Public Health Research & Practice最新文献

Objectives To explore the experiences of General Practitioners (GPs) when referring patients with positive bowel cancer screening tests for colonoscopy, and to identify enablers and barriers to increasing referrals to public nurse-led Direct Access Colonoscopy (DAC) services in New South Wales, Australia. Methods A mixed-methods study, with the design, analysis and interpretation informed by implementation science frameworks (COM-B and Theoretical Domains Framework). The quantitative component included an online survey of NSW GPs in July 2024 recruited through primary health care networks. Survey participants could opt-in for a follow-up, semi-structured online interview in August 2024. Descriptive statistics were produced with the quantitative data, by general practice setting and size of practice. Qualitative data were analysed deductively using theoretical frameworks. Results A total of 71 GPs completed the survey and 18 of those GPs participated in an interview. Ninety percent of survey participants were located in an area with a DAC service, but only 56% of these GPs were aware of the service (n = 51). All but two of the GPs who were aware of DAC had referred a patient to DAC in the previous 12 months (n = 34, 48%). The top three considerations for GPs when referring patients for a colonoscopy following a positive screening test were: average wait time for the procedure, patient finances and/or insurance, and the patient and/or service location. Key factors influencing general practitioner referral practices to DAC were knowledge gaps, unclear eligibility criteria, and no systemic prompts for referral to DAC. While DAC was valued for providing timely, cost-free access to colonoscopy, some GPs preferred private referrals because it was more timely and less burdensome for patients. GPs expressed concerns about specialist oversight and continuity of care, which led some to view DAC as an inferior referral pathway. Conclusions Feedback received from GPs in this study to improve DAC services and strengthen trust in referring to DAC were: increased communications about DAC to primary care; clear referral criteria, transparent wait times and simplified referral tools; statewide DAC service provision; clarifying specialist oversight and follow up of high risk patients; and targeted messaging about the DAC pathway using peer persuasion through professional networks.

Objectives and importance of study Chronic hepatitis B and C are leading causes of liver cancer in Australia, and understanding prevalence, diagnosis, and care uptake is a public health priority in the context of a strategic commitment to elimination. This study aims to estimate the degree of movement between jurisdictions among people with hepatitis B and hepatitis C in Australia, to understand the impact on national notifications data and the implications for modelling of prevalence and diagnosis, and consequently uptake measures. Study type Retrospective cohort study using linked health service provision data. Methods Individuals who received Medicare services restricted to those diagnosed with hepatitis B or hepatitis C (nucleic acid testing or treatment) via Medicare during 2011-2023 were analysed. The proportion who changed jurisdictions and the proportion who had a service in multiple jurisdictions were generated, with sub-analysis by jurisdiction and among priority populations (those born overseas and Aboriginal and/or Torres Strait Islander people). Results Among the cohort (n=137,041 hepatitis B; n=252,144 hepatitis C), 9.8% of those with hepatitis B and 15.1% of those with hepatitis C resided in more than one jurisdiction, ranging from 6.7%-33.3% by jurisdiction for hepatitis B and 14.5%-42.8% for hepatitis C. This compared to 10.3% (range 8.0%-28.9%) among the total Australian population. Movement was higher among Aboriginal and Torres Strait Islander people for hepatitis B, with a different pattern by jurisdiction than the total cohort. The proportion who had a hepatitis B or hepatitis C service in multiple jurisdictions was 3.2% and 4.6%, respectively, with similar trends by state and territory. Conclusions Movement among people with hepatitis B and C was highly variable according to jurisdiction. This movement should be accounted for in the use of notifications data according to geographic area, and in assessing national progress towards viral hepatitis elimination goals.

