Kathleen M Eagar

Why patients attend emergency departments for conditions potentially appropriate for primary care: Reasons given by patients and clinicians differ

Objectives:  To compare reasons identified by clinical staff for potential primary care attendances to the ED with those previously identified by patients.

The Griffith Area Palliative Care Service (GAPS): an evaluation of an Australian rural palliative care model

Abstract Quantitative and qualitative data, including service utilisation, health records, a provider survey and participant observation, were used to describe the impact of a new model of palliative care on patients, carers and staff in rural Australia. A total of 95 patients were enrolled between October 2001 and February 2003, for an average of 147 days. Deaths per month averaged 3.5. Participating general practitioners were positive about the model. The experiences of 14 patients or carers and 3 people who had cared for a relative with terminal illness prior to the new model were also positive. As one illustration, patients and carers commented that trips to the emergency department prior to the GAPS programme often involved long waiting times and unnecessary investigations and that this had now improved. The elements of the model that worked most effectively were weekly case conferences, the on-call nursing roster, patient-held records and shared protocols and procedures. The model achieved its aim of improving palliative care services and still continues with some modifications. The generalisability of the model is now being tested in eight rural and remote communities across Australia.

Functional Assessment to Predict Capacity for Work in a Population of School‐leavers with Disabilities

This study reports on an assessment system for school‐leavers with disabilities to identify their capacity for work and the type of transition‐to‐work programme best suited to each person. Participants were 1,556 high school students in four cohorts who left school between 1999 and 2002. Each school‐leaver was assessed by rehabilitation counsellors for functional ability and capacity for work. In a supplementary study, the 2002 cohort was assessed by special transition teachers using a short screening tool. The results demonstrate that there is a predictable hierarchy of functional acquisition among school‐leavers with disabilities and that the single best predictor of future capacity for work and need for transition‐to‐work programmes among this group of young people is the capacity to manage activities of daily living. The results also demonstrate that a short screen used by teachers, together with a behavioural assessment, is sufficient to stream school‐leavers with a disability into a range of transition‐to‐work programmes.