Australian journal of primary health最新文献

Background: Young adults (18-25 years) are struggling with the transition to becoming autonomous users of healthcare services. Although barriers to healthcare accessibility for young adults, such as service cost and difficulty navigating the healthcare system, have been identified, the interactions and relationships between these barriers have not been explored in depth.

Methods: A narrative literature review was conducted to determine the foundational knowledge and communication skills needed by young adults to effectively interact with the healthcare system. Semi-structured interviews were conducted with young adults from New South Wales and the Australian Capital Territory Australia to explore their experiences of healthcare and barriers to their care, and the potential for education based on the identified necessary knowledge and skills to improve their experiences.

Results: Inductive thematic analysis of 11 interviews showed young adults' experiences of barriers across policy, institutional, community, interpersonal, and individual levels. These factors contributed to suboptimal healthcare experiences and impeded participants' ability to effectively communicate with healthcare providers, leading to eroding trust between providers and young adult patients. All participants supported the subsequent recommendations of education priorities for young adults, expecting increased confidence and ability to self-advocate if provided teaching based on the suggested content.

Conclusions: This paper highlights specific targets and directions for future health policy and health education initiatives to improve the healthcare experiences of young adults.

Background: Emergency hormonal contraceptive pills (ECP), a safe and effective way to reduce the risk of unwanted pregnancy, are available without a prescription in community pharmacies in Australia, and >90 countries globally. Supply is informed by practice guidelines for pharmacists in several countries; however, use remains limited. This study aimed to explore the perspectives and practices of community pharmacists in Australia when providing ECP, to identify challenges and facilitators encountered when using ECP practice guidelines.

Methods: Semi-structured interviews were undertaken with purposively sampled Australian community pharmacists who actively supplied ECP, from across a diversity of locations and years of practice. Interview questions were informed by the Theoretical Domains Framework. The interviews were audio-recorded, transcribed verbatim, thematically analysed inductively, then deductively mapped against the Theoretical Domains Framework and double coded.

Results: Seventeen interviews were conducted. The four overarching themes - decision-making in ECP provision, geographic variation in practice, guideline use, and knowledge gaps and training needs - could be mapped against seven of the 10 relevant Theoretical Domains Framework domains. A lack of confidence and up-to-date knowledge among pharmacists was a challenge to optimal provision of ECP. Practice guidelines were acknowledged to contain valuable information, but were difficult to interpret, and use was limited.

Conclusions: Australian pharmacists' perspective of their practice in providing ECP has highlighted the challenges and facilitators to the use of the ECP practice guidelines. Guidelines were seen as inaccessible, ambiguous and impractical, indicating the need for future research to optimise their use. Findings can inform targeted interventions to enhance ECP guideline uptake and improve patient outcomes.

Background: Individuals of Chinese cultural background make up the second largest group within Australia's culturally and linguistically diverse population. However, there is limited understanding of the use of mental healthcare services in general practice by the Chinese community, particularly when considering the influence of cultural nuances. This study aimed to investigate how cultural factors shape the experiences of Chinese individuals in accessing mental health support through general practice.

Methods: One-on-one semi-structured interviews were conducted with 12 Chinese participants who had consulted a general practitioner for mental health care in Australia.

Results: Thematic analysis captured five themes: (1) attitudes or beliefs about mental ill-health, (2) barriers to seeking mental health care, (3) facilitators to seeking mental health care, (4) preferences in GP selection, and (5) experience in mental health recovery. These also encapsulated participant perceptions of GPs' roles in mental health care and patients' treatment preferences.

Conclusions: This study suggests that cultural stigma surrounding mental illness is a potential cause of underdiagnosis and underutilisation of mental health services among Chinese individuals in Australia. Practical barriers, such as costs, perceived care effectiveness and GP availabilities, further complicate care usage. Nonetheless, self-motivation and support from family and friends encourage positive help-seeking behaviours. Overall, the evolving beliefs about mental illnesses emphasise the need for strengthened communication and trust between GPs and Chinese patients to enhance prioritisation of GPs' role in mental health care. Future investigations into the adequacy of current cultural competency trainings for GPs are needed.

Background: Osteoarthritis (OA) is a prevalent, debilitating and costly chronic condition. National and international guidelines recommend the conservative treatment strategies of body mass reduction and exercise for the management of hip and knee OA because of the strong evidence to support the efficacy of these interventions. Despite this, these conservative management strategies are currently underutilised in Australia. Appropriately designed, novel models of care may play a role in improving the utilisation of appropriate conservative treatment strategies for hip and knee OA. Therefore, a qualitative study was conducted to investigate patient and clinician perspectives of a novel multidisciplinary case conference model to conservatively manage hip and knee OA within a primary care setting.

Methods: Qualitative data were collected via telephone-based semi-structured one-on-one interviews with patients with OA (n = 11), general practitioners (n = 2), accredited exercise physiologists (n = 2), accredited practising dietitians (n = 2) and practice nurses (n = 2).

Results: Thematic content analysis led to the generation of four major themes from the data: (i) potential benefits; (ii) foreseeable challenges; (iii) the benefit-engagement cycle and (iv) maintenance of lifestyle changes.

Conclusion: The proposed multidisciplinary model of care to conservatively manage hip and knee OA was perceived by both patients and clinicians to have many benefits and a limited number of manageable challenges. The identified challenges provide guidance on how the model should be refined before it is implemented in clinical practice.