Objectives Australia is among the few, large jurisdictions to experience more than one pandemic wave proceeded by no incident COVID-19 cases. We aimed to estimate the immediacy, extent and duration of impact of those waves on initial admission and readmission rates. Methods We used single and controlled interrupted time-series designs, segmented regression analyses and linked administrative data from 2016 to 2021. Results Congestive heart failure (CHF) patients experienced immediate and sizable reductions in weekly acute, initial admissions of 26% and 16% for up to 3 to 5 months after the first and Delta waves in 2020 and 2021, respectively. Unplanned readmissions within 30-days declined by 2.30 and 3.59 percentage points (10 to 16% rate reduction) and remained lower than expected for more than 4 to 5 months after both waves. These reductions occurred after years of stability in these measures. Reductions commenced earlier than the WHO declaration in 2020 and coincided stay-at-home orders in 2021. There was no significant change in average length of stay. Conclusions Pandemic waves and restrictions in NSW resulted in rapid, sizable, and sustained reductions in initial admission and readmission rates among CHF patients suggesting that clinician, patient and/or family decisions reduce potentially preventable admissions as these decisions occurred before or at the time of public health declarations. Future studies should explore the potential impact of this reduction on health outcomes of patients with CHF.

Objectives Hepatitis B virus (HBV) remains a public health challenge, with chronic HBV infection leading to advanced liver disease complications including decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC). Prevention of HBV-related DC and HCC relies on effective interventions, particularly antiviral therapy, with late HBV diagnosis a missed opportunity for earlier introduction. This study investigates factors associated with late HBV diagnosis in a large area of Sydney, Australia. Methods This study used a subset of an existing population-based linked dataset, consisting of all HBV and hepatitis C notifications in New South Wales, linked to hospital admission data and the National HIV Registry. DC and HCC diagnosis was based on first hospitalisation for each event. Late diagnosis was defined as HBV notification at or within two years of DC or HCC diagnoses. Cross-tabulation and unadjusted and adjusted logistic regression analyses were performed to assess the association of late diagnosis with demographic, temporal, geographic, and clinical factors. Results Between 2002 and March 2022, 10,910 individuals in SESLHD were notified with HBV, with 296 (3%) diagnosed with DC or HCC. Late diagnosis occurred in 102 (34%) of these individuals and was more common in females (43%) versus males (31%), individuals born between 1945 and 1964 (55%), and those born in West/South Asia (43%). Female sex was the only factor independently associated with late HBV diagnosis (adjusted odds ratio [aOR] 1.92, 95%CI 1.08-3.42). There were trends towards associations with late HBV diagnosis for birth cohort (≥1965) (aOR 2.02, 95% CI 0.85-4.82), overseas birth (aOR 1.92, 95% CI 0.96-4.01), history of alcohol use disorder (aOR 2.72, 95% CI 0.86-8.96), and year of DC or HCC diagnosis (aOR 0.57, 95% CI 0.28-1.16 2016-2021 vs 2001-2008). Conclusion A third of people with HBV-related advanced liver disease complications are diagnosed late, reducing opportunities for effective interventions. Strategies to enhance earlier HBV diagnosis are required to reduce HBV burden and advance elimination efforts. Local strategies should aim to engage older migrants from west and south Asia, ensuring equity of access for women in this cohort. These findings underscore the importance of localised data and benefits of data linkage.

Objectives Timely, accurate reporting of pregnancy vaccination coverage is key to evaluating pregnancy immunisation programs. We compared influenza and pertussis vaccination reporting on the New South Wales (NSW) Perinatal Data Collection (PDC) and the Australian Immunisation Register (AIR), to understand coverage, reporting, timing of vaccination and provider type. Methods This retrospective population-based cohort study in New South Wales, Australia, included people giving birth at ≥20-weeks' gestation (2017-2022) in the NSW PDC (total number of pregnancies 555,553), linked to AIR-reported influenza and pertussis vaccinations. Main outcomes of interest were influenza and pertussis coverage according to 1) the PDC and 2) linked AIR records. We assessed agreement between data sources (i.e. whether an AIR record during the pregnancy existed if vaccine receipt was reported on the PDC, and vice versa) by year (influenza: 2021-2022, pertussis: 2017-2022) and selected characteristics (2022). Provider type and timing for vaccinations reported to the AIR are described (2022). Results PDC-reported influenza and pertussis coverage peaked in 2020 (influenza: 58.8%, pertussis: 79.0%), decreasing thereafter (influenza: 49.1%, pertussis: 77.6% in 2022). AIR-reported influenza and pertussis vaccination coverage increased (influenza: 34.7% in 2021 to 44.8% in 2022; pertussis: 24.4% in 2017 to 51.6% in 2022). Agreement between AIR and PDC improved over time, but remained suboptimal (influenza: 75.5%, pertussis: 56.6% in 2022). AIR and PDC agreement differed most by antenatal care model, particularly for pertussis vaccinations. In 2022, of pregnancy vaccinations reported to the AIR, >75% were provided in general practices. Co-administration occurred infrequently (8.8%). Conclusions Despite mandated reporting to the AIR, there was significant underreporting of pregnancy vaccinations to the AIR as compared with the NSW PDC. National collection of accurate and timely data on pregnancy vaccination coverage is needed to monitor vaccine uptake, and identify and monitor strategies to improve uptake, particularly with the new pregnancy respiratory syncytial virus vaccine program in 2025. We identified co-administration as a potential strategy to improve influenza vaccination coverage during pregnancy.

