Australian journal of primary health最新文献

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 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.

Background The study aimed to understand the acceptability, satisfaction, uptake, utility and feasibility of a quality improvement (QI) intervention to improve care for coronary heart disease (CHD) patients in Australian primary care practices and identify barriers and enablers, including the impact of COVID-19. Methods Within the QUality improvement for Effectiveness of care for people Living with heart disease (QUEL) study, 26 Australian primary care practices, supported by five Primary Health Networks (PHN) participated in a 1-year QI intervention (November 2019 - November 2020). Data were collected from practices and PHNs staff via surveys and semi-structured interviews. Quantitative and qualitative data were analysed with descriptive statistics and thematic analysis, respectively. Results Feedback was received from 64 participants, including practice team members and PHN staff. Surveys were completed after each of six workshops and at the end of the study. Interviews were conducted with a subgroup of participants (n =9). Participants reported positive satisfaction with individual QI features such as learning workshops and monthly feedback reports. Overall, the intervention was well-received, with most participants expressing interest in participating in similar programs in the future. COVID-19 and lack of time were identified as common barriers, whereas team collaboration and effective leadership enabled practices' participation in the QI program. Additionally, 90% of the practices reported COVID-19 effected their participation due to vaccination rollout, telehealth set-up, and continuous operational review shifting their focus from QI. Conclusion Data-driven QI programs in primary care can boost practice staff confidence and foster increased implementation. Barriers and enablers identified can also support other practices in prioritising effective strategies for future implementation.

Background Caregiving is an essential yet often overlooked component of health care. Although carers play a pivotal role in reducing healthcare costs and improving patient outcomes, they are also prone to psychological and physical burdens that can lead to their own hospitalisation. This study aimed to explore the relationship between the frequency of interactions with general practitioners and hospitalisation rates among caregivers aged ≥45years in New South Wales, Australia. Methods This cohort study retrospectively identified participants from the Sax Institute's 45 and Up Study in New South Wales, linked with national datasets. The cohort comprised 26,004 individuals aged ≥45years who were caregivers. The primary outcome was hospitalisation within a 7-year period, and the intervention was whether the patient was a high or low general practice (GP) user, ascertained by determining if the average number of annual GP visits was above or below 11, respectively. Data analysis included descriptive statistics and Poisson regression models. Results The study found a statistically significant association between high GP use and reduced rates of hospitalisation among caregivers. Caregivers with frequent GP interactions had a relative risk of hospitalisation of 0.514 (95% CI: 0.479-0.550) compared with their counterparts who infrequently used GP services. This association remained significant, even after adjusting for various demographic and health-related factors with an adjusted relative risk of 0.619 (95% CI: 0.554-0.690). Conclusions The findings underscore the potential of primary care interventions in reducing hospitalisations among caregivers, in turn providing economic and societal benefits. They also highlight the need for future research to understand the specific aspects of GP interactions that contribute to this protective effect.

Background Long COVID is a new and prevalent condition defined by persistent symptoms following acute COVID-19 infection. While increasing resources are being directed to management, there is little evidence on how general practitioners (GPs) have changed their assessment and differential diagnosis of patients with potential long COVID symptoms including fatigue. This study aimed to examine how often GP registrars consider long COVID in patients presenting with fatigue, how often they think long COVID might be the cause for fatigue, and patient, registrar, practice, and consultation factors associated with these outcomes. Methods Data were collected through Registrar Clinical Encounters in Training (ReCEnT), an ongoing inception cohort study of GP registrars' in-consultation experiences, during two collection rounds in 2022-2023. Multivariable logistic regression was used to examine the relationship between predictor variables and outcomes. Results A total of 969 registrars recorded 3193 consultations where fatigue was a symptom. Registrars reported considering long COVID as a differential diagnosis in 2563 encounters (80%, 95% confidence interval (CI) 79-82%). Of these, registrars thought long COVID was the likely cause for fatigue in 465 encounters (18%, 95% CI 17-20%). While no patient variables were significantly associated with either outcome, multivariable associations included telehealth consultations having greater odds of both outcomes and Australian-trained registrars having lesser odds of considering long COVID likely. Conclusions Registrars report usually considering long COVID as a differential for fatigue and frequently considering it a likely diagnosis. Telehealth usage was significantly associated with both outcomes. Future work should explore GPs' diagnostic approaches to other potential long COVID symptoms.

