Australian journal of primary health最新文献

Background Vaccination is important for adults to reduce the morbidity and mortality associated with infectious diseases. In Australia, many vaccines are recommended and funded under the Australian National Immunisation Program. However, a number of vaccines are recommended for adults but not funded. This study aimed to explore factors impacting uptake of recommended vaccines in adults aged ≥50years in Australia. Methods An online cross-sectional survey was conducted from the general population aged ≥50years. The survey was distributed via a market research company using a convenience sample. Data were analysed descriptively, and logistic regression was used to investigate associations between participant characteristics and vaccine uptake. Results A total of 1012 individuals completed the survey. The majority (67.4%) of participants reported it was important for adults to receive recommended vaccines. More than half (59.6%) felt that vaccination was more important for children. Over 60% of participants reported they knew the vaccines that they should receive. The primary reason reported for not receiving a vaccine was, 'I do not believe it is necessary'. Being aged ≥66years was significantly associated with uptake of influenza, pertussis, herpes zoster, and pneumococcal vaccines. Being female was associated with higher uptake for most vaccines, except for pneumococcal vaccine, where no significant association was found. Conclusions The importance of vaccination and risks associated with lack of vaccination need to be highlighted to this population. Recommendations from healthcare professionals continue to be one of the most important facilitators for uptake. Overall, adults reported they are unlikely to pay for recommended vaccines, making increasing uptake of these vaccines difficult.

Background Abortion care is typically undertaken by doctors; however, alternate models, including nurse-led care, are increasingly seen as viable alternatives. However, attitudes towards the leadership of alternate models can be a barrier to change. We explored the acceptability of different models of abortion care, and whether attitudes differed by health profession for those working in sexual and reproductive health. Methods Our mixed method survey explored how doctors, nurses/midwives and those working in administrative roles in primary care in Australia felt about three models of abortion care: doctor-led, nurse-led and self-administered. ANOVAs compared favourability ratings and attitude strength across groups, and qualitative data exploring how they felt about each model was thematically analysed using Leximancer. Results Attitudes towards doctor-led and nurse-led models of care were overwhelmingly positive. However, doctors perceived doctor-led care more favourably than other professionals, and felt it provides a more holistic, safer experience, that opportunistically facilitated discussions about other sexual and reproductive health matters. Self-administered care was perceived unfavourably by ~60% of participants, and was associated with significant safety concerns. Conclusions Most health professionals working in sexual and reproductive health care perceive that nurse-led models of care are viable and acceptable, although doctors feel there are additional benefits to the current model. Self-administered abortion is overwhelmingly perceived as unsafe. Nurse-led care models could increase access to safe abortion in Australia, and are perceived favourably by those working in sexual and reproductive health care.

Background The factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children are unclear. This study's objective aimed to describe decision-makers' perspectives on factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children. Methods We conducted semi-structured interviews with 13 participants experienced in making funding decisions at organisational, state, territory and national levels. Decision-makers were from New South Wales, Northern Territory, Queensland, Victoria and Western Australia. Transcripts were analysed thematically following the principles of grounded theory. Results We identified five themes, each with subthemes. First, prioritising engagement for authentic partnerships (opportunities to build relationships and mutual understanding, co-design and co-evaluation for implementation). Second, valuing participant experiences to secure receptiveness (cultivating culturally safe environments to facilitate acceptability, empowering for self-determination and sustainability, strengthening connectedness and collaboration for holistic care, restoring confidence and generational trust through long-term commitments). Third, comprehensive approaches to promote health and wellbeing (linking impacts to developmental milestones, maintaining access to health care, broadening conceptualisations of child health). Fourth, threats to optimal service delivery (fractured and outdated technology systems amplify data access difficulties, failure to 'truly listen' fuelling redundant policy, rigid funding models undermining innovation). Fifth, navigating political and ideological hurdles to advance community priorities (negotiating politicians' willingness to support community-driven objectives, pressure to satisfy economic and policy considerations, countering entrenched hesitancy to community-controlled governance). Conclusion Decision-makers viewed participation, engagement, trust, empowerment and community acceptance as important indicators of service performance. This study highlights factors that influence decisions to fund health services for Aboriginal and Torres Strait Islander children.

