Australian journal of primary health最新文献

Co-design and co-production are increasingly used to improve and innovate healthcare practices and services to better address people's healthcare needs. Mental health consumers, especially people diagnosed with serious mental illness, experience considerable health disparities and barriers to primary care, while primary care providers experience barriers to addressing the healthcare needs of people diagnosed with serious mental illness. Both mental health consumers and primary care providers bring knowledge and expertise to improving mental health consumers' health care. This scoping review of the peer-reviewed and grey literature was undertaken to determine the extent and scope of co-design and co-production involving mental health consumers and primary care providers to address mental health consumers' healthcare needs. The review also sought to determine factors that enable or limit co-design and co-production involving mental health consumers and primary care providers. Twelve studies and reports of co-design and co-production involving mental health consumers and primary care providers were identified by the review. These studies showed that co-design and co-production were feasible and beneficial, and that there was significant scope for collaboration at the intersection of mental health and primary care services. Lessons learned from projects that have led the way include the need for (1) co-design/co-production practices that sustain equitable participation and address inevitable power imbalances when service users and service providers work together, (2) sufficient reporting on methods to ascertain claims of co-design/co-production and allow replication of these methods in similar healthcare improvement projects, and (3) co-design/co-production projects to be supported by other systems change strategies.

Background Approximately 500 million people worldwide live with type 2 diabetes mellitus. The UK's 'Diabetes Remission Clinical Trial' (DiRECT) is a potential novel method for care. An Australian trial of DiRECT (DiRECT-Aus) showed that 56% of participants achieved diabetes remission at 12months. We explored the experiences of patients, clinicians and trial partners involved in DiRECT-Aus to ascertain the acceptability and feasibility of DiRECT-Aus, as well as factors influencing implementation, to inform recommendations for sustainable scale up into mainstream primary care. Methods This qualitative implementation research conducted within a constructivist paradigm involved semi-structured interviews with key stakeholders. Data analysis followed an inductive thematic approach, informed by the Consolidated Framework for Implementation Research. Results Patients (n =14), general practitioners (n =3), practice nurses (n =6), dietitians (n =7) and DiRECT-Aus trial partners (n =5) were interviewed. We identified four core components of DiRECT-Aus that are essential for implementation and scale up. They were: (1) access to very low-energy diet products; (2) high frequency of contact with the dietitian; (3) dietitian's clinical knowledge and patient-centred practice; and (4) absence of financial costs to patients. Several additional factors that could support implementation and suggested funding models are described. Conclusions This study concludes that DiRECT-Aus was acceptable and feasible to patients and clinicians.

Background There are several studies investigating the effectiveness and participation rates of the Australian National Bowel Cancer Screening Program (NBCSP), but there is limited literature pertaining to the role and processes that general practitioners (GPs) follow after a positive immunochemical faecal occult blood test (iFOBT) result. The aim of this paper is to review evidence examining GP involvement in the follow-up of positive iFOBT results from the NBCSP and identify knowledge gaps. Methods A scoping review was undertaken involving the search of the Cochrane Library, Informit, PubMed and Scopus electronic databases. Inclusion criteria were the follow-up processes and practices by GPs subsequent to notification of a positive iFOBT from this program. Searches were limited to English and publication was from January 2006 to January 2024. A combination of keywords was used and adapted to each search engines' requirements: general practitioner AND bowel cancer AND screening AND Australia. Results Relevant sources of evidence were reviewed, and 24 records met inclusion criteria. Results are represented across three themes: (i) screening process and GP follow-up; (ii) follow-up rates and facilitation; and (iii) recommendations for improved follow-up. Conclusion This scoping review provides insight into the central role GPs play in the implementation of the NBCSP and highlights the lack of information regarding steps taken and systems employed in general practice to manage positive iFOBTs.

