Australian journal of primary health最新文献

{"title":"Contraceptive counselling in regions of Victoria with high incidence of teenage pregnancy: general practitioners' insights.","authors":"Jessica R Botfield, Greasha Rathnasekara, Danielle Mazza, Elodie Bernard, Cathy J Watson","doi":"10.1071/PY24169","DOIUrl":"https://doi.org/10.1071/PY24169","url":null,"abstract":"<p><p>Background Certain regions of Australia have a higher incidence of teenage pregnancy compared to the national average. In Australia, general practitioners (GPs) are the first-line providers of contraception information and provision. However, little is known regarding GP provision of contraceptive counselling among teenagers and whether they are offering teenagers long-acting reversible contraceptive methods. We aimed to obtain GPs' insights into how they approach contraceptive counselling with teenagers in regions of Victoria, Australia, with a high incidence of teenage pregnancy. Methods We conducted a qualitative descriptive study using semi-structured telephone interviews with GPs purposively sampled from regions of Victoria, Australia, with high incidence of teenage pregnancy. Interview data were analysed using a reflexive thematic analysis approach. Results The 18 GPs interviewed recognised there was an unmet need for contraception information and care among teenagers in their region. Most felt that teenagers in their region had limited knowledge of and access to contraception, due in part to the lower socioeconomic status of the community, associated costs, and limited providers available to insert long-acting reversible contraceptives. Participants' approaches to providing contraceptive counselling varied; however, most provided this opportunistically. Although they reported discussing all contraceptive options with teenagers, most were less inclined to recommend an intrauterine device (IUD). The primary reasons for this included concerns regarding suitability of IUDs for younger or nulliparous people and limited providers able to insert IUDs in their region. Participants described the importance of normalising contraception discussions to facilitate contraceptive counselling and decision-making. Conclusion Supporting informed decision-making and facilitating access to all methods of contraception for teenagers will require addressing misunderstandings among GPs regarding IUD suitability for teenage and nulliparous people and increasing the number of IUD-inserting GPs. Discussing contraception as part of routine care for teenagers will further support these endeavours.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximising the potential of type 2 diabetes remission: scale up and sustainability considerations from the DiRECT-Aus implementation trial.","authors":"Nilakshi Gunatillaka, Jenny Advocat, Lauren Ball, Terry Haines, Cylie Williams, Tze Lin Chai, Mitchell Bowden, Melissa Savaglio, Kate Gudorf, Elizabeth Sturgiss","doi":"10.1071/PY24116","DOIUrl":"https://doi.org/10.1071/PY24116","url":null,"abstract":"<p><p>Background Approximately 500 million people worldwide live with type 2 diabetes mellitus. The UK's 'Diabetes Remission Clinical Trial' (DiRECT) is a potential novel method for care. An Australian trial of DiRECT (DiRECT-Aus) showed that 56% of participants achieved diabetes remission at 12months. We explored the experiences of patients, clinicians and trial partners involved in DiRECT-Aus to ascertain the acceptability and feasibility of DiRECT-Aus, as well as factors influencing implementation, to inform recommendations for sustainable scale up into mainstream primary care. Methods This qualitative implementation research conducted within a constructivist paradigm involved semi-structured interviews with key stakeholders. Data analysis followed an inductive thematic approach, informed by the Consolidated Framework for Implementation Research. Results Patients (n =14), general practitioners (n =3), practice nurses (n =6), dietitians (n =7) and DiRECT-Aus trial partners (n =5) were interviewed. We identified four core components of DiRECT-Aus that are essential for implementation and scale up. They were: (1) access to very low-energy diet products; (2) high frequency of contact with the dietitian; (3) dietitian's clinical knowledge and patient-centred practice; and (4) absence of financial costs to patients. Several additional factors that could support implementation and suggested funding models are described. Conclusions This study concludes that DiRECT-Aus was acceptable and feasible to patients and clinicians.