4363.0.55.001 - National Health Survey: Users' Guide, 2001  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 27/05/2003   
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Contents >> Chapter 4 - Health-related Actions

CONTENTS

Introduction

Stays in hospital

Visits to casualty/emergency and outpatients

Visits to day clinics

Doctor consultations

Dental consultations

Consultations with other health professionals

Days away from work/school

Other days of reduced activity

Use of medications


Introduction

Note: Except where indicated, or in reference to the Indigenous data item list, respondents from the 2001 NHS(I) provided the same information as the 2001 NHS(G) although sparse NHS(I) had less content. Data in this chapter only refer to the 2001 NHS(G) sample and do not include the 2001 NHS(I) sample.

The 2001 NHS obtained information about selected actions persons had taken for their health in the reference period. The range of health-related actions covered by the 2001 NHS(G) and non-sparse NHS(I) included:

  • Stays in hospital
  • Visits to casualty (emergency) and outpatient units at hospital
  • Visits to day clinics
  • Consultations with doctors
  • Dental consultations
  • Consultations with other health professionals
  • Days away from work or school/study
  • Other days of reduced activity
  • Use of medications, including vitamins and natural/herbal preparations.

Health-related actions topics included in sparse NHS(I) were:
  • Stays in hospital
  • Visits to casualty (emergency) or outpatient units at hospital
  • Consultations with doctors
  • Dental consultations
  • Consultations with other health professionals
  • Days away from work or school/study for own illness
  • Use of medications (non-specific)

For practical reasons (i.e. limited interview time and the difficulties in defining every possible type of action a person may have taken in relation to his/her health), the survey covered only the limited range of actions listed above. These actions reflect the main areas known to be of interest to data users and cover the more common actions people take in relation to their health. However, care should be taken not to interpret the data as comprehensive of all actions taken.

Except for stays in hospital the reference period used for actions data is the two weeks prior to interview; stays in hospital uses both a 12 month and a two week reference period. A two week reference period was used in this and previous NHSs as an acceptable compromise between enabling respondents to accurately recall and report actions taken in the period while ensuring sufficient observations were recorded in the survey to support reliable results. While the two week period is used for consistency across all actions it is more appropriate to some types of action such as doctor consultations which are more frequently taken actions than to other types such as dental consultations which tend to be taken much less frequently. This will impact on the relative reliability of the estimates across action types.

Estimates are available for the number of persons taking a particular action in a two week period, and the number of occasions on which the action was taken in that period - e.g. the number of consultations or number of days away from work. Service use data from other sources are commonly compiled on an annual basis. Because the 2001 NHS(G) was conducted over a 10 month period, the results represent an average two weeks in that enumeration period. This enables 'annualised' estimates of the number of occasions to be produced from 2001 NHS(G) data simply by multiplying the two week estimate by 26. Although the 'annual' estimates produced will be approximates only, they are considered suitable for general comparative purposes. However this approach should be used with care in relation to producing 'annualised' estimates of persons taking a particular action, because it takes no account of the frequency patterns of actions taken by individuals. The 2001 NHS(I) was conducted over a 6 month period, so this 'annualised' approach is not considered to be suitable because of seasonal effects on the data.

Unlike previous NHSs, information about the medical condition or other reasons (e.g. test, checkup) for taking the action was not generally obtained in 2001; however limited linkage between actions taken and medical condition was recorded for persons reporting asthma or diabetes. Details are provided within the action descriptions below.

In previous NHSs information was collected about all medications used in the previous 2 weeks, and medications usage was included in actions data from the survey, and included in counts of persons taking action. In the 2001 NHS information was collected only about medications used for selected conditions (i.e. asthma, cancer, heart and circulatory conditions and diabetes) and for mental well-being only. Details of medications use are therefore available separately for each of these conditions, but because of the restricted coverage of the data, medications use has been removed from counts of actions taken. Information on mental well-being was excluded in the 2001 NHS(I) because the mental health measures used for the 2001 NHS(G) were considered to be culturally inappropriate to the Indigenous population, therefore there are no medication details for mental health from the NHS(I). Specific details regarding type of medication used were not collected in sparse NHS(I), although whether medication was used for the selected conditions was collected.

Apart from the points noted above, the actions data from the 2001 survey are broadly similar to those collected in the 1989–90 and 1995 surveys. However the following changes introduced for the 2001 survey should be noted:
  • the return to a 12 month reference period for stays in hospital
  • separation of consultations with general practitioners and specialist doctors
  • the expansion of the scope of days away from work to include days away as a carer as well as days away due to own illness or injury
  • expansion of the list of other health professionals covered by the survey questions.

All changes, and their implications for comparability between the surveys, are discussed under the relevant individual topic headings which follow.

The data items available from this section of the survey are listed under the particular topic to which they relate. In addition a set of data items which combine various actions taken, enabling analysis of action levels and patterns in respect of population groups, etc are also available. Some of these have been defined: see Actions Summary, in Output Data Item List. Other combination items can be derived on request.
    STAYS IN HOSPITAL


    Definition

    This topic refers to admissions to hospital as an inpatient (including same day patients). For the purposes of this survey, a hospital was defined as an institution which offers residential health care, other than a nursing or convalescent home.

    In order to be counted the stay in hospital must have commenced with formal admission and ended in formal discharge, with discharge taking place in the 12 months prior to interview. However, in some cases persons who had not been discharged were included; this occurred when persons technically still admitted patients were enumerated when home on day release or as hospital at home patients.


