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There is increased commitment to the participation and self-representation of people with lived experiences as refugees and asylum seekers in advocacy, especially at international, high-level events. However, we know very little about what opportunities and challenges such processes present. This paper reports on findings from a research project on youth participation and self-representation at the United Nations High Commissioner for Refugees (UNHCR) in collaboration with two young women and two young men from refugee backgrounds who live in Australia. We contribute new perspectives to contemporary debates on the potential for participation and self-representation in high-level consultations to effect policy change. [ABSTRACT FROM AUTHOR]

Objectives: To determine national service usage for initial and subsequent outpatient consultations with a consultant physician and any variation in service-use patterns between states and territories relative to population. Methods: An analysis was conducted of consultant physician Medicare claims data from the year 2014 for an initial (item 110) and subsequent consultation (item 116) and, for patients with multiple morbidities, initial management planning (item 132) and review (133). The analysis included 12 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, general medicine, geriatric medicine, haematology, immunology and allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology). Main outcome measures were per-capita service use by medical speciality and by state and territory and ratio of subsequent consultations to initial consultations by medical speciality and by state and territory. Results: There was marked variation in per-capita consultant physician service use across the states and territories, tending higher than average in New South Wales and Victoria, and lower than average in the Northern Territory. There was variation between and within specialties across states and territories in the ratio of subsequent consultations to initial consultations. Conclusion: Significant per-capita variation in consultant physician utilisation is occurring across Australia. Future studies should explore the variation in greater detail to discern whether workforce issues, access or economic barriers to care, or the possibility of over- or under-servicing in certain geographic areas is leading to this variation. What is known about the topic?: There are nearly 11 million initial and subsequent consultant physician consultations billed to Medicare per year, incurring nearly A$850 million in Medicare benefits. Little attention has been paid to per-capita variation in rates of consultant physician service use across states and territories. What does this paper add?: There is marked variation in per-capita consultant physician service use across different states and territories both within and between specialties. What are the implications for practitioners?: Variation in service use may be due to limitations in the healthcare workforce, access or economic barriers, or systematic over- or under-servicing. The clinical appropriateness of repeated follow-up consultations is unclear. [ABSTRACT FROM AUTHOR]

A significant gap exists in knowledge about general practice nurses'(GPNs) patient care activities, despite their now strong presence in Australian general practice. The aim of this paper is to explore the extent of direct general practitioner (GP) involvement in nurse-patient consultations, and to compare consultations where nurse-specific Medicare items were claimable with consultations where they were not. Data from the Practice Nurse Work Survey, a national cross-sectional survey conducted between May 2007 and May 2008, were analysed. Of the total 5253 nurse- patient encounters, 29% did not involve any contact between the patient and a GP, either directly before, during or directly after the nurse consultation. Encounters without GP involvement were more likely to be indirect (e.g. by telephone) and off-site (e.g. home visits), and had higher rates of administrative actions such as documentation and arranging visits. Nurse-specific Medicare item numbers applied in less than half (42%) of nurse-patient encounters. Encounters where no such item applied were more likely to involve medical examinations, blood tests, electrical tracings, physical function tests, removal of sutures, test results, assisting at operations and preparing for procedures. These results confirm that existing data collections do not capture the extent and nature of GPNs' clinical work. [ABSTRACT FROM AUTHOR]

Complementary and alternative medicine (CAM) is now a significant practice issue for those delivering cancer care with a range of CAM being utilized by a significant number of patients with cancer. While various studies have explored the prevalence of CAM use among cancer patients, little is currently known about naturopathy/herbalism use by patients with cancer in Australia. This paper reports the prevalence of naturopath/herbalist consultations among mid-aged Australian women with cancer. The research was conducted as part of the Australian Longitudinal Study on Women's Health, with the data for this analysis coming from the third survey of 11 202 women aged 50–55, conducted in 2001. For all cancers combined, 15.7% of women with cancer were found to consult a naturopath/herbalist. Mid-aged women with cancer were found to be more likely to consult a naturopath/herbalist than mid-aged women without cancer. Naturopathy/herbalism consultations appear to be utilized by the women with cancer alongside and as a supplement to conventional health services. Given the prevalence of consultations with herbal therapists/naturopaths among mid-aged women with cancer in Australia, it is important that physicians and others involved in cancer patient care and management are informed and educated about naturopathy/herbalism and its use among their patients. [ABSTRACT FROM AUTHOR]

Background People with an intellectual disability (ID) have more complex and different patterns of health care needs than the general population. They experience a greater burden of multi-morbidity, high levels of undetected and unmanaged health issues, and premature mortality than the general population. Primary care has a key role in the health care of people with an ID. Currently, very little is known about the consultation type and length, problems managed, and how general practitioners (GPs) manage these problems for people with an ID compared with the general population. This information would provide valuable insights into how GPs are achieving the health guidelines and facilitating people with an ID to achieve the highest attainable standard of health. Methods A secondary analysis of data was collected from January 2003 to December 2012 from the Bettering the Evaluation and Care of Health (BEACH) programme. Consultation type, consultation length in minutes, problem(s) managed during the consultation, medications, treatments provided, and referrals made, pre and post age-sex standardisation, at all GP encounters with people identified in the encounter record as having an ID ('ID' encounters, n = 690) were compared with those at 'non-ID' encounters ( n = 970 641). Statistical significance was tested with 95% confidence intervals. Results This study identified significant differences in consultation types, consultation length, problem(s) managed during the consultation, medications, treatments provided, and referrals made at 'ID' encounters compared with 'non-ID' encounters. 'ID' encounters had more indirect encounters, longer consultations, more problems managed, but an under management of common health conditions in people with an ID. Administrative rather than medically related actions dominated clinical treatments for people at 'ID' encounters, and they received fewer procedural treatments, referrals to specialists, and medications compared with those at 'non-ID' encounters. Conclusion The significant differences in consultations, problems identified and managed suggest that GPs may require additional support to (1) identify and manage common medical conditions experienced by people with an ID; (2) manage the increased time required for consultations; and (3) directly consult with people with an ID. Further research is required to determine why GPs managed problems in a significantly different way for people with an ID. [ABSTRACT FROM AUTHOR]