Kaye Ervin

Caregiver distress in dementia in rural Victoria

The aim of this study was to explore the levels of stress, anxiety and depression of informal carers caring for someone with dementia in a rural setting.

Responding to rural health needs through community participation: addressing the concerns of children and young adults

A small rural health service undertook a major needs analysis in 2008 to identify gaps in service delivery and duplication of services. This exercise was intended to inform strategic direction but the result was consumer and community consultation and outcomes that far exceeded everyones expectations. Organisations often pay lip service to the concept of community participation and consultation and the importance of consumer involvement. Turning this rhetoric into action is challenging and requires dedicated staff, organisational support and momentum for it to occur. The project described resulted in targeted, purposeful action regarding community engagement, and the findings and outcomes are reflective of this. The unexpected findings required an organisational shift, which was embraced by the health service and resulted in collaborative partnerships with consumers and organisations that are proving beneficial to the entire community and outlying areas. Few organisations would demonstrate the willingness to accommodate such change, or undertake a needs analysis that is chiefly community driven.

Do Not "Let Them Eat Cake": Correlation of Food-Consumption Patterns among Rural Primary School Children from Welfare and Non-Welfare Households.

Physical and financial access impacts food choice and consumption, while educational attainment, employment, income, gender, and socioeconomic status are also influential. Within this context, the aim of the paper is to examine the association between various foods consumed and eating patterns of children between low and higher income households. A paper-based survey was completed by parents/carers of children in 41 primary schools in rural and regional areas of Victoria. Data collected included demographics and the consumption of fruit, vegetable, and other foods including drinks. Ordinal data were analysed using Spearman’s rank-order correlation. The main findings were that children who consumed more fruit and vegetables tended to have a higher intake of healthy drinks (plain milk and water) as well as a lower intake of unhealthy snacks and drinks (sugar sweetened drinks). Those who perceived that fruit and vegetables cost too much reported greater consumption of unhealthy snacks and sugar-sweetened beverages, which was more prominent in low-income households. Changing food consumption behaviours requires a complex systems-based approach that addresses more than just individual issues variables. A participatory approach that works with local communities and seeks to build an understanding of unique challenges within sub-groups has potential for embedding long-lasting and meaningful change in eating behaviours.

Fruit and Vegetable Consumption in Rural Victorian School Children

Fruit and vegetable consumption is accepted as the cornerstone of healthy eating practices. In turn, healthy eating is linked to the prevention of a number of chronic diseases. Healthy eating practices should begin in early childhood and continue throughout life. This study aimed to determine fruit and vegetable consumption in children aged 6-12 years in three local government areas in rural Australia, and examines the factors which influence consumption, such as access, cost and parental education and behaviours. Parents of school children in grades one and three from 41 schools completed a survey regarding fruit and vegetable consumption, and associated factors, for their child. Five hundred and forty four surveys were completed and returned. The results showed that while fruit consumption was within the recommended guidelines for 97% of children, only 12% ate the recommended serves of vegetables for this age group. The results did not vary between the age and gender of children nor parental income or education. Parental sources of knowledge for healthy eating was reported as predominantly family and friends as well as newspapers, internet and magazines. Examining fruit and vegetable consumption separately highlighted the need for a focused intervention on increasing vegetable consumption in the three local government areas. The sources of parental knowledge provided important information for health promotion activities

Prevalence of adolescent violence in the home and service system capacity in rural Victoria

Adolescent violence in the home (AVITH) is increasing. In Victoria alone, police call-out data indicates a consistent 9% rise per annum from 2006. Community services are struggling to provide a cohesive response to this issue. This study examined the prevalence, risk factors and service system capacity regarding AVITH in Mitchell Shire, a geographical location in central Victoria. The results of the study revealed that specific funding was perceived by organisations to be the single highest need in regards to this phenomenon. Recommendations for the service system in Mitchell Shire included a collaborative approach to establish assessment guidelines, referral pathways and protocols for responding to the disclosure of AVITH. To effectively support workers in Mitchell Shire, a quality service system response would involve the development of common standards of practices across these processes. The methodology used with the AVITH Service System Capacity Assessment Survey, specifically developed for this study, may provide a useful tool for other locations investigating service gaps and needs in relation to adolescent family violence.

Service utilisation by carers of people with dementia in rural Victoria

To explore the use of community and dementia‐specific services by informal carers caring for someone with dementia in a rural setting.