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health consumers and primary care providers co-designing improvements and innovations: a scoping review.","authors":"Kathryn Thorburn, Bani Aadam, Shifra Waks, Brett Bellingham, Mark F Harris, Karen R Fisher, Catherine Spooner","doi":"10.1071/PY24104","DOIUrl":"https://doi.org/10.1071/PY24104","url":null,"abstract":"<p><p>Co-design and co-production are increasingly used to improve and innovate healthcare practices and services to better address people's healthcare needs. Mental health consumers, especially people diagnosed with serious mental illness, experience considerable health disparities and barriers to primary care, while primary care providers experience barriers to addressing the healthcare needs of people diagnosed with serious mental illness. Both mental health consumers and primary care providers bring knowledge and expertise to improving mental health consumers' health care. This scoping review of the peer-reviewed and grey literature was undertaken to determine the extent and scope of co-design and co-production involving mental health consumers and primary care providers to address mental health consumers' healthcare needs. The review also sought to determine factors that enable or limit co-design and co-production involving mental health consumers and primary care providers. Twelve studies and reports of co-design and co-production involving mental health consumers and primary care providers were identified by the review. These studies showed that co-design and co-production were feasible and beneficial, and that there was significant scope for collaboration at the intersection of mental health and primary care services. Lessons learned from projects that have led the way include the need for (1) co-design/co-production practices that sustain equitable participation and address inevitable power imbalances when service users and service providers work together, (2) sufficient reporting on methods to ascertain claims of co-design/co-production and allow replication of these methods in similar healthcare improvement projects, and (3) co-design/co-production projects to be supported by other systems change strategies.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a preconception medical record audit tool for general practice: a multimethod study.","authors":"Nishadi N Withanage, Jessica R Botfield, Sharon James, Kirsten I Black, Sharon Cameron, Danielle Mazza","doi":"10.1071/PY24132","DOIUrl":"https://doi.org/10.1071/PY24132","url":null,"abstract":"<p><p>Background Preconception health risk factors documented in general practice electronic medical records help general practitioners (GPs) understand the proportion and type of risks among women attending their practice. We aimed to collaborate with GPs to develop an audit tool for collecting preconception health data from structured electronic medical record fields. Methods This was a three-phase multimethod study. In Phase 1, we developed a preliminary audit tool informed by the literature. In Phase 2, we collaborated with GPs for feedback. In Phase 3, we finalised the audit tool. Results The preliminary audit tool comprised 25 preconception health risk factors, of which three were removed following GP feedback (second-hand smoke, social history, history of sexually transmitted infections). The final audit tool comprised 22 preconception health risk factors. Conclusion This audit tool may assist researchers in understanding the proportion of patients visiting general practice with preconception health risk factors, thereby facilitating the future development of a screening process that may be used to identify and provide preconception care to women who may most benefit from it.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing uptake and sustained utility of HealthPathways in Australian general practice: a qualitative study.","authors":"Susan Saldanha, Riki Lane, Sharon Clifford, Prisha Dadoo, Chris Barton, Grant Russell","doi":"10.1071/PY24142","DOIUrl":"https://doi.org/10.1071/PY24142","url":null,"abstract":"<p><p>Background Formalised clinical pathways have become popular approaches to translate evidence into clinical recommendations, tailored for the local healthcare setting. In recent years, the HealthPathways platform has been used to implement a range of clinical and referral pathways in New Zealand and Australia. Despite widespread adoption, little is known of factors influencing the sustained use of HealthPathways in Australian general practice. Methods This qualitative study, conducted in three Melbourne Primary Health Network catchments, applied normalisation process theory to explore HealthPathways implementation. We conducted semi-structured interviews with 43 participants, including general practitioners (GPs), practice nurses, practice managers, Primary Health Network staff and key regional informants. Analysis combined inductive and deductive approaches. Results The findings suggest that although HealthPathways holds promise for enhancing clinical practice, its adoption and impact are currently limited due to low awareness and varied integration across Primary Health Network catchments. Recent medical graduates found it useful for helping patients access appropriate care. Adoption was influenced by peer recommendations and time constraints, although established GPs resisted change. Targeted education, effective promotion and improved monitoring systems were identified as crucial to facilitate wider and more effective use of HealthPathways, ultimately contributing to better patient care and streamlined clinical processes. Conclusion Although HealthPathways' relative normalisation is evident, challenges in integration persist, requiring targeted strategies. Comprehensive promotion to GPs, standardisation across Australia and enhancing technical interoperability between digital interfaces is essential. Strong partnerships and feedback mechanisms can optimise HealthPathways' impact on patient care, supporting the objectives of the Australian National Primary Health Care 10-year plan.