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Australian Journal of Primary Health

Joanne Reeve
Person-centred primary care is a priority for patients, healthcare practitioners and health policy. Despite this, data suggest person-centred care is still not consistently achieved - and indeed, that in some areas, care may be worsening. Whole-person care is the expertise of the medical generalist - an area of clinical practice that has been neglected by health policy for some time. It is internationally recognised that there is a need to rebalance specialist and generalist primary care. Drawing on 15 years of scholarship within the science of medical generalism (the expertise of whole-person medical care), this discussion paper outlines a three-tiered approach to primary care redesign; describing changes needed at the level of the consultation, practice set up and strategic planning...
August 13, 2018: Australian Journal of Primary Health
Linton R Harriss, Mary Kyle, Katrina Connolly, Edward Murgha, Merton Bulmer, Darren Miller, Paul Munn, Paul Neal, Kingsley Pearson, Melanie Walsh, Sandra Campbell, Maximus Berger, Robyn McDermott, Malcolm McDonald
Gurriny Yealamucka Health Service Aboriginal Corporation (GYHSAC) is an Indigenous community-controlled health organisation providing comprehensive primary care to the people of Yarrabah in far north Queensland, Australia. GYHSAC conducts an annual Young Person's Health Check (YPC) for people aged 15-25 years based on the Medical Benefits Schedule Item 715. However, the YPC is constantly evolving to meet the needs of the community, and in 2016, in response to concerns about psychological risk among Indigenous youth, GYHSAC teamed up with James Cook University to trial an adapted PHQ-9 depression screening tool (aPHQ-9) as part of the YPC...
August 9, 2018: Australian Journal of Primary Health
Amelia Stephens, Wendy Brodribb, Treasure McGuire, Laura Deckx
There is considerable uncertainty regarding medication use during breastfeeding. This study compared lactation-related questions about medicines from consumers and health professionals to identify knowledge gaps. A retrospective, mixed-methods study of lactation-related call data extracted from two Australian medicines call centre databases: National Prescribing Service (NPS) Medicines Line (ML) for the general public and Therapeutic Advice and Information Service (TAIS) for health professionals, was conducted...
August 8, 2018: Australian Journal of Primary Health
Jean-Frederic Levesque, John J M O'Dowd, Éidín M Ní Shé, Jan-Willem Weenink, Jane Gunn
Various jurisdictions are moving towards population-based approaches to plan and manage healthcare services. The evidence on the implementation of these models remains limited. The aim of this study is to evaluate the effect of a regional operating model (ROM) on internal functioning and stakeholder engagement of a regional office. Semi-structured interviews and focus groups with staff members and stakeholders of the North West Metropolitan Regional office in Victoria, Australia, were conducted. Overall, the ROM was perceived as relevant to staff and stakeholders...
August 8, 2018: Australian Journal of Primary Health
Jo M Longman, Elizabeth Rix, Jennifer J Johnston, Megan E Passey
Developing and targeting interventions to reduce hospital admissions for ambulatory care sensitive (ACS) chronic conditions for older people is a key focus for improvement of the health system. To do this, an understanding of any modifiable factors that may contribute to such admissions is needed. To date, the literature on ACS admissions has rarely included the patient perspective. This qualitative study involved one-to-one telephone interviews with 24 patients aged ≥45 years who had had an unplanned admission for an ACS chronic condition to one of two participating regional hospitals between February and August 2015...
August 6, 2018: Australian Journal of Primary Health
Barbara Nattabi, Seham Girgis, Veronica Matthews, Ross Bailie, Jeanette E Ward
Integration of public health and primary healthcare (PHC) is a hallmark of comprehensive PHC to reduce inequitable rates of preventable diseases in communities at risk. In the context of a syphilis outbreak among Indigenous people in Northern Australia, the association between PHC clinic factors and syphilis testing performance (STP) was examined to produce empirical insights for service managers. Data from the Audit and Best Practice for Chronic Disease National Program (2012-14) were analysed to examine associations between clinic factors and STP (proportion of clients ≥15 years who were tested for or offered a test for syphilis in the prior 24 months)...
July 30, 2018: Australian Journal of Primary Health
Jonathan Foley
This paper reviews the effect of a primary care financing scheme introduced in New Zealand as a component of the New Zealand Primary Health Care Strategy, a comprehensive reform of the way that primary healthcare was governed, financed and delivered. The population-based funding formulae incorporated an area-based measure of social deprivation and ethnicity in an explicit attempt to improve access to care for certain population groups and fund social interventions aimed at addressing conditions that lead to improved health outcomes...
