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McGrath RL, Parnell T, Shephard S, Verdon S, Pope R. Physiotherapists often encounter clients disclosing suicidal thoughts and behaviors: a cross-sectional survey of Australian physiotherapists. Physiother Theory Pract 2024:1-15. [PMID: 38461461 DOI: 10.1080/09593985.2024.2327516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND All health professionals have a role in suicide prevention, although little is known about physiotherapists' contact with clients experiencing suicidal thoughts and behaviors. OBJECTIVE The aims of this study were to investigate physiotherapists' self-reported frequency of contact with clients who disclose suicidal thoughts and behaviors and to identify potential factors associated with frequency of contact. METHODS Three-hundred and thirty-eight Australian physiotherapists were surveyed using an online questionnaire, with an estimated response rate of 6.1%. Data were analyzed using descriptive analysis and logistic regression. RESULTS Over half the respondents (52.1%) reported encountering clients at least once a year who disclosed suicidal thoughts, and nearly half (49.4%) reported having received at least one disclosure of a suicide plan at some point in their career. Among those working in the public sector, 67.5% of respondents reported having received a disclosure of a suicide plan, and almost all physiotherapists working in pain management reported having received such a disclosure (93.8%). The binary logistic regression model explained approximately 39.7% of the variance in whether a physiotherapist had a client disclose a plan for suicide at some point in their career or not. CONCLUSION The results highlight that all physiotherapists should receive training in suicide prevention.
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Affiliation(s)
- Ryan L McGrath
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Tracey Parnell
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Sophie Shephard
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Sarah Verdon
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Rodney Pope
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
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Angeles MR, Crosland P, Hensher M. Challenges for Medicare and universal health care in Australia since 2000. Med J Aust 2023; 218:322-329. [PMID: 36739106 DOI: 10.5694/mja2.51844] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole-of-system strengthening. STUDY DESIGN Review of publications on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia published 1 January 2000 - 14 August 2021 that reported quantitative or qualitative research or data analyses, and of opinion articles, debates, commentaries, editorials, perspectives, and news reports on the Australian health care system published 1 January 2015 - 14 August 2021. Program-, intervention- or provider-specific articles, and publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners) were excluded. DATA SOURCES MEDLINE Complete, the Health Policy Reference Centre, and Global Health databases (all via EBSCO); the Analysis & Policy Observatory, the Australian Indigenous HealthInfoNet, the Australian Public Affairs Information Service, Google, Google Scholar, and the Organisation for Economic Co-operation and Development (OECD) websites. RESULTS The problems covered by the 76 articles included in our review could be grouped under seven major themes: fragmentation of health care and lack of integrated health financing, access of Aboriginal and Torres Strait Islander people to health services and essential medications, reform proposals for the Pharmaceutical Benefits Scheme, the burden of out-of-pocket costs, inequity, public subsidies for private health insurance, and other challenges for the Australian universal health care system. CONCLUSIONS A number of challenges threaten the sustainability and equity of the universal health care system in Australia. As the piecemeal reforms of the past twenty years have been inadequate for meeting these challenges, more effective, coordinated approaches are needed to improve and secure the universality of public health care in Australia.