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of general practitioners in the follow-up of positive results from the Australian National Bowel Cancer Screening Program - a scoping review.","authors":"Jane Gaspar, Caroline Bulsara, Diane Arnold-Reed, Karen Taylor, Anne Williams","doi":"10.1071/PY24090","DOIUrl":"https://doi.org/10.1071/PY24090","url":null,"abstract":"<p><p>Background There are several studies investigating the effectiveness and participation rates of the Australian National Bowel Cancer Screening Program (NBCSP), but there is limited literature pertaining to the role and processes that general practitioners (GPs) follow after a positive immunochemical faecal occult blood test (iFOBT) result. The aim of this paper is to review evidence examining GP involvement in the follow-up of positive iFOBT results from the NBCSP and identify knowledge gaps. Methods A scoping review was undertaken involving the search of the Cochrane Library, Informit, PubMed and Scopus electronic databases. Inclusion criteria were the follow-up processes and practices by GPs subsequent to notification of a positive iFOBT from this program. Searches were limited to English and publication was from January 2006 to January 2024. A combination of keywords was used and adapted to each search engines' requirements: general practitioner AND bowel cancer AND screening AND Australia. Results Relevant sources of evidence were reviewed, and 24 records met inclusion criteria. Results are represented across three themes: (i) screening process and GP follow-up; (ii) follow-up rates and facilitation; and (iii) recommendations for improved follow-up. Conclusion This scoping review provides insight into the central role GPs play in the implementation of the NBCSP and highlights the lack of information regarding steps taken and systems employed in general practice to manage positive iFOBTs.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring dementia service gaps and barriers in the Australian Capital Territory: a qualitative study.","authors":"Nathan M D'Cunha, Georgina Chelberg, Ian Huang, Hossein Tabatabaei-Jafari, Nasser Bagheri, Kasia Bail, Diane Gibson, Stephen Isbel, Lara Wiseman, Poulomi Chowdhury, Mary Anne Furst, Perminder S Sachdev, Luis Salvador-Carulla","doi":"10.1071/PY24174","DOIUrl":"https://doi.org/10.1071/PY24174","url":null,"abstract":"<p><p>Background In recent years, there has been increased recognition of the importance of unmet needs of services for people with dementia regionally and nationally. This study aimed to explore the service gaps described by health and aged care providers in the Australian Capital Territory (ACT) to inform decisions regarding dementia care services. Methods Semi-structured interviews were conducted with 29 health and aged care service providers, managers, and stakeholders providing dementia services in the ACT in 2022 and 2023. Responses to two open-ended questions regarding the perception of service gaps in the region were examined using content analysis. Results Six themes were identified across the interviews: (1) concerns with existing dementia care services; (2) concerns with primary care; (3) a lack of dementia-appropriate services; (4) workforce shortages and limited training; (5) funding as a barrier to access and collaboration between services; and (6) lack of understanding of dementia. Several participants felt these issues were not unique to the ACT and indicative of systemic issues common across Australia. Conclusions The service gaps described in the ACT region indicate a need for improved access to high-quality, coordinated, dementia-specific services with appropriate staffing, potentially reducing pressure on the ACT health system and current and future associated costs.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community health in Victoria: a history of challenges, adaptations and potential.","authors":"Virginia Lewis, Jennifer Macmillan, T McBride, David Legge","doi":"10.1071/PY24194","DOIUrl":"https://doi.org/10.1071/PY24194","url":null,"abstract":"<p><p>Background The Whitlam Labor government established the Community Health Program (CHP) in Australia in 1973 to improve access to health and related welfare services nationally. States reacted differently to the program. Designated Australian Government funding for the program ended in 1981. In spite of fluctuating state government support and changing legislative frameworks over time, Victoria is the only state that continues to operate a generic community health centre (CHC) program reflecting the original CHP. Methods Data were collected from policy documents and archival material, as well as interviews with 29 key stake holders from Victoria. Transcripts from the interviews were reviewed by the interviewees and permission given to include identifiable quotes. The research is part of a larger Australian Research Council project looking at the history of community health in Australia. Results In Victoria the CHP broke new ground in several respects including creating a public primary health care (PHC) sector, promoting equitable access to PHC, introducing