Australian journal of primary health最新文献

Mental health disorders among women during the perinatal period are common and cause significant morbidity, yet precise reasons why some women develop depression during this period, and others do not, are, as yet, unknown. Pregnancy may burden populations of women differently, and sociological variables, such as finances, social position, interpersonal resources; and extreme events, the coronavirus disease 2019 (COVID-19) pandemic for example, may be as significant as biological determinants. However, current treatment for depression remains focused on the individual woman as the main agent for change. Incorporating a systems-wide approach to diagnosing and treating perinatal depression by addressing structural and systemic determinants may be a more effective way to treat this illness. In this paper, we explore social determinants of health and their correlation with clinical depression in the antenatal period. We also investigate broader, society-wide interventions that may reduce this significant morbidity among women of reproductive age, in both developed and developing nations.

Background: The interconception period provides an opportunity to address women's health risks and optimise birth spacing before the next pregnancy. This scoping review aimed to identify models of interconception care (ICC) delivered at well-child visits (WCVs) around the world, review the impacts of ICC delivered, and what the feasibility and applicability of these models were.

Methods: The global review included clinical studies that that were identified using medical subject headings (MeSH) and keyword combinations. Studies were included if they met the criteria: were clinical studies; examined a model of ICC; were conducted by a registered health professional; and examined women who had given birth within the last 24-months. The following databases were searched: Medline (OVID); CINAHL (EBSCO); PubMed; and Embase (OVID). Relevant studies were screened in Covidence and the data was then extracted using a narrative analysis.

Results: Fifteen studies met the inclusion criteria. The benefits of ICC delivered at WCVs included screening for maternal health behaviours and conditions and increase women's uptake of interventions. The studies identified that implementing ICC at WCVs was acceptable to women. Identified challenges included lack of time for health providers, lack of education among women and health providers, and limited funding for WCVs.

Conclusion: ICC interventions found in this review included family planning counselling and provision of long-acting contraception; health promotion of folic acid; and postpartum depression screening. The research concluded that ICC delivered at WCVs contributes to improving health behaviours for future pregnancies. Increased capacity for this care at WCVs could be achieved with targeted resources and time allocation.

Background: Most oral contraception options require a doctor's prescription in Australia; however, there are many models of direct pharmacy access that have been successfully implemented internationally. Despite these advancements, the most preferable OTC model for consumers is yet to be explored in the international literature, and no prior studies have determined the potential benefits of implementation in Australia. The aim of this study was to explore women's perspectives and preferences for models of direct pharmacy access to oral contraceptive pills (OCPs).

Methods: Women participants (n =20) aged 18-44 residing in Australia were recruited via posts on a community Facebook page and participated in semi-structured telephone interviews. Interview questions were guided by Andersen's Behavioural Model of Health Service Use. Data were coded and thematically analysed in NVivo 12, using an inductive process to develop themes.

Results: Participants' perspectives and preferences in relation to direct pharmacy OCP access were characterised by: (1) the importance of autonomy, accessibility and decreasing stigma; (2) confidence and trust in pharmacists; (3) health and safety concerns regarding OTC access; and (4) the need for varying OTC models to cater for both experienced and first-time users.

Conclusion: Women's perspectives and preferences regarding direct pharmacy OCP access can be used to inform potential pharmacy practice advancements in Australia. While direct pharmacy OCP access is at the nexus of heated political debate in Australia, the potential benefits of being able to access OCPs directly from a pharmacist are evidently salient to women. Australian women's preferred OTC availability models were identified.

Background: Despite recommendations, long-acting reversible contraceptives (LARC) are not always offered as first-line contraceptives in general practice. This study aimed to describe pathways used by women for insertion of LARC.

Methods: This is a secondary analysis of data from the Australian Contraceptives ChOice pRoject (ACCORd), a cluster randomised controlled trial set in 57 general practices in Melbourne, Australia. We investigated whether an educational intervention for general practitioners (GPs) and a rapid LARC insertion clinic increased LARC uptake. The main outcome measures were the type of health service, location/provider of intrauterine device (IUD) insertion; time to insertion; and distance travelled for IUD insertion.

Results: During ACCORd, 149 women had LARC insertion. IUD training was reported by 37% of GPs, but only 12% inserted them. In contrast, 70% of GPs inserted implants and 95% of women accessed implant insertion through their own general practice. LARC rapid referral clinics were used by 52% (13/25) of intervention GPs, where 71% (41/56) of IUD insertions occurred in these clinics (but no implants). There was no difference in the mean time from referral to IUD insertion between women attending intervention and control GPs (mean days 37.6vs 32.7; P =0.61). GPs (including IUD inserters) used a variety of referral pathways for IUD insertion, including public and private clinics, and other GPs. Women travelled up to 90km for IUD insertion.

Conclusions: Although implant insertion has been integrated into general practice, few GPs insert IUDs. Where the option exists for GPs to refer to a LARC rapid referral clinic, the majority of IUD insertions will take place there. Establishing a network of such clinics Australia wide may both increase IUD uptake and address the extensive need for GP training in IUD insertion.

Background: Around one-third of pregnancies in women attending antenatal care are unintended. This means a substantial number of women enter pregnancy without optimising their health prior to conception. Primary care practitioners are uniquely placed to counsel women about how to plan for pregnancy and about how to avoid unintended conception. The One Key Question® (OKQ®) tool facilitates a discussion of pregnancy intention and opens up subsequent discussions regarding preconception or contraception care. This study aimed to assess the acceptability and usability of the OKQ® tool in the Australian primary care setting.

