Australian journal of primary health最新文献

Cancer is a major threat to public health and the second leading cause of death globally. Population-based cancer screening is an effective way to improve the early detection of a cancer and reduce mortality. Factors associated with participation in cancer screening have been increasingly explored in research. The challenges to undertaking such research are evident, but there is little discussion about how to address such challenges. This article discusses methodological issues associated with the recruitment and engagement of participants in research, drawing upon our experience of undertaking research exploring the support needs of people residing in Newport West, Wales, to participate in breast, bowel, and cervical screening programs. Four key areas were addressed: sampling issues, language barriers, IT issues, and time demand for participation. The paper highlights the importance of ongoing community engagement, the provision of appropriate study materials, and the adaption to different data collection modes to meet participants' needs to participate in research, thus enabling people who are usually excluded from research to have a voice and make a significant contribution to research.

This paper examines the implications of the second sentence in Tudor Harts statement about inverse care - that its operation was strongest when exposed to market forces. In the Australian context, we briefly review some available evidence for inverse care in three groups - Aboriginal and Torres Strait Islander people and those living in remote and socioeconomically disadvantaged areas. We then discuss the extent to which these examples can be attributed to the operation of supply-and-demand within Australia's hybrid fee-for-service system in general practice. Our analysis suggests disparities in workforce supply and the ability of disadvantaged groups to seek preventive and proactive care are critical factors. These, in turn, suggest the need to fund general practice to be responsible for proactive and preventive care of disadvantaged population groups alongside broader structural reforms in workforce, education and taxation.

This paper explores the roles of university departments of primary health care (PHC) and general practice in promoting health equity. The coronavirus disease 2019 (COVID-19) pandemic has exposed long-standing health and workforce inequities in Australia, as elsewhere. Addressing these inequities will require wide-ranging responses particularly focussed on PHC and the PHC workforce. Well-resourced university departments of PHC and general practice have potential to lead research informing PHC transformation and strategies to reduce health inequity, as well as to train and inspire a future PHC workforce. Examples from such academic departments in Australia and internationally are briefly described, and the experience of a recently established department of general practice is considered, in order to recommend enablers including institutional support, curriculum design, and partnerships with communities and between institutions. Support for community-based clinical schools, practice-based research networks and strengthening PHC research capacity will enable the PHC and general practice academy to engage more effectively in addressing health inequity.

Background: Equitable access to gender-affirming hormone treatment (GAHT) for trans and gender-diverse people has been identified as a key factor in addressing rates of poor health outcomes in the trans and gender-diverse community. In Australia, GAHT is largely delivered via a medical model, and within acute care facilities. Medicalisation and pathologisation of gender-affirming care acts as a significant barrier to access for many trans and gender-diverse individuals.

Methods: This project incorporated a case study approach using multiple methods to investigate a recent community sponsored, co-designed program providing GAHT that included a peer navigator (PN) model of care in a primary healthcare (community health) setting.

Results: Service activity in Year 1 and Year 2 demonstrated acceptability of the model, with over 1000 appointments delivered. This was supported by client feedback survey data collected at their initial (n =110) and then 6-months post visit (n =78) with the PN, and 31 interviews with clients, staff and stakeholders.

Conclusion: Findings highlight the integral nature of the PN to the sustainability of the program, with some key insights into potential barriers. Basing service design on an Informed Consent model recognises the agency of the individual and their right to equitable access to health care of their choosing.

Trans and gender-diverse individuals experience poor mental health, and face significant barriers when trying to access appropriate mental health care. Most seek treatment from mainstream primary care services, who have an ethical duty to provide care to all. Primary care practitioners can ameliorate traumatic harms by identifying helpful strategies and avoiding inappropriate or harmful strategies. However, there is limited robust, culturally sensitive evidence informing clinicians about the appropriateness and efficacy of psychological interventions for trans and gender-diverse clients. This forum article argues that the epistemological and ontological frameworks underlying psychotherapies can impact the therapeutic relationship, and are therefore important factors to consider in primary care practice with trans and gender-diverse clients. Our paper synthesises selected psychotherapies into four clusters. Each cluster is accompanied by discussion of the potential or demonstrated benefits and limitations of the underlying framework, in the context of primary care with trans and gender-diverse clients. We also explore power dynamics in therapeutic relationships with trans and gender-diverse clients, and the challenges these factors pose to developing a shared understanding of the client's needs and preferences. The article concludes with some practical considerations for managing these issues in primary care.

Background: General practitioners are well positioned to contribute to the pharmacovigilance of medical cannabis via the general practice electronic medical record (EMR). The aim of this research is to interrogate de-identified patient data from the Patron primary care data repository for reports of medicinal cannabis to ascertain the feasibility of using EMRs to monitor medicinal cannabis prescribing in Australia.

Methods: EMR rule-based digital phenotyping of 1 164 846 active patients from 109 practices was undertaken to investigate reports of medicinal cannabis use from September 2017 to September 2020.

Results: Eighty patients with 170 prescriptions of medicinal cannabis were identified in the Patron repository. Reasons for prescription included anxiety, multiple sclerosis, cancer, nausea, and Crohn's disease. Nine patients showed symptoms of a possible adverse event, including depression, motor vehicle accident, gastrointestinal symptoms, and anxiety.

Conclusions: The recording of medicinal cannabis effects in the patient EMR provides potential for medicinal cannabis monitoring in the community. This is especially feasible if monitoring were to be embedded into general practitioner workflow.