Background Understanding the experiences of Aboriginal and Torres Strait Islander peoples as healthcare recipients is essential for delivering culturally safe physiotherapy care; however, the literature inadequately explores these experiences. This study aimed to explore the experiences of Aboriginal and Torres Strait Islander peoples who have engaged with physiotherapists and understand their perspectives on how physiotherapists can provide culturally safe care in the community. Methods Semi-structured interviews were conducted with adult (aged >18years) self-identified Aboriginal and Torres Strait Islander peoples (n =12) who had received physiotherapy care within a community setting within the previous 3months. A First Nations methodology approach alongside reflexive thematic analysis was used to interpret the data. Results Four themes were generated: (1) building trust through yarning; (2) acknowledging and respecting culture; (3) creating a culturally safe environment; and (4) the importance of professional training. Conclusions Aboriginal and Torres Strait Islander peoples have expressed that physiotherapists can establish trust with their patients by dedicating time to develop a therapeutic relationship and by demonstrating respect for their culture. It is essential for physiotherapists to carefully consider the physical environment in which they deliver care to ensure it is welcoming and culturally safe for Aboriginal and Torres Strait Islander peoples. Physiotherapists should undertake professional development to immerse themselves in First Nations culture and history through connecting with community. This study offers insights into the lived experiences of Aboriginal and Torres Strait Islander peoples receiving care in the community and provides recommendations that may assist physiotherapists, alongside other community-based health professionals, to provide culturally safe care.

Background Diagnosis is essential for engagement in care for chronic hepatitis B (CHB) and chronic hepatitis C (CHC), however, many Australians remain undiagnosed, especially for CHB. Primary care represents an important setting for testing, and this study sought to examine coverage in a large representative cohort of patients. Methods We analysed retrospective data from the electronic medical records of active patients visiting 566 primary care clinics in Victoria, Australia. Pathology records were assessed to identify the proportion of patients with a record of CHB/CHC serology testing based on risk factors identified in national guidelines (ethnicity, Indigenous status, history of injecting drug use, diagnosed HIV, and/or indications of liver disease). Results Of 1,593,774 patients, 393,948 (24.7%) had an indication for testing for CHB and/or CHC, of which 150,821 (38.3%) had evidence of testing. This proportion was highest in patients with HIV (65.6%) or injecting drug use history (60.0%), and lowest for those whose Indigenous status/ethnicity indicated testing (38.2%) or with elevated liver enzymes (39.1%). The proportion with evidence of testing was only moderate among those with a cirrhosis diagnosis (48.6%) or probable cirrhosis based on laboratory testing (50.6%). Conclusions This analysis demonstrated considerable gaps in testing for CHB and CHC in a large population of patients, including many with evidence of cirrhosis, suggesting higher risk of adverse outcomes. Primary care practices should be supported to comprehensively offer testing for viral hepatitis, particularly where there is evidence of liver disease, and these findings should be used to guide future interventions.

Background Refugee health is an issue of global importance. Refugees have high and complex mental, physical and social needs and poor health outcomes. There is a clear need for more research prioritising refugees' perspectives of health care in their settlement countries; however, a number of methodological and ethical challenges can make this process difficult. Methods This methodological paper is an analysis of our recent experience conducting qualitative research with former refugees in Southern New Zealand. We utilized our research team's discussions, reflections and fieldnotes and the relevant literature to identify the key processes of our successful engagement with former refugees. Results Successful engagement with former refugees in qualitative health research entails: establishing relationships, recognising interpreters as cultural brokers, having a responsive suite of methods and finding meaningful ways to communicate. Conclusions This paper offers suggestions and guidance on conducting qualitative health research with former refugees.

