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Dwyer, Judith

doi:10.1186/1743-8462-1-6

Cited by 31 publications

(10 citation statements)

References 3 publications

(2 reference statements)

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“…This trend towards centralised decision-making has occurred in most Australian States and Territories. 30 Most recently, the SA Government implementation of the review of non-hospitalbased services 31 has led to budget cuts to almost all health promotion in PHC services and reinforces this change of direction. The Obesity Prevention and Lifestyle program (OPAL) is one of the few health promotion programs to escape cuts because it rests on a National Partnership Agreement on Preventive Health, but this program is implemented through selected local governments rather than PHC services.…”

Section: Discussionmentioning

confidence: 99%

Health policy in South Australia 2003–10: primary health care workforce perceptions of the impact of policy change on health promotion

Jolley

Freeman

Baum

et al. 2014

Health Prom J of Aust

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Issue addressed: This paper examines recent Australian health reform policies and considers how the primary health care (PHC) workforce experiences subsequent change and perceives its impact on health promotion practice. Methods: Health policy documents were analysed to determine their intended impact on health promotion. Interviews were conducted with 39 respondents from four State-funded PHC services to gain their perceptions of the impact of policy change on health promotion. Results: There have been a plethora of policy and strategy documents over the last decade relevant to PHC, and these suggest an intention to strengthen health promotion. However, respondents report that changes to the role and focus of PHC services have led to fewer opportunities for health promotion. Services are struggling to engage in health promotion activity, while funding and policy directions are prioritised to targeted, individual behaviour change. Conclusion:The experience of PHC workforce respondents in South Australia suggests that, despite policy intentions, health promotion practice is much reduced. Our research suggests that rigorous evaluation of health sector reforms should be undertaken to assess both intended and unintended outcomes in terms of service quality and delivery.So what? Health promoters are experiencing a contradictory policy and practice environment, and this research should assist health promoters in advocating for more government accountability in the implementation of policies in order to advance comprehensive PHC.?

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Section: Discussionmentioning

confidence: 99%

Health policy in South Australia 2003–10: primary health care workforce perceptions of the impact of policy change on health promotion

Jolley

Freeman

Baum

et al. 2014

Health Prom J of Aust

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“… 10 This retreat was despite the fact that Australian reviews of the health system have reinforced the importance of PHC and health promotion in particular. 26 27 Our models show that the broader sociopolitical context is crucial in shaping the implementation of PHC. Because comprehensive PHC challenges the powerful dominant biomedical model of health, a particularly supportive political context is required for its implementation.…”

Section: Discussionmentioning

confidence: 86%

What is the difference between comprehensive and selective primary health care? Evidence from a five-year longitudinal realist case study in South Australia

et al. 2017

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BackgroundSince the WHO’s Alma Ata Declaration on Primary Health Care (PHC) there has been debate about the advisability of adopting comprehensive or selective PHC. Proponents of the latter argue that a more selective approach will enable interim gains while proponents of a comprehensive approach argue that it is needed to address the underlying causes of ill health and improve health outcomes sustainably.MethodsThis research is based on four case studies of government-funded and run PHC services in Adelaide, South Australia. Program logic models were constructed from interviews and workshops. The initial model represented relatively comprehensive service provision in 2010. Subsequent interviews in 2013 permitted the construction of a selective PHC program logic model following a series of restructuring service changes.ResultsComparison of the PHC service program logic models before and after restructuring illustrates the changes to the operating context, underlying mechanisms, service qualities, activities, activity outcomes and anticipated community health outcomes. The PHC services moved from focusing on a range of community, group and individual clinical activities to a focus on the management of people with chronic disease. Under the more comprehensive model, activities were along a continuum of promotive, preventive, rehabilitative and curative. Under the selective model, the focus moved to rehabilitative and curative with very little other activities.ConclusionThe study demonstrates the difference between selective and comprehensive approaches to PHC in a rich country setting and is useful in informing debates on PHC especially in the context of the Sustainable Development Goals.

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“…30 Dwyer argued that the health systems reforms implemented by each state and territory, towards centralisation, would be counterproductive to stemming the Open access burgeoning tide of chronic disease plaguing the primary and secondary care levels of the Australian health system. 33 Dwyer flagged a need for better, innovative models of care. 33 The clinical governance models examined by Phillips describe clinical governance as a systematic, integrated approach to assuring safe, good, quality healthcare.…”

Section: Theme 1: Systems Strengtheningmentioning

confidence: 99%

“…33 Dwyer flagged a need for better, innovative models of care. 33 The clinical governance models examined by Phillips describe clinical governance as a systematic, integrated approach to assuring safe, good, quality healthcare. 21 Phillips' endorsement of the ACCHS model as a systems approach at an organisational level may lead to effective PHC, a decrease in chronic disease and an efficient business model.…”

Section: Theme 1: Systems Strengtheningmentioning

confidence: 99%

Quality management systems in Aboriginal Community Controlled Health Services: a review of the literature

et al. 2021

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BackgroundA national accreditation policy for the Australian primary healthcare (PHC) system was initiated in 2008. While certification standards are mandatory, little is known about their effects on the efficiency and sustainability of organisations, particularly in the Aboriginal Community Controlled Health Service (ACCHS) sector.AimThe literature review aims to answer the following: to what extent does the implementation of the International Organisation for Standardization 9001:2008 quality management system (QMS) facilitate efficiency and sustainability in the ACCHS sector?MethodsThematic analysis of peer-reviewed and grey literature was undertaken from Australia and New Zealand PHC sector with a focus on First Nations people. The databases searched included Medline, Scopus and three Informit sites (AHB-ATSIS, AEI-ATSIS and AGIS-ATSIS). The initial search strategy included quality improvement, continuous quality improvement, efficiency and sustainability.ResultsSixteen included studies were assessed for quality using the McMaster criteria. The studies were ranked against the criteria of credibility, transferability, dependability and confirmability. Three central themes emerged: accreditation (n=4), quality improvement (n=9) and systems strengthening (n=3). The accreditation theme included effects on health service expenditure and clinical outcomes, consistency and validity of accreditation standards and linkages to clinical governance frameworks. The quality improvement theme included audit effectiveness and value for specific population health. The theme of systems strengthening included prerequisite systems and embedded clinical governance measures for innovative models of care.ConclusionThe ACCHS sector warrants reliable evidence to understand the value of QMSs and enhancement tools, particularly given ACCHS (client-centric) services and their specialist status. Limited evidence exists for the value of standards on health system sustainability and efficiency in Australia. Despite a mandatory second certification standard, no studies reported on sustainability and efficiency of a QMS in PHC.

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Untitled

Cited by 31 publications

References 3 publications

Health policy in South Australia 2003–10: primary health care workforce perceptions of the impact of policy change on health promotion

Health policy in South Australia 2003–10: primary health care workforce perceptions of the impact of policy change on health promotion

What is the difference between comprehensive and selective primary health care? Evidence from a five-year longitudinal realist case study in South Australia

Quality management systems in Aboriginal Community Controlled Health Services: a review of the literature

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