Methods: We undertook a pilot study consisting of quantitative and qualitative componentsacross two general practice settings in Sydney, New South Wales, Australia. We documented women's responses to being asked the OKQ® as part of their consultation. We collected data on the characteristics of the participating GPs and their experience of using the OKQ® tool and conducted semi-structured interviews with all participating GPs.

Results: Fifty-six patients were asked the OKQ®, with the majority stating they were happy to be asked about their reproductive choices and felt it was relevant to their general health. The 10 participating GPs felt the OKQ® was easy to use and although 62.5% reported it extended the consultation time, the medium time taken was 2min. GPs felt framing the OKQ® helped introduce pregnancy intention discussions into a consultation.

Conclusions: The OKQ® is acceptable to patients and easy for GPs to use. This tool facilitates a proactive and routine discussion to enhance the delivery of preconception care and contraceptive counselling.

Preconception care (PCC) is effective in reducing modifiable risk factors and optimising maternal health. Primary care services such as general practices in Australia are an appropriate setting to provide PCC. However, PCC is not routinely provided in most of these settings, and many reproductive-aged women and men are not aware of the need for PCC. In this forum article, we discuss the factors that hinder PCC provision in Australian general practices and make recommendations on how access to PCC services can be broadened in Australia, including the potential opportunity for general practice nurses to contribute to the provision of PCC.

Background: Conciliatory attitudes, respect for medical professionals and avoidance of being direct can make health consultations with Burma-born patients difficult to navigate. Coupled with linguistic barriers, this may make the sensitive nature of many women's health consultations challenging. Little is known about current practices for obtaining informed consent in this context. The objectives of this study were to explore current practices, barriers and strategies to obtaining informed consent in medical consultations with women born in Burma.

Methods: Purposive and snowball sampling was used to recruit health practitioners (n =15, 2 male, 13 female) of different ages, years of professional experience, and country of origin, from clinics in Victoria that see a high volume of Burma-born patients. Thirty to sixty minute semi-structured interviews were conducted with four general practitioners, eight nurses and three interpreters, and de-identified audio recordings were transcribed for inductive thematic analysis.

Results: Five key themes were generated: (1) cultural cognisance; (2) influence of community; (3) skilful navigation of communication; (4) favourable consultation attributes; and (5) individual tailoring of consent conversations. Differing cultural expectations, and linguistic and educational barriers, were highlighted as challenges to obtaining informed consent, whereas thoughtful utilisation of non-verbal communication, and intentional customisation of consent conversations were identified as facilitators.

Conclusion: The findings of this study provide practical ways to optimise the informed consent process within the Australian primary healthcare context, and reinforce that accepted Western-based practices for obtaining informed consent are not a 'one-size-fits-all' process.

Background: Standard care for pregnant women includes universal screening for hepatitis B, and administration of influenza and pertussis vaccination to women and hepatitis B infant vaccination. This study explored how perinatal services relating to the prevention of these vaccine-preventable diseases are delivered to women and their infants in Victoria, Australia.

Methods: Two online surveys investigated service delivery for the prevention of influenza, pertussis and hepatitis B to identify barriers to optimal care during January-June 2021; (1) The Birthing Hospitals Survey captured facility-level information about service delivery for influenza and pertussis vaccination, and interventions to prevent mother-to-child-transmission of chronic hepatitis B (CHB); and (2) The Healthcare Providers Survey captured individual staff perceptions and knowledge in community and hospital settings.

Results: Thirty-four hospital unit managers (61%) completed The Birthing Hospitals Survey . One-hundred and forty participants completed The Healthcare Providers Survey . Half of the birthing hospitals provided influenza (50%) and pertussis (53%) vaccinations to pregnant women, and 53% provided an infectious diseases service for women with CHB. Barriers to optimal care delivery included reliance on pregnant woman's self-report to confirm influenza, pertussis vaccination and CHB status, lack of standardised reporting, inadequate workforce training, poor communication between services, and lack of guideline-based clinical care for mothers with CHB and their infants. Three hospitals reported 'stock out' of hepatitis B immunoglobulin (HBIG).

Conclusion: Coordinated and standardised system and clinical care improvements are required to provide equitable care for pregnant women and their infants, including training and education for healthcare providers, improving data capture and communication among health services.

Background: The lack of access to and uptake of postpartum contraception is a key contributor to an estimated 121million unintended pregnancies worldwide. Research on counselling and women's preferences for postpartum contraception is scarce in Australia. We therefore aimed to explore Australian women's experiences of, and preferences for, accessing postpartum contraceptive counselling.

Method: In this qualitative study, English-speaking women of reproductive age (18-40years) with at least one child under the age of 5years were recruited via social media to participate in a semi-structured telephone interview. Interviews focussed on women's experiences of, and preferences for, postpartum contraception. The interviews were audio-recorded, transcribed, coded and thematically analysed.

Results: Twenty women participated. Most did not receive in-depth contraceptive counselling antenatally or postnatally, though had brief discussions with their GPs or obstetricians at the 6-week postnatal check. Participants felt some counselling throughout their antenatal and postnatal care would have been useful, particularly those who experienced medical complications perinatally. Most participants expressed a general preference for their GP or a midwife to provide such counselling, rather than an obstetrician or nurse, and they noted characteristics such as compassion, trust and care as being particularly important.

Conclusion: The provision of postpartum contraceptive counselling could be enhanced in Australia. Contraceptive uptake in the postpartum period may be promoted by ensuring consistent and routine provision of contraceptive counselling for women antenatally and postnatally by their maternity carers.