    Methodology

    Respondents were asked whether they had been admitted to hospital in the 12 months prior to interview, and the number of times admitted in that 12 month period. Further details were obtained about the respondent's most recent inpatient episode in the last 12 months, including length of stay (number of nights in hospital), whether discharged in the two weeks prior to interview and whether admitted as a Medicare or Private patient. Reasons for hospitalisation were not recorded. See Q717 to Q721 in 2001 NHS(G) Adult form.

    These questions were asked after questions about recent visits to casualty and outpatients units and hospital, and questions about recent visits to day clinics, to minimise the risk of respondents reporting these visits as hospital admissions.


    Population

    Information was obtained for all persons.


    Data items
    • whether admitted to hospital in last 12 months
    • number of times admitted in last 12 months.

    In respect of the most recent admission in the last 12 months:
    • whether discharged in last 2 weeks
    • number of nights in hospital
    • patient type (Medicare or private patient).

    Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


    Interpretation

    Points to be considered when interpreting data from the survey relating to stays in hospital include:
    • In general "actions" results from the survey, only those persons discharged from hospital in the previous two weeks are included, consistent with the reference period for all other "actions" data obtained in the survey. The 12 months reference period is usually used in results relating specifically to stays in hospital
    • statistics on hospital inpatient episodes provided by this survey are not directly comparable with hospital morbidity statistics produced from other sources, due to differences in coverage, definitions and procedures used in their collection
    • where respondents were enumerated at home although they were technically still admitted patients at the time they have been included, although their admission had not been completed at that stage. Length of stay in these cases was recorded as the period from admission to date of interview. The number of cases where people in this situation were identified in the survey was very small, and therefore will have negligible effects on results
    • patient type at most recent episode refers to the patient type as reported by respondents, not to the type of hospital to which admitted; a person may be a private patient at either a public or private hospital. Persons who reported they had been a patient under a DVA entitlement were recorded as public patients; some of these may have been in a private hospital
    • a person may legitimately have reported no nights in hospital if admitted and discharged on the same day.


    Comparability with 1995

    Data relating to hospital episodes collected by the 2001 NHS differ in a number of ways from data obtained in the 1995 survey, and therefore comparisons between surveys should be made with caution:
    • the 1995 survey collected inpatient information based on a 2 week reference period; i.e. covered only inpatient episodes terminating in the two weeks prior to interview. The 2001 survey used a 12 month reference period, and although it identified episodes terminating in the last 2 weeks, the different methodology may have effected reporting and hence comparability
    • the reason for hospitalisation (i.e. the medical condition involved) was recorded in 1995 but not in 2001. Conversely information on patient type recorded in 2001 was not obtained in the 1995 survey.

    The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

    VISITS TO CASUALTY/EMERGENCY AND OUTPATIENTS UNITS AT HOSPITAL


    Definition

    This topic refers to visits to casualty/emergency and/or outpatients units at a hospital in the two weeks prior to interview. For the purposes of this survey, a hospital was defined as an institution which offers residential health care, other than a nursing or convalescent home.

    Only visits related to the respondent's health were included; visits such as taking another sick or injured person to emergency are excluded. Also excluded are situations where the respondent was admitted to hospital through a casualty/emergency ward; these instances were recorded as stays in hospital. Visits to dental hospitals, which are sometimes attached to a hospital as part of the outpatients section are also excluded from this topic; these cases were recorded under dental consultations.


    Methodology

    Respondents were asked whether they had visited a casualty/emergency or outpatients unit/ward for their own health in the two weeks prior to interview, and the number of visits in that period. People who reported visiting an outpatients unit/ward were asked whether their most recent visit in that 2 week period was related to a previous or expected admission to hospital. In sparse NHS(I), information regarding casualty/emergency or outpatients were collected as one item and not separated as per 2001 NHS(G) and non-sparse NHS(I).

    Information about the medical condition(s) or other reasons for visiting the casualty/emergency or outpatients unit/ward was not collected in the survey.See Q710 to Q714 in 2001 NHS(G) Adult form.


    Population

    Information was obtained for all persons.


    Data items
      • whether visited casualty/emergency unit/ward in last 2 weeks
      • number of visits to casualty/emergency unit/ward
      • whether visited outpatients unit/ward in last 2 weeks
      • number of visits to casualty/emergency unit/ward
      • whether most recent visit to outpatients unit/ward was related to previous/expected admission to hospital.

      Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


      Interpretation

      Points to be considered when interpreting data from the survey relating to casualty/emergency and outpatients visits include:
        • statistics on the usage of casualty/emergency or outpatients units provided by this survey are not directly comparable with statistics produced from other sources, due to differences in coverage, definitions and procedures used in their collection
        • although interviewers provided guidance to respondents if queried, the decision to report a visit against casualty/emergency or outpatients was the respondent's choice. While the distinction between casualty/emergency and outpatients units could be expected to be clear-cut in most cases, the potential for respondents to confuse outpatients with day clinics, or possibly outpatients with day admissions may have effected results.


        Comparability with 1995

        Similar concepts and methodology were used to obtain data relating to visits to casualty/emergency and outpatients units in the 2001 NHS to those used in the 1995 survey. As a result, data are considered directly comparable for items common to both surveys.

        The comparability outlined above for NHS(G) also applies to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

        VISITS TO DAY CLINICS


        Definition

        This topic refers to visits to day clinics in the 2 weeks prior to interview for the respondent's own health. Day clinics, which are often attached to or operate as part of a hospital, offer minor surgery or diagnosis procedures such as scans, ultrasounds, endoscopies, cardiac tests, etc. They do not offer residential health care in the same way as hospitals but in some cases a visit may result in an overnight stay.