Background This study aimed to identify the potential roles for Community Health Navigators (CHNs) in addressing problems faced by patients on discharge from hospital to the community, and attitudes and factors which may influence their adoption. Methods Twenty-six qualitative interviews and an online codesign workshop were conducted with patients, nurses, general practice staff, health service managers, community health workers, general practitioners, medical specialists, and pharmacists in the Sydney Local Health District. Qualitative themes from the interviews and workshop transcripts were analysed inductively and subsequently grouped according to a socio-ecological model. Results CHNs could assist patients to navigate non-clinical problems experienced by patients on discharge through assessing needs, establishing trust, providing social and emotional support that is culturally and linguistically appropriate, engaging family and carers, supporting medication adherence, and helping to arrange and attend follow up health and other appointments. Important factors for the success of the CHNs in the performance and sustainability of their roles were the need to establish effective communication and trust with other healthcare team members, be accepted by patients, have access to information about referral and support services, receive formal recognition of their training and experience, and be supported by appropriate supervision. Conclusions This study was unique in exploring the potential role of CHNs in addressing problems faced by patients on discharge from Australian hospitals and the factors influencing their adoption. It informed training and supervision needs and further research to evaluate CHNs' effectiveness and the acceptance of their role within the healthcare team.

Background Many refugee women and women seeking asylum arrive in high-income countries with unmet preventive sexual and reproductive health (SRH) care needs. Primary healthcare providers (HCPs) are usually refugee and asylum seekers' first point of care. This study aimed to identify HCP characteristics associated with initiating conversations and discussing SRH opportunistically during other health interactions. Methods An anonymous online survey was distributed nationally to representatives of health professional organisations and Primary Health Networks. Hierarchical logistic regression analysed factors including HCP demographics, knowledge and awareness, perceived need for training and professional experience with refugee women were included in the models. Results Among 163 HCPs, those initiating conversations ranged from 27.3% (contraceptive care) to 35.2% (cervical screening). Opportunistic discussions ranged from 26.9% (breast screening) to 40.3% (contraceptive care). Positively associated factors included offering care to refugee women or women seeking asylum at least once every 2months 7.64 (95% CI 2.41;24.22, P P P P P P Conclusions Direct professional experience, frequency of service provision, years of practice, and part time work positively influence HCPs' SRH care practices. Enhancing bilingual health worker programs, outreach, education, and support for SRH and cultural competency training are essential to improving the preventive SRH care of refugee women and women seeking asylum.

Cervical cancer screening programs in Australia have been developed to detect early precancerous changes in women with a cervix aged between 25 and 74. Yet, many barriers remain to the uptake of cervical screening. Barriers include a lack of culturally appropriate service provision, physical access, poor health literacy, emotional difficulties, socio-economic disadvantage and not having access to a female service provider. In remote and very remote areas of Australia, additional barriers experienced by Aboriginal or Torres Strait Islander peoples include a distrust of healthcare providers and a lack of services, resulting in a much higher rate of diagnosis and death from cervical cancer. General practice nurses (GPNs) are well placed to conduct cervical screening tests (CSTs) after they have undertaken additional education and practical training. GPNs' increase in scope of practice is beneficial to general practice as it helps to remove some barriers to cervical screening. In addition, GPNs conducting CSTs reduce GP workload and burnout and increase teamwork. GPNs working in metropolitan clinics have greater access to training facilities, whereas those working in rural and remote clinics are required to travel potentially long distances to complete practical assessments. This highlights the need for training to be made available in rural and remote areas. The aim of this forum paper is therefore to generate further discussion on the need for training programs to be made available in rural and remote areas to aid the upskilling of GPNs.

Background Patient Assessment of Care in Chronic Conditions (PACIC+), included in some Australian guidelines, has been shown reliable for measuring patient engagement and perception of their care in primary care settings. Various studies have focussed on PACIC+ use in specific conditions. This study aims to expand PACIC+ to measure patient empowerment to self-manage their chronic condition and validate it in the broader Australian primary care population. This study aims to evaluate internal consistency and reliability of PACIC+ and six new supplementary items proposed to assess patient wellbeing and empowerment to self-manage their chronic condition. Methods A repeated-measures correlation design study assessed the expanded PACIC+ over three time-points. Particpants were patients with at least one chronic disease, referred by consultant physician, or recruited by advertisement posters in hospital clinic areas. Results PACIC+ (26-item) had acceptable internal consitency (Cronbach's alpha 0.96). Test-retest reliability (Time-1 and 2, P r (48)=0.43; and New supplementary items: Confidence r (48)=0.54; Understanding r (48)=0.62; Support r (48)=0.43; Overall Health r (48)=0.42; Overall Health Change r (48)=-0.31, P =0.03; and Acute Episodes of Care in 1-month r (48)=0.42, P Conclusions The expanded PACIC+ is an improved psychometric tool providing for the patient's voice in a shared health journey. It is a valid, reliable tool to monitor and measure self-management of chronic conditions in Australian population clinic and primary healthcare settings.