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Affiliation(s)
| | - Paul Crosland
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | - Martin Hensher
- Menzies Institute for Medical Research, the University of Tasmania, Hobart, TAS
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Sobolewska A, Byrne AL, Harvey CL, Willis E, Baldwin A, McLellan S, Heard D. Person-centred rhetoric in chronic care: a review of health policies. J Health Organ Manag 2021; ahead-of-print. [PMID: 32027472 DOI: 10.1108/jhom-04-2019-0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in managing chronic care conditions. DESIGN/METHODOLOGY/APPROACH A qualitative content analysis was performed regarding the national, state and organisational Queensland Health policies using Elo and Kyngas' (2008) framework. FINDINGS Although the person-centred care as an approach is well articulated in health policies, there is still no definitive measure or approach to embedding it into operational services. Complex funding structures and competing priorities of the governments and the health organisations carry the risk that person-centred care as an approach gets lost in translation. Three themes emerged: the patient versus the government; health care delivery versus the political agenda; and health care organisational processes versus the patient. RESEARCH LIMITATIONS/IMPLICATIONS Given that person-centred care is the recommended approach for responding to chronic health conditions, further empirical research is required to evaluate how programs designed to deliver person-centred care achieve that objective in practice. PRACTICAL IMPLICATIONS This research highlights the complex environment in which the person-centred approach is implemented. Short-term programmes created specifically to focus on person-centred care require the right organisational infrastructure, support and direction. This review demonstrates the need for alignment of policies related to chronic disease management at the broader organisational level. ORIGINALITY/VALUE Given the introduction of the nurse navigator program to take up a person-centred care approach, the review of the recent policies was undertaken to understand how they support this initiative.
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Affiliation(s)
- Agnieszka Sobolewska
- Central Queensland University - Brisbane Campus, Brisbane, Queensland, Australia
| | - Amy-Louise Byrne
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Queensland, Australia
| | - Clare Lynette Harvey
- School of Nursing, Midwifery and Social Sciences, Central Queensland University - Townsville Campus, Mackay, Queensland, Australia
| | - Eileen Willis
- School of Nursing, Midwifery and Social Sciences, Central Queensland University - Townsville Campus, Mackay, Queensland, Australia
| | - Adele Baldwin
- School of Nursing, Midwifery and Social Sciences, Central Queensland University - Townsville Campus, Mackay, Queensland, Australia
| | - Sandy McLellan
- School of Nursing, Midwifery and Social Sciences, Central Queensland University - Mackay Campus, Mackay, Queensland, Australia
| | - David Heard
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Queensland, Australia
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Mazza D, McCarthy E, Carey M, Turner L, Harris M. "90% of the time, it's not just weight": General practitioner and practice staff perspectives regarding the barriers and enablers to obesity guideline implementation. Obes Res Clin Pract 2019; 13:398-403. [PMID: 31109793 DOI: 10.1016/j.orcp.2019.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the views of GPs and general practice staff regarding barriers and enablers to implementation of obesity guideline recommendations in general practice. METHODS Twenty general practitioners (GPs) and 18 practice staff from inner-eastern Melbourne, Australia, participated in semi-structured telephone interviews. The interview schedule was informed by the Theoretical Domains Framework (TDF). Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. RESULTS Participants lacked familiarity with and knowledge of the NHMRC obesity guidelines. Barriers and enablers were predominantly related to five theoretical domains: (1) environmental context and resources, (2) knowledge, (3) emotion, (4) beliefs about consequences, and (5) motivation and goals. Time pressures in consultations, costs for the patient, reluctance to add to patient burden particularly in those with comorbidities such as mental health issues, lack of awareness about services to refer patients to and GPs' fear of embarrassing patients and losing them were significant barriers. Enablers included having a strong doctor-patient relationship and a sense of responsibility to the patient to address weight. CONCLUSIONS Obesity guidelines and policy makers need to better engage with issues of multimorbidity, socioeconomic disadvantage and workforce issues if recommendations are to be widely adopted in general practice. Tasksharing, teamwork and technology are potential solutions to some of the barriers. Patient perspectives and approaches to being able to overcome stigma and legitimise obesity management in primary care consultations could also assist.
