Evaluation of the priority primary care centre program to reduce emergency department burden in regional Victoria, Australia: a mixed-method study

INTRODUCTION

In Australia, the Victorian State Government has established a number of priority primary care centres (PPCCs) across the state to address the increasing demand for emergency departments (EDs). PPCCs are general practitioner-led, free-of-charge services that aim to provide care for conditions that require urgent attention but do not require the high-acuity care of an ED. This study aims to evaluate the implementation processes, outcomes and the impact of the PPCC on reducing ED demand within Barwon, Warrnambool and Grampians Health Services in the Western region of Victoria, Australia.

METHODS AND ANALYSIS

This is a convergent mixed-method study. Qualitative data collection will be undertaken through semistructured interviews to understand the experiences of PPCC patients, PPCC clinical staff, PPCC managerial and administrative staff and ED clinical staff. A documentary analysis will be conducted on the materials relating to the implementation of the PPCC. The quantitative component will involve interrupted time series analysis of de-identified administrative data, comprising ED presentation records and PPCC clinical records. Implementation science frameworks will be integrated throughout the study. The RE-AIM framework is a guide used for the planning and evaluation of programmes through five outcomes: reach, effectiveness, adoption, implementation and maintenance. The Consolidated Framework for Implementation Research will be integrated.

ETHICS AND DISSEMINATION

This study has received ethical approval from Deakin University HREC (Ref No. 2023-046) and Barwon Health HREC (Ref No. 94374). Findings will be disseminated as reports, presentations and peer-reviewed journal articles.

Use of General Practitioner Telehealth Services During the COVID-19 Pandemic in Regional Victoria, Australia: Retrospective Analysis

BACKGROUND

In March 2020, the Australian Government expanded general practitioner (GP) telehealth services in response to the COVID-19 pandemic.

OBJECTIVE

This study sought to assess use patterns of GP telehealth services in response to changing circumstances (before and during the COVID-19 pandemic and with or without a lockdown) in regional Victoria, Australia.

METHODS

We conducted a secondary analysis of monthly Medicare claims data from July 2019 to June 2021 from 140 regional GP practices in Western Victoria. The longitudinal patterns of proportion of GP telehealth consultations stratified by type of consultation (ie, videoconference vs telephone) and by geographical, consumer, and consultation characteristics were analyzed.

RESULTS

Telehealth comprised 25.8% (522,932/2,025,615) of GP consultations over the 2-year period. After the introduction of the Australian telehealth expansion policy in March 2020, there was a rapid uptake in GP telehealth services (including telephone and video services), from 0% before COVID-19 to 15% (11,854/80,922) of all consultations in March 2020, peaking at 55% (50,828/92,139) in August 2020. Thereafter, the use of telehealth declined steadily to 31% (23,941/77,344) in January 2021 and tapered off to 28% (29,263/103,798) in June 2021. Telephone services and shorter consultations were the most dominant form, and those aged 15-64 years had higher telehealth use rates than younger or older age groups. The proportion of video consultations was higher during periods with government-imposed lockdowns and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas.

CONCLUSIONS

Our findings support the continuation of telehealth use in rural and regional Australia post pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of short telephone consultations.

The main olfactory system mediates pheromone-induced fos expression in the extended amygdala and preoptic area of the male Syrian hamster

Copulation in male hamsters is stimulated by exposure to vaginal secretions of conspecifics. These pheromones also stimulate fos expression in neural areas that regulate copulation including: the medial nucleus of the amygdala, the bed nucleus of the stria terminalis, and the preoptic area. The pheromones in vaginal secretions are detected by both the main and accessory olfactory systems. However, the accessory system plays the greater role in the regulation of mating behavior and has direct connections with the medial nucleus of the amygdala and bed nucleus of the stria terminalis. The goal of the present study was to determine which system mediates the effect of pheromones on the stimulation of more central areas by deafferenting these systems in experienced male hamsters before exposure to vaginal secretions. Destruction of the receptors in the main olfactory system with zinc sulfate eliminated the increase in fos immunoreactivity in the amygdala, bed nucleus of the stria terminalis and preoptic area following exposure to sexually stimulating pheromones. Deafferentation of the accessory olfactory system by removing the vomeronasal organ had no effect on pheromone-induced fos expression in these areas. We conclude that neurons expressing fos following exposure to vaginal secretions are stimulated via the main olfactory system and are not associated with the expression of copulatory behavior.

Maximizing the contribution doctors make to NHS management

Management is an increasingly important issue for many doctors. If doctors wish to influence resource allocation, they must involve themselves in health service management. This article describes the results of an enquiry action learning project involving six doctors. As part of the project, clinical directors and their business managers were interviewed. In addition, the Police Force and BAA (formerly the British Airport Authority) were visited and their management structure, out-of-hours activities and planning for emergencies assessed. This article examines the reasons why many doctors do not involve themselves in management, such as increased time commitment and negative peer pressure, and suggests some solutions to these problems, including the need for a wider understanding of the role of clinical directors. It also considers how some organizations are already starting to address these issues, and how both doctors and hospitals can benefit from greater involvement of doctors in health service management.

