Australian journal of primary health最新文献

Background Inaccessibility of primary healthcare services in rural and remote communities is argued to lead to higher rates of potentially preventable hospitalisations. This research aimed to develop an explanatory method that could be applied for investigating a rural setting considered high risk for potentially preventable hospitalisations, and to describe how to improve place-based pathways to primary healthcare services that would prevent potentially preventable hospitalisations. Methods The method described in this paper provides a structured and detailed plan for examining regions identified as high risk for a particular potentially preventable hospitalisation condition. The method was developed and tested through a series of research studies on ear, nose and throat (ENT) conditions in the Murray Primary Health Network, that had regions identified as high-risk hotspots for ear, nose and throat potentially preventable hospitalisations. Results The procedure developed for investigating hotspot regions of potentially preventable ear, nose and throat hospitalisations included six steps: (1) develop investigative questions; (2) identify and select potentially preventable hospitalisations condition and region; (3) literature review of best practice service needs and service mapping; (4) healthcare provider and consumer experiences; (5) illustrate patient journey; and (6) summarise recommendations for primary health care. Conclusions This method provides an understanding of the access pathways to primary healthcare services, and identifies where interventions and prevention strategies would support residents in obtaining equitable health care. This developed method can be further applied and tested as a mechanism for health and service needs assessment by primary healthcare planning and coordination agencies, which in Australia include Primary Health Networks, public health units and hospital networks.

Background China's tiered healthcare delivery system encourages patients to choose primary care institutions (PCIs) as their first point of contact, but no mandatory gatekeeping role has been imposed. Despite this policy encouragement, patients often prefer higher-level institutions. Existing research has largely focused on factors influencing patient preferences for higher-level care, but there is a gap in understanding the factors that drive patients to switch to primary care provided by general practitioners (GPs). Methods This study applied the push-pull-mooring (PPM) framework to analyze patients' switching intentions from higher-level healthcare institutions to a GP in PCIs for primary care, focusing on dissatisfaction with hospital services (push factors), attractiveness of the GP system (pull factors), and entrenched hospital habits and distrust in GPs (mooring factors). Data from 612 respondents in China were collected to test the proposed hypotheses using partial least squares-structural equation modeling. Results Our results suggest that both push factors, such as dissatisfaction with hospital services, and pull factors, such as the attractiveness of the GP system, positively influence switching intentions. Conversely, mooring factors, including entrenched hospital care habits and distrust in GPs, exert a negative influence on switching behavior. Furthermore, mooring factors moderate the relationship between push-pull factors and switching intentions. Conclusions The findings highlight the importance of addressing push and pull factors while mitigating the impact of mooring factors to promote efficient healthcare utilization. Policy interventions should focus on improving GP system attractiveness and reducing patient distrust in primary care.

Background Patient health navigators have an emerging role in assisting people to connect with health and social care services especially those experiencing language and communication barriers. A challenge with navigator programs is sustaining their implementation. This study evaluated the implementation and sustainability of bilingual community navigators (BCNs) in multilingual general practices in Sydney and their impact on patient access. The hypothesis was that the use of bilingual navigators within multilingual practices would be acceptable and feasible, improve patient access to appropriate care and staff workload, and reduce health inequities. Methods Patient referral information was collected and analysed descriptively. Interviews were conducted with practice staff, patients, and navigators after 10-week placements and analysed thematically using Normalisation Process Theory. Results A total of 110 patients were referred to navigators who assisted with booking appointments, accessing community resources, and translating and explaining information. Interviews were undertaken with four navigators, three patients, three carers, and four GPs. Practice participants could see the benefits of the BCNs and were motivated to engage with them, especially with GP endorsement. However, not all understood the navigator competencies and roles. In some practices, the population needs and the scheduling of appointments and staff routines could have aligned better, which constrained referrals and continued navigator involvement. Conclusions This study demonstrates the potential role of navigators in addressing navigation challenges experienced by culturally and linguistically diverse patients in general practice. More effort is needed to tailor attachments to the unique needs of the patient population and practice schedule. Sustainability requires ongoing funding and broad institutional support.