        Included in the survey are all reported visits to day clinics, except those visits solely for the purpose of an X-ray.


        Methodology

        Respondents were asked whether in the last two weeks they had visited a day clinic for minor surgery or diagnostic tests (other than an X-ray). The number of times they had visited a day clinic in that period was also recorded. No distinction was made as to whether the day clinic was part of or separate from a hospital facility. See Q715 and Q716 in 2001 NHS(G) Adult form.


        Population

        Information was obtained for all persons. This information was not collected in the sparse NHS(I).


        Data items
        • whether had visited a day clinic
        • number of times visited a day clinic.

        Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists.


        Interpretation

        Points to be considered when interpreting data from the survey relating to visits to day clinics include:
        • the wording of the questions, and their sequencing after questions about visits to casualty/emergency and outpatients units at hospitals were designed to ensure that as far as possible, respondents did not report use of hospital services (outpatient clinics in particular) as visits to day clinics or vice versa. However, some crossover in reporting between hospital and day clinics may have occurred, particularly for cases where day clinics are located on hospital premises
        • statistics on the use of day clinics provided by this survey are not directly comparable with statistics available from other sources, due to differences in coverage, definition and procedures used in their collection, and to possible reporting errors as noted above.


        Comparability with 1995

        Similar concepts and methodology were used to obtain data relating to visits to casualty/emergency and outpatients units in the 2001 NHS to those used in the 1995 survey. As a result, data are considered directly comparable for items common to both surveys.

        The comparability outlined above for NHS(G) also applies to non-remote NHS(I). For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

        DOCTOR CONSULTATIONS

        Definition

        This topic refers to any occasion in the two weeks prior to interview on which a respondent discussed his/her own health with, or received treatment from, a doctor. Included are consultations by telephone or having someone else consult a doctor on behalf of the respondent (such as a relative or friend, or doctor’s nurse or receptionist), but excluded are consultations during a visit to casualty/emergency or outpatient unit at a hospital or during a stay in hospital, or during a visit to a day clinic.

        As defined for this survey, ‘doctor’ includes general practitioners and specialists such as surgeons, pathologists, gynaecologists, radiologists, psychiatrists, etc.

        This item includes all consultations with a doctor in the reference period, regardless of the type of treatment/service provided. For example, a consultation with a doctor at which acupuncture or physiotherapy was performed has, where identified, been included in this item. However, visits to a doctor only to deliver a sample or collect a prescription, without seeing the doctor, are excluded.


        Methodology

        Respondents were asked whether during the two weeks prior to interview they had:
        • consulted a general practitioner and the number of consultations, and
        • consulted a specialist and the number of consultations.

        Respondents in 2001 NHS(G) and non-sparse NHS(I) were asked "When was the last time you consulted a doctor about your own health" whereas the question for respondents in sparse NHS(I) was slightly altered to read "When was the last time you saw a doctor because you were hurt or sick".

        Those who had not consulted either a general practitioner or specialist in that two week period were asked the time since they had last consulted a doctor (general practitioner or specialist) about their own health (other than as a hospital inpatient or at a visit to a hospital casualty/emergency or outpatients unit, or at a day clinic). Information about the medical condition or other reason for consultation was not recorded. See Q725 to 730 in 2001 NHS(G) Adult form.


        Population

        Information was obtained for all persons.


        Data items
        • whether consulted a general practitioner in the two weeks prior to interview
        • number of consultations with general practitioner in that period
        • whether consulted a specialist in the two weeks prior to interview
        • number of consultations with a specialist in that period
        • period since last consultation, with general practitioner or specialist, if neither had been consulted in the previous two weeks.
        Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


        Interpretation

        When interpreting data from the survey relating to doctor consultations the following should be considered:
        • consultations information is essentially ‘as reported’ by respondents. In some cases respondents may have reported consultations with health practitioners other than doctors because they consider them to be doctors. This should be taken into account with Indigenous persons particularly in sparsely settled areas as their understanding of the term doctor may be different to the general population. Conversely, some consultations reported as being with other health professionals should have been reported in this item where the practitioner consulted was a qualified medical practitioner (regardless of the type of treatment/service provided at the consultation). The questionnaire was designed such that most of these cases would be identified through subsequent questions, and information amended as required. However, some cases of misreporting may remain in final survey output
        • similarly, the reporting of a consultation as with a general practitioner or with a specialist was largely at the respondent's discretion, and some misreporting could be expected to have occurred
        • while the wording and ordering of the questions deterred respondents from reporting consultations with doctors during a visit to, or stay in, hospital or visit to a day clinic, some cases of misreporting or multiple-reporting may have occurred.
        • as noted in methodology, sparse NHS(I) specifically mentioned attendance because the respondent was hurt or sick, whereas NHS(G) and non-sparse NHS(I) were asked about attendance for their own health. It is possible that the data underrepresents attendence in sparsely settled areas if general check-ups or non-illness related visits have been omitted.


        Comparability with 1995

        The methodology adopted for recording information about doctor consultations was similar to that used in the 1995 NHS, and therefore data from the two surveys are considered to be broadly comparable.