Background Primary care practitioners worldwide are urged to promote dementia risk reduction as part of preventive care. To facilitate this in Australian primary care, we developed the Umbrella intervention, comprising a waiting room survey and patient information cards for use in consultations. Educational and relational strategies were employed to mitigate implementation barriers. Methods In this cross-sectional, non-randomised implementation study within the South East Melbourne Primary Health Network, we employed mixed-methods outcome evaluation. Antecedent outcomes (acceptability, appropriateness, and feasibility) and actual outcomes (adoption, penetration, and fidelity) were assessed from the perspective of primary care practitioners and patients. Results Five practices piloted the intervention and implementation strategies, including 16 primary care practitioners engaging with 159 patients. The Umbrella intervention was deemed acceptable, appropriate, and feasible, but penetration was limited. Approximately half of eligible primary care practitioners used the intervention, with moderate fidelity. Engagement with implementation strategies was similarly limited. While most strategies were well-received, improvements in online peer discussions and staff readiness were desired. Conclusions The Umbrella intervention is a viable approach to promoting dementia risk reduction in Australian general practice, supported by educational and relational strategies. Stakeholder-informed refinements to enhance uptake are recommended before advancing to a definitive trial.

Background Understanding community preferences for vaccination services is crucial for improving coverage and satisfaction. There are three main approaches for COVID-19 vaccination in Indonesia: health facility-based, community-based, and outreach approaches. This study aims to assess how the vaccination approaches impact user satisfaction levels. Methods This study was part of a large household survey involving 12,120 respondents across nine districts in Bali Province. The study population comprised all residents aged ≥12years who had received at least one dose of COVID-19 vaccination. Samples were selected through three stages of systematic random sampling. Data were collected through interviews using structured questionnaires, which included socio-demographic characteristics, vaccination services, and satisfaction levels. Analysis was performed using Chi Square test and logistic regression, with the entire process incorporating weighting factors. Results A total of 12,120 respondents reported receiving their first dose of COVID-19 vaccination. The satisfaction level among vaccine recipients (partial, complete, and booster doses) was high (84.31%). Satisfaction within each SERVQUAL dimension was highest in tangibles (96.10%), followed by responsiveness (93.25%), empathy (92.48%), assurance (92.35%), and reliability (92.32%). There was no significant difference in the overall SERVQUAL score between the health facility and community-based approaches. However, the latter slightly improved user satisfaction across three dimensions: tangibles (adjusted odds ratio, AOR=1.52, 95% confidence interval (CI)=1.21-1.90), reliability (AOR=1.67, 95%CI=1.42-1.96), and assurance (AOR=1.26, 95%CI=1.07-1.48). Conclusion During the pandemic, both health facility and community-based approaches resulted in a high satisfaction level. It is recommended that the government prioritise and optimise community-based programs and health facility-based delivery in future vaccination initiatives, especially during public health emergencies.

Background Sonder's In-Home Withdrawal Service (IHWS) has been providing a unique home-based, multidisciplinary, wraparound withdrawal option for people with low-to-moderate levels of substance dependence since September 2019. This paper provides an evaluation of the service's overall impact on reducing substance use among clients through the delivery of this innovative service model. The evaluation explores the acceptability and feasibility of the service via client, stakeholder, and staff perspectives. Methods A mixed-method design was used to evaluate the IHWS. Descriptive analysis of quantitative data was conducted using clinical assessments from client records and online feedback surveys. Qualitative data from client, staff, and stakeholder feedback surveys were analysed thematically. Results Overall, 1166 referrals were received over the lifespan of the service, and a data set of 96 clients was included in the analysis. Self-reported measures showed that most clients decreased their substance use (89%), improved their psychological health status (75%), improved their physical health (65%), improved their quality of life (69%), and improved their understanding and ability to manage their alcohol and other drugs (AOD) use (84%). Client feedback suggests the service is providing a unique option for AOD withdrawal. Stakeholders commend the service's home-based setting, multidisciplinary and person-centred approach to care, and recommended expansion of the service to increase access for clients and reduce demand on inpatient settings. Conclusions The IHWS is having a significant impact in reducing substance use and highlights the need for increased access to holistic approaches to withdrawal. This includes pre- and post-withdrawal support and the inclusion of multidisciplinary teams, and engaging lived experience practitioners. A focus on funding primary-based services is required to meet the rising costs of tertiary-based care and to better meet the needs of consumers.