Background Health literacy has evolved from a focus on individual skills to an interactive process influenced by relationships and the health system. Various instruments measure health literacy, developed from different conceptions and often for different measurement purposes. The aim of this study was to compare the properties of four widely used health literacy instruments: Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), European Health Literacy Survey (HLS-EU-Q47), and Health Literacy Questionnaire (HLQ). Methods This was a within-subject study comparing instrument performance. Composite reliability and Cronbach's alpha was used to measure internal consistency, floor/ceiling effects determined discriminate ability across low-to-high score ranges, and Spearman's R correlation coefficient was used to assess the relationship between instruments, particularly scales aiming to measure similar constructs. Results Fifty-nine patients consented, with 43 completing all four instruments. Internal consistency was high for all scales (composite reliability range 0.76-0.95). Floor and ceiling effects were observed, with TOFHLA demonstrating the largest ceiling effect (>62) and NVS the only floor effect (18%). Only moderate correlations were found between TOFHLA and NVS (r =0.60) and between HLS-EU-Q47 and HLQ scales (r ~0.6). Conclusion Our study found low to moderate correlations between the instruments, indicating they measure different constructs of health literacy. Clinicians and researchers should consider the intended measurement purpose and constructs when choosing an instrument. If the purpose of measurement is to understand reading, comprehension, and numeracy skills in individuals and populations, then performance based functional health literacy instruments such as the TOFHLA and NVS will be suitable. However, if the purpose is to generate insights into broader elements of health literacy, including social supports and relationships with health providers, then the HLS-EU and HLQ may be useful. The findings highlight the need for careful instrument selection to ensure meaningful and appropriate data interpretation. As improving population health literacy is a national priority in many countries, it is important that clinicians and researchers understand the measurement differences offered by different instruments to assist them to choose the right instrument for their measurement purpose.

Background The South Australian (SA) Chronic Pain Extension for Community Healthcare Outcomes (ECHO) Network was established to upskill primary care providers in best practice pain care aligned to a patient-centred, biopsychosocial approach using didactic and case-based virtual mentoring sessions. The aims of this study were to assess: (a) participation, satisfaction (relevance, satisfaction with format and content, perceptions of the mentorship environment), learning (perceived knowledge gain, change in attitudes), competence (self-confidence) and performance (intention to change practice, perceived practice change) of the ECHO Network clinician participants; and (b) self-perceived barriers at the clinical, service and system level to applying the learnings. Methods A mixed methods, participatory evaluation approach was undertaken. Data sources included analysis of program records (learning needs assessment, enrolment survey data, program participation data and online surveys of healthcare professionals including a satisfaction survey after each ECHO session (n=106 across the ECHO series of 10 sessions; average response rate=46%), a case presenters survey (n=7, response rate=78%) and an outcome survey after all 10 ECHO sessions (n=11, response rate=25%). Results Forty-four healthcare professionals participated in the ECHO Network from a range of career stages and professional disciplines (half were general practitioners). One-third of participants practised in regional SA. Participants reported that the ECHO sessions met their learning needs (average=99% across the series), were relevant to practice (average=99% across the series), enabled them to learn about the multidisciplinary and biopsychosocial approach to pain care (a verage=97% across the series) and provided positive mentorship (average=96% across the series). Key learnings for participants were the importance of validating the patient experience and incorporating psychological and social approaches into pain care. More than one-third of participants (average=42% across the series) identified barriers to applying the learnings such as limited time during a consultation and difficulty in forming a multidisciplinary team. Conclusions The ECHO Network model was found to be an acceptable and effective interdisciplinary education model for upskilling primary care providers in best practice pain care aligned to a patient-centred, biopsychosocial approach to pain managment. However, participants perceived barriers to translating this knowledge into practice at the clinical, service and system levels.