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Buss VH, Barr M, Parker SM, Kabir A, Lau AYS, Liaw ST, Stocks N, Harris MF. Correction: Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study. JMIR Mhealth Uhealth 2024; 12:e58507. [PMID: 38564771 PMCID: PMC11022129 DOI: 10.2196/58507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
[This corrects the article DOI: 10.2196/45942.].
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Affiliation(s)
- Vera Helen Buss
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
| | - Margo Barr
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
| | - Sharon M Parker
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
| | - Alamgir Kabir
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
| | - Annie Y S Lau
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Siaw-Teng Liaw
- School of Population HealthUniversity of New South WalesSydneyAustralia
| | - Nigel Stocks
- Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
| | - Mark F Harris
- Centre for Primary Health Care and EquityUniversity of New South WalesSydneyAustralia
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Buss VH, Barr M, Parker SM, Kabir A, Lau AYS, Liaw ST, Stocks N, Harris MF. Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study. JMIR Mhealth Uhealth 2024; 12:e45942. [PMID: 38335014 PMCID: PMC10891495 DOI: 10.2196/45942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/21/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The Health eLiteracy for Prevention in General Practice trial is a primary health care-based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp), and a referral to telephone coaching. OBJECTIVE This study aimed to assess mysnapp app use, its user profiles, the duration and frequency of use within the Health eLiteracy for Prevention in General Practice trial, its association with other intervention components, and its association with study outcomes (health literacy and diet) to determine whether they have significantly improved at 6 months. METHODS In 2018, a total of 22 general practices from 2 Australian states were recruited and randomized by cluster to the intervention or usual care. Patients who met the main eligibility criteria (ie, BMI>28 in the previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about this study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants' choice. Data were collected directly through the app and combined with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants' questionnaires at baseline and 6-month follow-up. The analyses comprised descriptive and inferential statistics. RESULTS Of the 120 participants who received the intervention, 62 (52%) chose to use the app. The app and nonapp user groups did not differ significantly in demographics or prior recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (2-sided Fisher exact test; P<.001) and participate in the telephone coaching (2-sided Fisher exact test; P=.007) than nonapp users. There was no association between app use and study outcomes shown to have significantly improved (health literacy and diet) at 6 months. CONCLUSIONS Recruitment and engagement were difficult for this study in disadvantaged populations with low health literacy. However, app users were more likely to attend the 6-week health check and participate in telephone coaching, suggesting that participants who opted for several intervention components felt more committed to this study. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617001508369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-023239.
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Affiliation(s)
- Vera Helen Buss
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Annie Y S Lau
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Siaw-Teng Liaw
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Nigel Stocks
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Taggart J, Chin M, Liauw W, Harris MF. Sharing Colorectal Cancer Follow-Up Using an E-Care Plan Between Cancer Services and Primary Health Care. Stud Health Technol Inform 2024; 310:1517-1518. [PMID: 38269724 DOI: 10.3233/shti231272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
High quality, long term follow-up care for cancer patients needs to be coordinated, comprehensive and tailored to the diverse needs of patients. This study implemented shared follow-up care using an interactive e-care plan that provided a collaborative space to schedule and share goals, tasks and information and support the monitoring of care. Qualitative results identified good relational coordination. Increasing communication from the cancer service is important.
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Affiliation(s)
| | - Melvin Chin
- South Eastern Sydney Local Health District Cancer Services
| | - Winston Liauw
- South Eastern Sydney Local Health District Cancer Services
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Spooner C, O'Shea P, Fisher KR, Harris-Roxas B, Taggart J, Bolton P, Harris MF. Access to general practice for preventive health care for people who experience severe mental illness in Sydney, Australia: a qualitative study. Aust J Prim Health 2024; 30:PY23195. [PMID: 38171548 DOI: 10.1071/py23195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND People with lived experience of severe mental illness (PWLE) live around 20years less than the general population. Most deaths are due to preventable health conditions. Improved access to high-quality preventive health care could help reduce this health inequity. This study aimed to answer the question: What helps PWLE access preventive care from their GP to prevent long-term physical conditions? METHODS Qualitative interviews (n=10) and a focus group (n=10 participants) were conducted with PWLE who accessed a community mental health service and their carers (n=5). An asset-based framework was used to explore what helps participants access and engage with a GP. A conceptual framework of access to care guided data collection and analysis. Member checking was conducted with PWLE, service providers and other stakeholders. A lived experience researcher was involved in all stages of the study. RESULTS PWLE and their carers identified multiple challenges to accessing high-quality preventive care, including the impacts of their mental illness, cognitive capacity, experiences of discrimination and low income. Some GPs facilitated access and communication. Key facilitators to access were support people and affordable preventive care. CONCLUSION GPs can play an important role in facilitating access and communication with PWLE but need support to do so, particularly in the context of current demands in the Australian health system. Support workers, carers and mental health services are key assets in supporting PWLE and facilitating communication between PWLE and GPs. GP capacity building and system changes are needed to strengthen primary care's responsiveness to PWLE and ability to engage in collaborative/shared care.
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Kanti Mistry S, Harris E, Li X, Harris MF. Correction to: Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia. BMC Health Serv Res 2023; 23:918. [PMID: 37644434 PMCID: PMC10463569 DOI: 10.1186/s12913-023-09903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Xue Li
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Mistry SK, Harris E, Li X, Harris MF. Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia. BMC Health Serv Res 2023; 23:476. [PMID: 37170092 PMCID: PMC10174608 DOI: 10.1186/s12913-023-09514-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/08/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Patients from culturally and linguistically diverse (CALD) backgrounds often face difficulties in accessing health and social care services. This study explored the feasibility and acceptability of involving community health workers (CHWs) as bilingual community navigators (BCNs) in general practice setting, to help patients from CALD backgrounds access health and social care services in Australia. METHODS This research was conducted in two general practices in Sydney where most patients are from specific CALD backgrounds (Chinese in one practice and Samoan in other). Three CHWs trained as BCNs were placed in these practices to help patients access health and social care service. A mixed-method design was followed to explore the feasibility and acceptability of this intervention including analysis of a record of services provided by BCNs and post-intervention qualitative interviews with patients, practice staff and BCNs exploring the feasibility and acceptability of the BCNs' role. The record was analyzed using descriptive statistics and interviews were audio-recorded, transcribed, and thematically analyzed. RESULTS BCNs served a total of 95 patients, providing help with referral to other services (52.6%), information about appointments (46.3%), local resources (12.6%) or available social benefits (23.2%). Most patients received one service from BCNs with the average duration of appointments being half an hour. Overall, BCNs fitted in well within the practices and patients as well as staff of participating practices accepted them well. Their role was facilitated by patients' felt need for and acceptance of BCNs' services, recruitment of BCNs from the patient community, as well as BCNs' training and motivation for their role. Major barriers for patients to access BCNs' services included lack of awareness of the BCNs' roles among some patients and practice staff, unavailability of information about local culture specific services, and inadequate time and health system knowledge by BCNs. Limited funding support and the short timeframe of the project were major limitations of the project. CONCLUSION BCNs' placement in general practice was feasible and acceptable to patients and staff in these practices. This first step needs to be followed by accredited training, development of the workforce and establishing systems for supervision in order to sustain the program. Future research is needed on the extension of the intrevention to other practices and culture groups.
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Affiliation(s)
- Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Xue Li
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Ansari RM, Harris MF, Hosseinzadeh H, Zwar N. Application of Artificial Intelligence in Assessing the Self-Management Practices of Patients with Type 2 Diabetes. Healthcare (Basel) 2023; 11:healthcare11060903. [PMID: 36981560 PMCID: PMC10048183 DOI: 10.3390/healthcare11060903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
The use of Artificial intelligence in healthcare has evolved substantially in recent years. In medical diagnosis, Artificial intelligence algorithms are used to forecast or diagnose a variety of life-threatening illnesses, including breast cancer, diabetes, heart disease, etc. The main objective of this study is to assess self-management practices among patients with type 2 diabetes in rural areas of Pakistan using Artificial intelligence and machine learning algorithms. Of particular note is the assessment of the factors associated with poor self-management activities, such as non-adhering to medications, poor eating habits, lack of physical activities, and poor glycemic control (HbA1c %). The sample of 200 participants was purposefully recruited from the medical clinics in rural areas of Pakistan. The artificial neural network algorithm and logistic regression classification algorithms were used to assess diabetes self-management activities. The diabetes dataset was split 80:20 between training and testing; 80% (160) instances were used for training purposes and 20% (40) instances were used for testing purposes, while the algorithms' overall performance was measured using a confusion matrix. The current study found that self-management efforts and glycemic control were poor among diabetes patients in rural areas of Pakistan. The logistic regression model performance was evaluated based on the confusion matrix. The accuracy of the training set was 98%, while the test set's accuracy was 97.5%; each set had a recall rate of 79% and 75%, respectively. The output of the confusion matrix showed that only 11 out of 200 patients were correctly assessed/classified as meeting diabetes self-management targets based on the values of HbA1c < 7%. We added a wide range of neurons (32 to 128) in the hidden layers to train the artificial neural network models. The results showed that the model with three hidden layers and Adam's optimisation function achieved 98% accuracy on the validation set. This study has assessed the factors associated with poor self-management activities among patients with type 2 diabetes in rural areas of Pakistan. The use of a wide range of neurons in the hidden layers to train the artificial neural network models improved outcomes, confirming the model's effectiveness and efficiency in assessing diabetes self-management activities from the required data attributes.
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Affiliation(s)
- Rashid M Ansari
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia
| | - Hassan Hosseinzadeh
- School of Health and Society, Faculty of Science, Medicine and Health, University of Wollongong, Sydney, NSW 2522, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Queensland University, Brisbane, QLD 4072, Australia
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Perez-Concha O, Goldstein D, Harris MF, Laaksonen MA, Hanly M, Suchy S, Vajdic CM. Uptake of Team Care Arrangements for adults newly diagnosed with cancer. Aust J Prim Health 2023; 29:20-29. [PMID: 36076333 DOI: 10.1071/py22078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Medicare-subsidised Team Care Arrangements (TCAs) support Australian general practitioners to implement shared care between collaborating health professionals for patients with chronic medical conditions and complex needs. We assessed the prevalence of TCAs, factors associated with TCA uptake and visits to TCA-subsidised allied health practitioners, for adults newly diagnosed with cancer in New South Wales, Australia. METHODS We carried out a retrospective individual patient data linkage study with 13 951 45 and Up Study participants diagnosed with incident cancer during 2006-16. We used a proportional hazards model to estimate the factors associated with receipt of a TCA after cancer diagnosis. RESULTS In total, 6630 patients had a TCA plan initiated (47.5%). A TCA was more likely for patients aged ≥65years, those with higher service utilisation 4-15months prior to cancer diagnosis, a higher number of comorbidities, lower self-rated overall health status, living in areas of greater socio-economic disadvantage, lower educational attainment and those with no private health insurance. A total of 4084 (61.6%) patients with a TCA had at least one TCA-subsidised allied health visit within 24months of the TCA. CONCLUSIONS TCAs appear to be well targeted at cancer patients with chronic health conditions and lower socioeconomic status. Nevertheless, not all patients with a TCA subsequently attended a TCA-subsidised allied healthcare professional. This suggests either a misunderstanding of the plan, the receipt of allied health via other public schemes, a low prioritisation of the plan compared to other health care, or suboptimal availability of these services.