        Both surveys separately identified whether respondents had consulted a general practitioner and/or a specialist in the last 2 weeks. However, whereas the 2001 survey collected number of consultations separately for general practitioners and specialists, the 1995 survey obtained only a total number of consultations. While data at the total consultations level can therefore be compared between surveys, the effect of separately reporting general practitioner and specialist consultations may have tended to increase the number of reported consultations in 2001.

        The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

        DENTAL CONSULTATIONS

        Definition

        Dental consultations refer to any occasion in the two weeks prior to interview on which a respondent consulted a dentist or other dental professional (e.g. orthodontist, dental nurse, dental technician, dental mechanic) about their teeth, dentures or gums.

        Consultations at dental hospitals are included, but dental consultations during a hospital inpatient stay or visit to casualty/emergency, outpatients or day clinic are excluded. Persons who consulted a doctor about a dental problem are included under the item Doctor Consultations.


        Methodology

        Respondents were asked whether during the two weeks prior to interview they had consulted a dentist or anyone about their teeth, dentures or gums, and the number of times consulted in that period. In sparse NHS(I) the questions were just in relation to teeth. Persons who did not consult in that period were asked the time since their last dental consultation. See Q722 to 724 in 2001 NHS(G) Adult form.


        Population

        Information was obtained for all persons. In sparse NHS(I), information was only collected from those persons two years and over and for output purposes children under two were presumed not to have consulted a dentist.


        Data items
        • whether dental consultation in two weeks prior to interview
        • number of consultations in that period
        • period since last consultation if not in previous two weeks.

        Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


        Interpretation

        The following points should be considered when interpreting dental consultations data provided by this survey:
        • for reasons of consistency with other actions data obtained in the survey, a two-week reference period was used for dental consultations. However, it is recognised that general dental consultations occur less frequently than consultations with other health professionals. As a result, the data from this survey may not be as representative of the usage of dental services (particularly in applications such as deriving annual aggregates of service usage) as for other types of health service covered in the survey.


        Comparability with 1995 NHS

        Data provided by this survey about dental consultations are comparable with those provided by the 1995 survey for those items and populations common to both surveys. However,
        • in the 1995 survey information on dental consultations was collected for persons aged 2 years or more, compared with all persons in 2001
        • information on type of treatment or service received at the most recent consultation was collected in 1995 but not in 2001.

        The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

        CONSULTATIONS WITH OTHER HEALTH PROFESSIONALS (OHPs)

        This topic refers to occasions in the 2 weeks prior to interview on which respondents consulted a nominated health professional other than a doctor or dentist/dental professional; specifically one or more of the following health professionals:


        Definition
        • Aboriginal health worker (nec)
        • accredited counsellor
        • acupuncturist
        • alcohol and drug worker (nec)
        • audiologist/audiometrist
        • chiropractor
        • chemist
        • chiropodist/podiatrist
        • dietician/nutritionist
        • herbalist
        • hypnotherapist
        • naturopath
        • nurse
        • optician/optometrist
        • osteopath
        • occupational therapist
        • physiotherapist/hydrotherapist
        • psychologist
        • social worker/welfare officer, and
        • speech therapist/pathologist.

        For sparse NHS(I) the following were specifically considered other health professionals:
        • Aboriginal (or Torres Strait Islander) Health worker
        • Nurse or sister
        • Alcohol and drug worker
        • Social worker/welfare officer
        This constituted the only question sparse NHS(I) respondents were asked in relation to other health professionals.

        This item refers to consultations at which some discussion and/or treatment of a health-related matter or medical condition took place, or was arranged.

        Excluded are:
        • occasions on which respondents may have visited the professional only to obtain medical supplies, aids, etc. For example, consulting a chemist about a medication would be included, while visiting a chemist simply to fill a prescription would not; consulting an optometrist about a sight problem would be included but going to an optometrist to have a pair of glasses made to prescription would not
        • consultations occurring during a stay in hospital, or visit to a casualty/emergency or outpatients unit, or day clinic
        • consultations with nurses as part of a doctor or dental consultation (including dental nurses); these are included under doctor and dental consultations respectively
        • consultations with a doctor at which any of these services (e.g. acupuncture, counselling, etc) were received. These occurrences are recorded as doctor consultations.

        Consultations were recorded against the type of OHP involved, not the type of treatment provided at a particular consultation. For example, if a chiropractor performed physiotherapy, the consultation was recorded under chiropractor. If a practitioner was considered by the respondent to fit more than one of the types listed above, the visit has been recorded against that type of OHP most closely associated with the most recent consultation in the two week period.


        Methodology

        Using a prompt card, respondents were asked whether they had consulted any of the listed OHPs in the two weeks prior to interview. If so, the respondent was asked to identify which types of OHP had been consulted. For up to two OHPs (the two most recently visited), respondents were asked to report the number of consultations they had in that period.

        Information about medical condition(s) or other reason(s) for visiting that OHP was not recorded. See Q731 to Q738 in 2001 NHS(G) Adult form. In sparse NHS(I) prompt cards were not used, and the only data collected was on type of other health professional consulted. Information regarding number of consultations was not obtained.


        Population

        Information was collected in respect of all persons in scope of the survey.


        Data items
        • whether consulted OHP in two weeks prior to interview
        • types of OHP consulted in the last two weeks.
        For the two types of OHP most recently consulted:
        • number of consultations in that two weeks.

        Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


        Interpretation

        Points to be considered when interpreting data on OHP consultations from this survey include:
        • the data relate to those types of OHP specified in the survey and hence should not, in aggregate, be interpreted as relating to all health professionals other than doctors and dentists
        • while it was recognised that all respondents may not understand the functions of all the OHPs listed, it was considered that in most cases they could accurately identify the type of OHP they had consulted. Interviewers were provided with a list defining the main activities of each of the OHPs covered to assist respondents if queried
        • despite the point above, some misreporting of type of OHP may have occurred. For example, in cases where the distinction between types of OHP was unclear in the respondent's mind and/or the professional practised more than one form of treatment (e.g. chiropractor/osteopath, naturopath/herbalist)
        • conceptually consultations were only to be recorded where some treatment and/or discussion of a health-related matter took place. However, it is recognised that this distinction may be difficult to make in some cases and interpretation may differ between respondents. In particular, the likelihood of reported consultations with chemists and opticians/optometrists being outside the defined scope of the survey should be considered.


        Comparability with 1995

        Data for this topic are broadly comparable between the 1995 and 2001 NHS, for those items common to both surveys. Three additional types of OHP were covered in the 2001 survey: Aboriginal health worker (not elsewhere classified), accredited counsellors and alcohol and drug worker (not elsewhere classified). The inclusion of these categories will have increased total OHP consultations reported relative to 1995 results, but is not expected to have effected results for other types of OHP.

        The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

        DAYS AWAY FROM WORK OR SCHOOL/STUDY

        Definition

        This topic refers to days, during the 2 weeks prior to interview, on which respondents stayed away from their school/study or work:
        • due to an illness or injury which they had , or
        • as a carer for someone else who was sick or injured.

        In sparse NHS(I), information was only collected for days away due to the respondent's own illness.
          For the purposes of this topic a "day away" was defined as more than half the (working or student) day absent. If a person was away from both work and study details were recorded against days away from work only.


          Methodology

          As appropriate to the age, educational and employment circumstances previously recorded at the interview, respondents were asked separately whether in the last two weeks they had stayed away from work or school/study because of an illness/injury they had, and whether in the last two weeks they had stayed away from work or school/study to care for someone else who was sick or injured (days away for caring was not collected in sparse NHS(I)).

          The number of days away was recorded for each of these actions as appropriate. Information about the medical condition involved was not collected in the 2001 NHS. See Q700 - Q709 in 2001 NHS(G) Adult form. In sparse NHS(I), the number of days away from work or school for own illness was not recorded.


          Population

          Information about time away from work or school/study for populations as follows:
          • Days away from work due to own illness: employed persons aged 15 - 64 years
          • Days away from school/study due to own illness: persons aged 5 - 64 years who were not employed but were attending school;
          • Days away from work as carer: employed persons aged 15 - 64 years
          • Days away from school/study as carer: persons aged 10 - 64 years who were not employed but were attending school.


          Data items
          • Whether had any days away from work due to own illness/injury
          • Whether had any days away from school/study due to own illness/injury
          • Number of days away from school/study due to own illness/injury
          • Whether had any days away from work as carer
          • Number of days away from work as carer
          • Whether had any days away from school/study as carer
          • Number of days away from school/study as carer.

          Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


          Interpretation

          Points to be considered when interpreting data on days away from work or study/school include:
            • sequencing of respondents through this section of the questionnaire relied on previous information recorded about their current employment and/or student status. To the extent that reporting or recording errors may have occurred in this information, the information recorded about days away from work or school/study will also be effected
            • the survey can provide information both about the numbers of people (and their characteristics) taking time away from work or school/study due to illness, and about the numbers of days away. While efforts were made in the appropriate questions to ensure only illness - related days away are included, and only days where more than half a day's absence was involved are counted, some misreporting may have occurred.
            • for persons who had days away from both work and school/study in the reference week, the days away have been recorded against days away from work only. The number of persons in the survey who reported both days away from work and school/study was very small; nevertheless a small undercount of persons having days away from school/study, and of the number of days away will have occurred.
            • the questions on days away from work were not asked specifically in terms of a particular job. As a result, for persons with more than one job, the days away were not necessarily (or solely) days away from their main job. While the impact of this is expected to be minor, it should be considered when, for example, analysing information on days away from work against reported occupation or industry of main job.
            • the numbers of persons and days away due to own illness/injury and as carer were separately reported and were intended to be conceptually separate so they could be aggregated to produce total "days away" due to illness or injury if required. However, a small number of respondents reported both days away due to illness and as carers, and in these cases there is some possibility that the same days were reported in each. However, as the number involved was small, even if this did occur it is expected to have minimal effect on estimates.


            Comparability with 1995

            Data for this topic are considered to be directly comparable between the 1995 and 2001 NHS, for those items and populations common to both surveys. However, it should be noted that:
              • information about days away from work or school/study as a carer was not collected in 1995
              • days away from work and/or school/study were not obtained for persons aged 65 years and over in 2001, but were included in 1995. The numbers of people aged 65 years or more who reported days away from work or school/study in 1995 was small and would therefore have minimal impact on estimates overall.
              • in the 2001 survey persons who had days away from both work and school/study are counted against days away from work only. In the 1995 survey such days may be counted as both days away from work, and days away from school/study, according to the population (employed persons or students) for which the data are compiled.

              The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

              OTHER DAYS OF REDUCED ACTIVITY

              Definition

              This topic refers to days during the two weeks prior to interview on which a person cut-down on his/her usual activities for all or most of the day due to an illness/injury which they had, excluding days away from work or school/study because of own illness/injury.

              Note that these (other) days of reduced activity exclude days cut down on activities to care for another person.