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Affiliation(s)
- D Mazza
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - E McCarthy
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Carey
- School of Medicine and Public Health, University of Newcastle, Australia
| | - L Turner
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - M Harris
- School of Public Health and Community Medicine, University of New South Wales, Australia
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Sturgiss E, Madigan CD, Klein D, Elmitt N, Douglas K. Metabolic syndrome and weight management programs in primary care: a comparison of three international healthcare systems. Aust J Prim Health 2018; 24:372-377. [DOI: 10.1071/py18021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/01/2018] [Indexed: 11/23/2022]
Abstract
Lifestyle behaviours are contributing to the increasing incidence of chronic disease across all developed countries. Australia, Canada and the UK have had different approaches to the role of primary care in the prevention and management of lifestyle-related diseases. Both obesity and metabolic syndrome have been targeted by programs to reduce individual risk for chronic disease such as type 2 diabetes. Three interventions are described – for either obesity or metabolic syndrome – that have varying levels of involvement of GPs and other primary care professionals. The structure of a healthcare system for example, financing and physical locations of primary care clinicians, shapes the development of primary care interventions. The type of clinicians involved in interventions, whether they work alone or in teams, is influenced by the primary care setting and resource availability. Australian clinicians and policymakers should take into account the healthcare system where interventions are developed when translating interventions to the Australian context.
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Sturgiss EA, Douglas K. A collaborative process for developing a weight management toolkit for general practitioners in Australia-an intervention development study using the Knowledge To Action framework. Pilot Feasibility Stud 2016; 2:20. [PMID: 27965840 PMCID: PMC5154117 DOI: 10.1186/s40814-016-0060-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is commonly seen in the Australian general practice population; however, few resources are specifically targeted at GPs working with these patients. The National Health and Medical Research Council (Australia) guideline for managing patients who are overweight and obese supports the involvement of a regular health professional. As 85 % of the population visit a GP annually, resources to support GPs working with this patient population are needed. This study describes the collaborative process used to develop an obesity management programme based on current Australian guidelines for GPs and their patients to be used in primary care. The Knowledge To Action framework was applied to develop a weight management toolkit for GPs based on current Australian guidelines. This draft was then reviewed by clinical GPs, GP registrars, consumer representatives and allied health professionals using focus groups and interviews. The participants gave feedback on the content, layout and acceptability of the documents. The feedback from the stakeholder groups was evaluated, and changes were incorporated into the final documents. A graphic designer was contracted to assist with the layout to improve useability and attractiveness of the documents. RESULTS A total of 38 participants gave feedback on the draft weight management programme, and the research team amalgamated their responses to further improve the documents. The general response from GPs and consumer representatives was positive with most conveying their wish to try the programme themselves. CONCLUSIONS "The Change Program" is a practical tool for Australian GPs to use with their patients who are overweight or obese. It was developed in collaboration with GPs, allied health professionals and consumer stakeholders based on current Australian guidelines. It is currently being piloted in five general practices.
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Affiliation(s)
- Elizabeth Ann Sturgiss
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
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Sturgiss EA, van Weel C, Ball L, Jansen S, Douglas K. Obesity management in Australian primary care: where has the general practitioner gone? Aust J Prim Health 2016; 22:473-476. [DOI: 10.1071/py16074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/24/2016] [Indexed: 11/23/2022]
Abstract
Obesity is a chronic condition with significant health and economic consequences that requires more effective management in Australia. General practitioners (GPs) currently act as care co-ordinators in line with national guidelines for overweight and obesity. Australian patients indicate that they would appreciate more involvement from their GP in the management of obesity, and this is in line with international findings. Not all patients have access to specialist obesity services or affordable allied health care because of location, cost and time, particularly in rural and remote areas where there is a greater prevalence of obesity. Empowering GPs to use their skills as expert generalists to manage obesity is an option that should be explored to improve access for all individuals. GPs will require evidence-based tools to assist them in structuring obesity management within their own general practice environment.