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Affiliation(s)
- Oscar Perez-Concha
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, NSW, Australia
| | - Maarit A Laaksonen
- School of Mathematics and Statistics, UNSW Sydney, Sydney, NSW, Australia
| | - Mark Hanly
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Sue Suchy
- Consumer Advisory Panel, Translational Cancer Research Network, Sydney, NSW, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
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Sitas F, Harris-Roxas B, White SL, Haigh FA, Barr ML, Harris MF. Smoking cessation on discharge summaries. Med J Aust 2023; 218:46. [PMID: 36423644 PMCID: PMC10098480 DOI: 10.5694/mja2.51792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/15/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Freddy Sitas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW.,Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW
| | | | - Sarah L White
- Cancer Council Victoria, Quit Victoria, Melbourne, VIC
| | - Fiona A Haigh
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
| | - Margo L Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
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Mistry SK, Harris E, Harris MF. Learning from a codesign exercise aimed at developing a navigation intervention in the general practice setting. Fam Pract 2022; 39:1070-1079. [PMID: 35365997 DOI: 10.1093/fampra/cmac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In this study, we aimed to describe and evaluate the codesign of an intervention in general practice setting to help address navigation problems faced by the patients from the culturally and linguistically diverse (CALD) community in Australia. METHODS An experience-based codesign (EBCD) methodology was adopted using the Double Diamond design process. Two codesign workshops were conducted online with 13 participants including patients, their caregivers, health service providers, researchers, and other stakeholders. Workshops were audio-recorded, transcribed, and thematically analyzed. RESULTS The codesign participants identified several navigation problems among CALD patients such as inadequate health literacy, cultural and language barriers, and difficulties with navigating health and social services. They believed that bilingual community navigators (BCNs; lay health workers from the same language or cultural background) could help them address these problems. However, this depended on BCNs being trained and supervised, with a clear role definition and manageable workloads, and not used as an interpreter. In undertaking the codesign process, we found that pre-workshop consultations were useful to ensure engagement, especially for consumers who participated more actively in group activities with service providers after these and their own separate small group discussions during the workshop. CONCLUSION Overall, participants identified that BCNs could offer help in addressing the problems faced by the CALD patients in accessing care in general practice setting. The codesign process provided new insights into the navigation problems faced by CALD patients in accessing care and collaboratively developed a strategy for further testing and evaluation.
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Affiliation(s)
- Sabuj K Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Botany Street, Kensington, NSW 2052, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Botany Street, Kensington, NSW 2052, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Botany Street, Kensington, NSW 2052, Australia
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Mistry SK, Harris E, Harris MF. Scoping the needs, roles and implementation of bilingual community navigators in general practice settings. Health Soc Care Community 2022; 30:e5495-e5505. [PMID: 36004646 DOI: 10.1111/hsc.13973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 07/10/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
This research aimed to explore the needs, potential roles and implementation of Bilingual Community Navigators (BCNs) in providing navigation support for patients in general practice settings in Australia. A total of 19 participants (general practitioners, practice managers, practice nurses and receptionists) from five general practices in Sydney where most of the patients spoke a language other than English were interviewed about their views on needs, potential roles and implementation of BCNs in general practice settings. Data were collected between August 2019 and July 2020. The interview transcripts were inductively analysed for themes. Themes emerged across four broad categories: patients' barriers to access health and social care services; potential roles of BCNs; recruitment, training, and employment of BCNs and considerations and anticipated barriers to BCNs' role. Many barriers both at the patient and at the service provider levels in accessing healthcare and social care services were consistent with the Levesque et al. access framework including lack of understanding of the health system, language and cultural barriers, hesitancy to approach general practice and problems navigating services. Participants believed that BCNs would be able to help overcome these barriers through health education, support in booking appointments, arranging transport, providing language and cultural support and improving communication with the health services. Conditions for effective implementation of BCNs in practice included proper training of the navigators to ensure patient confidentiality and addressing organisational/system barriers such as lack of a funding mechanism, a clear role definition of BCNs and acceptance of BCNs by patients. BCNs potential role in facilitating access to appropriate care by culturally and linguistically diverse (CALD) patients in general practice warrants further evaluation in the context of the Australian healthcare system.
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Affiliation(s)
- Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Mistry SK, Ali ARMM, Yadav UN, Huda MN, Ghimire S, Saha M, Sarwar S, Harris MF. Loneliness and its correlates among Bangladeshi older adults during the COVID-19 pandemic. Sci Rep 2022; 12:15020. [PMID: 36056090 PMCID: PMC9438873 DOI: 10.1038/s41598-022-19376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022] Open
Abstract
The present study aims to investigate the prevalence of loneliness and its associated factors among older adults during the COVID-19 pandemic in Bangladesh. This cross-sectional study was conducted in October 2020 among 1032 older Bangladeshi adults aged 60 years and above through telephone interviews. A semi-structured questionnaire was used to collect information on participants' characteristics and COVID-19-related information. Meanwhile, the level of loneliness was measured using a 3-item UCLA Loneliness scale. More than half (51.5%) of the older adults experienced loneliness. We found that participants formally schooled [adjusted odds ratio (aOR = 0.62, 95% CI 0.43-0.88)] and received COVID-19-related information from health workers (aOR = 0.33, 95% CI 0.22-0.49) had lower odds of being lonely during the pandemic. However, older adults living alone (aOR: 2.57, 95% CI 1.34-4.94), residing distant from a health facility (aOR = 1.46, 95% CI 1.02-2.08) and in rural areas (aOR = 1.53, 95% CI 1.02-2.23) had higher odds of loneliness than their counterparts. Likewise, odds of loneliness were higher among those overwhelmed by COVID-19 (aOR = 1.93, 95% CI 1.29-2.86), who faced difficulty in earning (aOR = 1.77, 95% CI 1.18-2.67) and receiving routine medical care during pandemic (aOR = 2.94, 95% CI 1.78-4.87), and those perceiving requiring additional care during the pandemic (aOR = 6.01, 95% CI 3.80-9.49). The findings suggest that policies and plans should be directed to reduce loneliness among older adults who require additional care.
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Affiliation(s)
- Sabuj Kanti Mistry
- ARCED Foundation, 13/1 Pallabi, Mirpur-12, Dhaka, Bangladesh.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
- BRAC James P Grant School of Public Health, BRAC University, Medona Tower, Bir Uttam AK Khandakar Road, Dhaka, 1213, Bangladesh.
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh.
| | | | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Md Nazmul Huda
- ARCED Foundation, 13/1 Pallabi, Mirpur-12, Dhaka, Bangladesh
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbeltown, NSW, 2560, Australia
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Manika Saha
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Clayton, VIC, 3145, Australia
| | - Sneha Sarwar
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Spooner C, Afrazi S, de Oliveira Costa J, Harris MF. Demographic and health profiles of people with severe mental illness in general practice in Australia: a cross-sectional study. Aust J Prim Health 2022; 28:408-416. [PMID: 35649529 DOI: 10.1071/py21240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with severe mental illness have a higher rate of premature death than the general population, largely due to primary care preventable diseases. There has been little research on the health profile of this population attending Australian general practices. METHODS In this nationwide cross-sectional study, MedicineInsight data for adult patients regularly attending general practices in 2018 were analysed to estimate the prevalence of schizophrenia or bipolar disorders (SBD) and investigate the health profile of people with SBD compared with other patients. Multilevel models clustered by practice (n = 565) and patient, and practice characteristics were created. RESULTS The prevalence of recorded SBD was 1.91% (95% CI = 1.88%-1.94%) among the 618 849 patients included. Patients with recorded SBD were more likely than other patients to have records of health risk factors, particularly smoking (aOR = 3.8, 95% CI = 3.6-3.9) and substance use (aOR = 5.9, 95% CI = 5.6-6.3), and higher probabilities of comorbidities including cardiovascular diseases (aOR = 1.3, 95% CI = 1.2-1.4), cancer (aOR = 1.1, 95% CI = 1.0-1.2), diabetes mellitus type 2 (aOR = 2.2, 95% CI = 2.0-2.3), chronic kidney diseases (aOR = 1.7, 95% CI = 1.5-2.0), chronic liver diseases (aOR = 3.3, 95% CI = 2.6-4.0) and chronic respiratory diseases (aOR = 1.7, 95% CI = 1.7-1.8). CONCLUSIONS The higher prevalence of health risk factors and comorbidities among patients with recorded SBD underscores the need for proactive health risk monitoring and preventive care to address this health inequity.
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Affiliation(s)
- Catherine Spooner
- Centre for Primary Health Care and Equity (CPHCE), Faculty of Medicine, UNSW Sydney, High Street, Kensington, NSW 2052, Australia
| | - Samira Afrazi
- CPHCE/CBDRH, Faculty of Medicine, UNSW Sydney, High Street, Kensington, NSW 2052, Australia
| | - Juliana de Oliveira Costa
- Centre for Big Data Research in Health (CBDRH), Faculty of Medicine, UNSW Sydney, High Street, Kensington, NSW 2052, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity (CPHCE), Faculty of Medicine, UNSW Sydney, High Street, Kensington, NSW 2052, Australia
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14
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Harris MF, Rhee J. Achieving continuity of care in general practice: the impact of patient enrolment on health outcomes. Med J Aust 2022; 216:460-461. [DOI: 10.5694/mja2.51508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Mark F Harris
- Centre for Primary Health Care and Equity University of New South Wales Sydney NSW
| | - Joel Rhee
- University of New South Wales Sydney NSW
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15
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Hespe CM, Giskes K, Harris MF, Peiris D. Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation. BMC Health Serv Res 2022; 22:108. [PMID: 35078460 PMCID: PMC8790896 DOI: 10.1186/s12913-021-07310-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are discrepancies between evidence-based guidelines for screening and management of cardiovascular disease (CVD) and implementation in Australian general practice. Quality-improvement (QI) initiatives aim to reduce these gaps. This study evaluated a QI program (QPulse) that focussed on CVD assessment and management. Methods This mixed-methods study explored the implementation of guidelines and adoption of a QI program with a CVD risk-reduction intervention in 34 general practices. CVD screening and management were measured pre- and post-intervention. Qualitative analyses examined participants’ Plan-Do-Study-Act (PDSA) goals and in-depth interviews with practice stakeholders focussed on barriers and enablers to the program and were analysed thematically using Normalisation Process Theory (NPT). Results Pre- and post-intervention data were available from 15 practices (n = 19,562 and n = 20,249, respectively) and in-depth interviews from seven practices. At baseline, 45.0% of patients had their BMI measured and 15.6% had their waist circumference recorded in the past 2 years and blood pressure, lipids and smoking status were measured in 72.5, 61.5 and 65.3% of patients, respectively. Most high-risk patients (57.5%) were not prescribed risk-reducing medications. After the intervention there were no changes in the documentation and prevalence of risk factors, attainment of BP and lipid targets or prescription of CVD risk-reducing medications. However, there was variation in performance across practices with some showing isolated improvements, such as recording waist circumference (0.7-32.2% pre-intervention to 18.5-69.8% post-intervention), BMI and smoking assessment. Challenges to the program included: lack of time, need for technical support, a perceived lack of value for quality improvement work, difficulty disseminating knowledge across the practice team, tensions between the team and clinical staff and a part-time workforce. Conclusion The barriers associated with this QI program was considerable in Australian GP practices. Findings highlighted they were not able to effectively operationalise the intervention due to numerous factors, ranging from lack of internal capacity and leadership to competing demands and insufficient external support. Trial registration Australian New Zealand Clinical Trials Reference Number (ACTRN12615000108516), registered 06/02/2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07310-6.