Background: Recruiting participants for clinical trials poses significant challenges, which can result in escalating costs, delay, and possible abandonment of the trial. Torch Recruit is a software tool that is developed to streamline recruitment process by identifying general practice patients who meet the recruitment criteria specific to a clinical trial by interrogating the patient electronic medical record (EMR) database, thereby optimizing trial recruitment. The aim of the study was to explore the use, acceptability and feasibility of Torch Recruit to support patient recruitment in Australian general practice.

Methods: Twenty-three semi-structured interviews were completed with four practice staff, nine research staff and ten patients. between January to September 2023, to explore the use of Torch Recruit to recruit and manage patients in clinical trials. Data were thematically analysed and interpreted using the updated Consolidated Framework of Implementation Research.

Results: Both practice and research staff expressed that Torch Recruit was a well-designed, intuitive tool, enabling accurate and automatic identification of eligible patients for clinical trials. Identifying eligible patients using trial inclusion and exclusion reduced time spent on otherwise traditional methods such as identifying patients through practice electronic medical records or through waiting room recruitment. Patient privacy was mentioned as a possible concern for participants. However, having patient related data stored within the practice, limiting patient information access, as well as having practice and research staff trained in patient recruitment using Torch Recruit, alleviated most concerns. Patients' trust in their GPs and their general practice were seen as a facilitator in patient trial recruitment.

Conclusions: Patient recruitment into any clinical trial is often difficult. This study demonstrated that using an innovative tool such as Torch Recruit provides accurate identification of eligible participants, can streamline a time-consuming process that aligns with practice workflow.

Background: This paper examines the social movements that influenced the development and implementation of the original Whitlam Government Community Health Program, the community health movement that emerged, and the opportunities it created for people to develop and deliver health programs in new ways.

Methods: Oral history interviews with 93 people involved in community health in South Australia, Victoria and New South Wales, and 212 community health policy and archival documents were collected as a part of an Australian Research Council study documenting the history of community health services in Australia since the 1970s.

Results: Ideas about community health in Australia were influenced by several social movements that had overlapping, but distinctive, contributions: (1) left-wing movements: political parties, workers' health; trade unions, anti-war and anti-establishment; (2) international social medicine and community-oriented primary care; (3) Indigenous rights/Black Power; (4) feminist; and (5) community development/community power. These movements influenced Australian community health to embrace community management, advocacy and community development strategies in addition to multi-disciplinary care. However, these progressive elements were undermined by neo-liberal management reforms and medical opposition to elements of the Community Health Program.

Conclusions: The early passion for community health in the 1970s and 1980s was fuelled by social movements, but the inconsistent support from the federal and most state governments limited progressive and innovative community health practice. The window of opportunity for the Community Health Program was supported by progressive social movements, but restricted from the 1990s onwards.

Background: Despite Australia's universal health coverage framework, a substantial proportion of Australians, particularly those from marginalised populations, continue to report unmet healthcare needs. Barriers to accessing care are complex and multifactorial, particularly for marginalised groups. This study aimed to identify the prevalence and reasons for not accessing health services in Australia despite perceiving a need to do so, and to explore variations by service type and demographic characteristics.

Methods: A secondary analysis was conducted using data from a cross-sectional survey on healthcare experiences. Participants (N = 636) were recruited via social media and an online panel. Respondents were asked whether they had foregone needed health care in the past 12 months and to indicate the types of services and reasons. Descriptive statistics and chi-squared tests were used to examine associations between reported barriers and participant characteristics.

Results: Over one-third (38.5%) of participants reported an unmet healthcare need in the past year. Cost was the most commonly cited barrier (54.9%), followed by the belief the issue would resolve itself (44.7%), time constraints (32.8%), and appointment difficulties (25.3%). Significant gender differences emerged, with women more likely to cite cost (P = 0.031). LGBTIQA+ participants were more likely to report fear of the outcome (P = 0.046) and concerns about privacy (P = 0.013). No significant differences were observed by Indigenous status or country of birth.

Conclusion: Unmet healthcare needs remain prevalent in Australia, driven by financial, structural, and personal barriers. The findings underscore the importance of targeted reforms to address cost and capacity issues, and suggest a continued need to improve culturally safe, accessible care - particularly for marginalised populations, though further targeted research is needed to fully capture these groups' experiences.

Reproductive coercion (RC) is a form of gender-based violence that directly undermines reproductive autonomy, and can result in significant sexual, reproductive and mental health harms. Clinicians in general practice are well-positioned to address RC, given the central role of general practice in sexual and reproductive health care, as well as domestic and family violence response. Yet, RC often remains poorly understood in this setting, and guidance for clinical responses is underdeveloped. In this forum article, we examine why RC should be prioritised in general practice settings, outline what an appropriate response could involve in general practice, and discuss the system-, clinician-, and patient-level challenges and considerations to identifying and responding to RC in general practice. We also draw attention to how clinical practices, particularly in sexual and reproductive health care, can unintentionally reproduce dynamics of RC, and must be consciously managed to uphold patient autonomy. We argue for a more intentional role for general practice in RC recognition and response, underpinned by context-specific evidence-based guidelines, targeted training and integrated system-level support, to safeguard reproductive autonomy among general practice patients.