July 30, 2018: Australian Journal of Primary Health
Elizabeth Sturgiss, Claire Deborah Madigan, Doug Klein, Nicholas Elmitt, Kirsty Douglas
Lifestyle behaviours are contributing to the increasing incidence of chronic disease across all developed countries. Australia, Canada and the UK have had different approaches to the role of primary care in the prevention and management of lifestyle-related diseases. Both obesity and metabolic syndrome have been targeted by programs to reduce individual risk for chronic disease such as type 2 diabetes. Three interventions are described - for either obesity or metabolic syndrome - that have varying levels of involvement of GPs and other primary care professionals...
July 30, 2018: Australian Journal of Primary Health
Cameron M Wright, Richard Norman, Richard Varhol, Jacqueline Davis, Elizabeth Wilson-Taylor, Justin Dorigo, Suzanne Robinson
The Drug and Alcohol Withdrawal Network (DAWN) is a home-based withdrawal service based in Perth, Western Australia. Literature on outcomes, costs and client attitudes towards this type of home-based detoxification in Australia is sparse. Therefore, this study assessed these factors for clients enrolled over a 5-year period (July 2011-June 2016). Client experience was explored through semi-structured interviews with 10 clients. Over the study period, 1800 clients (54% male, mean age 38 years) were assessed, and there were 2045 episodes of care...
July 23, 2018: Australian Journal of Primary Health
Angela Durey, Susan Kaye Lee, Bola Adebayo, Linda Slack-Smith
Adult women in Australia are more likely than men to have no teeth, more missing teeth or have a dental hospital admission. Experiences of war, family and domestic violence, mental health or alcohol and other drug use problems may also negatively affect women's oral health. Yet, oral health is often excluded from primary healthcare. Little is known about what helps or inhibits primary healthcare service workers to promote oral health to women in need. Identifying the perceptions and experiences of such workers is a step towards a strategy to develop resources to support them in raising oral health issues with disadvantaged clients...
July 17, 2018: Australian Journal of Primary Health
Jacqueline Goode, Ha Hoang, Leonard Crocombe
Homeless people have poor oral health and high treatment needs, yet tend to make problem-based dental visits. This review aimed to determine how and where homeless adults receive oral health care, the barriers that prevent homeless adults accessing dental care and find strategies to promote oral health to homeless adults. The databases MEDLINE via OvidSP, PubMed, CINAHL and Scopus were searched using the keywords: homeless, roofless, houseless, rough sleeper, couch surfer, shelter, hostel, dental and oral health...
July 9, 2018: Australian Journal of Primary Health
Deborah Davies
Primary Health Networks (PHNs) are tasked to enhance the efficiency and effectiveness of general practice. Gold Coast Primary Health Network (GCPHN) has been collecting de-identified aggregated clinical data from general practices and reporting back on areas for improvement on data coding and some clinical metrics, such as blood pressure not being recorded. However, aggregated data cannot be used to intervene at the individual patient level, and because of the collection-to-reporting time-lag, the data cannot help facilitate immediate action in the general practice...
June 14, 2018: Australian Journal of Primary Health
Jamie Bryant, Breanne Hobden, Kristy Forshaw, Christopher Oldmeadow, Justin Walsh, Rob Sanson-Fisher
The negative health consequences of tobacco and risky alcohol consumption are compounded when used concurrently. Australian preventative health guidelines recommend that general practitioners (GPs) assess and provide evidence-based intervention. No studies, however, have examined the accuracy of GP detection of concurrent tobacco use and risky alcohol consumption or the factors associated with accurate detection. This study aimed to examine the: (i) accuracy of GP detection of concurrent tobacco and risky alcohol use compared to patient self-report; and (ii) GP and patient characteristics associated with accurate detection following a single clinical encounter...
June 14, 2018: Australian Journal of Primary Health
Sophia Samuel, Heather Thompson
The problem of medical practitioner burnout and loss of morale remains an ongoing challenge in the Australian health workforce. Collegiate recommendations are individualistic or personalised, or worse, punitive. Critical reflection in supervision is a long-accepted and key aspect of social work theory and practice. The use of critical reflection within a general practitioner support group is examined and key learnings from our findings over 3years are discussed. All participants reported the group enhanced individual and team workplace satisfaction, and wellbeing...