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Affiliation(s)
- C M Hespe
- School of Medicine, Sydney, University of Note Dame Australia, 160 Oxford St, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - K Giskes
- School of Medicine, Sydney, University of Note Dame Australia, 160 Oxford St, Darlinghurst, Sydney, NSW, 2010, Australia.,Heart Research Institute, University of Sydney, Sydney, Australia
| | - M F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - D Peiris
- The George Institute for Global Health, University of Sydney, Sydney, Australia
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16
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Harris E, Harris MF. An exploration of the inverse care law and market forces in Australian primary health care. Aust J Prim Health 2022; 29:137-141. [PMID: 36403292 DOI: 10.1071/py22160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/01/2022] [Indexed: 11/21/2022]
Abstract
This paper examines the implications of the second sentence in Tudor Harts statement about inverse care - that its operation was strongest when exposed to market forces. In the Australian context, we briefly review some available evidence for inverse care in three groups - Aboriginal and Torres Strait Islander people and those living in remote and socioeconomically disadvantaged areas. We then discuss the extent to which these examples can be attributed to the operation of supply-and-demand within Australia's hybrid fee-for-service system in general practice. Our analysis suggests disparities in workforce supply and the ability of disadvantaged groups to seek preventive and proactive care are critical factors. These, in turn, suggest the need to fund general practice to be responsible for proactive and preventive care of disadvantaged population groups alongside broader structural reforms in workforce, education and taxation.
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Affiliation(s)
- Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
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17
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Conigrave KM, Ali RL, Armstrong R, Chikritzhs TN, d'Abbs P, Harris MF, Hewlett N, Livingston M, Lubman DI, McKenzie A, O'Leary C, Ritter A, Wilson S, Grimmond M, Banks E. Revision of the Australian guidelines to reduce health risks from drinking alcohol. Med J Aust 2021; 215:518-524. [PMID: 34839537 PMCID: PMC9299166 DOI: 10.5694/mja2.51336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023]
Abstract
Introduction The Australian guidelines to reduce health risks from drinking alcohol were released in 2020 by the National Health and Medical Research Council. Based on the latest evidence, the guidelines provide advice on how to keep the risk of harm from alcohol low. They refer to an Australian standard drink (10 g ethanol). Recommendations: Guideline 1: To reduce the risk of harm from alcohol‐related disease or injury, healthy men and women should drink no more than ten standard drinks a week and no more than four standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol. Guideline 2: To reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol. Guideline 3: To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby.
Changes as result of the guideline The recommended limit for healthy adults changed from two standard drinks per day (effectively 14 per week) to ten per week. The new guideline states that the less you drink, the lower your risk of harm from alcohol. The recommended maximum on any one day remains four drinks (clarified from previously “per drinking occasion”). Guidance is clearer for pregnancy and breastfeeding, and for people aged less than 18 years, recommending not drinking.
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Affiliation(s)
| | | | | | - Tanya N Chikritzhs
- National Drug Research Institute, Curtin University, Perth, WA.,Menzies School of Health Research, Darwin, NT
| | | | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
| | - Nicole Hewlett
- Menzies School of Health Research, Darwin, NT.,Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD
| | | | - Dan I Lubman
- Turning Point, Eastern Health, Melbourne, VIC.,Monash Addiction Research Centre, Monash University, Melbourne, VIC
| | | | - Colleen O'Leary
- Office of the Chief Psychiatrist of Western Australia, Perth, WA
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, NSW
| | - Scott Wilson
- University of Sydney, Sydney, NSW.,Aboriginal Drug and Alcohol Council SA, Aboriginal Corporation, Adelaide, SA
| | | | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
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18
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Mistry SK, Ali AM, Yadav UN, Huda MN, Ghimire S, Bestman A, Hossain MB, Reza S, Qasim R, Harris MF. Difficulties faced by older Rohingya (forcibly displaced Myanmar nationals) adults in accessing medical services amid the COVID-19 pandemic in Bangladesh. BMJ Glob Health 2021; 6:e007051. [PMID: 34903566 PMCID: PMC8671847 DOI: 10.1136/bmjgh-2021-007051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/17/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND COVID-19 has seriously disrupted health services in many countries including Bangladesh. This research aimed to explore whether Rohingya (forcefully displaced Myanmar nationals) older adults in Bangladesh faced difficulties accessing medicines and routine medical care services amid this pandemic. METHODS This cross-sectional study was conducted among 416 Rohingya older adults aged 60 years and above residing in Rohingya refugee camps situated in the Cox's Bazar district of Bangladesh and was conducted in October 2020. A purposive sampling technique was followed, and participants' perceived difficulties in accessing medicines and routine medical care were noted through face-to-face interviews. Binary logistic regression models determined the association between outcome and explanatory variables. RESULTS Overall, one-third of the participants reported difficulties in accessing medicines and routine medical care. Significant factors associated with facing difficulties accessing medicine included feelings of loneliness (adjusted OR (AOR) 3.54, 95% CI 1.93 to 6.48), perceptions that older adults were at the highest risk of COVID-19 (AOR 3.35, 95% CI 1.61 to 6.97) and required additional care during COVID-19 (AOR 6.89, 95% CI 3.62 to 13.13). Also, the notable factors associated with difficulties in receiving routine medical care included living more than 30 min walking distance from the health centre (AOR 3.57, 95% CI 1.95 to 6.56), feelings of loneliness (AOR 2.20, 95% CI 1.25 to 3.87), perception that older adults were at the highest risk of COVID-19 (AOR 2.85, 95% CI 1.36 to 5.99) and perception that they required additional care during the pandemic (AOR 4.55, 95% CI 2.48 to 8.35). CONCLUSION Many Rohingya older adults faced difficulties in accessing medicines and routine medical care during this pandemic. This call for policy-makers and relevant stakeholders to re-assess emergency preparedness plans including strategies to provide continuing care.
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Affiliation(s)
- Sabuj Kanti Mistry
- ARCED Foundation, Dhaka, Bangladesh
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Arm Mehrab Ali
- ARCED Foundation, Dhaka, Bangladesh
- Global Research and Data Support, Innovations for Poverty Action, New Haven, Connecticut, USA
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Md Nazmul Huda
- School of Health Sciences, Western Sydney University, Campbeltown, New South Wales, Australia
- The School of Liberal Arts and Social Sciences, Independent University, Dhaka, Bangladesh
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | - Amy Bestman
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Md Belal Hossain
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sompa Reza
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Rubina Qasim
- Dow Institute of Nursing and Midwifery, Dow University of Health Sciences, Karachi, Pakistan
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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19
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Russell GM, Long K, Lewis V, Enticott JC, Gunatillaka N, Cheng IH, Marsh G, Vasi S, Advocat J, Saito S, Song H, Casey S, Smith M, Harris MF. OPTIMISE: a pragmatic stepped wedge cluster randomised trial of an intervention to improve primary care for refugees in Australia. Med J Aust 2021; 215:420-426. [PMID: 34585377 PMCID: PMC9292802 DOI: 10.5694/mja2.51278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine whether primary care outreach facilitation improves the quality of care for general practice patients from refugee backgrounds. DESIGN Pragmatic, cluster randomised controlled trial, with stepped wedge allocation to early or late intervention groups. SETTING, PARTICIPANTS 31 general practices in three metropolitan areas of Sydney and Melbourne with high levels of refugee resettlement, November 2017 - August 2019. INTERVENTION Trained facilitators made three visits to practices over six months, using structured action plans to help practice teams optimise routines of refugee care. MAJOR OUTCOME MEASURE Change in proportion of patients from refugee backgrounds with documented health assessments (Medicare billing). Secondary outcomes were refugee status recording, interpreter use, and clinician-perceived difficulty in referring patients to appropriate dental, social, settlement, and mental health services. RESULTS Our sample comprised 14 633 patients. The intervention was associated with an increase in the proportion of patients with Medicare-billed health assessments during the preceding six months, from 19.1% (95% CI, 18.6-19.5%) to 27.3% (95% CI, 26.7-27.9%; odds ratio, 1.88; 95% CI, 1.42-2.50). The impact of the intervention was greater in smaller practices, practices with larger proportions of patients from refugee backgrounds, recent training in refugee health care, or higher baseline provision of health assessments for such patients. There was no impact on refugee status recording, interpreter use increased modestly, and reported difficulties in refugee-specific referrals to social, settlement and dental services were reduced. CONCLUSIONS Low intensity practice facilitation may improve some aspects of primary care for people from refugee backgrounds. Facilitators employed by local health services could support integrated approaches to enhancing the quality of primary care for this vulnerable population. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618001970235 (retrospective).
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Affiliation(s)
| | | | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, VIC
| | - Joanne C Enticott
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC.,Southern Synergy, Monash University, Melbourne, VIC
| | - Nilakshi Gunatillaka
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, VIC
| | | | - Geraldine Marsh
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, VIC
| | | | | | - Shoko Saito
- Centre for Primary Health Care and Equity, UNSW, Sydney, NSW
| | - Hyun Song
- Centre for Primary Health Care and Equity, UNSW, Sydney, NSW.,NSW Agency for Clinical Innovation, Sydney, NSW
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Melbourne, VIC
| | - Mitchell Smith
- NSW Refugee Health Service, South Western Sydney Local Health District, Sydney, NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity, UNSW, Sydney, NSW
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20
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Spooner C, Lewis V, Scott C, Dahrouge S, Haggerty J, Russell G, Levesque JF, Dionne E, Stocks N, Harris MF. Improving access to primary health care: a cross-case comparison based on an a priori program theory. Int J Equity Health 2021; 20:223. [PMID: 34635116 PMCID: PMC8504080 DOI: 10.1186/s12939-021-01508-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Inequitable access to primary health care (PHC) remains a problem for most western countries. Failure to scale up effective interventions has been due, in part, to a failure to share the logic and essential elements of successful programs. The aim of this paper is to describe what we learned about improving access to PHC for vulnerable groups across multiple sites through use of a common theory-based program logic model and a common evaluation approach. This was the IMPACT initiative. Methods IMPACT’s evaluation used a mixed methods design with longitudinal (pre and post) analysis of six interventions. The analysis for this paper included four of the six sites that met study criteria. These sites were located in Canada (Alberta, Quebec and Ontario) and Australia (New South Wales). Using the overarching logic model, unexpected findings were reviewed, and alternative explanations were considered to understand how the mechanisms of each intervention may have contributed to results. Results Each site addressed their local access problem with different strategies and from different starting points. All sites observed changes in patient abilities to access PHC and provider access capabilities. The combination of intended and observed consequences for consumers and providers was different at each site, but all sites achieved change in both consumer ability and provider capability, even in interventions where there was no activity targeting provider behaviors. Discussion The model helped to identify, explore and synthesize intended and unintended consequences of four interventions that appeared to have more differences than similarities. Similar outcomes for different interventions and multiple impacts of each intervention on abilities were observed, implying complex causal pathways. Conclusions All the interventions were a low-cost incremental attempt to address unmet health care needs of vulnerable populations. Change is possible; sustaining change may be more challenging. Access to PHC requires attention to both patient abilities and provider characteristics. The logic model proved to be a valuable heuristic tool for defining the objectives of the interventions, evaluating their impacts, and learning from the comparison of ‘cases’.