Why Australia needs to define obesity as a chronic condition

BackgroundIn Australia people with a diagnosed chronic condition can be managed on unique funded care plans that allow the recruitment of a multidisciplinary team to assist in setting treatment goals and adequate follow up. In contrast to the World Health Organisation, the North American and European Medical Associations, the Australian Medical Association does not recognise obesity as a chronic condition, therefore excluding a diagnosis of obesity from qualifying for a structured and funded treatment plan.BodyThe Australian guidelines for management of Obesity in adults in Primary Care are structured around a five step process -the ‘5As’: Ask & Assess, Advise, Assist and Arrange’. This article aims to identify the key challenges and successes associated with the ‘5As’ approach, to better understand the reasons for the gap between the high Australian prevalence of overweight and obesity and an actual diagnosis and treatment plan for managing obesity. It argues that until the Australian health system follows the international lead and defines obesity as a chronic condition, the capacity for Australian doctors to diagnose and initiate structured treatment plans will remain limited and ineffective.ConclusionAustralian General Practitioners are limited in their ability manage obesity, as the current treatment guidelines only recognise obesity as a risk factor rather than a chronic condition.

Evaluation of Preventative Screening for Chronic Disease in a Rural Primary Health Service

Prevention is a key element of primary health care and screening provides the ability to reduce complications and health care burden by early identification of potential disease. There is however little information on the effectiveness or uptake of advice from positive chronic disease screening in rural areas of Australia. This study provides evidence for screening for chronic conditions and uptake of advice to consult their medical practitioner when risk factors were identified. Community screening in rural Victoria was undertaken with 56 people screened over a six month period from November 2014 to April 2015. Only participants who scored above 12 on the Australian Diabetes type 2 diabetes risk assessment tool (AUSDRISK) who were not regularly engaged with a medical practitioner regarding their diabetes risk or with high blood pressure were asked to participate in the research project. A total of 24 people were screened positive and were advised to attend their medical practitioner. Twenty three participants consented to a follow up interview post participation in screening to determine uptake of advice and outcomes of medical practitioner engagement with a final 20 participants interviewed. Results demonstrated that the majority of people with a risk of high blood pressure identified during the screening made an appointment with their medical practitioner. Medical practitioners initiated treatment or further testing with these people, ensuring that early intervention would lead to a reduction in complications reducing further burden on the health care system. This early intervention has the potential to avert complications and although the sample was small, it suggests that screening is beneficial and uptake of advice is acted on by those at risk of chronic disease.

Establishing a clinic for young people in a rural setting: a community initiative to meet the needs of rural adolescents

This paper describes the establishment and evaluation of a rural clinic for young people. A conceptual approach to community development was used to establish the clinic in a small north Victorian rural health service, with qualitative methods used to evaluate services. Study participants were members of an operational committee and advisory committee for the establishment of the rural clinic for young people. The clinic was evaluated against the World Health Organization framework for the development of youth-friendly services. With robust community support, the clinic was established and is operational. Most consultations have been for sexual and mental health. Qualitative evaluation identifies that not all the World Health Organization benchmarks have been met, but this is hampered predominantly by financial constraints. In conclusion, establishing clinic for young people in a small rural setting can be achieved with community support and the development of referral pathways.

Utilising the screening tool to alert doctors to the right treatment with the screening tool of older people's potentially inappropriate prescriptions.

Dear Editor,Your recent publication of the work of Manias et al. [1]highlighted the prevalence of potentially inappropriate medi-cations (PIMs) in older people admitted to Australian hospi-tals. It is well known that older people have a far greater riskof adverse events related to medication, the causes of whichare multifactorial [2], but include the pharmacokineticchanges that occur with ageing (changes in drug absorption,distribution, metabolism and elimination), as well asdrug–disease interactions because of multiple comorbiditiesand drug–drug interactions due to polypharmacy [3].Polypharmacy, the prescription of multiple medications, haslong been recognised as problematic [4].It must also be recognised that older people have multiplecomorbidities for which they are prescribed multiple medica-tions[5].ItisforthisreasonthatthetoolusedbyManiaset al.[1], the Screening Tool of Older People’s potentially inappro-priate Prescriptions (STOPP) [6], was further developed toinclude a Screening Tool to Alert doctors to the Right Treat-ment (START) [7]. The tool was devised by a panel of expertsingeriatricpharmacy[8],hasgoodinterraterreliabilityandisreported to be more clinically relevant than similar toolsmeasuring medication usage [6]. The combined STOPP/START tool addresses undertreatment among older adultsalongwithuseofmedicationsthatarepotentiallyinappropri-ate [8,9]. A randomised controlled trial that compared usualpharmaceutical practices with screening using the STOPP/START tool suggested that significantly lower rates ofpolypharmacy and potential drug–drug and drug–diseaseinteractions occurred in the intervention group, as well asreductions in underprescribing [7]. Like Manias et al. [1],otherrecentAustralianstudieshavefailedtoutilisetheSTARTtooltodetectpotentialunderprescribingforolderpeople[10].The use of a medication is generally considered appropriateif the expected benefits of the medication outweigh thepotential risks. While vital, efforts to identify and reducePIMs in older people must be secondary to maintainingphysical or cognitive function or relief of symptoms, whichcan only be achieved by concurrently identifying potentialunderprescribing.