mortality from less developed countries have been limited by poor data quality and inaccurate population estimates. This paper examines trends in cervical cancer mortality in South Africa from 1949 to 1990 and discusses the impact of cytology screening on these trends. METHODS: Analysis of national mortality statistics and reconstructed population data. RESULTS: The age-standardized mortality rates for Whites declined after the mid 1960s, while that for Coloureds rose, particularly before the 1970s. These trends were affected predominantly by trends among women in the 35-64 age range. CONCLUSIONS: The pattern of mortality in successive birth cohorts for Whites is consistent with a reduction in age-specific mortality following the advent of cytological screening. The same pattern is not evident in trends for Coloureds, among whom screening has apparently had a minor impact if any at all. The apparent lack of impact of screening in those groups of women most at risk of cervical cancer lends weight to demands for the implementation of equitable and rational screening programmes for cervical cancer in South Africa and internationally.

Adult↗
PubMed1994

Trends in photochemical smog in the Cape Peninsula and the implications for health.

There has been growing public concern over reports of increasing air pollution in the Cape Peninsula. Attention has been focused on the 'brown haze' and on photochemical smog. Because of deficiencies in the monitoring equipment, information on trends in photochemical smog levels over the past decade is limited. Trends in oxides of nitrogen, one of the main precursors of photochemical smog, and therefore an indicator of the potential for its formation, were examined for the period 1984-1993. Meaningful data for determining trends were available from only a single site. Increases in mean monthly levels, peak hourly levels and the number of times guidelines were exceeded were demonstrated. Given the dynamics of formation of photochemical smog and the particular role of motor vehicles, it is argued that the trends measured at this site are probably an underestimate of the trends in other parts of the Cape Town metropolitan area. Some of the precursors of photochemical smog, notably nitrogen dioxide, and some of its components, notably ozone, have been shown to be detrimental to respiratory health at levels close to, or below, current recommended guidelines. A continuing increase in these pollutants will therefore result in more respiratory illness, particularly among susceptible groups. This calls for an upgrading of monitoring of air pollution in Cape Town and for appropriate steps to prevent its further increase.

Air Pollutants↗