Kay Price

Multimorbidity - not just an older person's issue. Results from an Australian biomedical study

BackgroundMultimorbidity, the simultaneous occurrence of two or more chronic conditions, is usually associated with older persons. This research assessed multimorbidity across a range of ages so that planners are informed and appropriate prevention programs, management strategies and health service/health care planning can be implemented.MethodsMultimorbidity was assessed across three age groups from data collected in a major biomedical cohort study (North West Adelaide Health Study). Using randomly selected adults, diabetes, asthma, and chronic obstructive pulmonary disease were determined clinically and cardio-vascular disease, osteoporosis, arthritis and mental health by self-report (ever been told by a doctor). A range of demographic, social, risk and protective factors including high blood pressure and high cholesterol (assessed bio-medically), health service use, quality of life and medication use (linked to government records) were included in the multivariate modelling.ResultsOverall 4.4% of the 20-39 year age group, 15.0% of the 40-59 age group and 39.2% of those aged 60 years of age or older had multimorbidity (17.1% of the total). Of those with multimorbidity, 42.1% were aged less than 60 years of age. A variety of variables were included in the final logistic regression models for the three age groups including family structure, marital status, education attainment, country of birth, smoking status, obesity measurements, medication use, health service utilisation and overall health status.ConclusionsMultimorbidity is not just associated with older persons and flexible care management support systems, appropriate guidelines and care-coordination programs are required across a broader age range. Issues such as health literacy and polypharamacy are also important considerations. Future research is required into assessing multimorbidity across the life course, prevention of complications and assessment of appropriate self-care strategies.

The North West Adelaide Health Study: detailed methods and baseline segmentation of a cohort for selected chronic diseases

The North West Adelaide Health Study is a population-based biomedical cohort study investigating the prevalence of a number of chronic conditions and health-related risk factors along a continuum. This methodology may assist with evidence-based decisions for health policy makers and planners, and inform health professionals who are involved in chronic disease prevention and management, by providing a better description of people at risk of developing or already diagnosed with selected chronic conditions for more accurate targeting groups for health gain and improved health outcomes. Longitudinal data will provide information on progression of chronic conditions and allow description of those who move forward and back along the continuum over time. Detailed methods are provided regarding the random recruitment and examination of a representative sample of participants (n = 4060), including the rationale for various processes and valuable lessons learnt. Self-reported and biomedical data were obtained on risk factors (smoking, alcohol consumption, physical activity, family history, body mass index, blood pressure, cholesterol) and chronic conditions (asthma, chronic obstructive pulmonary disease, diabetes) to classify participants according to their status along a continuum. Segmenting this population sample along a continuum showed that 71.5% had at least one risk factor for developing asthma, chronic obstructive pulmonary disease or diabetes. Almost one-fifth (18.8%) had been previously diagnosed with at least one of these chronic conditions, and an additional 3.9% had at least one of these conditions but had not been diagnosed. This paper provides a novel opportunity to examine how a cohort study was born. It presents detailed methodology behind the selection, recruitment and examination of a cohort and how participants with selected chronic conditions can be segmented along a continuum that may assist with health promotion and health services planning.

Cohort Profile: The North West Adelaide Health Study (NWAHS)

Published by Oxford University Press on behalf of the International Epidemiological Association

Vitamin D levels in an Australian population.

BackgroundLevels of vitamin D in the population have come under increasing scrutiny, however there are only a few studies in Australia which measure levels in the general population. The aim of this study was to measure the levels of vitamin D within a large population cohort and examine the association with seasons and selected demographic and health risk factors.MethodsA longitudinal cohort study of 2413 participants in the northwest suburbs of Adelaide, South Australia conducted between 2008 and 2010 was used to examine serum levels of 25-hydroxy vitamin D (25(OH)D) in relation to demographic characteristics (age, sex, income, education and country of birth), seasons, the use of vitamin D supplements and selected health risk factors (physical activity, body mass index and smoking). Both unadjusted and adjusted mean levels of serum 25(OH)D were examined, as were the factors associated with the unadjusted and adjusted prevalence of serum 25(OH)D levels below 50 and 75xa0nmol/L.ResultsOverall, the mean level of serum 25(OH)D was 69.2xa0nmol/L with 22.7% of the population having a serum 25(OH)D level below 50xa0nmol/L, the level which is generally recognised as vitamin D deficiency. There were significantly higher levels of 25(OH)D among males compared to females (tu2009=u20094.65, pu2009<u20090.001). Higher levels of 25(OH)D were also measured in summer and autumn compared with winter and spring. Generally, mean levels of 25(OH)D were lower in those classified as obese. Smokers and those undertaking no or less than 150xa0minutes/week of physical activity also had lower levels of serum vitamin D. Obesity (as classified by body mass index), season and undertaking an insufficient level of physical activity to obtain a health benefit were significantly associated with the prevalence of vitamin D deficiency.ConclusionsVitamin D deficiency is prevalent in South Australia, affecting almost one quarter of the population and levels are related to activity, obesity and season even when adjusted for confounding factors. Improved methods of addressing vitamin D levels in population are required.

The doctor and the patient—How is a clinical encounter perceived?