Involving young people in the development of health interventions can result in interventions that are more fit for purpose. However, few, if any, studies outline how to successfully and meaningfully engage young people in the development process. This report outlines the successes and challenges of three strategies we used to involve young people in designing a health intervention targeting young people. It is hoped that our experience can help inform other researchers how young people can be meaningfully engaged in research.

The term 'culturally and linguistically diverse' (CALD) is used in Australia to describe some groups of migrants. Implicitly, the term defines 'others' who are 'different' to the dominant normative Australian. The use of the term as standard language in health literature and public discourse has increased dramatically over the past decade. Australians who are labelled as CALD have argued that the term affects their sense of belonging to the Australian community. As public health researchers and practitioners, we must minimise potential risks of harm, maximise health benefits and ensure the rigour of our data collection, analysis and reporting methods. We argue that we must refrain from continuing to use this concept and that there is no need for a new label to categorise some members of our diverse Australian population as 'others'.

Objectives Promoting the Australian National Bowel Cancer Screening Program in general practice has been identified as an effective strategy to increase participation rates. Despite the positive influence general practitioners (GPs) have on patient decision-making, program endorsement is not routinely included within the national program's policy and practice. The aim of this study was to gain a comprehensive understanding of knowledge, health promotion strategies and the challenges/opportunities for general practice staff to support patient participation and navigation through the National Bowel Cancer Screening Program pathways. Study type A 52-item online cross-sectional survey. Methods A total of 320 general practice clinics in the Metro South Hospital and Health Service, Queensland, Australia received a direct invitation via email to participate. The survey contained items on knowledge, health promotion strategies and challenges/opportunities to endorse participation in the National Bowel Cancer Screening Program, including enquiry about the utilisation of electronic medical records. Results Eighty-eight individuals participated, including GPs, practice managers and practice nurses. Of GPs, 96.2% indicated they were likely to promote the National Bowel Cancer Screening Program to patients. Few participants used systems to identify/notify patients due for screening, and over half indicated that Medicare reimbursements (56.8%) and electronic systems for identifying eligible or overdue patients (53.4%) would support their ability to promote the National Bowel Cancer Screening Program in routine practice. Conclusion Early detection and treatment of bowel cancer is a public health priority in Australia and internationally. Findings highlight the willingness of staff to promote participation; however, the need for incentivisation and streamlined software integration to identify and prompt eligible patients to screen through the National Bowel Cancer Screening Program remains. These findings contribute new evidence regarding the resources, preferences and system-level requirements needed to support routine GP endorsement of the National Bowel Cancer Screening Program.

Objectives Adaptation planning is needed at all levels of government to limit the adverse impacts of climate change on public health. This study aims to examine adaptation planning with a health focus at the local government level in Australia. Methods All 541 Australian local governments were contacted by email, and their websites were searched to determine which had a climate change adaptation plan. These plans were analysed for their health-word content. Results Almost one-quarter (23%, 124/541) of Australian local governments had a climate change adaptation plan. A larger proportion of urban local governments had plans when compared with rural local governments (41% vs 8%, P P P Conclusions Australia's local governments differ in adaptation planning for health and climate change, with just under a quarter having produced a plan, and the extent and nature of health content are highly variable.