ORCID Profile
0000-0001-6520-4213
Current Organisation
University of Tasmania
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Publisher: American Physical Society (APS)
Date: 18-02-2004
Publisher: CSIRO Publishing
Date: 13-08-2021
DOI: 10.1071/PY21022
Abstract: Falls among older people are highly prevalent, serious and costly, and translation of evidence about falls prevention needs to occur urgently. GPs can identify older people at risk of falling and put preventative measures in place before a fall. Because GPs are key to identifying older people at risk of falls and managing falls risk, this study explored how GPs adapted to the iSOLVE (Integrated SOLutions for sustainable falls preVEntion) process to embed evidence-based falls prevention strategies within primary care, and whether and how they changed their practice. A theoretically informed qualitative study using normalisation process theory was conducted in parallel to the iSOLVE trial to elicit GPs’ views about the iSOLVE process. Data were coded and a thematic analysis of interview transcripts was conducted using constant comparison between the data and themes as they developed. In all, 24 of 32 eligible GPs (75%) from general practices located in the North Sydney Primary Health Network, Australia, were interviewed. Six themes were identified: (1) making it easy to ask the iSOLVE questions (2) internalising the process (3) integrating the iSOLVE into routine practice (4) addressing assumptions about patients and fall prevention (5) the degree of change in practice and (6) contextual issues influencing uptake. The iSOLVE project focused on practice change, and the present study indicates that practice change is possible. How GPs addressed falls prevention in their practice determined the translation of evidence into everyday practice. Support tools for falls prevention must meet the needs of GPs and help with decision making and referral. Fall prevention can be integrated into routine GP practice through the iSOLVE process to tailor fall risk management. Trial Registry. This trial was registered with the Australian New Zealand Clinical Trial Registry (www.anzctr.org.au Trial ID: ACTRN12615000401550).
Publisher: BMJ
Date: 06-2023
DOI: 10.1136/BMJOPEN-2022-070267
Abstract: Frailty in Older people: Rehabilitation, Treatment, Research Examining Separate Settings (the FORTRESS study) is a multisite, hybrid type II, stepped wedge, cluster, randomised trial examining the uptake and outcomes of a frailty intervention. The intervention is based on the 2017 Asia Pacific Clinical Practice Guidelines for the Management of Frailty and begins in the acute hospital setting and transitions to the community. The success of the intervention will require in idual and organisational behaviour change within a dynamic health system. This process evaluation will examine the multiple variables at play in the context and mechanism of the frailty intervention to enhance understanding of the outcomes of the FORTRESS study and how the outcomes can be translated from the trial into broader practice. The FORTRESS intervention will recruit participants from six wards in New South Wales and South Australia, Australia. Participants of the process evaluation will include trial investigators, ward-based clinicians, FORTRESS implementation clinicians, general practitioners and FORTRESS participants. The process evaluation has been designed using realist methodology and will occur in parallel to the FORTRESS trial. A mixed-method approach will be used with qualitative and quantitative data collected from interviews, questionnaires, checklists and outcome assessments. Qualitative and quantitative data will be examined for CMOCs (Context, Mechanism, Outcome Configurations) and programme theories will be developed, tested and refined. This will facilitate development of more generalisable theories to inform translation of frailty intervention within complex healthcare systems. Ethical approval for the FORTRESS trial, inclusive of the process evaluation, has been obtained from the Northern Sydney Local Health District Human Research Ethics Committees reference number 2020/ETH01057. Recruitment for the FORTRESS trial uses opt-out consent. Dissemination will be via publications, conferences and social media. ACTRN12620000760976p (FORTRESS trial).
Publisher: Springer Science and Business Media LLC
Date: 30-05-2023
DOI: 10.1186/S13063-023-07363-4
Abstract: An increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown. The GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3–5/5D who are frail, measured by a Frailty Index (FI) of 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index – Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units. This trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial’s findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD. ClinicalTrials.gov NCT04538157. Registered on 3 September 2020.
Publisher: CSIRO Publishing
Date: 2023
DOI: 10.1071/PY22276
Publisher: JMIR Publications Inc.
Date: 24-09-2020
DOI: 10.2196/19431
Abstract: There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course. This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care. A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m2 or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation (2) a single clinician–led group, Lifestyle Modification Program (LMP) and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF). Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means −3.86, 95% CI −6.81 to −0.90, P=.01 week 18: difference in means −4.05, 95% CI −6.81 to −1.28, P .001 week 36: difference in means −4.99, 95% CI −8.04 to −1.94, P .001 and week 62: difference in means −4.62, 95% CI −7.62 to −1.62, P .001). A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small s le size, and replication on a larger s le with longer follow-up will strengthen the results. Australian clinical trials registration number (ACTRN): 12616000868482 anzctr.org.au/ACTRN12616000868482.aspx.
Publisher: CSIRO Publishing
Date: 11-02-2021
DOI: 10.1071/PY20189
Abstract: This study examined Australian primary healthcare providers’ knowledge about dementia risk factors and risk reduction and their perspectives on barriers and enablers to risk reduction in practice. Primary healthcare providers were recruited through Primary Health Networks across Australia (n = 51). Participants completed an online survey that consisted of fixed-responses and free-text components to assess their knowledge, attitudes and current practices relating to dementia risk factors and risk reduction techniques. The results showed that Australian primary healthcare providers have good knowledge about the modifiable risk factors for dementia however, face several barriers to working with patients to reduce dementia risk. Commonly reported barriers included low patient motivation and healthcare system level limitations. The most commonly reported recommendations to helping primary healthcare providers to work with patients to reduce dementia risk included increasing resources and improving dementia awareness and messaging. While the results need to be interpreted in the context of the limitations of this study, we conclude that collaborative efforts between researchers, clinicians, policy makers and the media are needed to support the uptake of risk reduction activities in primary care settings.
Publisher: CSIRO Publishing
Date: 2021
DOI: 10.1071/PY20118
Abstract: The limited capacity of secondary health services to address the increasing prevalence of dementia within the community draws attention to the need for an enhanced role for nurses working collaboratively with GPs in diagnosing and coordinating post-diagnostic care for patients with dementia. This study investigated the feasibility and acceptability of a nurse practitioner-led mobile memory clinic that was embedded within general practice and targeted to caring for patients and their carers in areas of socioeconomic disadvantage with poor access to specialist health services. Over the period from mid-2013 to mid-2014, 40 GPs referred 102 patients, with the nurse practitioner conducting assessments with 77 of these patients in their homes. Overall, there was a strong interest in this model of care by general practice staff, with the assessment and care provided by the nurse practitioner evaluated as highly acceptable by both patients and their carers. Nonetheless, there are financial and structural impediments to this model of care being implemented within the current Australian health service framework, necessitating further research investigating its cost-effectiveness and efficacy.
Publisher: JMIR Publications Inc.
Date: 17-04-2020
Abstract: here is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course. his study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care. pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m sup /sup or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation (2) a single clinician–led group, Lifestyle Modification Program (LMP) and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF). aseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means −3.86, 95% CI −6.81 to −0.90, i P /i =.01 week 18: difference in means −4.05, 95% CI −6.81 to −1.28, i P /i & .001 week 36: difference in means −4.99, 95% CI −8.04 to −1.94, i P /i & .001 and week 62: difference in means −4.62, 95% CI −7.62 to −1.62, i P /i & .001). web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small s le size, and replication on a larger s le with longer follow-up will strengthen the results. ustralian clinical trials registration number (ACTRN): 12616000868482 anzctr.org.au/ACTRN12616000868482.aspx.
Location: No location found
Location: Australia
No related grants have been discovered for Constance Dimity Pond.