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Affiliation(s)
- Catherine Spooner
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
| | | | | | - Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Grant Russell
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | | | - Emilie Dionne
- St. Mary's Research Centre, McGill University, Montreal, Quebec, Canada
| | - Nigel Stocks
- Department of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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21
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Rahimi-Ardabili H, Spooner C, Harris MF, Magin P, Tam CWM, Liaw ST, Zwar N. Online training in evidence-based medicine and research methods for GP registrars: a mixed-methods evaluation of engagement and impact. BMC Med Educ 2021; 21:492. [PMID: 34521409 PMCID: PMC8439372 DOI: 10.1186/s12909-021-02916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence-based medicine (EBM) is a core skillset for enhancing the quality and safety of patients' care. Online EBM education could improve clinicians' skills in EBM, particularly when it is conducted during vocational training. There are limited studies on the impact of online EBM training on clinical practice among general practitioner (GP) registrars (trainees in specialist general practice). We aimed to describe and evaluate the acceptability, utility, satisfaction and applicability of the GP registrars experience with the online course. The course was developed by content-matter experts with educational designers to encompass effective teaching methods (e.g. it was interactive and used multiple teaching methods). METHODS Mixed-method data collection was conducted after individual registrars' completion of the course. The course comprised six modules that aimed to increase knowledge of research methods and application of EBM skills to everyday practice. GP registrars who completed the online course during 2016-2020 were invited to complete an online survey about their experience and satisfaction with the course. Those who completed the course within the six months prior to data collection were invited to participate in semi-structured phone interviews about their experience with the course and the impact of the course on clinical practice. A thematic analysis approach was used to analyse the data from qualitative interviews. RESULTS The data showed the registrars were generally positive towards the course and the concept of EBM. They stated that the course improved their confidence, knowledge, and skills and consequently impacted their practice. The students perceived the course increased their understanding of EBM with a Cohen's d of 1.6. Registrars identified factors that influenced the impact of the course. Of those, some were GP-related including their perception of EBM, and being comfortable with what they already learnt; some were work-place related such as time, the influence of supervisors, access to resources; and one was related to patient preferences. CONCLUSIONS This study showed that GP registrars who attended the online course reported that it improved their knowledge, confidence, skill and practice of EBM over the period of three months. The study highlights the supervisor's role on GP registrars' ability in translating the EBM skills learnt in to practice and suggests exploring the effect of EBM training for supervisors.
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Affiliation(s)
| | - Catherine Spooner
- Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, NSW 2052 Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, NSW 2052 Australia
| | - Parker Magin
- Research and Evaluation Unit, GP Synergy, Sydney, NSW 2304 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2304 Australia
| | - Chun Wah Michael Tam
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, NSW 2170 Australia
| | - Siaw-Teng Liaw
- WHO Collaborating Centre (eHealth), School of Population Health, UNSW Sydney, Sydney, NSW 2052 Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4229 Australia
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22
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Saito S, Harris MF, Long KM, Lewis V, Casey S, Hogg W, Cheng IH, Advocat J, Marsh G, Gunatillaka N, Russell G. Response to language barriers with patients from refugee background in general practice in Australia: findings from the OPTIMISE study. BMC Health Serv Res 2021; 21:921. [PMID: 34488719 PMCID: PMC8419978 DOI: 10.1186/s12913-021-06884-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
Background Language is a barrier to many patients from refugee backgrounds accessing and receiving quality primary health care. This paper examines the way general practices address these barriers and how this changed following a practice facilitation intervention. Methods The OPTIMISE study was a stepped wedge cluster randomised trial set within 31 general practices in three urban regions in Australia with high refugee settlement. It involved a practice facilitation intervention addressing interpreter engagement as one of four core intervention areas. This paper analysed quantitative and qualitative data from the practices and 55 general practitioners from these, collected at baseline and after 6 months during which only those assigned to the early group received the intervention. Results Many practices (71 %) had at least one GP who spoke a language spoken by recent humanitarian entrants. At baseline, 48 % of practices reported using the government funded Translating and Interpreting Service (TIS). The role of reception staff in assessing and recording the language and interpreter needs of patients was well defined. However, they lacked effective systems to share the information with clinicians. After the intervention, the number of practices using the TIS increased. However, family members and friends continued to be used to interpret with GPs reporting patients preferred this approach. The extra time required to arrange and use interpreting services remained a major barrier. Conclusions In this study a whole of practice facilitation intervention resulted in improvements in procedures for and engagement of interpreters. However, there were barriers such as the extra time required, and family members continued to be used. Based on these findings, further effort is needed to reduce the administrative burden and GP’s opportunity cost needed to engage interpreters, to provide training for all staff on when and how to work with interpreters and discuss and respond to patient concerns about interpreting services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06884-5.
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Affiliation(s)
- Shoko Saito
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, New South Wales, Kensington, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, New South Wales, Kensington, Australia. .,UNSW Sydney, NSW, 2052, Sydney, Australia.
| | - Katrina M Long
- Department of General Practice, School of Primary & Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne, Australia
| | - Virginia Lewis
- Centre for Health Systems Development, Australian Institute for Primary Care and Ageing, La Trobe University, Victoria, Melbourne, Australia
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - I-Hao Cheng
- Department of General Practice, School of Primary & Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne, Australia
| | - Jenny Advocat
- Department of General Practice, School of Primary & Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne, Australia
| | - Geraldine Marsh
- Centre for Health Systems Development, Australian Institute for Primary Care and Ageing, La Trobe University, Victoria, Melbourne, Australia
| | - Nilakshi Gunatillaka
- Department of General Practice, School of Primary & Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne, Australia
| | - Grant Russell
- Department of General Practice, School of Primary & Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne, Australia
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Lee PH, Spooner C, Harris MF. Access and communication for deaf individuals in Australian primary care. Health Expect 2021; 24:1971-1978. [PMID: 34378292 PMCID: PMC8628593 DOI: 10.1111/hex.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/01/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aims The Australian Deaf Community face barriers that impede their access to, and communication within, primary health care settings. This study aimed to identify barriers and facilitators to access and communication for deaf individuals and Auslan interpreters in Australian general practice settings. Methods Semi‐structured interviews were conducted with eight Auslan interpreters and four deaf participants recruited from interpreter organisations and social media. Transcripts of interviews were coded inductively and deductively based on a model of access to health care. Results Patient, provider and contextual factors were reported. Patient barriers included English and Auslan fluency levels within the Australian Deaf Community. GP clinics varied in the degree of accommodation to the needs of deaf people. There were barriers related to the communication methods used by health care providers and their use of interpreters. Visual aids and flexibility in terms of the GP clinics' appointment systems facilitated access. Contextual barriers included the shortage of Auslan interpreters and the complexity of the National Disability Insurance Scheme. Conclusion The main barriers identified concerned the availability of interpreters, accommodation by health providers, cultural sensitivity and the adequacy of communication methods. Research is needed to explore the limitations of the National Disability Insurance Scheme and interventions to improve GPs' skills in communicating with Deaf individuals. Patient or Public Contribution A researcher with a hearing impairment and experience in working with people with hearing impairments was consulted on study design and interview questions. Recruitment was assisted by Auslan interpreter agencies and a Deaf Community Facebook group.
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Affiliation(s)
- Phoebe H Lee
- Faculty of Medicine and Health, Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, New South Wales, Australia
| | - Catherine Spooner
- Faculty of Medicine and Health, Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, New South Wales, Australia
| | - Mark F Harris
- Faculty of Medicine and Health, Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, New South Wales, Australia
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Mistry SK, Ali ARMM, Yadav UN, Ghimire S, Hossain MB, Das Shuvo S, Saha M, Sarwar S, Nirob MMH, Sekaran VC, Harris MF. Older adults with non-communicable chronic conditions and their health care access amid COVID-19 pandemic in Bangladesh: Findings from a cross-sectional study. PLoS One 2021; 16:e0255534. [PMID: 34324556 PMCID: PMC8320993 DOI: 10.1371/journal.pone.0255534] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Burgeoning burden of non-communicable disease among older adults is one of the emerging public health problems. In the COVID-19 pandemic, health services in low- and middle-income countries, including Bangladesh, have been disrupted. This may have posed challenges for older adults with non-communicable chronic conditions in accessing essential health care services in the current pandemic. The present study aimed at exploring the challenges experienced by older Bangladeshi adults with non-communicable chronic conditions in receiving regular health care services during the COVID-19 pandemic. MATERIALS AND METHODS The study followed a cross-sectional design and was conducted among 1032 Bangladeshi older adults aged 60 years and above during October 2020 through telephone interviews. Self-reported information on nine non-communicable chronic conditions (osteoarthritis, hypertension, heart disease, stroke, hypercholesterolemia, diabetes, chronic respiratory diseases, chronic kidney disease, cancer) was collected. Participants were asked if they faced any difficulties in accessing medicine and receiving routine medical care for their medical conditions during the COVID-19 pandemic. The association between non-communicable chronic conditions and accessing medication and health care was analysed using binary logic regression model. RESULTS Most of the participants aged 60-69 years (77.8%), male (65.5%), married (81.4%), had no formal schooling (58.3%) and resided in rural areas (73.9%). Although more than half of the participants (58.9%) reported having a single condition, nearly one-quarter (22.9%) had multimorbidity. About a quarter of the participants reported difficulties accessing medicine (23%) and receiving routine medical care (27%) during the pandemic, and this was significantly higher among those suffering from multimorbidity. In the adjusted analyses, participants with at least one condition (AOR: 1.95, 95% CI: 1.33-2.85) and with multimorbidity (AOR: 4.75, 95% CI: 3.17-7.10) had a higher likelihood of experiencing difficulties accessing medicine. Similarly, participants with at least one condition (AOR: 3.08, 95% CI: 2.11-4.89) and with multimorbidity (AOR: 6.34, 95% CI: 4.03-9.05) were significantly more likely to face difficulties receiving routine medical care during the COVID-19 pandemic. CONCLUSIONS Our study found that a sizeable proportion of the older adults had difficulties in accessing medicine and receiving routine medical care during the pandemic. The study findings highlight the need to develop an appropriate health care delivery pathway and strategies to maintain essential health services during any emergencies and beyond. We also argue the need to prioritise the health of older adults with non-communicable chronic conditions in the centre of any emergency response plan and policies of Bangladesh.