Medication patterns of recurrent headache sufferers: a community study

This community-based telephone survey determined medication patterns of 274 frequent headache sufferers who reported 12 or more headaches a year. Headaches were classified using the International Headache Society's (IHS) criteria. Participants reported on 465 types of headaches: 129 tension headaches, 158 migraine headaches, 8 chronic tension headaches, and 148 headaches which were unclassifiable using IHS criteria. Females (n = 133) reported an average of 1.9 types of headache and males (n = 141) reported 1.5 headache types. Fifty-six percent of respondents used acetaminophen for tension-type and 60% used acetaminophen for migraine. One percent used prescription medication for tension headache and 12% used prescriptions for migraine. The perceived effectiveness of over-the-counter medication was approximately 7 on a scale of 0-10 for tension headaches and 6 for migraine. Both tension-headache and migraine-headache sufferers waited about 1 h before taking any medication. Tension-headache sufferers waited until the headache was above 5 on a 0 to 10 scale (4.6 for migraine). It is possible that more aggressive use of medication might improve headache management.

Sex differences in function of a pheromonally stimulated pathway: role of steroids and the main olfactory system

Exposure to the pheromones contained in female hamster vaginal secretions (FHVS) produces stereotypic, sex-specific behaviors in Syrian hamsters. Using Fos as a marker of neuronal stimulation we have found that (1) FHVS stimulates neurons in the posterior subdivision of the medial nucleus of the amygdala (MeP), the posterior medial subdivision of the bed nucleus of the stria terminalis (BNSTpm), and the magnocellular subdivision of the medial preoptic nucleus (MPN mag); (2) this stimulation is mediated by the main olfactory system; (3) stimulation of the MPN mag is regulated by testosterone in males; (4) stimulation of the BNSTpm and MeP is regulated by testosterone in females; and (5) FHVS does not induce Fos production in the MPN mag in females regardless of the hormonal state. These results support the hypothesis that the main olfactory system plays an important role in the regulation of pheromonally driven behaviors, identifies functional sex differences in pathways that regulate these behaviors, and emphasizes the different roles of the BNSTpm, MeP, and MPN mag in the regulation of male copulatory behavior.

Substance P and neurokinin A are colocalized in the central chemosensory pathway of the male golden hamster

The medial nucleus of the amygdala, bed nucleus of the stria terminalis and medial preoptic area play critical roles in the regulation of mating behavior in the male hamster. Destruction of these nuclei or the pathways that connect them severely disrupt copulation. We have begun identifying the neuropeptides contained in these neurons as a prelude to determining the role of peptide neurotransmitters in the regulation of male copulatory behavior. We have found that substance P is localized within these neurons and is regulated by gonadal steroids. In this study we report 1) that a closely related peptide, NKA (substance K), is also present in the medial nucleus of the amygdala, the bed nucleus of the stria terminalis and the medial preoptic area; 2) that all those neurons which contain SP also contain NKA and 3) testosterone also regulates the production of NKA. Thus, NKA may also play a role in the regulation of male copulatory behavior.

Sensitization to noise-mediated induction of seizure susceptibility by MK-801 and phencyclidine

The effect of single administrations of MK-801 (5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine) or PCP (phencyclidine) on the induction of audiogenic seizure susceptibility by noise in immature rats was examined. Treatments with these non-competitive N-methyl-D-aspartate (NMDA) receptor antagonists resulted in increases in noise exposure-dependent susceptibility. In neonatally drug-treated rats, seizures during adulthood were found to occur with significantly higher incidence and severity. Furthermore, drug treatments were found to lengthen what is normally a restricted developmental period within which susceptibility can be induced by noise exposure. The drugs, however, had no inherent ability to induce audiogenic seizure susceptibility if given alone. Moreover, in already-susceptible rats, MK-801 exhibited predictable anticonvulsant effects. These data suggest acute PCP or MK-801 exposures may transiently exacerbate risks inherent in certain forms of trauma. The mechanism underlying these effects is unknown although certain inferences are possible and may reveal much about epileptogenesis in this model.