Background In recent years, there has been increased recognition of the importance of unmet needs of services for people with dementia regionally and nationally. This study aimed to explore the service gaps described by health and aged care providers in the Australian Capital Territory (ACT) to inform decisions regarding dementia care services. Methods Semi-structured interviews were conducted with 29 health and aged care service providers, managers, and stakeholders providing dementia services in the ACT in 2022 and 2023. Responses to two open-ended questions regarding the perception of service gaps in the region were examined using content analysis. Results Six themes were identified across the interviews: (1) concerns with existing dementia care services; (2) concerns with primary care; (3) a lack of dementia-appropriate services; (4) workforce shortages and limited training; (5) funding as a barrier to access and collaboration between services; and (6) lack of understanding of dementia. Several participants felt these issues were not unique to the ACT and indicative of systemic issues common across Australia. Conclusions The service gaps described in the ACT region indicate a need for improved access to high-quality, coordinated, dementia-specific services with appropriate staffing, potentially reducing pressure on the ACT health system and current and future associated costs.

Background Chronic conditions are a major health concern. Most Australian men are overweight or obese and half live with at least one chronic health condition. Many chronic conditions are preventable and treatable by reducing lifestyle risk factors. General practice delivers a range of services, including preventive health care; however, men have been noted to have low engagement with general practice. This study aimed to investigate men's perspectives on preventive health care within general practice. Methods Seventeen semi-structured interviews were conducted with a purposive sample of Australian men recruited from the NSW Rural Fire Service following an initial survey. Interviews sought to explore men's perspectives on engagement in preventive health care within general practice. Data were thematically analysed. Results Two sub-themes were identified relating to men's engagement in preventive health care within general practice. 'The scope of general practice services' highlighted diverse understandings among men's perceptions of the role and value of preventive health care. Whereas 'addressing lifestyle risk factors' revealed the nature of communication and advice provided within general practice concerning lifestyle risks and behavioural change. The findings indicated that when advice is provided, men want tangible and meaningful healthcare strategies that support them in making behavioural changes. Conclusions General practice clinicians need to prioritise preventive health care. Proactively addressing preventive health care with men and supporting them to make informed decisions about their lifestyle choices has the potential to enhance their health and reduce chronic health conditions.

Background This study aimed to gain a comprehensive understanding of oral COVID-19 antiviral prescribing in Australian general practice. Methods The study was a retrospective observational cohort study. Routinely collected, de-identified, Australian general practice consultation and prescription data was used with permission from participating primary health networks, from 938 general practices between March 2022 and September 2023. Study cohorts were patients aged ≥15 encompassing (i) an 'antiviral cohort' comprising patient records with ≥1 oral COVID-19 antiviral prescription/s and (ii) a 'comparison cohort' of remaining records. Primary outcome measures were the frequency and type of oral COVID-19 antivirals prescribed, and sociodemographic and health characteristics of patients prescribed antivirals. Secondary measures were the frequency of antiviral repeat prescribing and consultation modality. Results Within the study population of 3,813,051 patients, oral COVID-19 antivirals were prescribed to 3.39% (129,267) of patients including 14.79% (82,215/555,757) of patients aged ≥70years. Molnupiravir prescribing exceeded nirmatrelvir-ritonavir across all study months. Proportionally, antiviral prescribing was higher in the female population (74,709/2,059,676: 3.63%), Victoria (81,184/2,222,837: 3.65%), residing in high socioeconomic advantage areas (87,530/2,224,501: 3.93%), and ages 80-84 years (16,419/100,911: 16.27%). Of patients prescribed COVID-19 antivirals, 7.27% (9402/129,267) had repeat prescribing. Cardiovascular and musculoskeletal conditions were the most prevalent chronic diagnoses, and telehealth (58,660/107,727: 54.45%) exceeded face-to-face consultations. Conclusions Oral COVID-19 antiviral prescribing volumes in general practice may serve as an indicator of periods of increased transmission of COVID-19, through increases in prescribing activity. Telehealth exceeding face-to-face for oral COVID-19 antiviral prescribing supports continued access to telehealth to reduce exposure to COVID-19 and provide time-critical access to treatment.