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Affiliation(s)
- Sabuj Kanti Mistry
- ARCED Foundation, Dhaka, Bangladesh
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - A. R. M. Mehrab Ali
- ARCED Foundation, Dhaka, Bangladesh
- Innovations for Poverty Action, New Haven, Connecticut, United States of America
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- Center for Research Policy and Implementation, Biratnagar, Nepal
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, United States of America
| | - Md. Belal Hossain
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Suvasish Das Shuvo
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Manika Saha
- Action Lab, Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, Australia
| | - Sneha Sarwar
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Md. Mohibur Hossain Nirob
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Varalakshmi Chandra Sekaran
- Department of Community Medicine, Melaka Manipal Medical College (Manipal Campus) MAHE, Manipal, Karnataka, India
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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25
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Hespe CM, Harris MF, Peiris DP. Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed. Med J Aust 2021; 215:189-189.e1. [PMID: 34291475 DOI: 10.5694/mja2.51190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Mark F Harris
- Centre for Primary Health Care and Equity, UNSW, Sydney, NSW
| | - David P Peiris
- Office of the Chief Scientist, The George Institute for Global Health, Sydney, NSW
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Dougherty L, Riley A, Caffrey P, Wallbank A, Milne M, Harris MF, Lloyd J. Supporting Newly Arrived Migrant Mothers: A Pilot Health Literacy Intervention. Health Lit Res Pract 2021; 5:e201-e207. [PMID: 34260320 PMCID: PMC8280910 DOI: 10.3928/24748307-20210601-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Experiencing migration can create or exacerbate vulnerability to ill health, particularly during pregnancy and new motherhood. Providing a culturally appropriate health literacy intervention to new migrant families may increase social support and the skills and confidence to access health care services and information. This study developed and piloted a health literacy intervention, in the form of culturally redesigned new parent classes, in a culturally diverse location in Australia. The intervention was delivered over a 4-week period by Child and Family Health Nurses, with the help of interpreters and Bilingual Community Researchers, to Bangladeshi and Mandarin-speaking Chinese mothers and grandmothers with a baby age 0 to 1 year. A mixed-methods evaluation was conducted to measure (1) recruitment and attendance of participants, (2) feasibility of the intervention, (3) health literacy of participants, and (4) provider understanding of barriers to health care access. Thirty participants were recruited, and 18 women attended at least three of the four group sessions. Nurses viewed the program as being within the scope of their usual role, demonstrating intervention feasibility. Health literacy scores were higher post-intervention than pre-intervention. Nurses described having increased awareness of barriers to health care access after facilitating the intervention. The program has potential to be scaled up to other areas and languages. [HLRP: Health Literacy Research and Practice. 2021;5(3):e201–e207.]
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Affiliation(s)
| | | | | | | | | | - Mark F. Harris
- Address correspondence to Mark F. Harris, PhD, Centre for Primary Health Care and Equity, Level 3, AGSM Building, University of New South Wales, Sydney NSW 2052, Australia;
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Welberry HJ, Jorm LR, Schaffer AL, Barbieri S, Hsu B, Harris MF, Hall J, Brodaty H. Psychotropic medicine prescribing and polypharmacy for people with dementia entering residential aged care: the influence of changing general practitioners. Med J Aust 2021; 215:130-136. [PMID: 34198357 DOI: 10.5694/mja2.51153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine relationships between changing general practitioner after entering residential aged care and overall medicines prescribing (including polypharmacy) and that of psychotropic medicines in particular. DESIGN Retrospective data linkage study. SETTING, PARTICIPANTS 45 and Up Study participants in New South Wales with dementia who were PBS concession card holders and entered permanent residential aged care during January 2010 - June 2014 and were alive six months after entry. MAIN OUTCOME MEASURES Inverse probability of treatment-weighted numbers of medicines dispensed to residents and proportions of residents dispensed antipsychotics, benzodiazepines, and antidepressants in the six months after residential care entry, by most frequent residential care GP category: usual (same as during two years preceding entry), known (another GP, but known to the resident), or new GP. RESULTS Of 2250 new residents with dementia (mean age, 84.1 years; SD, 7.0 years; 1236 women [55%]), 625 most frequently saw their usual GPs (28%), 645 saw known GPs (29%), and 980 saw new GPs (44%). The increase in mean number of dispensed medicines after residential care entry was larger for residents with new GPs (+1.6 medicines; 95% CI, 1.4-1.9 medicines) than for those attended by their usual GPs (+0.7 medicines; 95% CI, 0.4-1.1 medicines; adjusted rate ratio, 2.42; 95% CI, 1.59-3.70). The odds of being dispensed antipsychotics (adjusted odds ratio [aOR], 1.59; 95% CI, 1.18-2.12) or benzodiazepines (aOR, 1.69; 95% CI, 1.25-2.30), but not antidepressants (aOR, 1.32; 95% CI, 0.98-1.77), were also higher for the new GP group. Differences between the known and usual GP groups were not statistically significant. CONCLUSIONS Increases in medicine use and rates of psychotropic dispensing were higher for people with dementia who changed GP when they entered residential care. Facilitating continuity of GP care for new residents and more structured transfer of GP care may prevent potentially inappropriate initiation of psychotropic medicines.
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Affiliation(s)
- Heidi J Welberry
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Andrea L Schaffer
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
| | - John Hall
- University of New South Wales, Sydney, NSW
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, NSW.,Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW
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28
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Mistry SK, Harris-Roxas B, Yadav UN, Shabnam S, Rawal LB, Harris MF. Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries. Front Public Health 2021; 9:666753. [PMID: 34239854 PMCID: PMC8258154 DOI: 10.3389/fpubh.2021.666753] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond.
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Affiliation(s)
- Sabuj Kanti Mistry
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Ben Harris-Roxas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Sadia Shabnam
- Health Nutrition and Population Program, BRAC, Dhaka, Bangladesh
| | - Lal Bahadur Rawal
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney Campus, Rockhampton, QLD, Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
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29
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Taggart J, Chin M, Liauw W, Goldstein D, Dolezal A, Plahn J, Harris MF. Challenges and solutions to sharing a cancer follow-up e-care plan between a cancer service and general practice. Public Health Res Pract 2021; 31:31122108. [PMID: 33942047 DOI: 10.17061/phrp31122108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This paper describes the process of developing a shared cancer care approach in follow-up, and identifies the e-health options that support an interactive e-care plan shared between a public cancer service, general practitioners (GPs) and cancer survivors. Type of program/service: The cancer service improvement initiative for shared care in follow-up targets colorectal cancer patients who have completed active treatment and who agree to shared care between specialists, GPs and other care team members. The intiative is supported by an agreed shared care pathway and an interactive e-care plan that is dynamic, can be shared and has functionalities that support collaboration. Design and development: A consultative process with stakeholders (local and state health services, a Primary Health Network, GPs and a consumer) was undertaken. Responses from individual consultations (25 stakeholders) were collated and commonalities identified to inform a workshop with 13 stakeholders to obtain consensus on the care pathway and e-health solution. Implications for policy and practice were identified throughout the process. OUTCOMES The stakeholders agreed to a shared care pathway, which included assessment and consent, GP engagement, tailoring the care plan and communicating results and information as tasks are completed. The nurse coordinator monitored care. No interactive e-care plans were available at national, state or local health service levels. A web-based GP interactive e-care plan was selected. The main concerns raised were uncertainty about the security of e-health systems not controlled by the local health service and sharing clinical information with external health providers, engaging GPs, and patient anxiety about the capacity of general practice to provide care. The e-care plan provided a low-risk solution to sharing patient information and supported collaborative care. Challenges to share e-care plans have implications for policy and practice. LESSONS LEARNT Stakeholders and the project team agreed that finding an e-health system that supported shared cancer care in follow-up and addressed the security and information sharing concerns could not all be adequately addressed at the local level. A GP interactive e-care plan provides a promising solution to a number of the barriers.
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Affiliation(s)
- Jane Taggart
- Centre for Primary Health Care and Equity, UNSW Sydney, Australia;
| | - Melvin Chin
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, South Eastern Sydney Local Health District, NSW, Australia; Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Australia
| | - Winston Liauw
- Cancer Services, South Eastern Sydney Local Health District, NSW, Australia; St George Hospital Cancer Care Centre, Sydney, NSW, Australia; Translational Cancer Research Network, UNSW Sydney, Australia
| | - David Goldstein
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, South Eastern Sydney Local Health District, NSW, Australia; Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Australia; Translational Cancer Research Network, UNSW Sydney, Australia
| | - Alex Dolezal
- Central and Eastern Sydney Primary Health Network, Sydney, NSW, Australia
| | - John Plahn
- eHealth NSW, New South Wales Ministry of Health, Sydney, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, UNSW Sydney, Australia; Translational Cancer Research Network, UNSW Sydney, Australia; School of Public Health and Community Medicine, UNSW Sydney, Australia
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30
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Mistry SK, Ali ARMM, Akther F, Yadav UN, Harris MF. Exploring fear of COVID-19 and its correlates among older adults in Bangladesh. Global Health 2021; 17:47. [PMID: 33853616 PMCID: PMC8045579 DOI: 10.1186/s12992-021-00698-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study was aimed to assess the perceived fear of COVID-19 and its associated factors among older adults in Bangladesh. METHODS This cross-sectional study was conducted in October 2020 among 1032 older Bangladeshi adults aged ≥60 years. A semi-structured questionnaire was used to collect information on participants' characteristics and COVID-19 related information. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S), where the cumulative score ranged from 7 to 35. Multiple linear regression was performed to identify factors associated with perceived fear of COVID-19. RESULTS The mean fear score was 19.4. Participants who were concerned about COVID-19 (β: 2.75, 95% CI: 1.71 to 3.78) and overwhelmed by COVID-19 (β: 3.31, 95% CI: 2.33 to 4.29) were significantly more likely to be fearful of COVID-19. Moreover, older adults who felt themselves isolated from others and whose close friends and family members were diagnosed with COVID-19 were more fearful. However, the participants who received COVID-19 related information from the health workers had a lower level of fear (β: -1.90, 95% CI: - 3.06 to - 0.73). CONCLUSIONS The presence of overwhelming fear of COVID-19 among the older adults of Bangladesh underlines the psychological needs of these vulnerable groups. Health workers have a key role in addressing these needs and further research is needed to identify the effective strategies for them to use.
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Affiliation(s)
- Sabuj Kanti Mistry
- ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka, Bangladesh ,grid.1005.40000 0004 4902 0432Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia ,grid.52681.380000 0001 0746 8691BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - A. R. M. Mehrab Ali
- ARCED Foundation, 13/1, Pallabi, Mirpur-12, Dhaka, Bangladesh ,grid.479464.c0000 0004 5903 5371Innovations for Poverty Action, New Haven, USA
| | - Farhana Akther
- grid.443019.b0000 0004 0479 1356Mawlana Bhashani Science and Technology University, Tangail, Bangladesh ,grid.10347.310000 0001 2308 5949SPM department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Uday Narayan Yadav
- grid.1005.40000 0004 4902 0432Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark F. Harris
- grid.1005.40000 0004 4902 0432Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Hespe CM, Campain A, Webster R, Patel A, Rychetnik L, Harris MF, Peiris DP. Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed. Med J Aust 2020; 213:327-328. [DOI: 10.5694/mja2.50756] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 05/29/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Anna Campain
- The George Institute for Global Health Sydney NSW
- University of New South Wales Sydney NSW
| | - Ruth Webster
- The George Institute for Global Health Sydney NSW
| | | | - Lucie Rychetnik
- The University of Notre Dame Australia Sydney NSW
- The Australian Health Prevention Partnership Sax Institute Sydney NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity University of New South Wales Sydney NSW
- Office of the Chief Scientist The George Institute for Global Health Sydney NSW
| | - David P Peiris
- Office of the Chief Scientist The George Institute for Global Health Sydney NSW
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Tran B, Vajdic CM, Webber K, Laaksonen MA, Stavrou EP, Tiller K, Suchy S, Bosco AM, Harris MF, Lloyd AR, Goldstein D. Self-reported health, lifestyle and social circumstances of Australian adult cancer survivors: A propensity score weighted cross-sectional study. Cancer Epidemiol 2020; 67:101773. [PMID: 32615538 DOI: 10.1016/j.canep.2020.101773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND With the prevalence of cancer survivors increasing, their unique needs must be better understood. We examined the health, lifestyles and social circumstances of adults with and without a history of cancer. METHODS We performed a cross-sectional study, using exposure and outcome data from the baseline survey (2006-2009) of participants in the 45 and Up Study, a prospective cohort study in New South Wales, Australia. We compared 20,811 cancer registry-verified adult cancer survivors with 207,148 participants without a history of cancer using propensity score weighting and accounting for multiple testing. The propensity weighting included age, sociodemographic factors and number of self-reported co-morbidities. RESULTS Cancer survivors were more likely to report poorer physical and psychological health and quality of life compared to those without a cancer history, with most deficits still evident more than 10 years after cancer diagnosis. Cancer survivors were more likely to have a higher body mass index, but were less likely to smoke. Cancer survivors had greater functional limitations, including sexual, and were less likely to work full time, volunteer and spend time outdoors. Their social connectedness was, however, similar. Those with haematological cancer, lung cancer, or distant metastases, and those diagnosed at an older age, had the greatest health deficits and functional limitations. CONCLUSIONS A history of cancer is associated with poorer health and less paid and unpaid work. Our findings reinforce the importance of routine long-term, integrated multidisciplinary care for cancer survivors and indicate the subgroups with the greatest unmet needs.
