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Introduction: The Australian Gold Coast Integrated Care programme trialled an innovative model of care to proactively manage high risk patients with complex and chronic conditions in collaboration with general practitioners. The objective was to enhance coordination and continuity of care across primary and secondary health services from a single point-of-entry multidisciplinary coordination centre. This case study, embedded in the broader trial, analysed the perceptions of patients, healthcare staff and general practitioners on the adequacy, comprehensiveness, timeliness and acceptability of the new model of care to help inform the decision by the health service whether to adopt it beyond the trial. Methods: This mixed method embedded, explanatory case study design included surveys of general practice staff and focus groups with patients, carers and coordination centre staff. Qualitative data were thematically analysed and findings merged with survey data in a narrative explanatory case report. Discussion: Staff, patients, general practitioners and practice nurses were generally satisfied with services, coordination of care and information sharing but general practice staff satisfaction ratings declined over time. Conclusion: The programme enhanced care and coordination of services and was valued by patients and healthcare providers. Study results provide a rationale for adopting the model for those with chronic and complex conditions. [ABSTRACT FROM AUTHOR]

This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve the capacity of specialist outpatients, and decrease planned and unplanned admission rates. Central to the model is a shared care record which is maintained and accessed by staff in the Coordination Centre. We provide a process map outlining the care protocols from initial assessment to care of the patient presenting for emergency care. The model is being evaluated over a pilot three year proof of concept phase to determine economic and process perspectives. If found to be cost-effective, acceptable to patients and professionals and as good as or better than usual care in terms of outcomes, the strategic intent is to scale the programme beyond the local health service. [ABSTRACT FROM AUTHOR]

This quality improvement project implemented bedside handover in nursing. Using Lewin's 3-Step Model for Change, 3 wards in an Australian hospital changed from verbal reporting in an isolated room to bedside handover. Practice guidelines and a competency standard were developed. The change was received positively by both staff and patients. Staff members reported that bedside handover improved safety efficiency, teamwork, and the level of support from senior staff members. [ABSTRACT FROM AUTHOR]

This article argues that a primary health care approach is an appropriate conceptual framework for addressing the health needs of Indigenous people. Primary health care is strategic, focusing on equity, access, empowerment and intersectoral partnerships as essential elements for maintaining health. Stereotypical notions of Indigenous ill health as being embedded in a general view of 'culture' can mitigate against achieving equity, access to health care and ultimately self-determinism. Because health is embedded in the social conditions of people's lives, the emphasis in Indigenous health care should first address Indigenous social disadvantage and ways of working in partnership with various groups of Indigenous people to achieve their health goals. A critical multicultural approach situates cultural differences within the wider nexus of power relations, and helps overcome the negative stereotyping that often prevents inclusive, self-determined care. Recommendations are suggested for change at the societal, professional and individual level. [ABSTRACT FROM AUTHOR]

Aim. To investigate general surgical patients’ perspectives of the adequacy and appropriateness of their discharge planning. Objectives. To identify any aspects of discharge planning that could be strengthened to assist people in managing their posthospital care and maintaining continuity of care. Background. Appropriate discharge planning is a priority in today's healthcare environment in which patients are discharged ‘quicker and sicker’, sometimes without home support. Adequate and appropriate discharge planning helps promote health literacy, which has benefits for both patients and their caregivers in helping them manage postsurgical recovery at home. Design. A qualitative, interpretive study was designed in which patients were interviewed at least one week after they returned home from hospital. Methods. Purposeful sampling was used to interview 13 general surgical patients from one of three hospitals (two public and one private) in New South Wales and Queensland, Australia. Data were collected in unstructured interviews and analysed using thematic analysis. Reflective analysis by individual research team members generated preliminary themes, which were then analysed collectively by all members of the research team to achieve consensus on patients’ perspectives. Results. Themes included a ‘one-size-fits-all’ approach to providing discharge information; inconsistent or variable advice from different health professionals; a lack of predischarge assessment of their home and/or work conditions and the need for follow-up assessment of patient and carer needs. Conclusions. The findings of this study illuminate the need for a more individualized approach to discharge planning, taking into account the patient's age, gender, surgical procedure and family and community support for immediate and longer-term nursing follow-up. Relevance to clinical practice. Patients would be more adequately prepared for their recovery period at home, by encouraging client-centred, interdisciplinary communication between health practitioners; adopting a flexible, approach to discharge planning which is tailored to individual needs of postsurgical patients, particularly in relation to advice and information related to recovery; and encouraging and supporting adequate health literacy for self-management. [ABSTRACT FROM AUTHOR]

Reports on the movement toward health care for all through community self-empowerment in the U.S. Role of nurses to devise strategies to mediate between people and their physical, cultural and social environment; Advancement of the professional image, status and credibility of nursing; Involvement in social and political advocacy. INSET: Health for All-Where are We Today?.