Ontogenetic features of audiogenic seizure susceptibility induced in immature rats by noise

Although numerous models are currently used for systematic study of the mechanisms of epileptogenesis in mature brain, few animal models have been developed that allow similar explorations in the developing nervous system. One experimental model of epilepsy supports a premise that perinatal experience can lead to eventual seizure susceptibility, however. Audiogenic seizure (AGS) susceptibility can be induced during a critical developmental period in normal mice by auditory deprivation and therefore by cochlear trauma. We studied the developmental parameters that affect success of both induction and testing of AGS-susceptibility in the rat. Intense high-frequency noise exposure was used as the traumatizing agent. The Wistar rat strain used is inherently seizure-resistant because in greater than 400 trials, untreated rats have never exhibited susceptibility at any age. Although single prolonged exposures to high-intensity noise were administered to groups of rats at ages between postnatal days (PNDs) 12 and 36, PND 14 was the age when exposure was most likely to result in eventual seizure susceptibility. Furthermore, duration of initial exposure on PND 14 determined the rate of susceptibility when measured 2 weeks later. Accordingly, we noted that single noise exposures at an intensity of 125 dB and ranging between 6 and 10 min in duration induced susceptibility in 100% of rats tested on PND 28; nonetheless, seizures among the rats exposed for 8 min were the most severe. Typically, these seizures began as wild running attacks and were followed by tonic/clonic convulsions.(ABSTRACT TRUNCATED AT 250 WORDS)

Sperm function and structure and seminal plasma prostanoid concentrations in men with IDDM

Semen from 18 men with insulin-dependent diabetes mellitus (IDDM) aged 20-40 yr was compared with that from 15 age-matched control subjects. Although semen volume, sperm count, and spermatozoal motility were similar in the two groups, semen from diabetic men had significantly greater numbers of abnormal spermatozoa and significantly lower ability to penetrate hamster eggs. Concentrations of prostaglandins E2, F2 alpha, and I2 and thromboxane A2 were significantly elevated in the seminal plasma from semen of diabetic subjects compared with control subjects. These observations indicate the need for a careful assessment of fertility in diabetic men, the mechanisms underlying the abnormalities in spermatozoa, and the relationship of these abnormalities to the increase in prostanoid concentrations in diabetic men.

N-methyl-D-aspartate (NMDA) receptors are inactivated by trypsin

Acute isolation of hippocampal CA3 pyramidal cells using trypsin produces neurons which respond to kainate and quisqualate but not N-methyl-D-aspartate (NMDA). Incubation of 6- to 12-day-old cultured hippocampal neurons or slices of pyriform cortex with trypsin irreversibly removes the NMDA responses normally present without significant effect on responses to kainate or quisqualate. These data indicate that the NMDA receptor has a trypsin-sensitive component which is necessary for agonist recognition or ion channel activation.

Speaking fundamental frequency: some physical and social correlates

Previous correlational studies have found no relationship between speaker height, weight and speaking fundamental frequency, although it has often been claimed that listeners can correctly identify the height, weight, and bodily build of speakers and that voice pitch is one of the cues used. In this study various social factors were controlled for, and contrasting samples of speech from each subject were analysed. Twelve men and 15 women, drawn from a socially homogeneous group, were asked to read two passages and to phonate the vowel /a:/ at "their lowest attainable pitch." The median speaking fundamental frequency from both passages was calculated and a measure of basal F0 was obtained from the phonation of /a:/. In contrast to other studies, a relationship was found between speaker height and median speaking fundamental frequency, but no relationship was found between speaker weight and F0. The correlation between median speaking fundamental frequency and height was significant only in the male sample and in one passage. Physical and social interpretations for these findings are discussed.

Cycle of lordosis behavior in female hamsters whose circadian activity rhythm has split into two components

Within 75 days of exposure to constant light (LL), the circadian activity rhythm of 21 of 32 hamsters had dissociated or "split" into two distinct components. These components were labeled either evening (E) or morning (M) depending on whether they appeared to be derived from the E or M portion of the activity phase prior to the occurrence of "splitting." Both regular (i.e., 4-day) and irregular (i.e., non-4-day) cycles in lordosis behavior were observed in all of the animals with an intact activity rhythm and in 18 of the 21 animals with a split rhythm of activity. The onset of behavioral estrus always occurred near the time of the onset of locomotor activity in animals with an intact activity rhythm. Among the females with a split activity rhythm, seven showed lordosis onsets only near the onset of the E component whereas five others began lordosis behavior only near the onset of the M component. Importantly, in five animals the onset of lordosis was associated on different days with either the E or M component. These results indicate that cycles in lordosis behavior persist even after the circadian rhythm of activity has dissociated into two components, and that at least one component of the estrous cycle, onset of lordosis behavior, can be coupled to either of two oscillators that underlie the circadian rhythm of locomotor activity in hamsters.

Phenylethanolamine: a new putative neurotransmitter in Aplysia

Phenylethanolamine is present in the Aplysia nervous system in concentrations similar to that of octopamine. These are receptors that are very specific for phenylethanolamine, which on different neurons mediate sodium, chlorine, or potassium conductance increase responses. These observations indicate that phenylethanolamine may act as a neurotransmitter in Aplysia.