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Affiliation(s)
- Bich Tran
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
| | - Kate Webber
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Department of Oncology, Monash Health, Melbourne, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Maarit A Laaksonen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Efty P Stavrou
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | | | - Sue Suchy
- Consumer Advisory Panel, Translational Cancer Research Network, Sydney, Australia
| | - Ann Marie Bosco
- Prince of Wales Hospital, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Andrew R Lloyd
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - David Goldstein
- Department of Medical Oncology, Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia
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Patel B, Peiris DP, Patel A, Jan S, Harris MF, Usherwood T, Panaretto K, Lung T. A computer-guided quality improvement tool for primary health care: cost-effectiveness analysis based on TORPEDO trial data. Med J Aust 2020; 213:73-78. [PMID: 32594567 DOI: 10.5694/mja2.50667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of a computer-guided quality improvement intervention for primary health care management of cardiovascular disease (CVD) in people at high risk. DESIGN Modelled cost-effectiveness analysis of the HealthTracker intervention and usual care for people with high CVD risk, based on TORPEDO trial data on prescribing patterns, changes in intermediate risk factors (low-density lipoprotein cholesterol, systolic blood pressure), and Framingham risk scores. PARTICIPANTS Hypothetical population of people with high CVD risk attending primary health care services in a New South Wales primary health network (PHN) of mean size. INTERVENTION HealthTracker, integrated into health care provider electronic health record systems, provides real time decision support, risk communication, a clinical audit tool, and a web portal for performance feedback. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratios (ICERs): difference in costs of the intervention and usual care divided by number of CVD events averted with HealthTracker. RESULTS The estimated numbers of major CVD events over five years per 1000 patients at high CVD risk were lower in PHNs using HealthTracker, both for patients with prior CVD events (secondary prevention; 259 v 267 with usual care) and for those without prior events (primary prevention; 168 v 176). Medication costs were higher and hospitalisation costs lower with HealthTracker than with usual care for both primary and secondary prevention. The estimated ICER for one averted CVD event was $7406 for primary prevention and $17 988 for secondary prevention. CONCLUSION Modelled cost-effectiveness analyses provide information that can assist decisions about investing in health care quality improvement interventions. We estimate that HealthTracker could prevent major CVD events for less than $20 000 per event averted. TRIAL REGISTRATION (TORPEDO) Australian New Zealand Clinical Trials Registry, ACTRN 12611000478910.
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Affiliation(s)
- Bindu Patel
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - David P Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Anushka Patel
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW.,Sydney Medical School, the University of Sydney, Sydney, NSW
| | - Tim Usherwood
- Sydney Medical School, the University of Sydney, Sydney, NSW
| | - Kathryn Panaretto
- Centre for Chronic Disease, University of Queensland, Brisbane, QLD.,Medical Centre Queensland, University of Technology, Brisbane, QLD
| | - Thomas Lung
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW
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Ansari RM, Harris MF, Hosseinzadeh H, Zwar N. The Summary of an Urdu Version of Diabetes Self-Care Activities Measure: Psychometric Evaluation and Validation. J Prim Care Community Health 2020; 11:2150132720935292. [PMID: 32538255 PMCID: PMC7297472 DOI: 10.1177/2150132720935292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: The English version of the Summary of Diabetes Self-Care Activities (SDSCA) measure is the most frequently used self-reporting instrument assessing diabetes self-management. This study is aimed at translating English SDSCA into the Urdu version and validating and evaluating its psychometric properties. Methods: The Urdu version of SDSCA was developed based on the guidelines provided by the World Health Organization for translation and adaptation of instruments. The panel of experts examined the content validity, reliability, and internal consistency of the instrument. The translation process from the English version to the Urdu version revealed excellent results at all the stages. Results: The instrument showed promising and acceptable results. Of particular mention are the results related to split-half reliability coefficient 0.90, test-retest reliability (r = 0.918, P < .001), intraclass coefficient (0.912), and Cronbach’s alpha (.79). The factor analysis (exploratory and confirmatory) was not performed in this study due to the small sample size (n = 30) as the objective was to validate the Urdu version of the SDSCA instrument. Conclusions: This study provided evidence for the reliability and validity of the Urdu Summary of Diabetes Self-Care Activities (U-SDSCA) instrument, which may be used in the future for the patients of diabetes in order to assess type 2 diabetes self-management activities in the rural area of Pakistan and other Urdu-speaking countries.
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Affiliation(s)
- Rashid M Ansari
- University of New South Wales, Sydney, New South Wales, Australia
| | - Mark F Harris
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nicholas Zwar
- University of New South Wales, Sydney, New South Wales, Australia
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Ansari RM, Harris MF, Hosseinzadeh H, Zwar N. Psychometric Evaluation and Validation of an Urdu Version of the Summary of Diabetes Self-Care Activities Measure (U-SDSCA). Am J Med Qual 2020; 36:131-132. [PMID: 32126796 DOI: 10.1177/1062860620908060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rashid M Ansari
- University of New South Wales, Sydney, New South Wales, Australia University of Wollongong, Wollongong, New South Wales, Australia University of New South Wales, Sydney, New South Wales, Australia
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Wiles LK, de Wet C, Dalton C, Murphy E, Harris MF, Hibbert PD, Molloy CJ, Arnolda G, Ting HP, Braithwaite J. The quality of preventive care for pre-school aged children in Australian general practice. BMC Med 2019; 17:218. [PMID: 31805928 PMCID: PMC6896286 DOI: 10.1186/s12916-019-1455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence. METHODS Clinical experts (n = 6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n = 976) from general practices (n = 80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals. RESULTS IQs (n = 43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5). CONCLUSIONS This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards.
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Affiliation(s)
- Louise K Wiles
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Carl de Wet
- Healthcare Improvement Unit, Clinical Excellence Division, Queensland Health, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | | | - Elisabeth Murphy
- New South Wales Ministry of Health, North Sydney, Sydney, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
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Faruqi N, Thomas L, Parker S, Harris-Roxas B, Taggart J, Spooner C, Wong V, Harris MF. Primary health care provider-focused interventions for improving outcomes for people with type 2 diabetes: a rapid review. Public Health Res Pract 2019; 29:29121903. [PMID: 31800646 DOI: 10.17061/phrp29121903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives and importance of the study: The bulk of care for people with type 2 diabetes occurs in primary health care. This rapid review evaluated the effectiveness of primary health care provider-focused interventions in improving biochemical, clinical, psychological and health-related quality-of-life outcomes in people with type 2 diabetes. METHODS We searched Medline, Embase, All EBM Reviews, CINAHL, PsycINFO and grey literature focusing on the Organisation for Economic Co-operation and Development (OECD) member countries. We selected studies that targeted adults with type 2 diabetes, described a provider-focused intervention conducted in primary health care, and included an evaluation component. Four researchers extracted data and each included study was assessed for quality by two researchers. RESULTS Of the 15 studies identified, there was one systematic review (high quality), four randomised controlled trials (RCTs) (two strong quality, one each moderate and weak) and 10 cluster RCTs (two strong quality, five moderate, three weak). The range of follow-up periods was 3-32 months. In all but one study, the intervention was compared against usual care. The applied interventions included: computerised and noncomputerised decision support; culturally tailored interventions; feedback to the healthcare provider on quality of diabetes care; practice nurse involvement; and integrated primary and specialist care. All interventions aimed to improve the biochemical outcomes of interest; 13 studies also included clinical, psychological and/or health-related quality-of-life outcomes. Outcome results were mixed. CONCLUSIONS All interventions had mixed impacts on the outcomes of interest except the one study testing a decision aid, which did not show any improvement. A number of interventions are already available in Australia but need wider adoption. Other effective interventions are yet to be broadly adopted, and need to be evaluated for their applicability, feasibility and sustainability in the Australian context.
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Affiliation(s)
- Nighat Faruqi
- Centre for Primary Health Care and Equity, UNSW Sydney, Australia
| | - Louise Thomas
- Centre for Primary Health Care and Equity, UNSW Sydney, Australia
| | - Sharon Parker
- Centre for Primary Health Care and Equity, UNSW Sydney, Australia
| | - Ben Harris-Roxas
- Centre for Primary Health Care and Equity, UNSW Sydney, Australia; Primary Integrated and Community Health, South Eastern Sydney Local Health District, NSW, Australia
| | - Jane Taggart
- Centre for Primary Health Care and Equity, UNSW Sydney, Australia
| | | | - Vincent Wong
- South Western Sydney Clinical School, UNSW Sydney, Australia; Diabetes and Endocrine Service, Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, UNSW Sydney, Australia;
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Russell G, Lane R, Parker S, Litt J, Mazza D, Lloyd J, Zwar N, van Driel M, Del Mar C, Smith J, Harris MF. Preventive Evidence into Practice: what factors matter in a facilitation intervention to prevent vascular disease in family practice? BMC Fam Pract 2019; 20:113. [PMID: 31395020 PMCID: PMC6688202 DOI: 10.1186/s12875-019-0995-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/15/2019] [Indexed: 11/24/2022]
Abstract
Background A perennial challenge of primary care quality improvement is to establish why interventions work in some circumstances, but not others. This study aimed to identify factors explaining variations in the impact on clinical practice of a facilitation led vascular health intervention in Australian family practice. Methods Our mixed methods study was embedded within a cluster randomised controlled trial of a facilitation intervention designed to increase the uptake of evidence-based prevention of vascular disease in family practices. The study was set in four Australian states using eight of the study’s 16 intervention practices. Facilitators worked with intervention practices to develop and implement improvements in preventive care informed by a vascular risk factor audit. We constructed case studies of each practice’s “intervention narrative” from semi-structured interviews with clinicians, facilitators and other staff, practice observation, and document analysis of facilitator diaries. The intervention narratives were combined with pre- and post-intervention audit data to generate typologies of practice responses to the intervention. Results We found substantial variability between practices in the changes made to vascular risk recording. Context (i.e. practice size), adaptive reserve (i.e. interpersonal relationships, manager and nurse involvement), and occasional data idiosyncrasies interacted to influence this variability. Conclusion The findings emphasise the importance of tailoring facilitation interventions to practice size, clinician engagement and, critically, the organisation of, and relationships between, the members of the practice team. Trial registration The trial was registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000578808 (29/5/2012). This trial registration is retrospective as our first patient returned their consent on the 21/5/2012. Patient recruitment was ongoing until 31/10/2012. Electronic supplementary material The online version of this article (10.1186/s12875-019-0995-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic, 3168, Australia.
