Making a difference: Intervening to improve health outcomes
 The 39th annual PHAA conference
28-30 September 2009, Canberra
Attended by Ellen McIntyre, PHC RIS
The 39th Annual Conference of the Public Health Association of Australia, (PHAA) held in Canberra from 28-30 September, focused on research, policy and practice that sought to improve health for all. Professor Terry Dwyer (Murdoch Children’s Research Institute) demonstrated the significance of observational studies in providing insights leading to interventions that have reduced the incidence of important diseases. Professor Simon Chapman (University of Sydney) outlined how Australia’s tobacco control program exemplified best practice in tackling the leading cause of premature death.
Papers on bridging the evidence-policy-practice gap aroused much interest. Examples of ways in which these gaps are being bridged include Evidence Check and Policy in Action Roundtable from the SAX Institute <www.saxinstitute.org.au>, the Policy Liaison Initiative from Australasian Cochrane Centre <www.cochrane.org.au/ebpnetwork>, the Public Health Advocacy Institute of WA (PHAIWA) <www.phaiwa.org.au>), the Benevolent Society <www.bensoc.org.au/director/whatwedo/policyandresearch.cfm> and Health in all Policies (HiaP), an innovative policy strategy that responds to the critical role that health plays in the economies and social life of 21st century societies <www.ilonakickbusch.com/health-in-all-policies>.
Syndemics, the study of factors (eg. diseases, poverty etc) interacting synergistically and contributing to excess burden of disease in a population, was the topic of Centers for Disease Control (CDC) Dr Bobby Milstein’s presentation. Through using formal system science techniques such as causal mapping and simulation modelling, Dr Milstein demonstrated a more dynamic understanding of how best to navigate change in complex systems. <www.cdc.gov/syndemics/monograph/index.htm>
In contrast, Dr David Whiteman (Qld Institute of Medical Research) gave examples of how ‘blue sky’ epidemiology (to explore relationships between any factors or phenomenon you find interesting) can lead to paradigm-shifting discoveries. There was certainly something for everyone at this event.
The 40th annual PHAA conference will be held in Adelaide from 27-29 September 2010. The Call for abstracts is already open at <www.phaa.net.au/40thPHAAAnnualConference.php>
Learning from patient experience: a growing field
 Integrated Primary Health Care Conference
30 September – 1 October 2009, Melbourne
Attended by Eleanor Jackson Bowers, PHC RIS
The Integrated Primary Health Care Conference, held in Melbourne on 30 September and 1 October 2009 provided many case studies of Australian models of service integration which will provide learnings for any future national system. These include Health One in NSW, the Victorian Primary Care Partnerships and the Connecting Healthcare in Communities (CHIC) projects from Queensland. We also heard about a number of regional models and about eHealth initiatives which can support service integration.
The Conference had a sub theme of measuring and learning from the experience of patients using our services. Learning from the experience of our patients is more than assessing patient satisfaction. As Michael Greco said, public confidence requires more than clinical competence. What wins minds and hearts are the relational aspects of care and the type of interaction experienced by a patient. It is not only the patients who benefit. The interaction is ‘sacred space’ and in working with patients within that space clinicians learn from our patients’ suffering. Nothing gives us more knowledge of our humanity. ‘We get strong in the broken places’.
Brisbane South Division of General Practice is taking a systematic approach to listening to the voice of the patient, believing that a prepared proactive practice team and an informed activated patient make for productive interaction. Patients from each practice are asked about the interaction skills of their GPs and the results are de-identified and fed back to individual GPs. The information remains confidential to that GP and is not used in any other way. However this can be confronting for GPs. Vicki Poxon, from the division, told us of one GP who initially thought it was ‘the work of the Devil’ but later came to be the greatest advocate for the project. An evaluation is in progress and we look forward to the findings.
See the Conference website for more information <www.integratedprimaryhealth.com/>
Evidence and Evaluation
 2009 Australasian Evaluation Society International Conference
31 August - 4 September 2009, Canberra
Attended by Nova Reinfeld-Kirkman, PHC RIS
After a beautiful welcome to country and a song from the New Zealand contingent, the plenary session presented by William Trochim commenced. The subject of the talk reflected the Conference’s focus on Evidence and Evaluation. Professor Trochim gave an overview of the history of the evidence-based movement in evaluation, arising from the work of Sackett et al. in medicine. The talk can be seen at <www.aesconference2009.com.au/documents/WilliamTrochim.pdf>. Professor Trochim’s talk further encompassed recent controversies arising in the USA, between proponents of experimental methods, in particular randomised controlled trials, and evaluators who doubt the feasibility or necessity of using only such methods. The issues that arose in this talk remained pertinent throughout the Conference. In fact, many delegates became embroiled in rather heated discussions about the nature of evidence and what constitutes good evidence. This made for extremely interesting question times! As part of the primary health community, I think we can be proud of the extent to which we have used sophisticated epistemological/methodological frameworks in order to reconcile different methods of data collection and analysis. Certainly, it would seem that other fields are still struggling with issues that have been, for the most part, resolved in PHC.
Other presentation highlights included Terry O’Brian (First Assistant Commissioner, The Productivity Commission) who gave a great insight into the workings of the Commission, and Patricia Rogers who did an exceptional job of balancing the arguments for and against the pure use of quantitative methods. Another highlight for me was presenting on the topic of data visualisation techniques; although the 40 min timeframe was a bit nerve-wracking for a first-time presenter!
Themes that emerged throughout the conference were the ways to integrate evaluation evidence in to policy. Specifically, we were reminded that the evaluation community often has different goals and priorities to that of policy makers and were given some very useful strategies and ideas as to how best to handle this schism.
Further information is available at: <www.aesconference2009.com.au/>
Health Care Reform: Primary Health Care Organisations
 National Forum PHCOs
21 October 2009, Sydney
Attended by Libby Kalucy and
Eleanor Jackson-Bowers, PHC RIS
The UNSW Centre for Primary Health Care and Equity organised a national forum to discuss a possible future role for Primary Health Care Organisations (PHCO) in Australia. Keen response to the forum invitation led to more than 60 invited self funded participants from a wide range of organisations and jurisdictions coming together to formulate their views.
The group heard case studies of the achievements and evolution of primary health care organisations from Jim Primrose from the Ministry of Health in New Zealand, Chris Brook from the Victorian Department of Health and Terry Findlay, formerly from the Greater Glasgow and Clyde NHS in Scotland. In each case the organisations took a long time to develop around local and national needs, and they continue to evolve. Good data systems and prospective evaluations have made it possible to assess and monitor the achievements of these PHCOs.
The case studies triggered productive discussion about numerous issues. Health reform is being undertaken in a highly complex environment and the shape of the proposed new organisations will be influenced by the outcome of other decisions in areas such as eHealth, patient enrolment, population health and general practice funding as well as the outcome of Commonwealth–State negotiations. There are many options and each affects the other. Changes will need to take into account the differing context in each State and Territory.
Participants found many areas of agreement and common ground. The forum drafted a compendium of ‘things that we need to get right’ and documented important considerations to inform future decisions. The atmosphere reflected a mood for serious change.
A summary report and presentations for this Forum are available through the CPHCE website
<http://notes.med.unsw.edu.au/CPHCEWeb.nsf/page/News+and+Events>
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