Australian journal of primary health最新文献

Background Short message service (SMS) messages are an effective means of delivering health interventions, including promoting cancer screening. SMS offers opportunities to remind people about cervical screening and promote the self-collection option available in Australia's National Cervical Screening Program. This research aimed to explore the acceptability of SMS reminders sent by general practices to eligible patients promoting the option of self-collection for cervical screening. Methods We conducted a cross-sectional survey (n =221) with women and people with a cervix, and focus group discussions (n =5) with women aged ≥50years (n =7), regional/rural residents (n =6) and bicultural health educators (n =10) in Victoria, Australia. We examined awareness of self-collection, current receipt and acceptability of health promotion SMSs, and preferences for SMS content promoting cervical screening. Results Most survey respondents (83%) found SMS reminders for cervical screening acceptable, stating a preference for their first name (71%) and clinic's name (58%) to be included. Focus group participants had varying awareness of self-collection, with concerns about accuracy, sample collection and accessibility. Clear communication about clinician- and self- collection options was considered crucial. Most participants were hesitant to click embedded links. SMS acceptability may be affected by limited knowledge of self-collection, accessibility for people with disabilities, differing English or digital literacy, and privacy concerns. Conclusion SMS messages appear to be an appropriate way to raise awareness about the choice of self-collection, but SMS may not be suitable as a population-based strategy. Leveraging general practitioner endorsement through SMS may improve participation, particularly for people who may prefer self-collection, but are unaware of this option.

Background Despite increasing recognition of the lived-experience of premenstrual distress (PMD), research into individuals' accounts of healthcare support for these conditions remains limited, particularly in Australia. This study aimed to qualitatively explore how individuals experience Australian healthcare support for PMD, with a focus on identifying helpful and unhelpful elements of care. Methods Qualitative data were collected through open-ended survey questions and one-to-one, in-depth interviews. Data were analysed using thematic analysis informed by The Listening Guide. Results A total of 106 survey respondents and 13 interview participants took part in the study. Participants' experiences of Australian healthcare support for PMD reflected four main themes. The comprehensive experience described helpful experiences with healthcare providers who offered validating, knowledgeable and holistic care. The reductionist experience described experiences with superficial solutions that failed to address the complexity of participants' experiences. The uninformed experience described experiences with healthcare providers who lacked awareness or understanding of PMD. The dismissed experience described experiences where participants' concerns were minimised or invalidated by their healthcare providers. Conclusions Findings highlight both the presence of affirming care and the persistence of dismissive and inadequate responses within the Australian healthcare system. These results underscore the need for improved clinician education, trauma-informed and person-centred approaches, and a broader range of care options that are responsive to the complexity of PMD experiences.

Background To describe the impact of long COVID on disability, function and quality of life among adults living in Australia. Method People aged >18years with a history of COVID-19 infection confirmed by polymerase chain reaction or rapid antigen test were eligible for this cross-sectional survey. The World Health Organization Disability Assessment Schedule 2.0 measured disability and function, and the 36-Item Short Form Health Survey assessed quality of life. Results Participants (n =121) reported significant functional impairment and reduced quality of life compared with established population norms for these outcome measures. Most (n =104, 86%) reported clinically significant disability and participation limitations in daily activities. Mean World Health Organization Disability Assessment Schedule 2.0 scores indicated higher levels of disability than 98% of the general population. The 36-Item Short Form Health Survey scores indicated lower quality of life across all domains, but particularly in relation to vitality and social functioning. Regression analysis found significant associations between the World Health Organization Disability Assessment Schedule 2.0 and 36-Item Short Form Health Survey scores, and vaccine dose number, comorbidities and self-rated recovery. Conclusion Long COVID is associated with significantly reduced function and quality of life, which are distinct outcomes requiring targeted assessment and intervention. The overall impact may be exacerbated in people with pre-existing comorbidities who are more susceptible to long COVID in the first place. The findings underscore the need for targeted rehabilitation and support services for people living in Australia with long COVID, and further longitudinal research to explore the long-term impact on disability and quality of life, and inform policy and healthcare service delivery.

