Rebecca L. Phillips

Time's up. descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey.

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5–16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.

Measuring activity and participation in children and adolescents with disabilities: a literature review of available instruments.

BACKGROUND/AIM This article aims to (1) identify instruments available to measure activity and participation in children with disabilities; (2) describe the reliability and validity of these instruments; and (3) consider whether the available instruments capture the extent of involvement, as well as the difficulty and satisfaction/enjoyment associated with performance in all life areas. METHOD A literature review was completed by undertaking an electronic search to identify instruments that measure activity and participation in children with disabilities. A further electronic search was conducted to obtain an adequate description of the instruments, including psychometric properties. RESULTS The search identified 20 instruments purporting to measure activity and participation, however, no single instrument measured extent of involvement, difficulty and satisfaction/enjoyment in all life areas. There were instances in which each of these aspects was captured, but not within the one instrument. Instruments assessed combinations of frequency, difficulty, assistance, environment and satisfaction across varying contexts, for example, school, domestic life, recreational tasks, leisure tasks or all life areas. CONCLUSIONS Although a large number of instruments exist to measure varying aspects of activity and participation, there is currently no single instrument available to measure the extent of involvement, difficulty and satisfaction/enjoyment in all life areas. This finding indicates that there is the opportunity to develop a single instrument to measure activity and participation across all life areas.

Achieving patient‐centred care: the potential and challenge of the patient‐as‐professional role

The patient‐as‐professional concept acknowledges the expert participation of patients in interprofessional teams, including their contributions to managing and coordinating their care. However, little is known about experiences and perspectives of these teams.

Developing an inter-organizational community-based health network: an Australian investigation

Networks in health care typically involve services delivered by a defined set of organizations. However, networked associations between the healthcare system and consumers or consumer organizations tend to be open, fragmented and are fraught with difficulties. Understanding the role and activities of consumers and consumer groups in a formally initiated inter-organizational health network, and the impacts of the network, is a timely endeavour. This study addresses this aim in three ways. First, the Unbounded Network Inter-organizational Collaborative Impact Model, a purpose-designed framework developed from existing literature, is used to investigate the process and products of inter-organizational network development. Second, the impact of a network artefact is explored. Third, the lessons learned in inter-organizational network development are considered. Data collection methods were: 16 h of ethnographic observation; 10 h of document analysis; six interviews with key informants and a survey (n = 60). Findings suggested that in developing the network, members used common aims, inter-professional collaboration, the power and trust engendered by their participation, and their leadership and management structures in a positive manner. These elements and activities underpinned the inter-organizational network to collaboratively produce the Health Expo network artefact. This event brought together healthcare providers, community groups and consumers to share information. The Health Expo demonstrated and reinforced inter-organizational working and community outreach, providing consumers with community-based information and linkages. Support and resources need to be offered for developing community inter-organizational networks, thereby building consumer capacity for self-management in the community.

Social inclusion for children with hearing loss in listening and spoken Language early intervention: an exploratory study

BackgroundSocial inclusion is a common focus of listening and spoken language (LSL) early intervention for children with hearing loss. This exploratory study compared the social inclusion of young children with hearing loss educated using a listening and spoken language approach with population data.MethodsA framework for understanding the scope of social inclusion is presented in the Background. This framework guided the use of a shortened, modified version of the Longitudinal Study of Australian Children (LSAC) to measure two of the five facets of social inclusion (‘education’ and ‘interacting with society and fulfilling social goals’). The survey was completed by parents of children with hearing loss aged 4–5 years who were educated using a LSL approach (n = 78; 37% who responded). These responses were compared to those obtained for typical hearing children in the LSAC dataset (n = 3265).ResultsAnalyses revealed that most children with hearing loss had comparable outcomes to those with typical hearing on the ‘education’ and ‘interacting with society and fulfilling social roles’ facets of social inclusion.ConclusionsThese exploratory findings are positive and warrant further investigation across all five facets of the framework to identify which factors influence social inclusion.