RESUMEN
BACKGROUND: Improving the care of stroke patients is a national priority for the health system in Australia. In rural areas the challenges may be greater. Although best-practice guidelines for acute and subacute stroke care are well established, their general uptake appears to be limited and implementation strategies are required to promote the use of this evidence-based care. The Rural Organisation of Australian Stroke Teams (ROAST) project sought to promote the evidence-based stroke practice in rural hospitals. METHODS: This was a prospective observational project designed to improve the services provided to rural stroke patients, primarily through better organisation of care on general medical wards and emergency departments. Using recognized support strategies, we encouraged the use of nationally recognized key performance indicators and provided audit and feedback of adherence to these indicators to participating hospitals. RESULTS: Six Victorian hospitals participated in this initial phase of the ROAST project. Information was collected on 348 patients. Ten of the 11 indicators showed greater than 10% improvement in adherence levels and by the end of the project period compared favourably to levels of adherence described in metropolitan hospitals. CONCLUSION: The ROAST projected supported a network of clinicians to implement evidence-based guidelines in acute stroke care in the setting of general medical wards. In doing so, this project has shown that it is quite feasible to deliver best-practice care to stroke patients in rural Australia.
Asunto(s)
Medicina Basada en la Evidencia/organización & administración , Adhesión a Directriz/estadística & datos numéricos , Hospitales Rurales/normas , Grupo de Atención al Paciente/organización & administración , Garantía de la Calidad de Atención de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud , Accidente Cerebrovascular/terapia , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Actitud del Personal de Salud , Medicina Basada en la Evidencia/estadística & datos numéricos , Femenino , Adhesión a Directriz/tendencias , Encuestas de Atención de la Salud , Hospitales Rurales/organización & administración , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Medición de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Tasa de Supervivencia , VictoriaRESUMEN
This report compares the results from two sampling strategies used to determine the prevalence of elevated blood lead concentrations and iron status in 12-36 month old children in Central Sydney. The two methods were stratified random sampling using census collector districts and an opportunistic sampling strategy using client registers at Early Childhood Centres (ECCs). The response rates were 75.3% (n = 718 of whom 198 were aged 12-36 months) and 24.1% (n = 304) respectively. The geometric mean blood lead concentrations were 0.40 and 0.34 mumol/L respectively (p = 0.001). The traditional random sampling prevalence survey identified a significantly higher proportion of children with blood lead concentrations greater than 0.48 (OR = 0.61, 95% CI 0.40-0.93) and 0.72 mumol/L (OR = 0.44, 95% CI 0.21-0.92) compared to the simpler opportunistic survey. The median plasma ferritin concentration for both studies was 19 micrograms/L (p = 0.4). The prevalence of iron depletion, iron deficiency and iron deficiency anaemia was not significantly different between the two studies. In conclusion, opportunistic sampling through ECCs does not appear to be a substitute for the traditional random sampling prevalence surveys of determine the prevalence of elevated blood lead concentrations in pre-school children in Central Sydney. However, opportunistic sampling through ECCs may be an appropriate method for monitoring iron status, in particular iron depletion, in pre-school children in Central Sydney.
Asunto(s)
Hierro/sangre , Plomo/sangre , Distribución Aleatoria , Muestreo , Anemia Ferropénica/epidemiología , Australia/epidemiología , Guarderías Infantiles , Preescolar , Intervalos de Confianza , Estudios Transversales , Recolección de Datos , Femenino , Humanos , Lactante , Masculino , Oportunidad Relativa , Prevalencia , Sensibilidad y Especificidad , Distribución por SexoRESUMEN
OBJECTIVE: To compare GPs' willingness to participate in a GP pre-discharge project as measured by a survey, with actual participation rates. To identify the characteristics of GPs likely to make a pre-discharge visit to frail, aged inpatients admitted under the care of a geriatrician. METHOD PRE-IMPLEMENTATION GP SURVEY: Survey of a random sample of 100 GPs from the Central Sydney area using a standardised questionnaire. PRE-DISCHARGE VISIT PROJECT: Information on actual participation rates and GPs who declined to make a pre-discharge visit was obtained from an audit of Division of General Practice records. Information on Patient characteristics was obtained from patient interviews and medical records. The survey was conducted at the Balmain Hospital and Concord Repatriation and General Hospitals located within the Central Sydney Area Health Service. The subjects were GPs practising in central Sydney and patients admitted under the care of a geriatrician at Balmain and Concord Hospitals. RESULTS: Twenty-nine per cent of GPs reported that they were willing to undertake visits without remuneration and 71% reported they were willing to make a pre-discharge visit if remunerated. Fifty-three per cent of GPs actually complied with a request to make a remunerated pre-discharge visit. This was 18% less than the rate determined by the survey. GPs were less likely to make a visit if they were solo practitioners and not members of the Division. Patients who were more dependent, as measured by total Barthel's score, and those from nursing homes were less likely to receive a visit. CONCLUSION: GP surveys may overestimate participation rates in Division projects. In reality, it appears difficult for GPs to accommodate pre-discharge visits in a general practice routine and the offered remunerations may not be adequate compensation for time lost when undertaking a pre-discharge visit. Lastly, some GPs may not see a benefit in visiting more dependent patients.
Asunto(s)
Actitud del Personal de Salud , Alta del Paciente , Médicos de Familia , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Distribución de Chi-Cuadrado , Anciano Frágil , Humanos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To compare the intakes of haem and non-haem iron in iron depleted and iron replete children. DESIGN: Case-control study. SETTING: Early Childhood Centres and a long day care centre in Sydney, Australia. SUBJECTS: Children aged 12-36 months depleted in iron and controls matched for age and sex. MEAN OUTCOME MEASURES: Iron status by using plasma ferritin concentration. A three day weighed dietary intake record completed by the parents. Risk factors for iron deficiency assessed by questionnaire. RESULTS: Fifty six iron depleted and 68 iron replete children participated. The average daily intake of haem iron was significantly lower in the iron depleted group (t = 2.392, P = 0.018); there was a tendency towards a lower average daily intake of non-haem iron (t = 1.724, P = 0.086) and vitamin C (t = 1.921, P = 0.057) for iron depleted children. Low intake of haem iron (< 0.71 mg/day) was significantly associated with iron depletion with an odds ratio fo 3.0 (P = 0.005). The proportion of iron depleted children who were given whole cows' milk before 12 months of age was almost double that of iron replete children; multivariate analysis showed that both haem iron intake and age of introduction of cows' milk were independently associated with iron depletion. CONCLUSIONS: The results of this study show that, in young children in developed countries, a lower haem iron intake is a major risk factor for iron depletion; the introduction of whole cows' milk before 12 months is further confirmed as a risk factor. Parental education on nutrition should now focus on these two aspects of nutrition for infants and young children.