Background This study aimed to synthesise global research examining the experiences of fathers and non-birth parents using child and family health services, and to identify the facilitators and barriers to father- and non-birth parent-inclusive practice. Methods A systematic review, using the Joanna Briggs Institute mixed-methods approach, and meta-synthesis of the data were performed. We undertook a quality appraisal of the research using the Quality Assessment with Diverse Studies (QuADS) tool. An initial systematic search was conducted of four scientific databases (ProQuest Central, CINAHL, MEDLINE, EMBASE) in January 2023, and updated in February 2024. Results were reported according to the PRISMA guidelines with no patient or public contribution. Results We identified thirty-five studies for inclusion. Thirty-one papers identified barriers to inclusive practice, such as program design (n =15), traditional gender roles and gatekeeping (n =11), and lack of workforce knowledge and skills (n =11). Facilitators of inclusive practice included factors such as explicit inclusion (n =14), support with transition to parenthood (n =11), connection with other fathers (6), and attention to the father's health and well-being (n =13). The four papers that concerned same-sex parents identified additional and specific barriers experienced by same-sex parents, including discrimination and homophobic attitudes. Conclusion We found barriers and facilitators of father and non-birth parent engagement in child and family health services at individual, community, and health service levels, with organisational and cultural barriers impacting inclusive practice. Inclusive practice for fathers and non-birth parents entails the development of environments, policies, and programs that actively involve and support the father and non-birth parent in all aspects of parenting and family life. Strategies include systematic outreach to fathers and non-birth parents, customising activities to fathers' and non-birth parents' preferences, and addressing their needs.

Background Domestic violence and abuse (DVA) impacts all communities, including migrant/refugee populations. Although general practitioners (GPs) are often a first point of contact for victim-survivors, most lack training in culturally safe responses to DVA. Methods We evaluated culturally safe DVA training (HARMONY), co-delivered by a GP educator and bilingual South Asian DVA advocate, to general practice clinics in Victoria, Australia. The program included clinical audits, case studies, simulated migrant/refugee patients and lived experience videos. Pre- and post-training surveys assessed practitioners' attitudes, understanding and confidence in responding to DVA. Results Twenty-three of 43 practitioners (53.5%) completed both surveys. Pre-training, 10 practitioners (43.5%) felt confident asking about violence when they thought it might be culturally accepted, and eight (34.8%) were confident locating support resources. Post-training, most practitioners (82.6%) reported increased confidence and communication skills. The training met learning needs for 19 of 23 (82.6%) participants, with 17 of 23 (73.9%) participants reporting greater understanding of cultural safety and South Asian patients' needs. Practitioners particularly valued the advocate educator's involvement, with 17 of 23 (73.9%) finding this 'quite useful' (n =4) or 'very useful' (n =13). Conclusion Although DVA training often improves knowledge and confidence, and may not change clinical behaviour or patient outcomes, embedding cultural safety in such training remains important in responding effectively to the specific needs of ethnically diverse patients and their families experiencing DVA. The HARMONY program demonstrates potential benefits of combining clinical expertise with cultural advocacy, although further research is needed to evaluate its impact on practice and patient care among other minoritised patient communities.

Background Nationally, the increase in syphilis notifications over recent years has demonstrated persistent bridging across to wider populations, particularly women of reproductive age. Populations experiencing adverse social determinants, caught in a cycle of marginalisation and social exclusion through mental ill-health, alcohol and drug misuse, and economic and housing stress, have increasingly become susceptible. Methods The aim of this pilot was to develop and implement a protocol for delivering syphilis point of care testing (POCT) through a street-based nursing outreach program, specifically to the homeless, with a focus on women. The evaluation utilised a multi-methods approach to assess the feasibility and acceptability of the service, i.e. qualitative through discussions with nursing staff and clients; and quantitative through the collection and analysis of simple demographic (gender, Indigenous status, housing, age status) and test data. Results The 6-month pilot demonstrated the potential utility of opportunistic syphilis testing and the ease with which the POCT could be incorporated within existing service delivery by outreach nursing teams. Nurses reported the test as easy to apply. The pilot was received well by nurses who gained confidence in the delivery of sexual health education and testing. Nonetheless, despite the establishment of testing, management, and referral protocols, as well as thorough training and preparation, a number of important challenges became apparent through the course of the pilot, particularly with respect to recruitment and follow-up of test results. Conclusions This project effectively embedded a rapid diagnostic assay (Syphilis POCT) within a well-established, outreach health service working within the most marginalised inner-city communities. Nonetheless the challenge with referring syphilis reactive clients for follow-up has necessitated a review of referral protocols and what additional services, including treatment, can be delivered by nurses at the point of first engagement. The need for linking outreach teams with a broad range of other accessible primary health services is considered a priority to ensure efficient referral of homeless persons and minimise loss to follow-up.

