Background: Community Health Workers (CHWs) are proven to be highly effective in low- and middle-income countries with many examples of successful large-scale programs. There is growing interest in deploying CHW programs in high-income countries to address inequity in healthcare access and outcomes amongst population groups facing disadvantage. This study is the first that examines the scope and potential value of CHW programs in Australia and the challenges involved in integrating CHWs into the health system. The potential for CHWs to improve health equity is explored. Methods: Academic and grey literature was searched to examine existing CHW roles in the Australian primary healthcare system. Semi-structured telephone interviews were conducted with a purposive sample of 11 people including policymakers, program managers and practitioners, to develop an understanding of policy and practice. Results: Literature on CHWs in Australia is sparse, yet combined with interview data indicates CHWs conduct a broad range of roles, including education, advocacy and basic clinical services, and work with a variety of communities experiencing disadvantage. Many, and to some extent inconsistent, terms are used for CHWs, reflecting the various strategies employed by CHWs, the characteristics of the communities they serve, and the health issues they address. The role of aboriginal health workers (AHWs) is comparatively well recognised, understood and documented in Australia with evidence on their contribution to overcoming cultural barriers and improving access to health services. Ethnic health workers assist with language barriers and increase the cultural appropriateness of services. CHWs are widely seen to be well accepted and valuable, facilitating access to health services as a trusted ‘bridge’ to communities. They work best where ‘health’ is conceived to include action on social determinants and service models are less hierarchical. Short term funding models and the lack of professional qualifications and recognition are challenges CHWs encounter. Conclusion: CHWs serve a range of functions in various contexts in Australian primary healthcare (PHC) with a common, valued purpose of facilitating access to services and information for marginalised communities. CHWs offer a promising opportunity to enhance equity of access to PHC for communities facing disadvantage, especially in the face of rising chronic disease.

Objective: The use of benzodiazepines by elderly people is of limited therapeutic benefit and increases the risk of adverse events. This study aimed to examine the extent to which benzodiazepines are prescribed for elderly Australians. Methods: Data for 3,970 individuals aged 65 years or more were extracted from a general practice database. Benzodiazepine prescriptions for 2002 were reviewed. Results: Overall, 16% (95% CI 11–21%) of elderly patients had at least one benzodiazepine prescription. Females were almost twice as likely as males to be prescribed a benzodiazepine and prescription prevalence increased with age. Conclusions: Despite risks, benzodiazepines are widely prescribed for the elderly. Limited availability and cost of alternative therapies and pressures on the primary care system in Australia may contribute to their continued overuse. Implications: The prescribing of benzodiazepines for elderly Australians needs to be reduced by better managing sleep and anxiety problems.

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This study identifies current practices of private health funds (PHFs) in Australian primary health care (PHC), including areas where their involvement is increasing, and examines the risks and benefits of these practices for quality of, and equity of access to PHC. The paper draws on research to investigate equity implications of current PHF involvement in PHC in Australia. We reviewed literature, analysed documents relating to a Senate Committee inquiry and interviewed stakeholders and experts in private health insurance policy from government, private sector and nongovernment organisations. Involvement of PHFs in the PHC sector in Australia is increasing, presenting risk of increased inequities in access to PHC based on insurance status, which could undermine the universality of PHC under Medicare. However, some stakeholders think these risks can be managed within current policy arrangements.There are also risks for quality of PHC services arising from greater involvement of PHFs in service delivery and "preferred provider" models. Differing stakeholder views on equity implications of PHF involvement in PHC are associated with different views on desirable policy action. We conclude that there is a risk of increased involvement of PHFs in PHC risks exacerbating existing inequities in the health system, but this is moderated by public support for Medicare.

Background: Strategies to help researchers use the research evidence they (co)produce to inform policy should be tailored to the context. Yet there is little guidance on research-policy engagement activities in nursing and health sciences disciplines. Aims and objectives: We explored the experiences and perspectives of nursing and health sciences researchers at different career stages, regarding research-policy engagement activities and their impacts on policy. We also explored researchers’ understanding of terminology and theory regarding research-policy engagement. Methods: We conducted semi-structured qualitative interviews with 17 researchers, at various career stages, and conducted content and thematic analysis of the data. Findings: ‘Disseminating and communicating research’, and ‘building professional partnerships’ were the most common types of activity, with senior researchers favouring the latter. Early and mid-career researchers favoured the former, citing the need to build credibility and track record before engaging with policy actors. We identified individual and contextual factors that influence policy impact and researchers’ capacity to engage in such activities. Researchers’ conceptions and understanding regarding evidence-informed policymaking theory and process varied. Terminology also varied, with ‘knowledge translation’ the most common term. Discussion and conclusions: Despite evidence indicating the limited effectiveness of dissemination activities on policy, researchers pursue such efforts, to enable the formation of relationships with influential policy actors and policy impact in the longer term, and because of academia’s drive for research outputs. Researchers would benefit from supportive organisational contexts and greater knowledge of research-policy engagement theory, evidence and practice, through tailored workshops addressing relational and political considerations, as well as structured mentoring.