              Methodology

              Respondents were asked whether on any days in the previous 2 weeks they had cut down on anything they usually did because of an illness or injury they had, and the number of days they had cut down. For respondents who were employed or at school/study, these questions followed questions on days away from work or school/study, and respondents were asked to exclude those days they had already reported. See Q700 - Q709 in 2001 NHS(G) Adult form. Information about the medical conditions or other reason(s) for other days of reduced activity was not collected.


              Population
              Information was collected for all persons aged 5 years or more. This information was not collected in the sparse NHS(I).


              Data items
              • whether had (other) days of reduced activity
              • number of (other) days of reduced activity.

              Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists.


              Interpretation

              Points to be considered when interpreting data for this item include:
              • the information is ‘as reported’ by respondents. Perceptions of concepts such as ‘cut-down on usual activities’ may differ between respondents and hence influence the consistency of the data recorded;
              • because (other) days of reduced activity conceptually exclude days away from work or school/study due to own illness/injury, the items from each group can be aggregated to provide a total of persons experiencing 'days out of role' during the previous 2 weeks, and the number of days involved.


              Comparability with 1995
              Data for this topic from the 2001 NHS are considered comparable with those available from the 1995 survey once adjustments are made to ensure common age groups are used. The age group for which data on (other) days of reduced activity was collected was 5 years or more in 2001 compared with ages 2 years or more in 1995.

              The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.

              USE OF MEDICATIONS


              Definition

              This topic refers to the consumption or other use (for specific conditions only) of any medications, pills or ointments during the two weeks prior to interview, including vitamins, mineral supplements and herbal or natural medications, and including both prescribed and non-prescribed medications.

              Unlike previous NHSs, the medication data collected in the 2001 survey do not relate to all medications used, but only to those reported by respondents as used for the following medical conditions/reasons:
              • asthma
              • cancer
              • heart and circulatory conditions
              • diabetes
              • mental well-being.
              In survey output, the following terms are used to describe particular groups of products:

              Medications refers to all reported medications, including pharmaceutical medications, vitamin and mineral supplements and natural and herbal medicines.

              Pharmaceutical medications refers to reported medications excluding those reported by respondents as vitamin or mineral supplements, and those reported as natural or herbal medicines.
                The sparse NHS(I) did not differentiate between pharmaceutical medications and medications. Predominantly respondents were only asked whether they had taken any tablets. Information on medications taken for mental wellbeing was not collected for NHS(I).


                Methodology

                The methodology used and the information collected differed for each of the 5 NHPA groups above for NHS(G) and non-sparse NHS(I):
                • Asthma: Respondents who reported they had been told by a doctor or nurse that they had asthma, and reported it was still a current condition, were asked:
                  1. whether they used any medication (other than vitamins, minerals, natural and herbal medicines) for their asthma in the last 2 weeks,
                  2. the name of up to 3 medications used, and for each of these,
                  3. whether the medication had been used for prevention, relief or both reasons.
                  4. whether they had taken other actions for their asthma in that 2 week period; use of vitamin and mineral supplements, and natural/herbal medications were separate response categories; and
                  5. whether they had used a nebuliser to administer any medications in the previous 2 weeks. See Q364 - Q376 in 2001 NHS(G) Adult form.
                • Cancer: Respondents who reported they had been told by a doctor or nurse that they had cancer, and reported it was still a current condition, were asked:
                  1. whether they had used any vitamin or mineral supplements or any herbal or natural medicines for cancer in the previous 2 weeks,
                  2. whether they had used any other medications for cancer in that period, and
                  3. the names of up to 3 medications used. See Q412 - Q418 in 2001 NHS(G) Adult form.
                • Heart and circulatory conditions: Respondents who reported they had been told by a doctor or nurse that they had a heart and circulatory condition, and reported it was a current and long-term condition, were asked separately about use of medications in respect of each of the first 3 heart and circulatory conditions they had reported. If more than three conditions were reported the respondent was asked to provide information about medications taken for the three most severe conditions. The most severe conditions were determined by the respondent.
                  For each of the three conditions respondents were asked:
                  1. whether they had used any vitamin or mineral supplements or any herbal or natural medicines for that condition in the previous 2 weeks,
                  2. whether they had used any other medications for that condition in that 2 week period, and
                  3. the names of up to 3 medications used.
                  Testing had shown that some people with multiple heart and circulatory conditions sometimes did not know the particular condition for which a particular medication was used. People who could not associate all their cardiovascular medications with a specific condition were also asked to report the names of up to 3 (additional) medications used for cardiovascular conditions. See Q460 - Q492 in 2001 NHS(G) Adult form.
                • Diabetes: Respondents who reported they had been told by a doctor or nurse that they had diabetes (other than diabetes insipidus) or high sugar levels in their blood or urine, and reported it was still a current condition, were asked:
                  1. whether they were currently having daily insulin injections, and age started having these injections,:
                  2. whether they had used any medications (other than vitamin or mineral supplements or any herbal or natural medicines for that condition in the previous 2 weeks,
                  3. the names of up to 3 medications used,
                  4. whether they had taken any other action to manage their condition in the previous two weeks, including use of vitamin or mineral supplements or any herbal or natural medicines. See Q509 - Q519 in 2001 NHS(G) Adult form.
                • Mental well-being: Adult respondents in the NHS(G) were asked about medication use in the previous 2 weeks for mental well-being; for example to improve concentration or reduce stress, as follows:
                  1. whether they had used vitamin or mineral supplements, or herbal or natural medicines,
                  2. whether they had used, sleeping tablets/capsules, tablets/capsules for anxiety or nerves, tranquillisers, antidepressants, mood stabilisers, other medication for mental health,
                  3. for each of up to 3 types of medication reported, the duration of use and frequency of use. See Q262 to Q269 in 2001 NHS(G) Adult form.
                In the sparse NHS(I) respondents were asked if they took tablets or other medications for asthma, cancer, heart and circulatory conditions, and diabetes.