June 14, 2018: Australian Journal of Primary Health
Anneliese J Synnot, Catherine L Cherry, Michael P Summers, Rwth Stuckey, Catherine A Milne, Dianne B Lowe, Sophie J Hill
This paper describes the people, activities and methods of consumer engagement in a complex research project, and reflects on the influence this had on the research and people involved, and enablers and challenges of engagement. The 2.5-year Integrating and Deriving Evidence Experiences and Preferences (IN-DEEP) study was conducted to develop online consumer summaries of multiple sclerosis (MS) treatment evidence in partnership with a three-member consumer advisory group. Engagement methods included 6-monthly face-to-face meetings and email contact...
June 7, 2018: Australian Journal of Primary Health
Jo-Anne E Manski-Nankervis, Sharmala Thuraisingam, Phyllis Lau, Irene Blackberry, Janet K Sluggett, Jenni Ilomaki, J Simon Bell, John Furler
Australian guidelines recommend annual screening and monitoring of chronic kidney disease (CKD) in people with type 2 diabetes (T2D). A cross-sectional study utilising data from NPS MedicineWise MedicineInsight program from June 2015 to May 2016 was undertaken to explore: (1) the proportion of patients with T2D attending general practice who have had screening for, or ongoing monitoring of, CKD; (2) the proportion of patients without a documented diagnosis of CKD who have pathology consistent with CKD diagnosis; and (3) the patient factors associated with screening and the recording of a diagnosis of CKD...
May 29, 2018: Australian Journal of Primary Health
Judith A Meiklejohn, Brian Arley, Ross Bailie, Jon Adams, Gail Garvey, Jennifer H Martin, Euan T Walpole, Patricia C Valery
Indigenous Australians diagnosed with cancer experience higher mortality and lower survival rates compared to non-Indigenous Australians. Reasons are multifaceted and complex. Knowledge about Indigenous cancer survivors' perspectives of positive cancer survivorship is a gap in research evidence. The study explored cancer survivorship perspectives of Indigenous cancer survivors, their support people and healthcare workers with a view to developing recommendations for cancer survivorship. Indigenous Australians who completed cancer treatment in the previous 6 months to 5 years, their support people and primary healthcare workers were recruited from primary healthcare centres and a large tertiary Queensland hospital...
May 28, 2018: Australian Journal of Primary Health
Louise S Deeks, Sam Kosari, Mark Naunton, Gabrielle Cooper, Julie Porritt, Rachel Davey, Paresh Dawda, John Goss, Gregory Kyle
Previous studies have found that integrating non-dispensing pharmacists in general practice may improve patient safety, improve patient outcomes, deliver health system efficiencies and generate savings. However, the employment of pharmacists in general practice is not common in Australia. A naturalistic study was conducted in the Australian Capital Territory with three general practices, each employing a part-time pharmacist for 12 months. This study reports on stakeholder perspectives of the benefits, barriers and enablers for integrating pharmacists into general practice...
May 28, 2018: Australian Journal of Primary Health
Pauline Marsh, Sebrina Brennan, Miriam Vandenberg
Using a participatory research framework, researchers at the Centre for Rural Health, University of Tasmania, explored the potential of Community Gardens to function as comprehensive primary healthcare (CPHC) environments. Community gardeners, coordinators, volunteers and Neighbourhood House coordinators discussed their understandings of the health benefits of community gardens, how they contribute to broad CPHC aims and the barriers and enablers to greater CPHC contributions in the future. This research identifies therapeutic features of Community Gardens and explores the correlations between these and CPHC...
May 28, 2018: Australian Journal of Primary Health
Jay Thakkar, Julie Redfern, Ehsan Khan, Emily Atkins, Jeffrey Ha, Kha Vo, Aravinda Thiagalingam, Clara K Chow
The 'Tobacco, Exercise and Diet Messages' (TEXT ME) study was a 6-month, single-centre randomised clinical trial (RCT) that found a text message support program improved levels of cardiovascular risk factors in patients with coronary heart disease (CHD). The current analyses examined whether receipt of text messages influenced participants' engagement with conventional healthcare resources. The TEXT ME study database (N=710) was linked with routinely collected health department databases. Number of doctor consultations, investigations and cardiac medication prescriptions in the two study groups were compared...
May 23, 2018: Australian Journal of Primary Health
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