| | - Riki Lane
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic, 3168, Australia
| | - Sharon Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
| | - John Litt
- Discipline of General Practice, Health Sciences Building, Flinders University, Adelaide, SA, 5042, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic, 3168, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, 2052, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, 4029, Australia
| | - Chris Del Mar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| | - Jane Smith
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
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Dennis S, Taggart J, Yu H, Jalaludin B, Harris MF, Liaw ST. Linking observational data from general practice, hospital admissions and diabetes clinic databases: can it be used to predict hospital admission? BMC Health Serv Res 2019; 19:526. [PMID: 31357992 PMCID: PMC6661817 DOI: 10.1186/s12913-019-4337-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/10/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Linking process of care data from general practice (GP) and hospital data may provide more information about the risk of hospital admission and re-admission for people with type-2 diabetes mellitus (T2DM). This study aimed to extract and link data from a hospital, a diabetes clinic (DC). A second aim was to determine whether the data could be used to predict hospital admission for people with T2DM. METHODS Data were extracted using the GRHANITE™ extraction and linkage tool. The data from nine GPs and the DC included data from the two years prior to the hospital admission. The date of the first hospital admission for patients with one or more admissions was the index admission. For those patients without an admission, the census date 31/03/2014 was used in all outputs requiring results prior to an admission. Readmission was any admission following the index admission. The data were summarised to provide a comparison between two groups of patients: 1) Patients with a diagnosis of T2DM who had been treated at a GP and had a hospital admission and 2) Patients with a diagnosis of T2DM who had been treated at a GP and did not have a hospital admission. RESULTS Data were extracted for 161,575 patients from the three data sources, 644 patients with T2DM had data linked between the GPs and the hospital. Of these, 170 also had data linked with the DC. Combining the data from the different data sources improved the overall data quality for some attributes particularly those attributes that were recorded consistently in the hospital admission data. The results from the modelling to predict hospital admission were plausible given the issues with data completeness. CONCLUSION This project has established the methodology (tools and processes) to extract, link, aggregate and analyse data from general practices, hospital admission data and DC data. This study methodology involved the establishment of a comparator/control group from the same sites to compare and contrast the predictors of admission, addressing a limitation of most published risk stratification and admission prediction studies. Data completeness needs to be improved for this to be useful to predict hospital admissions.
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Affiliation(s)
- Sarah Dennis
- Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- South Western Sydney Local Health District, Liverpool, Liverpool, NSW 2170 Australia
| | - Jane Taggart
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
| | - Hairong Yu
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- South Western Sydney Local Health District, Liverpool, Liverpool, NSW 2170 Australia
- School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, NSW 2052 Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
| | - Siaw-Teng Liaw
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, NSW 2052 Australia
- South Western Sydney Local Health District, Liverpool, Liverpool, NSW 2170 Australia
- School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, NSW 2052 Australia
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Liaw S, Wade V, Furler JS, Hasan I, Lau P, Kelaher M, Xuan W, Harris MF. Cultural respect in general practice: a cluster randomised controlled trial. Med J Aust 2019; 210:263-268. [DOI: 10.5694/mja2.50031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Siaw‐Teng Liaw
- UNSW Sydney Sydney NSW
- Centre for Primary Health Care and EquityUNSW Sydney Sydney NSW
| | - Vicki Wade
- Menzies School of Health Research Darwin NT
| | | | - Iqbal Hasan
- Centre for Primary Health Care and EquityUNSW Sydney Sydney NSW
| | | | | | - Wei Xuan
- Ingham Institute of Applied Medical Research Sydney NSW
| | - Mark F Harris
- UNSW Sydney Sydney NSW
- Centre for Primary Health Care and EquityUNSW Sydney Sydney NSW
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Gray J, Hoon EA, Afzali HHA, Spooner C, Harris MF, Karnon J. Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study. Aust J Prim Health 2019; 23:348-363. [PMID: 28490411 DOI: 10.1071/py16105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/05/2017] [Indexed: 11/23/2022]
Abstract
Nurse-led weight management programs, like the Counterweight Program in the United Kingdom, may offer a way for Australian general practices to provide weight management support to adults who are overweight or obese. During Counterweight, nurses provide patients with six fortnightly education sessions and three follow-up sessions to support weight maintenance. This study examined the feasibility, acceptability and perceived value of the Counterweight Program in the Australian primary care setting using a mixed-methods approach. Six practice nurses, from three general practices, were trained and subsidised to deliver the program. Of the 65 patients enrolled, 75% (n=49) completed the six education sessions. General practitioners and practice nurses reported that the training and resource materials were useful, the program fitted into general practices with minimal disruption and the additional workload was manageable. Patients reported that the program created a sense of accountability and provided a safe space to learn about weight management. Overall, Counterweight was perceived as feasible, acceptable and valuable by Australian practice staff and patients. The key challenge for future implementation will be identifying adequate and sustainable funding. An application to publically fund Counterweight under the Medicare Benefits Schedule would require stronger evidence of effectiveness and cost-effectiveness in Australia.
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Affiliation(s)
- Jodi Gray
- School of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA 5005, Australia
| | - Elizabeth A Hoon
- School of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA 5005, Australia
| | - Hossein Haji Ali Afzali
- School of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA 5005, Australia
| | - Catherine Spooner
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), c/o CPHCE, University of NSW, Level 3, AGSM Building, Sydney, NSW 2052, Australia
| | - Mark F Harris
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), c/o CPHCE, University of NSW, Level 3, AGSM Building, Sydney, NSW 2052, Australia
| | - Jonathan Karnon
- School of Public Health, University of Adelaide, Level 7, 178 North Terrace, Adelaide, SA 5005, Australia
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Wiles LK, Hooper TD, Hibbert PD, Molloy C, White L, Jaffe A, Cowell CT, Harris MF, Runciman WB, Schmiede A, Dalton C, Hallahan AR, Dalton S, Williams H, Wheaton G, Murphy E, Braithwaite J. Clinical indicators for common paediatric conditions: Processes, provenance and products of the CareTrack Kids study. PLoS One 2019; 14:e0209637. [PMID: 30625190 PMCID: PMC6326465 DOI: 10.1371/journal.pone.0209637] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/10/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities. METHODS Clinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care. RESULTS From 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was 'feasibility' (likely to be able to be used for determining compliance with 'appropriate care' from medical record audit). CONCLUSION A set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.
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Affiliation(s)
- Louise K. Wiles
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Tamara D. Hooper
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Peter D. Hibbert
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Charlotte Molloy
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Les White
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children’s Hospital, Sydney Children’s Hospitals Network, Randwick, Sydney, New South Wales, Australia
- New South Wales Ministry of Health, North Sydney, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Sydney Children’s Hospital, Sydney Children’s Hospitals Network, Randwick, Sydney, New South Wales, Australia
| | - Christopher T. Cowell
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, Children’s Hospital at Westmead, Sydney Children’s Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - William B. Runciman
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Annette Schmiede
- BUPA Health Foundation Australia, Sydney, New South Wales, Australia
| | - Chris Dalton
- BUPA Health Foundation Australia, Sydney, New South Wales, Australia
| | - Andrew R. Hallahan
- Children’s Health Queensland Hospital and Health Service, South Brisbane, Brisbane, Queensland, Australia
| | - Sarah Dalton
- New South Wales Ministry of Health, North Sydney, Sydney, New South Wales, Australia
- New South Wales (NSW) Agency for Clinical Innovation (ACI), Chatswood, Sydney, New South Wales, Australia
| | - Helena Williams
- Russell Clinic, Blackwood, Adelaide, South Australia, Australia
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
- Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia
- Cancer Australia, Surry Hills, Sydney, New South Wales, Australia
- Adelaide Primary Health Network, Mile End, Adelaide, South Australia, Australia
- Country SA Primary Health Network, Nuriootpa, Adelaide, South Australia, Australia
| | - Gavin Wheaton
- Division of Paediatric Medicine, Women’s and Children’s Health Network, Adelaide, South Australia, Australia
| | - Elisabeth Murphy
- New South Wales Ministry of Health, North Sydney, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Dao J, Spooner C, Lo W, Harris MF. Factors influencing self-management in patients with type 2 diabetes in general practice: a qualitative study. Aust J Prim Health 2019; 25:176-184. [DOI: 10.1071/py18095] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/12/2019] [Indexed: 11/23/2022]
Abstract
Many Australian adults with type 2 diabetes mellitus (T2DM) do not follow recommended self-management behaviours that could prevent or delay complications. This exploratory study aimed to investigate the factors influencing self-management of T2DM in general practice. Semi-structured qualitative interviews were conducted with patients with T2DM (n = 10) and their GPs (n = 4) and practice nurses (n = 3) in a low socioeconomic area of Sydney, New South Wales, Australia. The interviews were analysed thematically using the socio-ecological model as a framework for coding. Additional themes were derived inductively based on the explicitly stated meaning of the text. Factors influencing self-management occurred on four levels of the socio-ecological model: individual (e-health literacy, motivation, time constraints); interpersonal (family and friends, T2DM education, patient-provider relationship); organisational (affordability, multidisciplinary care); and community levels (culture, self-management resources). Multi-level strategies are needed to address this wide range of factors that are beyond the scope of single services or organisations. These could include tailoring health education and resources to e-health literacy and culture; attention to social networks and the patient–provider relationship; and facilitating access to affordable on-site allied health services.
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Harris MF, Harris-Roxas B, Knight AW. Care of patients with chronic disease: achievements in Australia over the past decade. Med J Aust 2018; 209:55-57. [PMID: 29996749 DOI: 10.5694/mja18.00333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/18/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
| | - Ben Harris-Roxas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
| | - Andrew W Knight
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
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McNamara RJ, Kearns R, Dennis SM, F Harris M, Gardner K, McDonald J. Knowledge, Skill, and Confidence in People Attending Pulmonary Rehabilitation: A Cross-Sectional Analysis of the Effects and Determinants of Patient Activation. J Patient Exp 2018; 6:117-125. [PMID: 31218257 PMCID: PMC6558947 DOI: 10.1177/2374373518778864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Patient activation is a significant predictor of health behaviors; however, the level of activation in people attending a pulmonary rehabilitation program and the effect of pulmonary rehabilitation on patient activation have not been measured. Furthermore, the potential determinants and relationship between patient activation and characteristics of people attending pulmonary rehabilitation have not previously been reported. Methods The Patient Activation Measure (PAM) was measured in people with a chronic respiratory disease or congestive cardiac failure at a baseline pulmonary rehabilitation assessment and again at the completion of the 8-week outpatient program. Results This study included 194 people with chronic respiratory disease or congestive cardiac failure (41% male; mean [standard deviation, SD] age: 73 [11] years; mean [SD] forced expiratory volume in 1 second % predicted: 60% [20%]). The pulmonary rehabilitation program was completed by 61% (n = 118) of participants. The mean (SD) PAM score at baseline was 60.5 (15.7), which improved to 65.4 (15.5) after completion of the pulmonary rehabilitation program (P = .001). In a stepwise forward multiple regression analysis, anxiety, lung information needs, and health-related quality of life impact were found to be significant determinants of baseline PAM. This model explained 12% (P < .001) of the variance. Conclusion People with a chronic respiratory disease or congestive cardiac failure commencing a pulmonary rehabilitation program demonstrated a moderate level of activation, which improved following an 8-week hospital outpatient pulmonary rehabilitation program. Anxiety, a higher level of lung information needs, and greater health-related quality of life impact were significantly associated with poor patient activation.