Background Medicare, Australia's universal healthcare coverage system, has been described as unfit for modern purposes. Its predominantly fee-for-service payment model penalises longer, more complex consultations, and does not adequately remunerate non-physician healthcare workers. To address issues of access for marginalised groups, the Community Health Program was introduced by the Whitlam government in 1973. After federal funding was withdrawn, Victoria remained the only state to continue generalist, non-government, community health centres. Notwithstanding the success of the community health model in Victoria, primary care nationally predominantly occurs in private general practices with no programmatic funding from state governments. The federal government has recently brought to the table a swathe of proposals to modernise Medicare to make it accessible for society's most vulnerable, regardless of whether they receive their care in a community health centre or not. Methods This paper presents a case study of a private, not-for-profit primary care centre. The clinic aims to replicate elements of the community health model within the private sector. The case study will examine interventions implemented by the clinic to provide primary care for groups living in vulnerable circumstances. Results The case study demonstrates innovations usually seen in community health centres adopted in a private primary care service such as use of navigators, improved primary-secondary care interface, purpose-driven care, task-shifting, trust-building, tailored services and community engagement. Conclusions The case study represents a unique model of care that replicates elements of community health services in a private setting. Medicare reform must support multi-disciplinary care, rebates that actually reflect the cost of providing care, adequate remuneration for non-physician healthcare professionals and address the pay disparity between primary care physicians and non-GP specialists.

Background Although most young Australians visit their general practitioner at least once a year, discrepancies remain between healthcare need and healthcare support in this group. A detailed contemporary understanding of youth presentations to general practice is needed, given that the last comprehensive investigation into Australian adolescent encounters with primary care is now over two decades old. The aim of this study is to describe rates of presentation and reasons for visit among young people in Victorian primary care using data extracted from electronic medical records. Methods A retrospective descriptive study of de-identified electronic medical records data from >22,000 adolescents aged 10-24 years who presented to Victorian general practice in 2019 was undertaken. Results The overall mean attendance rate of young people was 2.89visits/patient per year, with rates highest amongst older patients, females and those in regional localities. Young people presented most frequently for physical (biomedical) concerns (such as respiratory, skin and general physical complaints), and psychological (mental health) reasons for visit. Conclusions The study addresses a significant gap in our understanding of the role of general practice for young Australians. Although physical problems continue to predominate among Australian adolescents' reasons for visit to general practice, psychological presentations occur much more frequently than estimated in past studies. This study also demonstrates that general practice electronic medical records data can be harnessed to provide a meaningful description of primary care activity.

Background Diabetes-associated morbidity and mortality are higher among some groups of migrants. However, differences in age structure between migrants and the destination countries' populations can affect the estimated prevalence. There is also a lack of knowledge about the characteristics associated with poor diabetes outcomes among migrants. This study aimed to report the age-standardised prevalence of diabetes and characteristics associated with poor diabetes outcomes among different migrant groups in Australia, based on region of birth. Methods Using the whole population data from the Australian 2021 census data, diabetes age-specific and sex-specific prevalence, age-standardised prevalence and age-standardised prevalence ratio (ASPR) were calculated for people aged ≥30 years. Characteristics associated with poor diabetes outcomes were analysed. Results Age-standardised prevalence was higher than the Australian-born population among migrants from South-East Asia (ASPR: 1.4), North Africa and the Middle East (ASPR: 1.7), Southern and Central Asia (ASPR: 2.2) and Oceania (ASPR: 2.2). Among those with diabetes >50% had a weekly income 31% of individuals born in Australia, North-West Europe and Southern and Eastern Europe had ≥3 comorbidities. Over 37% of people born in Southern and Eastern Europe and North Africa and the Middle East needed assistance with core activities, and >8% born in Southern and Eastern Europe, North Africa and the Middle East and South-East Asia had no formal education. People born in Northeast Asia had the highest percentage of people with low English proficiency (55.2%) and who arrived in Australia Conclusion In prioritising the migrant populations for diabetes prevention, control and healthcare delivery, characteristics associated with poor diabetes outcomes and prevalence of diabetes in different migrant populations in Australia should be considered. Strategies should be designed based on the characteristics of different migrant populations to empower them to manage their diabetes.