                Except in the case of medications used for mental well-being, provision was made to record up to a maximum of 3 separate medication names for each of the reported conditions, as specified above. In cases where 4 or more medications were reported, only the 3 medications regarded by the respondent as the "main" medications they use for that condition were recorded. Provision was made to record the fact that more than 3 medications were used.

                In responding to questions on medication use interviewers encouraged respondents to collect and refer to medication bottles, packets, etc. This served to both assist respondents in reporting all medications used for a particular conditions, and assist interviewers in accurately recording the medication name. The name recorded may have been a brand or generic name.

                The names of the medications reported as used for asthma, cancer, heart and circulatory conditions and diabetes/high blood sugar were office coded to a classification of generic type of medication. Outputs from this classification can be compiled in accordance with WHO's Anatomical Therapeutic Chemical Classification (ATCC), and the Australian Medicines Handbook (AMH); see Appendix 6.

                Medicine name was not recorded for those medications used for mental well-being; the 6 broad types of medication used in the question is the finest level of detail available for these. Although these types reflect reasons for use rather than generic type, where possible interviewers recorded the use against the type of medication most appropriate to the generic type, rather than the type as reported by respondents; for example, if a respondent reported they had used Serepax for sleeping, interviewers recorded this against the category "tablets for anxiety or nerves" rather than against the category "sleeping tablets or capsules". The "generic" based classification for common medications was shown on the prompt card provided to respondents; a more detailed list was available to interviewers.
                  Population:

                  Except for medications used for mental well-being, medications data are available for persons of all ages who had reported they currently had asthma, cancer, heart and circulatory conditions or diabetes (excl. diabetes insipidus)/high sugar levels in blood or urine, which had or was expected to last six months or more.

                  Use of medications for mental well-being was collected only for persons aged 18 years and over

                  The population was the same for 2001 NHS(I) except medications were not collected for mental well-being, and in sparse NHS(I) there was not a requirement for the condition to have lasted or be expected to last six months or more. Please see respective comments for each condition in Chapter 3 regarding this requirement.


                  Data items

                  For persons with asthma:
                  • whether used any medications
                  • number of medications used
                  • generic types of medication used (incl vitamins and mineral, and natural and herbal medicines)
                  • whether used for prevention, relief or both reasons
                  • whether nebuliser used to administer any medication.

                  For persons with cancer:
                  • whether used any medications
                  • number of medications used
                  • generic types of medication used (incl vitamins and mineral, and natural and herbal medications).
                    For persons with cardiovascular conditions:
                    • whether used any medications
                    • number of medications used (total and for each of 3 conditions)
                    • generic types of medication used (incl vitamins and mineral, and natural and herbal medications).
                      For persons with diabetes or high sugar levels:
                      • whether used any medications
                      • number of medications used
                      • generic types of medication used (incl insulin and vitamins and minerals, and natural and herbal medications).


                      For persons in the NHS(G) using medication for mental well-being:
                      • whether used any medications;
                      • number of medication types used
                      • broad types of medication used
                      • frequency of use by broad medication type
                      • duration of use by broad medication type.
                        For NHS(G) and non-sparse NHS(I) medication name is recorded for the purposes of enabling coding of generic type of medication; medication name is not available for output from the survey.

                        For further details of the items available, and for details of the standard output categories see the relevant illness topic descriptions.
                          In addition to medication items related to specific medications there are a number of summary items which have been defined. These include:
                          • Whether used medications for selected conditions
                          • Combination selected medications taken
                          • Type of pharmaceutical medication
                          • Whether used natural /herbal medications
                          • Whether used pharmaceutical medications
                          • Whether used vitamins/minerals
                          Output categories for the 2001 NHS(G) and 2001 NHS(I) are available from the ABS web site, through links provided in the Health and Indigenous theme pages to the respective output data items lists. The Indigenous output data items list indicates whether each item is available for non-remote only or both non-remote and remote.