Background: There is a high burden of skin and soft tissue infections (SSTI) - including cellulitis - among Aboriginal and Torres Strait Islander peoples living in remote communities. In tropical environments, such as the Torres Strait, cellulitis accounts for 37% of potentially preventable hospitalisations. This study aimed to evaluate the safety, effectiveness and community acceptance of outpatient antibiotic treatment for the management of skin infections in the Torres Strait.

Conclusions: Outpatient management of skin infection in the Torres Strait is effective, safe and appreciated by patients.

Methods: This was a 12-month prospective, observational study commencing in January 2019 involving 295 adults with a skin infection across the Torres Strait.

Results: Most (276/295 (94%)) participants were treated successfully in the community. Of 295 enrolled patients, 151 of 295 (51%) had cellulitis, 59 of 295 (20%) had a skin abscess and 85 of 295 (28%) had a wound infection. Of the 77 of 278 (27%) infections accompanied by systemic features, 63 of 77 (82%) were managed in the community. Staphylococcus aureus was the most frequent isolate, at 165 of 261 (63%); 56 of 165 (33%) were methicillin resistant. In the 276 community-managed cases, oral trimethoprim/sulfamethoxazole was initially used in 159 (57%), oral flucloxacillin in 75 (27%) and intravenous cefazolin plus oral probenecid in 32 (13%). The clinical course was complicated in eight of 232 (3%) patients who had complete follow-up data: seven patients required hospitalisation after initial treatment in the communityand one had an antibiotic side-effect. All 232 patients with complete follow-up data were content with the care they received.

Background: Aboriginal and Torres Strait Islanders bear a higher burden of oral disease compared to non-Indigenous persons. Rural Aboriginal and Torres Strait Islander communities are further disadvantaged due to service access difficulties. This study, initiated by community concern for oral health identified through its Health Action Group, aimed to explore a rural Aboriginal community's strategies to resolve oral health problems.

Conclusion: Community members are aware of local barriers and potential facilitators for improving oral health within their community. Their identification of priority strategies can be used to inform the delivery of oral healthcareservices and to develop oral healthcare promotion programs for the community. Co-designing solutions with the community should be an integral part of solving complex problems such as oral health.

Methods: A qualitative research study using a phenomenological research design with focus group discussions and in-depth interviews was completed in partnership with a rural community in Queensland, Australia, with a predominantly Aboriginal population. The research team included Aboriginal and non-Aboriginal personnel; community and external personnel; and dental and non-dental personnel. The collaborative approach included the development, implementation, analysis and interpretation of the research involving the community through its Health Action Group. Community engagement led to the recruitment of 27 participants from local health and community groups.

Results: Themes emerging from the data included: reducing financial barriers to accessing oral health care; integrating oral health care with other health services; increasing oral healthcare promotion activities; and ensuring local input and cultural safety within local oral healthcare services.

Background: Community pharmacists are highly accessible for advice, as most pharmacies are open long hours and no appointment is needed. Community pharmacists, as essential community health workers, play a critical role in the fight against coronavirus disease 2019 (COVID-19). This study aimed to determine the general wellbeing and work impacts of pharmacists and the factors important for adaptability and resilience during the COVID-19 pandemic.

Methods: This study adopted a cross-sectional design. Community pharmacists from various professional networks in Australia were invited through emails and social media posts to complete an anonymous online survey during the second wave of the COVID-19 pandemic in Victoria, Australia.

Results: Sixty-five community pharmacists completed the online survey. The respondents reported fair levels of general wellbeing during the COVID-19 pandemic, with a mean self-related health score of 33.57 (s.d.=13.19) out of a maximal of 96, despite relatively high levels of job stress and emotional labour. Lower levels of general wellbeing were correlated with higher levels of job stress (r =0.645, P <0.01) and emotional labour (r =0.513, P <0.01), and lower levels of occupational self-efficacy (r =-0.566, P <0.01). Leader member exchange was negatively correlated with job stress (r =-0.419, P <0.01) and positively correlated with psychological safety (r =0.693, P <0.01). The linear regression models showed that female pharmacists had lower occupational self-efficacy (β =-0.286, P =0.024), but higher psychological safety (β =0.234, P =0.042). Higher work ability was associated with lower job stress (β =-0.529, P <0.001), higher occupational self-efficacy (β =0.511, P =0.001), and poorer self-related health (β =-0.659, P <0.001).

Conclusions: The findings highlight the importance of a supportive work environment in helping community pharmacists to feel psychologically safe and reduce stress during a crisis.

Background: Lifestyle factors place those who experience incarceration at increased risk of morbidity and mortality from a range of preventable diseases, including cancer.

Methods: Two nurses were employed for a period of 6months to facilitate bowel and breast cancer screening of prisoners across four correctional centres in Queensland. We identify factors impacting on cancer screening in prisons and document the outcomes for those screened.

Results: Both screening programs produced a positivity rate of ∼17% in those screened, with 23 individuals returning a positive faecal occult blood test and five women requiring further investigations following breast screening. At 3months postscreening, all of the positive cases had been referred for further investigations. It is likely that the screening programs were instrumental in preventing morbidity (and mortality) in the subgroup with positive test results.

Conclusions: Cancer screening within the prison environment presents a number of challenges. Intervention at the individual and systems level is required to ensure prisoners can access a standard of care equal to that provided in the community.