Background Tuberculosis (TB) infection prevention and control (TB-IPC) is recommended as an essential public health intervention to control TB transmission worldwide. Nonetheless, merely applying evidence-based prevention and control measures is often inadequate for effective TB prevention and treatment goals. This study examined healthcare workers' (HCWs') perceptions of strategies important for TB-IPC in primary healthcare (PHC) settings in Papua New Guinea. Methods Using a nominal group technique, this study sought the views of a diverse range of HCWs (ranging from clinical, IPC personnel to policymakers) from national and subnational levels, and various provinces to prioritise TB-IPC guidelines implementation needs in practice. Group discussions were conducted with 51 HCWs, and encompassed quantitative and qualitative data collection techniques. Nine key strategies drawn from a preceding study and literature review were presented to participating HCWs, and from these, three significant strategies related to TB-IPC policy were identified as key priorities. Results The participants recommended HCWs' capacity building on TB-IPC policy and strategy, improving PHC infrastructure, and increasing community awareness of TB as the most important strategies to improve TB-IPC practices. Conclusions This study investigated the perceptions of diverse key HCWs of the implementation of TB-IPC guidelines in PHC settings in rural Papua New Guinea. The HCWs identified key strategies needed for effective TB-IPC practice in PHC to prevent TB transmission. This study supports previous recommendations that call for adopting multi-pronged strategies to improve the high TB burden. Key stakeholders' insights have been shared to inform public health policy and program implementation both locally and as part of the global goals of the TB eradication program.

Background Cancer survivors have a broad range of supportive care needs that are not consistently managed in general practice. Understanding the barriers primary healthcare providers face in providing high quality supportive care is crucial for improving the delivery of supportive care in general practice. Methods This Australian qualitative study involved semi-structured interviews with general practitioners (n =9), practice nurses (n =8), and a community liaison worker employed in general practice (n =1), to explore barriers and facilitators to identifying and managing supportive care for cancer survivors. Data were thematically analysed to develop recurring themes related to the identification and provision of supportive care. Results Four major themes were developed: identification of supportive care needs, time and provision of supportive care, challenges in supportive care for diverse populations, and desire for more information. Improved education; enhanced communication across all levels of healthcare, including centralised access to patient information; and greater knowledge of available services were highlighted as facilitators to the management of supportive care for cancer survivors. Conclusions Targeted efforts to support the facilitators identified here can contribute to more effective management of supportive care for diverse cancer survivor populations to improve the overall quality of care and health outcomes for these individuals.

Background The Aboriginal community controlled health sector has been a leader in community health in Australia. We sought to understand the influence this sector has had on the non-Indigenous community health movement in Australia since the 1970s. Methods We interviewed 87 key informants on the history of community health in Australia, including policy makers, researchers, medical doctors, allied health, social workers, nurses and politicians. Five were Aboriginal, and 11 had particular experience in Aboriginal community health. A team approach was taken to qualitative analysis using a codebook. We interrogated data to seek evidence for the influence of Aboriginal community health on non-Indigenous community health, and the relationship between the two sectors. This was complemented by construction of a policy timeline. Results Aboriginal community health services were regarded as best practice community health, and informed and influenced practice in non-Indigenous community health services. Non-Indigenous community health was sometimes more of a competitor than an ally. The respect for the Aboriginal community health sector, particularly community controlled, was seen to have grown over time, acknowledging the strengths of the model. Although establishing Aboriginal community health services was a struggle, the resulting model has better resisted managerialist control compared with non-Indigenous community health. Conclusions The Aboriginal health sector developed a vision and practice of community health that went on to inform generalist non-Indigenous community health sector in Australia. The sector continues to remain strong today as an example model of community health that is relevant to all Australians.