salaried GPs, creating multidisciplinary PHC teams, valuing community involvement (in planning, accountability, health promotion) and taking action on the social determinants of health. Key stakeholders described the challenges that the sector has faced in the decades from 1973 to the current day. The basis for the sector's survival ultimately rests with how it was initially established and the cultural environment in which it developed and continues to operate. In addition to the (albeit irregular) geographically wide distribution of CHCs, their high level of public recognition and sense of community ownership were seen as critical factors that aided their survival and worked against their closure or absorption into hospital networks. Conclusions Based on a synthesis of our findings and personal experiences, we propose five new directions for policy, management and practice that could support this model to have a greater contribution to the health system in Australia.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions and willingness concerning the collection of sexual orientation and gender identity data in Australian healthcare services.","authors":"Daniel Demant, Paul Byron, Deborah Debono, Suneel Jethani, Beth Goldblatt, Michael Thomson, Jo River River","doi":"10.1071/PY24178","DOIUrl":"https://doi.org/10.1071/PY24178","url":null,"abstract":"<p><p>Background Despite growing recognition of the importance of collecting sexual orientation and gender identity (SOGI) data to improve healthcare access and equity for LGBTQA+ populations, uncertainty remains around how these data are collected, their perceived importance and individuals' willingness to disclose such information in healthcare settings. The aim of this study was to understand perceptions of the collection of data on sexual orientation and gender identity in healthcare settings across Australia, and individuals' willingness to provide this data. Methods A cross-sectional online survey of 657 Australian residents was conducted to assess participants' attitudes towards SOGI data in healthcare settings, along with preferences for methods to collect these data. Statistical analyses included ANCOVA, Chi-squared tests and Wilcoxon signed-rank tests. Results Participants generally recognised the importance of the collection of basic demographic data to support the provision of health services. Willingness to share SOGI data varied, with significant differences noted across gender, sexual orientation and cultural backgrounds. LGBTQA+ participants expressed greater willingness to provide SOGI data, but only in contextually appropriate situations, and preferred more inclusive data collection methods. Conclusions The study shows a context-dependent willingness to provide SOGI data in health care, underscoring the need for sensitive data collection methods. Insights into SOGI data collection attitudes are vital for developing inclusive and respectful healthcare practices. Improved SOGI data collection can enrich healthcare outcomes for diverse groups, informing public health policies and practices tailored to LGBTQA+ needs.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health promotion activities in Ontario Community Health Centres: a descriptive report.","authors":"Sara Bhatti, Jennifer Rayner","doi":"10.1071/PY25009","DOIUrl":"https://doi.org/10.1071/PY25009","url":null,"abstract":"<p><p>Background Community Health Centres (CHCs) in Ontario, Canada have been delivering health promotion programming as part of their model of comprehensive primary health care to communities for decades. The purpose of this paper is to describe how health promotion programming is delivered within the context of Ontario CHCs. Methods This report used both quantitative and qualitative methods. Electronic medical record data were used to describe the variety of health promotion programming offered, as well as target populations, funding sources, and evaluation. Six focus groups were conducted with 72 health promotion staff and managers across 42 CHCs between February and March of 2023 to provide greater context on how health promotion is delivered. Results In 2021-2022, 2452 programs were reported amongst 69 CHCs, with the top three priorities for programming being social support, food security and education, and physical activity. The most prevalent target populations reported were the general community (24%) and children and youth (15%). Focus group data revealed that priorities are identified through a variety of approaches to ensure programs are relevant, address the needs of their communities, and promote health equity. Programs provided by CHCs leverage community volunteers to support program development and delivery, reduce barriers to participating, and link participants to other programs and services offered by the CHC. Conclusion Health promotion as an upstream approach can relieve pressure on the healthcare system, reduce disease prevalence and health inequities all while being cost-effective. Greater investments in health promotion are needed if we want to support and sustain our healthcare systems.</p>","PeriodicalId":93892,"journal":{"name":"Australian journal of primary health","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}