The Medical journal of Australia
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Biography Historical Article
The upsurge of interest in Indigenous health in the 1950s and 1960s.
During the 1950s and 1960s, there was a dramatic explosion in the number of letters to the editor about Indigenous health published in the MJA, reflecting increased reader interest. The letters from Barry Christophers were part of the Federal Council for Aboriginal Advancement's largely successful campaign for equal civil rights for Aboriginal and Torres Strait Islander people. His letters not only drew attention to discriminatory legislation and policies, but also emphasised the structural (especially economic) determinants of Indigenous ill-health, and the negative impact on Indigenous people of racist medical representations.
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The Austin Bowel Cancer Consortium aimed to identify drivers of clinical decision-making so as to inform a continuous practice improvement approach to the use of evidence. Strategies for engaging clinicians included a direct clinician-clinician approach, gaining the support of opinion leaders and using the clinicians' desire for patient outcome data. Interviews with clinicians identified barriers to using evidence in practice. ⋯ Interviews with patients and carers highlighted psychosocial and communication difficulties and prompted greater clinician awareness. Consumers developed patient information resources with minimal assistance from project staff. The clinical encounter is the prime site for change for putting evidence into practice, rather than trying to change individual clinicians.
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In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after-hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). ⋯ CHF: Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P = 0.06) and from 13.4% to 10.1% (P = 0.06) for patients with ACS and from 22.8% to 15.2% (P < 0.001) and from 32.8% to 22.4% (P = 0.005) for patients with CHF. Quality improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes.
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Comparative Study
Association between diabetes and coronary heart disease in Aboriginal people: are women disadvantaged?
To determine the incidence rate of coronary heart disease (CHD) in Australian Aboriginal people with type 2 diabetes, and to compare the impact of diabetes on CHD risk in Aboriginal women and men. ⋯ Aboriginal women with diabetes experienced a significantly higher risk of CHD than women without diabetes. Although the difference was not statistically significant, women with diabetes had a higher CHD risk than men with diabetes.
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The concept of the Clinical Support Systems Program (CSSP) was transformed from an idea into reality through the efforts of representatives of the Australian Government Department of Health and Ageing and the Royal Australasian College of Physicians. This collaboration involved developing common ground between two different perspectives: those of the funder/policy/administrative sector and those of the clinical practice world. Bridging these differences to establish an agreed approach to moving forward was a lengthy and difficult process. ⋯ Compromise, persistence and commitment to the end-goal by the parties involved were important features in building and maintaining the momentum of the change process. Many of the difficulties experienced could be traced to differences in decision-making processes between the clinical and the administrative paradigms. Knowledge brokers can assist in bridging the different languages and perspectives of the groups involved.