Australian journal of primary health最新文献

Background: Practice managers and other administrative and management staff in Aboriginal Medical Services operate in a highly specialised cultural, social and administrative environment requiring a unique skill set. The TAFE NSW Diploma in Practice Management for Aboriginal Medical Services (DPMAMS) addresses the need for training in these skills. This study sought to explore DPMAMS graduates' experiences of having undertaken the diploma course, and the effects on their subsequent work practice and career.

Methods: A qualitative study utilising individual, semi-structured interviews conducted via videoconference and employing a thematic analysis approach was performed.

Results: Ten DPMAMS alumni participated. At the time of DPMAMS completion, two participants were Aboriginal Medical Services practice managers, two were reception staff, five were in non-practice manager administrative or management roles and one was in a clinical role. Principal themes in the study findings were related to (1) the rich and singular learning environment with emphasis on peer-to-peer learning (which also facilitated 'communities of practice' extending the collaborative learning model to post-DMAMS peer learning and support); (2) knowledge and subsequent professional and personal confidence (leading to taking on increased workplace responsibility including post-DPMAMS mentoring roles); (3) translational effects on personal work and professional performance; (4) translational effects on work processes at the participants' Aboriginal Medical Services; and (5) the permeating influence of Aboriginal culture and commitment to Aboriginal communities.

Conclusions: The DPMAMS is an education/training program of perceived high value and fitness for purpose. The findings of utility of education that is empowered by culture, values and peer support may be applicable in wider settings.

People from LGBTIQA+ communities living in rural areas experience significant disparities across a range of health and wellbeing indicators, high levels of stigma and discrimination, and difficulty accessing inclusive health and support services. This article discusses a targeted health promotion intervention designed to build supportive health and social programs to address these problems. We describe the initial needs assessment undertaken to inform the intervention, the role and activities of the health promotion officer funded through the program, and present evaluation data on program outcomes. The article demonstrates that modest funding for health promotion can make a positive contribution to connecting and supporting individuals in a small regional community, leading to better health and wellbeing outcomes.

Background: The study explored the experiences and perceptions of GPs regarding the management of chronic non-cancer pain (CNCP). Specifically, participants were asked to identify perceived enablers and barriers to CNCP care and how the care of patients with CNCP may be improved.

Methods: The study utilised a qualitative descriptive methodology. General practice in Western Australia. The sample was purposive with 12 Australian GPs from predominantly metropolitan locations and with experience in managing CNCP. Semi structured interviews were conducted. Each interview was of 45-60min duration. All interviews were audio recorded and transcribed using a secure transcription service. Thematic analysis developed themes inductively and deductively.

Results: Themes emerged regarding: the importance of a holistic and personalised approach; the important role of a coordinating GP; the need for an evidence-based approach to opioid management; concerns relating to access to multidisciplinary services; the importance of clinician and patient education regarding CNCP; and an acknowledgement of the challenges for doctors and patients in managing CNCP.

Conclusions: Currently, the management of CNCP in Australia is challenging. Notable challenges include: difficulties with continuity of patient care; challenges with patient expectations of treatment, in particular opioid medications; difficulty with access to the health services required to enable holistic care; and the need for improved pain education in the community. The breadth of these challenges suggests there is a need for supportive organisational and structural considerations in the healthcare system to enable optimal care of CNCP in the community.

Background: General practitioners (GPs) have played an integral role in Australia's coronavirus disease 2019 (COVID-19) pandemic response. However, little is known about how GPs themselves have been impacted by the COVID-19 pandemic. This study aimed to increase our understanding of the experiences of GPs working during the COVID-19 pandemic.

Methods: A qualitative study was conducted using semi-structured interviews. Using purposive sampling, 15 GPs from South-Eastern Australia were asked to reflect on their experiences during the first year of the COVID-19 pandemic. Interview transcripts underwent thematic analysis.

Results: Five main themes were identified: fear of infection; uncertainty and information overload; impacts on the government-GP relationship; impacts on the patient-doctor relationship; and teamwork within practices and among GPs.

Conclusions: The 15 GPs interviewed in this study provided valuable insights into their experiences working during the first year of the COVID-19 pandemic. From these insights, four recommendations propose what could be done to help support GPs to respond to a pandemic while continuing to deliver primary health care.

Background: Indigenous youth are navigating the transition from childhood to adulthood while contending with challenges of ongoing colonisation and everyday lived experiences of racism. A comprehensive assessment of Indigenous youth's health could enable early diagnosis and respond to health concerns. This narrative systematic review synthesises evidence about the acceptability and utility of primary health care-based health assessments for improving the health and wellbeing of Indigenous youth.

Methods: A systematic search strategy was conducted using 20 electronic databases. Studies were included if they reported on health assessments conducted in primary health care with youth aged 12-24years who were Indigenous to Australia, New Zealand, Canada, the USA, Taiwan, and the arctic regions of Scandinavia and Russia. A narrative synthesis was undertaken.