Background Prioritising the characteristics of health services delivery can guide improvements to the quality of care for Aboriginal and Torres Strait Islander children and their carers. The aim of this study was to estimate the relative importance of 20 health services delivery characteristics for Aboriginal and Torres Strait Islander children. Methods From May 2022 to November 2023, best-worst scaling surveys were distributed in person and online to carers of Aboriginal and Torres Strait Islander children and staff who work at health services used by Aboriginal and Torres Strait Islander children. Preference scores (0-1) were calculated using multinomial logit regression models. Interaction terms were added to a regression model to examine preference heterogeneity. Results A total of 109 surveys were completed. Most participants identified as Aboriginal and Torres Strait Islander (81%), and were aged ≥30years(77%), female (83%) and either worked or used health services at an Aboriginal Community Controlled Health Organisation (84%). For the combined sample of carers and staff, the most important attribute was 'Treatment options are explained, and the carer is involved in decisions about the child's care', followed by 'Clinical staff ask carer about their concerns for their child and respond to them' and 'Clinical staff provide carers with the skills to manage their child's health at home'. Conclusions Our study identified that communication characteristics related to shared decision-making and empowerment are considered the most important characteristics of health services delivery for Aboriginal and Torres Strait Islander children.

Background Sarcopenia, marked by the progressive decline of skeletal muscle mass and strength, is a significant health issue in aging populations. Primary care-based interventions may offer effective management strategies, yet randomised controlled trials evaluating these interventions are limited. Methods We conducted an unblinded, parallel-group randomised controlled trial at a public health centre in Korea responsible for primary care, enrolling participants aged ≥65 years with sarcopenia. Participants were randomised to either an intervention group (receiving a 12-week program of group exercises and nutritional support) or a control group (receiving lifestyle management education). The primary outcome was the change in gait speed over the intervention period. Secondary outcomes included changes in physical performance, grip strength, muscle mass, quality of life and frailty index. Results A total of 86 participants were enrolled and randomised (intervention group: n =43; control group: n =43). The intervention group demonstrated significant improvements in gait speed (0.14m/s (95% CI: 0.10-0.18) vs -0.04m/s (95% CI: -0.08-0.00), P Conclusion The 12-week exercise and nutrition intervention yielded significant gains in physical performance, grip strength, quality of life and frailty reduction among community-dwelling older adults with sarcopenia. These findings support the value of community-based, multicomponent interventions for managing sarcopenia. The trial is registered at Clinical Research Information Service (http://cris.nih/go.kr , registration number: KCT0008952).

Community health plays a vital role in Victoria's healthcare system, improving health and wellbeing outcomes, and advancing health and social equity. Despite the absence of a formal definition, community health services are recognised for applying the social model of health to deliver evidence-based approaches that foster positive outcomes for individuals, communities and the broader healthcare setting. This paper explores the strength and impact of the community health sector, including reach, outcomes and experiences. Through case studies of programs and initiatives delivered by Your Community Health, a community health service operating in Melbourne's north, the paper highlights the innovative application of evidence-based approaches to meet local need. The practice examples demonstrate how multi-disciplinary care, peer-led models, setting-based approaches, early intervention and capacity building are successfully implemented, and the positive impact they have on health and wellbeing outcomes. The paper concludes that community health services and approaches are integral in supporting health outcomes and achieving health equity, alleviating pressure on acute systems while delivering economic benefits. To sustain and enhance community health's role within the healthcare system, ongoing investment is essential.

Background Acquired hearing loss has significant negative effects on quality of life, general health, maintenance of independence, and healthy aging. Despite this, rates of self-directed help seeking are low, as are referral rates from general practice to hearing care. This study aimed to explore the barriers and enablers to general practitioner (GP) referral of adults aged 50+ years to hearing care. Methods A cross-sectional questionnaire was designed using the Theoretical Domains Framework of behaviour change and administered to a self-selected sample of 103 Australian GPs. Results Identified enablers included positive beliefs about the consequences of hearing rehabilitation and experiencing positive role models of hearing care including referral. Contextual issues such as time constraints, costs of hearing care, and limited availability of local audiology resources were the most frequently cited barriers to referral. Content analysis of free-format responses yielded 25 themes in total, eight of which were not previously documented in the published literature. Conclusions GP beliefs about hearing care and the outcomes of referral were generally positive, however, logistical concerns and contextual constraints such as restricted appointment times were prominent barriers to hearing care referral. Identifying the key barriers and enablers to GP referral of older adults to hearing care will facilitate the design of targeted behavioural interventions aimed at increasing referral rates. Further qualitative investigation of the key modifiable barriers and enablers identified in this study is warranted to clarify how best to address these in clinical practice.