OBJECTIVEnTo examine the population distribution of different types of relationships between people with chronic conditions and their doctors that influence decisions being made from a shared-decision making perspective.nnnMETHODSnA survey questionnaire based on recurring themes about the doctor/patient relationship identified from qualitative in-depth interviews with people with chronic conditions and doctors was administered to a national population sample (n=999) of people with chronic conditions.nnnRESULTSnThree factors explained the doctor/patient relationship. Factor 1 identified a positive partnership characteristic of involvement and shared decision-making; Factor 2 doctor-controlled relationship; Factor 3 relationship with negative dimensions. Cluster analysis identified four population groups. Cluster 1 doctor is in control (9.7% of the population); Cluster 2 ambivalent (27.6%); Cluster 3 positive long-term relationship (58.6%); Cluster 4 unhappy relationship (4.4%). The proportion of 18-34 year olds is significantly higher than expected in Cluster 4. The proportion of 65+ year olds is significantly higher than expected in Cluster 1, and significantly lower than expected in Cluster 4.nnnCONCLUSIONnThis study adds to shared decision-making literature in that it shows in a representative sample of people with chronic illnesses how their perceptions of their experiences of the doctor-patient relationship are distributed across the population.nnnPRACTICE IMPLICATIONSnConsideration needs to be given as to whether it is better to help doctors to alter their styles of interactions to suit the preferences of different patients or if it is feasible to match patients with doctors by style of decision-making and patient preference.

Nurses in general practice settings: roles and responsibilities

Abstract Nurses are an important human resource, vital for the delivery of health services in countries across the globe. To improve the quality, access and affordability of primary care services to support rural and remote communities, in 2001, the Australian Government implemented the Nursing in General Practice Initiative [NIGPI] to increase the numbers of nurses to work in general practice settings. The NIGPI positions nurses as both a human resource and a human commodity. This paper examines how developments emerging from this initiative enable and constrain the role and responsibilities of nurses working in general practices in Australia.

Being strategic: Utilising consumer views to better promote an expanded role for nurses in Australian general practice

Australian consumers have articulated their perceptions of the role of the nurse in general practice. Practice Nurses (PNs) and General Practitioners (GPs) have also highlighted the issues they believe currently and potentially impact on this role in Australia. This paper identifies and discusses the nexus between the consumers perceptions and expectations and health professionals issues. Data collected from focus groups and interviews in 2 Australian studies of consumer perception of nursing in general practice, are re-considered alongside findings reported in the Royal Australian College of General Practitioners and the Royal College of Nursing, Australia report; General Practice Nursing in Australia. Consumers, doctors and nurses working in general practices in Australia, raised similar issues. However, consumers considered these issues in relation to their health care needs, whereas the GPs and PNs tended to focus more on professional and structural tensions related to the current and potentially expanded role of the PN. Understanding consumer views vis-a-vis issues raised by PNs and GPs about the role of nursing in general practice provides direction for both professions to better work with consumers to enhance their understanding of what general practice services could be and how changes, like expanding the role of nurses, may bring about improvements in the health outcomes of consumers. Health professionals can benefit from reflecting on the experiences and expectations of consumers if they desire to make general practice services more responsive to individual consumers needs and at the same time adopt a primary health care focus.

What hinders and what helps? Searching for solutions to mature aged unemployment and the residential aged care workforce crisis

Objective:u2002 This paper provides an overview of a research project that investigated strategies to address the workforce crisis currently threatening the provision of health and residential care services to Australias rapidly ageing population. Underpinning this projects development was the need to understand why, in the face of high levels of sustained mature age unemployment (and under‐employment) and the urgent need for staff in residential and community aged care, mature aged people do not consider, or are unable to undertake, further education and training to gain the necessary skills to work in this particular area.

Hip protectors: are they beneficial in protecting older people from fall-related injuries?

AIMS AND OBJECTIVESnTo report findings of an investigation into the methodological quality of research informing the use of hip protectors for those clients in residential aged care considered to be at high risk of falls and to contribute to the translation of research evidence into practice by identifying issues surrounding the use of hip protectors in practice.nnnBACKGROUNDnFalls risk is a predominant concern when nursing older people, especially those in residential aged care. Fall-related injuries, specifically pertaining to the hip, yield a high cost to the individual both physically and psychologically. Accordingly, hip protectors are argued in related literature as a form of protection against such injuries.nnnDESIGNnA database search as per a specified search strategy was conducted for quantitative research publications and randomised control trials.nnnMETHODSnEnglish language publications were sought from the year 2000-2011. Searches were made, using specific combinations of keywords, in the following databases: MEDLINE via OvidSP, CINAHL via EBSCOHost, Ageline via OvidSP, Cochrane Library, The Joanna Briggs Institute and Google Scholar.nnnRESULTSnSix articles were selected for review. Methodological quality of the research publications collated varied, and the use of hip protectors was deemed inconclusive. Compliance was raised as a prevailing issue.nnnCONCLUSIONnThe problem of fall-related injuries is significant. Whilst some evidence is inconclusive, the use of hip protectors is recommended as best practice.nnnRELEVANCE TO CLINICAL PRACTICEnThe issue of compliance, however, was identified to affect the use of appliances in residential aged care. Addressing compliance issues must be tackled if hip protectors are to be part of a resident-centred approach.

Making breathing your business: enterprising practices at the margins of orthodoxy

Over the last 30 years there has been a gradual but nonetheless significant shift in the political economy of healthcare in developed countries. The health reforms that have accompanied this shift have had a significant impact upon medicine, nursing and a number of other orthodox health professions, but to date, little work has been done to explore the changing nature of physiotherapy practice. This study draws on Foucaults notion of governmentality to explore the enterprising practices of a new physiotherapy clinic established in Auckland, New Zealand. Drawing on a critical history of respiratory physiotherapy, which had previously been firmly anchored within the public health sector, we show that the actions and practices of the clinics staff are testing the margins of orthodox physiotherapy practice and exploring the new market possibilities offered by consumer demand for optimal health. The study explores how the physiotherapists at the clinic are problematizing the practices, clinical spaces and clientele associated with orthodox practice, and, most notably, commodifying breathing, to create a space within which it is possible to think about physiotherapy otherwise. This study builds on the instability now surrounding the orthodox health professions and asks if exemplars like that offered in this article provide some meaningful insights into the future for healthcare practice.