                          Interpretation

                          Points to be considered when interpreting data from this survey on the use of medications include:
                          • the information is ‘as reported’ by respondents. This may have implications for the extent to which usage of certain types of medications were reported (e.g. tranquillisers) and the accuracy of some details provided (e.g. name of medication used, frequency of use). Medication data were collected differently for the sparse NHS(I) and the differences in questions should be taken into account when making comparisons between sparse NHS(I) data and data from NHS(G) and non-sparse NHS(I).
                          • although respondents were encouraged to bring out the medication packets, bottles, etc to assist them and interviewers in recording complete and correct details, this did not always occur, which may have led to some medications not being reported at all, or being reported incorrectly.
                          • the methodology relied on respondents knowing that a particular medication was being taken for a particular condition. For respondents having several conditions and using multiple medications some medications may have been incorrectly reported as used for a particular condition, or not reported at all because the respondent understood the medication was for a different condition.
                          • the data relates only to medications (known and reported by respondents as) used for particular types of medical conditions or reasons. As a result the data does not indicate the levels of total medication use, nor does it necessarily indicate the use of a particular medication type in cases where a medication can be used for a range of different conditions.
                          • data relating to medication use for mental well-being differs from the other medication data in that;
                            1. it is not necessarily related to a medically diagnosed condition, and conceptually includes use for preventive or other reasons where no medical condition is present;
                            2. the data are collected and output in terms of broad categories of medication (reflecting broad purpose of use) rather than generic type of medication.
                          • no questions were asked about the type of product/substance respondents reported as vitamins/minerals or natural or herbal medicines. As a result, the products reported in these categories were entirely at the discretion of respondents. Some products of this type were reported in response to the questions on other medication use; where this has occurred and the product could be identified as a vitamin/mineral or natural/herbal medicine, it was classified to a general vitamin/mineral/natural/herbal category within the generic type classification. However, where the product could not be identified as a vitamin/mineral or natural/herbal medicine it was classified to the general 'other medications' group. As a result, combining responses from the separate vitamins/minerals and natural/herbal medicine questions with those classified to this category within the generic type classification will provide a more complete picture of the use of these products for the specified condition, but will not necessarily include all medications of these types.
                          • because the distinction between vitamins/minerals and natural/herbal medicines was at the discretion of respondents, and because these can be very similar (or even the same) products, just differently described, data for these categories might more confidently be used in combination, rather than separately.

                          Comparability with 1995 NHS

                          The methodology for collecting data on medication use in the 2001 NHS, and the classification of generic type of medication, differ markedly from those used in the 1995 NHS. Overall this means that there is little direct comparability between surveys, and even though there are some specific points of commonality which may enable some comparisons to be made, this should be done with care.

                          The main differences between the surveys are:
                          • the scope of the medications data. In 1995 information was obtained about all medications used in the last 2 weeks; in 2001 information was obtained about medications used in the last 2 weeks for specific conditions (asthma, cancer, heart and circulatory conditions, diabetes and high sugar levels) and medications used for mental well-being (which as noted above need not have been condition related).
                          • the link of medical conditions to medication use. The methodology used in the 1995 survey sought to link medications reported with the medical conditions or other reasons for use, such as illness prevention. The medical conditions were self-reported and not necessarily based on medical diagnosis. Except in the case of medications used for mental well-being, the methodology in the 2001 survey required that respondents had been told by a doctor or nurse they had a specified condition, and that conditions was still current and long-term.
                          • the way the questions were asked. Both surveys relied on respondents reporting use, and where possible, bringing out the medications they had used. However, the 1995 methodology still enabled all medications to be reported/recorded even where respondents were unable to report the condition for which the medication was used.
                          • the number of medications recorded. The 1995 survey enabled up to 12 medications used to be recorded, although further detail was recorded for a maximum of 7 of these; conceptually these could have been reported for one condition or 7 different conditions, or any combination of conditions. In 2001 a maximum of 3 medications were recorded for each selected condition.
                          • the classification of medication type. Both surveys involved recording brand or generic medication name at interview which was then coded to generic type; the 1995 survey also collected data based on reported medication type, which was associated with the reasons respondents used the medication. The self-reported type was similar to the approach used in collecting medication use for mental well-being in 2001.The classifications of generic type used in the two surveys were similar; both based primarily on the WHO's ATC. However, because the focus in the 2001 survey was on medications used for specific conditions, it has an expanded coverage of particular medications, but a much reduced level of detail for other medication types. See Appendix 6.
                          • information on whether prescribed or advised by a doctor, and information on frequency and duration of use obtained in 1995 was not collected in the 2001 survey; except frequency and duration of use was recorded for medications used for mental well-being. Frequency and duration of use in the 1995 survey was only asked of those reporting their use as regular; in the 2001 survey these items related to all use (of relevant medications).

                          In addition to the specific survey issues noted above, other factors which may potentially affect comparability of medications data between surveys include the availability of medications (coming onto or leaving the market), changes effecting accessibility (e.g. prescription requirements), access to/arrangements for pharmaceutical benefits, evolving practices for the treatment/management of conditions, etc.

                          The comparability issues outlined above for NHS(G) also apply to non-remote NHS(I). Data are not available for remote areas in the 1995 NHS so time series comparisons are only possible for non-remote areas. For other general comparability issues between 1995 NHS and the 2001 NHS(I) refer to Chapter 7.


                          Chapter 1 - Introduction

                          Chapter 2 - Survey Design and Operation

                          Chapter 3 - Health Status Indicators

                          Chapter 4 - Health Related Actions

                          Chapter 5 - Health Risk Factors

                          Chapter 6 - Population Characteristics

                          Chapter 7 - Data Quality and Interpretation of results

                          Chapter 8 - Data Output and Dissemination
                          Appendix 1 - Glossary of Terms Used

                          Appendix 2 - Sample Counts and Weighted Estimates

                          Appendix 3 - Classification of Long-term Medical Conditions: Based on ICD-10

                          Appendix 4 - Classification of Long-term Medical Conditions: Based on ICD-9

                          Appendix 5 - Classification of Long-term Medical Conditions: ICPC Based

                          Appendix 6 - Classification of Type of Medication

                          Appendix 7 - Classification of Country of Birth

                          Appendix 8 - Classification of Language Spoken at Home
                          Appendix 9 - Classification of Occupation

                          Appendix 10 - Classification of Industry of Employment

                          Appendix 11 - Classification of Types of Alcoholic Drinks

                          Appendix 12 - Standard Errors

                          Appendix 13 - Content of the 2001 National Health Survey (Indigenous)

                          Appendix 14 - List of Abbreviations

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