Background In 2018, a community care organisation in Northwest Tasmania collaborated with University of Tasmania researchers to develop and implement a strategy for incorporating a reablement-based model of care into their service delivery model as a core organisational approach to care. This study aimed to investigate the long-term outcomes from the initial reablement education to improve our understanding of the needs of staff and clients of community care organisations. Methods The research explored the impact of reablement on client outcomes and how reablement can be translated across organisations. A qualitative research method was utilised to explore experiences of senior staff 2years after the first reablement education sessions. Two focus groups were held 4weeks apart. Nine senior staff participated in focus group one and seven in focus group two. Results Three key themes emerged; reablement needs an appropriate governance and organisational strategy; reablement is a beneficial practice; and strong organisational culture supports reablement. Achieving long-term outcomes involves integrating reablement into working practices and this remains challenging due to organisational constraints. Conclusions This study contributes to the growing body of evidence that shifting underlying practices in community care from 'doing for' to 'doing with' involves a major change of behaviour and practice for individuals and organisations.

In 2017, Taiwan launched a dedicated long-term care plan for Indigenous peoples, enhancing tribal cultural health stations. By 2018, the Indigenous Council introduced a cultural safety mentoring program for caregivers, aiming to improve their cultural sensitivity in providing elder care. This article reviews practical experiences documented in the Indigenous culture care curriculum, examining examples of culturally sensitive care and proposing an elder care model suitable for Indigenous communities based on the findings. The development of social safety policies for Indigenous peoples underscores the critical role of cultural health stations in their welfare. Insights from these stations highlight their adaptation to meet local elders' needs while respecting diverse tribal cultures. Challenges include aligning with policies, training caregivers effectively and ensuring operational efficiency. Addressing these issues requires stable caregiver salaries, proficiency in ethnic languages, and training programs to enhance professionalism and preserve elders' traditional knowledge. Integrating this wisdom into future policies, along with collaboration with cultural experts, will build a robust foundation for future generations.

Background The increasing prevalence of dementia requires a change in the organisation and delivery of primary care to improve the accessibility of best-practice care for people living with dementia and their carer(s). The aim of this study is to describe potential models of dementia care in the primary care setting whereby the nurse plays a central role, from the perspectives of nurses working in general practice, people living with dementia and carer(s). Methods Data from two qualitative semi-structured interview studies were pooled to explore the views of nurses working in general practice, people living with dementia and carer(s) on potential models for the provision of nurse-delivered dementia care. Data were thematically analysed. Six carers, five people living with dementia and 13 nurses working in general practice took part in the study. The data used in this study have not been previously reported. Results Three themes describing nurse-delivered models of care to meet the healthcare needs of people living with dementia and their carer(s) were identified: nurse-led care, dementia care nurse specialist outreach and nurse-enhanced post-diagnostic care. Conclusions This study describes three potential models of dementia care delivery by the nurse in general practice. These findings can be used to guide the implementation of new models of care that integrate the provision of dementia care by nurses within interdisciplinary primary care teams, to better meet the healthcare needs of people living with dementia and their carer(s).

Background Despite the paramount importance of oral health, individuals undergoing treatment for opioid use disorder face unique challenges beyond traditional addiction care. This qualitative study explores the challenges Opioid Treatment Program (OTP) clients in Australia encounter when accessing oral health care, aiming to understand the underlying factors and identify effective strategies for integrating oral health into an OTP. Methods Semi-structured interviews were conducted with OTP clients, OTP clinicians and oral health clinicians using tested interview guides. Thematic analysis identified patterns and themes across participants' responses. Results Client behaviour and traits such as inadequate health prioritisation, crisis-driven care and lack of motivation, shaped by a complex social environment, contribute significantly to inconsistent care and neglected oral health. Addiction exacerbates oral health issues as clients prioritise drug use over oral care and financial constraints, resulting in poor oral hygiene and a higher prevalence of dental problems. Psychological barriers such as dental anxiety deter clients from seeking care, while access issues including administrative burdens and system barriers, lost phones and unstable living conditions hinder consistent management of oral health. Stakeholders recommend actionable steps to address OTP clients' challenges, including integrating holistic care, establishing collaborative support systems, improving awareness and education and enhancing accessibility and flexible scheduling. Conclusion This study established a framework for improving OTP clients' oral health through integrated, holistic strategies. By addressing gaps in existing research, it supports the development of public health policies integrating oral health care into OTPs, aiming to foster collaboration, improve access and advance client education for better health outcomes.