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Affiliation(s)
- Renae J McNamara
- Department of Physiotherapy, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Rachael Kearns
- South Eastern Sydney Research Collaboration Hub, Centre for Primary Health Care and Equity, University of New South Wales, Kensington, New South Wales, Australia
| | - Sarah M Dennis
- Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, New South Wales, Australia
| | - Karen Gardner
- South Eastern Sydney Research Collaboration Hub, Centre for Primary Health Care and Equity, University of New South Wales, Kensington, New South Wales, Australia
| | - Julie McDonald
- South Eastern Sydney Research Collaboration Hub, Centre for Primary Health Care and Equity, University of New South Wales, Kensington, New South Wales, Australia
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Parker SM, Stocks N, Nutbeam D, Thomas L, Denney-Wilson E, Zwar N, Karnon J, Lloyd J, Noakes M, Liaw ST, Lau A, Osborne R, Harris MF. Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial. BMJ Open 2018; 8:e023239. [PMID: 29866737 PMCID: PMC5988137 DOI: 10.1136/bmjopen-2018-023239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Adults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese. METHODS AND ANALYSIS A two-arm pragmatic practice-level cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40-70 years with a body mass index ≥28 kg/m2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patient-facing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme. ETHICS AND DISSEMINATION The study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval. TRIAL REGISTRATIONREGISTRATION NUMBER ACTRN12617001508369; Pre-results.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Nigel Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Don Nutbeam
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Thomas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nicholas Zwar
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jon Karnon
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Manny Noakes
- Nutrition and Health Program, CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Annie Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Richard Osborne
- School of Health and Social Development, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Abstract
BACKGROUND The rising incidence of cancer and increasing number of cancer survivors place competing demands on specialist oncology clinics. This has led to a need to consider collaborative care between primary and secondary care for the long-term post-treatment care of cancer survivors. OBJECTIVE To explore the views of breast and colorectal cancer survivors, their oncologist and GP about GPs taking a more active role in long-term cancer follow-up care. METHODS Semi-structured interviews using a thematic analysis framework. Respondents were asked their views on the specialist hospital-based model for cancer follow-up care and their views on their GP taking a greater or leading role in follow-up care. Researcher triangulation was used to refine the coding framework and emergent themes; source triangulation and participant validation were used to increase credibility. RESULTS Fifty-six interviews were conducted (22 patients, 16 oncologists, 18 GPs). Respondents highlighted the importance of GPs needing specialist cancer knowledge; the need for GPs to have an interest in and time for cancer follow-up care; the GPs role in providing psychosocial care; and the reassurance that was provided from a specialist overseeing care. A staged, shared care team arrangement with both GPs and specialists flexibly providing continuing care was found to be acceptable for most. CONCLUSION Collaborative care of cancer survivors may lessen the load on specialist oncology clinics. The findings suggest that building this model will require early and ongoing shared care processes.
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Affiliation(s)
- Heike Schütze
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Melvin Chin
- Nelune Comprehensive Cancer Center, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Mark F Harris
- Centre for Primary Health Care and Equity, UNSW Australia, Sydney, New South Wales, Australia
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Levesque JF, Harris MF, Scott C, Crabtree B, Miller W, Halma LM, Hogg WE, Weenink JW, Advocat JR, Gunn J, Russell G. Dimensions and intensity of inter-professional teamwork in primary care: evidence from five international jurisdictions. Fam Pract 2018; 35:285-294. [PMID: 29069391 PMCID: PMC5965094 DOI: 10.1093/fampra/cmx103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inter-professional teamwork in primary care settings offers potential benefits for responding to the increasing complexity of patients' needs. While it is a central element in many reforms to primary care delivery, implementing inter-professional teamwork has proven to be more challenging than anticipated. OBJECTIVE The objective of this study was to better understand the dimensions and intensity of teamwork and the developmental process involved in creating fully integrated teams. METHODS Secondary analyses of qualitative and quantitative data from completed studies conducted in Australia, Canada and USA. Case studies and matrices were used, along with face-to-face group retreats, using a Collaborative Reflexive Deliberative Approach. RESULTS Four dimensions of teamwork were identified. The structural dimension relates to human resources and mechanisms implemented to create the foundations for teamwork. The operational dimension relates to the activities and programs conducted as part of the team's production of services. The relational dimension relates to the relationships and interactions occurring in the team. Finally, the functional dimension relates to definitions of roles and responsibilities aimed at coordinating the team's activities as well as to the shared vision, objectives and developmental activities aimed at ensuring the long-term cohesion of the team. There was a high degree of variation in the way the dimensions were addressed by reforms across the national contexts. CONCLUSION The framework enables a clearer understanding of the incremental and iterative aspects that relate to higher achievement of teamwork. Future reforms of primary care need to address higher-level dimensions of teamwork to achieve its expected outcomes.
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Affiliation(s)
- Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia.,Agency for Clinical Innovation, Chatswood, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia
| | - Cathie Scott
- Alberta Centre for Child, Family and Community Research, Edmonton, Canada
| | - Benjamin Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - William Miller
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Lisa M Halma
- Zone Analytics and Reporting Services, Alberta Health Services, Edmonton, Canada
| | - William E Hogg
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Jan-Willem Weenink
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jenny R Advocat
- Southern Academic Primary Care Research Unit, School of Primary Health Care; Monash University, Clayton, Australia
| | - Jane Gunn
- Department of General Practice and Primary Health Care; University of Melbourne, Melbourne, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, School of Primary Health Care; Monash University, Clayton, Australia
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Russell GM, Miller WL, Gunn JM, Levesque JF, Harris MF, Hogg WE, Scott CM, Advocat JR, Halma L, Chase SM, Crabtree BF. Contextual levers for team-based primary care: lessons from reform interventions in five jurisdictions in three countries. Fam Pract 2018; 35:276-284. [PMID: 29069376 PMCID: PMC5965082 DOI: 10.1093/fampra/cmx095] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most Western nations have sought primary care (PC) reform due to the rising costs of health care and the need to manage long-term health conditions. A common reform-the introduction of inter-professional teams into traditional PC settings-has been difficult to implement despite financial investment and enthusiasm. OBJECTIVE To synthesize findings across five jurisdictions in three countries to identify common contextual factors influencing the successful implementation of teamwork within PC practices. METHODS An international consortium of researchers met via teleconference and regular face-to-face meetings using a Collaborative Reflexive Deliberative Approach to re-analyse and synthesize their published and unpublished data and their own work experience. Studies were evaluated through reflection and facilitated discussion to identify factors associated with successful teamwork implementation. Matrices were used to summarize interpretations from the studies. RESULTS Seven common levers influence a jurisdiction's ability to implement PC teams. Team-based PC was promoted when funding extended beyond fee-for-service, where care delivery did not require direct physician involvement and where governance was inclusive of non-physician disciplines. Other external drivers included: the health professional organizations' attitude towards team-oriented PC, the degree of external accountability required of practices, and the extent of their links with the community and medical neighbourhood. Programs involving outreach facilitation, leadership training and financial support for team activities had some effect. CONCLUSION The combination of physician dominance and physician aligned fee-for-service payment structures provide a profound barrier to implement team-oriented PC. Policy makers should carefully consider the influence of these and our other identified drivers when implementing team-oriented PC.
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Affiliation(s)
- Grant M Russell
- Southern Academic Primary Care Research Unit, School of Primary and Allied Health Care, Monash University, Clayton, Australia
| | - William L Miller
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Jane M Gunn
- Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Australia
| | - Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia.,Bureau of Health Information, Chatswood, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia
| | - William E Hogg
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Cathie M Scott
- Alberta Centre for Child, Family and Community Research, Edmonton, Canada
| | - Jenny R Advocat
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Clayton, Australia
| | - Lisa Halma
- Zone Analytics and Reporting Services, Alberta Health Services, Edmonton, Canada
| | - Sabrina M Chase
- Rutgers Biomedical and Health Sciences (RBHS), Rutgers School of Nursing, Rutgers University, New Brunswick, USA
| | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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50
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Crabtree BF, Miller WL, Gunn JM, Hogg WE, Scott CM, Levesque JF, Harris MF, Chase SM, Advocat JR, Halma LM, Russell GM. Uncovering the wisdom hidden between the lines: the Collaborative Reflexive Deliberative Approach. Fam Pract 2018; 35:266-275. [PMID: 29069335 PMCID: PMC5965090 DOI: 10.1093/fampra/cmx091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Meta-analysis and meta-synthesis have been developed to synthesize results across published studies; however, they are still largely grounded in what is already published, missing the tacit 'between the lines' knowledge generated during many research projects that are not intrinsic to the main objectives of studies. OBJECTIVE To develop a novel approach to expand and deepen meta-syntheses using researchers' experience, tacit knowledge and relevant unpublished materials. METHODS We established new collaborations among primary health care researchers from different contexts based on common interests in reforming primary care service delivery and a diversity of perspectives. Over 2 years, the team met face-to-face and via tele- and video-conferences to employ the Collaborative Reflexive Deliberative Approach (CRDA) to discuss and reflect on published and unpublished results from participants' studies to identify new patterns and insights. RESULTS CRDA focuses on uncovering critical insights, interpretations hidden within multiple research contexts. For the process to work, careful attention must be paid to ensure sufficient diversity among participants while also having people who are able to collaborate effectively. Ensuring there are enough studies for contextual variation also matters. It is necessary to balance rigorous facilitation techniques with the creation of safe space for diverse contributions. CONCLUSIONS The CRDA requires large commitments of investigator time, the expense of convening facilitated retreats, considerable coordination, and strong leadership. The process creates an environment where interactions among diverse participants can illuminate hidden information within the contexts of studies, effectively enhancing theory development and generating new research questions and strategies.
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Affiliation(s)
- Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - William L Miller
- Department of Family Medicine; Lehigh Valley Health Network, Allentown, USA
| | - Jane M Gunn
- Department of General Practice and Primary Health Care, University of Melbourne, Melbourne, Australia
| | - William E Hogg
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Cathie M Scott
- Alberta Centre for Child, Family and Community Research, Edmonton, Canada
| | - Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia.,Bureau of Health Information, Chatswood, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, Australia
| | - Sabrina M Chase
- Rutgers Biomedical and Health Sciences (RBHS), Rutgers School of Nursing, Rutgers University, New Brunswick, USA
| | - Jenny R Advocat
- Southern Academic Primary Care Research Unit, School of Primary and Allied Health Care, Monash University, Clayton, Australia
| | - Lisa M Halma
- Zone Analytics and Reporting Services, Alberta Health Services, Edmonton, Canada
| | - Grant M Russell
- Southern Academic Primary Care Research Unity, School of Primary and Allied Health Care, Monash University, Clayton, Australia
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