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Sturgiss EA, Elmitt N, van Weel C, Haesler E, Sargent G, Stevenson A, Harris M, Douglas K. The role of the family doctor in the management of adults who are obese: a scoping review protocol. SPRINGERPLUS 2015; 4:820. [PMID: 26753108 PMCID: PMC4695474 DOI: 10.1186/s40064-015-1647-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022]
Abstract
Background The role of family doctors in the management of obesity in primary care will become increasingly important as more of the adult population become overweight or obese. Having a solid understanding of the family doctor’s role as a sole practitioner is important for supporting practitioners in providing patient care and for informing future research. Objective The purpose of this paper is to describe a protocol for a scoping review that aims to examine and map the current research base for the role of the family doctor in managing adults who are overweight or obese. Methods This scoping review is based on the methodology as described by the Joanna Briggs Institute which involves final consultation with stakeholders. Two reviewers (ES, NE) will be responsible for the iterative development of a search strategy based on the basic initial search terms obesity, doctor and primary care. Black and grey literature will be searched to elucidate any manuscripts involving the family doctor in the management of adults who are overweight or obese. A customised data extraction tool will be used to collect relevant items from each manuscript. Results Data extraction will expose the role family doctors are playing in obesity management in all stages of research including recruitment, intervention or as a control group. By looking at a broad scope of manuscripts we will discover the family doctor’s role as portrayed in research, in international guidelines and by peak bodies. We will also determine if there are any gaps in the research base. Conclusion This protocol describes a scoping review that will illustrate the supporting international research for the role family doctors are playing in the management of adults who are overweight or obese. Scoping of the international literature will then be translated for Australian primary care.
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Affiliation(s)
- Elizabeth Ann Sturgiss
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Nicholas Elmitt
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Chris van Weel
- Radboud University Nijmegen, Nijmegen, The Netherlands ; Primary Health Care Research, Australian Primary Health Care Research Institute, Research School of Population Health, ANU College of Medicine, Canberra, Australia
| | - Emily Haesler
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Ginny Sargent
- National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | - Alex Stevenson
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), UNSW, Sydney, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
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Volker N, Williams LT, Davey RC, Cochrane T. Community-based lifestyle modification workforce: an underutilised asset for cardiovascular disease prevention. Aust J Prim Health 2015; 22:327-331. [PMID: 26330102 DOI: 10.1071/py14178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/19/2015] [Indexed: 11/23/2022]
Abstract
This paper reports on a qualitative study exploring the capacity of the community sector to support a whole-of-system response to cardiovascular disease prevention in primary health care. As a component of the Model for Prevention (MoFoP) study, community-based lifestyle modification providers were recruited in the Australian Capital Territory to participate in focus group discussions; 34 providers participated across six focus groups: 20 Allied Health Professionals (four groups) and 14 Lifestyle Modification Program providers (two groups). Thematic analysis of focus group transcripts was undertaken using a mixed deductive and inductive approach. Participant responses highlight several barriers to their greater contribution to cardiovascular disease prevention. These included that prevention activities are not valued, limited sector linkages, inadequate funding models and the difficulty of behaviour change. Findings suggest that improvements in the value proposition of prevention for all stakeholders would be supported by improved funding mechanisms and increased opportunities to build relationships across health and community sectors.
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Affiliation(s)
- Nerida Volker
- University of Canberra, Centre for Research & Action in Public Health, University of Canberra, College Road, Bruce, Canberra, ACT 2601, Australia
| | - Lauren T Williams
- University of Canberra, Centre for Research & Action in Public Health, University of Canberra, College Road, Bruce, Canberra, ACT 2601, Australia
| | - Rachel C Davey
- University of Canberra, Centre for Research & Action in Public Health, University of Canberra, College Road, Bruce, Canberra, ACT 2601, Australia
| | - Thomas Cochrane
- University of Canberra, Centre for Research & Action in Public Health, University of Canberra, College Road, Bruce, Canberra, ACT 2601, Australia
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Farag I, Sherrington C, Ferreira M, Howard K. A systematic review of the unit costs of allied health and community services used by older people in Australia. BMC Health Serv Res 2013; 13:69. [PMID: 23421756 PMCID: PMC3586358 DOI: 10.1186/1472-6963-13-69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 02/19/2013] [Indexed: 11/25/2022] Open
Abstract
Background An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. Method A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. Results The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72. Conclusions Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.
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Affiliation(s)
- Inez Farag
- George Institute for Global Health, University of Sydney, 321 Kent Street, Sydney, NSW 2006, Australia.
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