Results: Of 3061 unique studies identified, seven met the eligibility criteria. Included studies showed that youth health assessments were useful for making new diagnoses, detecting social and emotional wellbeing concerns, and biomedical parameters. Co-created health assessments with Indigenous youth conducted by clinicians familiar to the community were well accepted. Digital health assessments administered using an electronic tablet provide advantages. No health outcomes were reported. Additionally, no health assessments addressed the impacts of colonisation and racism.

Conclusion: There is insufficient evidence to make firm conclusions about the benefits of health assessments; however, health assessments can be useful for detecting new diagnoses and concerns regarding social determinants of health, and social and emotional wellbeing. Future development of Indigenous youth health assessments needs to involve Indigenous youth's perspectives and interpretations of health.

There are no clear guidelines or validated models for artificial intelligence (AI)-based approaches in the monitoring of coronavirus disease 2019 (COVID-19) patients who were isolated in the community, in order to identify early deterioration of their health symptoms. Developed in partnership with Curious Thing (CT), a Sydney-based AI conversational technology, a new care robot technology was introduced in South Western Sydney (SWS) in September 2021 to manage the large numbers of low-to-medium risk patients with a COVID-19 diagnosis and who were isolating at home. The CT interface made contact with patients via their mobile phone, following a locally produced script to obtain information recording physical condition, wellness and support. The care robot has engaged over 6323 patients between 2 September to 14 December 2021. The AI-assisted phone calls effectively identified the patients requiring further support, saved clinician time by monitoring less ailing patients remotely, and enabled them to spend more time on critically ill patients, thus ensuring that service and supply resources could be directed to those at greatest need. Engagement strategies had ensured stakeholders support of this technology to meet clinical and welfare needs of the identified patient group. Feedback from both the patients and healthcare staff was positive and had informed the ongoing formulation of a more patient-centred model of virtual care.

Background: In 2020 and 2021, Western Australia (WA) was an early adopter of the 'COVID zero' policy, eliminating community transmission and pursuing vaccine roll out to enable a 'soft landing' once coronavirus disease 2019 (COVID-19) infiltrated the community in 2022. Optimisation and augmentation of general practice services were at the forefront of policies. This study explores metropolitan general practice responses to the resulting disruption caused.

Methods: Qualitative descriptive methodology, purposive sampling and template analysis were used. Semi-structured interviews were undertaken from March to June 2021 with teams from six general practices in metropolitan WA; six general practitioners, four practice nurses and three practice managers.

Results: Staff at all levels responded rapidly amid uncertainty and workload challenges with marked personal toll (anxiety and fear of exposure to risks, frustrations of patients and balancing work and family life). Self-reliance, teamwork and communication strategies built on inclusivity, autonomy and support were important. Responding to changes in general patient behaviour was to the fore. Increasing use of telehealth (telephone and video) became important to meet patient needs. Lessons learned from what was implemented in early-stage lockdowns provided practices with preparedness for the future, and smoother transitions during subsequent lockdowns.

Conclusion: The study demonstrates the self-reliance, teamwork and adaptability of the general practice sector in responding to a sudden, unexpected major disruption, yet maintaining ongoing service provision for their patients. Although the COVID-19 landscape has now changed, the lessons learned and the planning that took place will help general practice in WA adapt to similar future situations readily.

Background: Security of health facilities in low- and middle-income countries (LMICs) is of vital importance in ensuring that health care can be provided in safe conditions. There is paucity of literature on the issue of threats to the personal safety of primary healthcare (PHC) providers and service users in Nigeria and what should be done. Thus, the current study seeks to fill this gap.

Method: Key-informant interviews with 12 health workers and non-participant observations were utilised for data collection in Enugu, Nigeria. Their responses were analysed using a descriptive qualitative analysis approach in structuring narratives in themes.

Result: There is lack of vital security infrastructure across the health facilities, and we recorded reports on armed robbery attacks, theft of drugs and other items, including a case of a stolen newborn. These findings are structured in three themes that reveal experienced threats in PHC facilities, their implications on health service delivery, and responses that can be taken to make PHC facilities safe.

Conclusion: Security challenges constrain both access and provision of essential and affordable healthcare services at the primary healthcare level in Enugu, Nigeria.

Post-acute COVID-19 condition (PACC) - also known as long COVID - is a serious and growing problem in primary health. This letter describes the work of the Victorian Post-Acute COVID-19 Study (VPACS) group, which comprises clinician researchers, basic scientists and consumers. Two key priorities for PACC research in Australia are identified and discussed: (1) the establishment of COVID-19 patient registries and data linkage; and (2) the consolidation of clinical guidelines. Collaboration between consumers, researchers, clinicians and institutions must be the foundation of PACC management in Australia. Ongoing research should focus on large, multicentre controlled studies, the protective effect of vaccination, differential impacts from variants, pathobiological underpinnings, disease mechanisms to avoid severe and enduring impacts on the Australian economy. The lived experience of people with PACC is also essential to enable the design and implementation of effective models of care. VPACS brings a diverse group of people together to work on a shared vision of holistic and high-quality care, and collectively maximise their impact on outcomes for patients and the broader community.