ORCID Profile
0000-0001-8645-4756
Current Organisations
UNSW Sydney
,
South Western Sydney Local Health District
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Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/PY19221
Abstract: Older women seem to have lower GP follow-up rates after an emergency department (ED) discharge than men. This qualitative study investigated how older women seek GP follow up after an ED visit. In 2018, women aged ≥65 years were recruited from an ED in a suburban hospital in south-western Sydney, Australia, and then contacted 1 week later for a telephone interview exploring factors associated with their follow-up behaviour. Grounded theory was used to construct a potential explanatory model of follow-up behaviours. Of the 100 women recruited, 64% had attended a GP follow up by Day 7, as instructed. The balance of perceived cost and benefit of GP follow up emerged as a useful model to understand the factors affecting follow-up behaviour. Perceived costs included inconvenience caused to self and others, access to transport options and the availability of a patient’s GP. Perceived benefits included previous experiences with the healthcare system, pre-existing health-seeking behaviours and ED messaging. Our findings suggest that follow-up rates could be improved by strengthening the perceived benefit of GP follow up at the point of ED discharge, in addition to addressing perceived costs. Approaches may include ensuring discharge instructions are purposeful and given in the company of an older woman’s social supports.
Publisher: Oxford University Press (OUP)
Date: 02-09-2021
Abstract: Brief interventions (BIs) delivered in primary care can reduce harmful alcohol consumption. Yet, clinicians do not routinely offer BIs to reduce harmful alcohol use. We explored the perspectives of clinicians and patients about the use of alcohol BIs during consultations in Australian primary care. Semi-structured interviews and focus groups (face-to-face and virtual) were undertaken with 34 general practitioners, eight practice nurses and 17 patients. Field notes were made from audio-recordings and themes were identified using a descriptive qualitative approach with the field notes as the point of data analysis. Participants identified barriers within the consultation, practice setting and wider healthcare system plus across the community which reduce the delivery of BIs in primary care including: Australian drinking norms inconsistent public health messaging around alcohol harm primary care not recognized as a place to go for help community stigma towards alcohol use practice team culture towards preventive health, including systems for recording alcohol histories limitations of clinical software and current patient resources. Multiple layers of the healthcare system influence the use of BIs in primary care. Identified facilitators for embedding BIs in primary care included: (i) raising community and clinician awareness of the health harms of alcohol, (ii) reinforcing a primary care culture that promotes prevention and, (iii) supportive resources to facilitate discussion about alcohol use and strategies to reduce intake. Alcohol BIs in primary care could be further supported by community public health messages about alcohol use.
Publisher: The Royal Australian College of General Practitioners
Date: 06-2022
Publisher: AMPCo
Date: 12-2011
DOI: 10.5694/MJA11.11333
Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJOQ-2021-001800
Abstract: This systematic review used qualitative methodologies to examine the role of quality improvement collaboratives (QICs) in general practice. The aim was to inform implementers and participants about the utility of using or participating in QICs in general practice. Included studies were published in English, used a QIC intervention, reported primary research, used qualitative or mixed methods, and were conducted in general practice. A Medline search between January 1995 and February 2020 was developed and extended to include Embase, CINAHL and PsycInfo databases. Articles were sought through chaining of references and grey literature searches. Qualitative outcome data were extracted using a framework analysis. Data were analysed using thematic synthesis. Articles were assessed for quality using a threshold approach based on the criteria described by Dixon-Woods. 15 qualitative and 18 mixed-methods studies of QICs in general practice were included. Data were grouped into four analytical themes which describe the role of a collaborative in general practice: improving the target topic, developing practices and providers, developing the health system and building quality improvement capacity. General practice collaboratives are reported to be useful for improving target topics. They can also develop knowledge and motivation in providers, build systems and team work in local practice organisations, and improve support at a system level. Collaboratives can build quality improvement capacity in the primary care system. These roles suggest that QICs are well matched to the improvement needs of general practice. General practice participants in collaboratives reported positive effects from effective peer interaction, high-quality local support, real engagement with data and well-designed training in quality improvement. Strengths of this study were an inclusive search and explicit qualitative methodology. It is possible some studies were missed. Qualitative studies of collaboratives may be affected by selection bias and confirmation bias. CRD4202017512.
Publisher: Frontiers Media SA
Date: 23-04-2021
Abstract: Background: The early detection of developmental conditions such as autism is vital to ensure children can access appropriate and timely evidence-based supports, services, and interventions. Children who have undetected developmental conditions early in life are more likely to develop later health, developmental, learning, and behavioral issues, which in turn can have a cumulative effect over the life course. Methods: The current protocol describes a multi-site, cluster randomized control trial comparing a developmental surveillance pathway for autism to usual care, using opportunistic visits to general practitioners (GPs). Units of randomization are GP clinics across two Australian states (New South Wales and Victoria), with thirty clinics within each state, each of which will aim to recruit approximately forty children aged between ~18- and 24-months, for a total of ~2,400 participants. Children will be randomized to two clusters namely, an autism surveillance pathway (ASP) or surveillance as usual (SaU). The screening process for the ASP arm involves primary and secondary screenings for developmental concerns for autism, using both parent and GP reports and observations. Children in both arms who show signs of developmental concerns for autism will be offered a full developmental assessment by the research team at 24 months of age to determine the efficacy of developmental surveillance in successfully identifying children with autism. Trial Registration: The trial is registered with ANZCTR (ACTRN12619001200178) and reporting of the trial results will be according to recommendations in the CONSORT Statement.
Publisher: Emerald
Date: 20-12-2019
DOI: 10.1108/JICA-08-2019-0039
Abstract: HealthPathways (HPW) is an online health information portal which provides general practitioners (GPs), guidance on the assessment, management and referral of a range of conditions linked to local resources. However, there is a lack of understanding of the acceptance of pathways within primary health. The paper aims to discuss this issue. This qualitative study identified baseline factors that promote the successful implementation of HPW in a major local health district (LHD) in Australia. The development, implementation and acceptance of Diabetes HPW were evaluated. A total of 16 semi-structured interviews were conducted with 12 stakeholders and 4 GPs. Interviews were digitally recorded, transcribed and analyzed qualitatively using a thematic analysis approach. Four major themes were identified that promote the integration of care in the region through utilizing HPW: engagement, sustainability, transparency and accountability. Several factors identified as “enablers” or “barriers” are described at micro and macro levels of the healthcare system. By combining the perspectives of both stakeholders and end-users, this qualitative evaluation of the localized HPW has identified relational and structural factors that promote the successful implementation of HPW to facilitate the integration of care in this LHD. Furthermore, this study provides other implementers with a comprehensive evaluation of the HPW development.
Publisher: Royal College of General Practitioners
Date: 28-04-2021
Abstract: Alcohol is a major source of harm in Australia that disproportionately affects low-income communities. Alcohol brief interventions (ABIs) combine an assessment of a person’s alcohol use with advice to reduce health risks. Despite their effectiveness, ABIs are not routinely performed by clinicians. This article presents a protocol for a feasibility trial of pragmatic implementation strategies and a new set of resources to support clinicians to complete ABIs in Australian general practices. To explore the facilitators and barriers to increasing the uptake of ABIs in primary care, including acceptability, reach, adoption, fidelity, and sustainability. A mixed-methods evaluation of the uptake of ABIs in general practice clinics serving low-income communities in Melbourne, Australia. The approach is informed by the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). The implementation strategies and resources will be trialled in five general practices over 12 months. The primary outcome will be change in the proportion of adult patients with a complete alcohol history in their electronic medical records. Baseline data collection includes a practice survey to describe practice routines for ABIs and de-identified patient medical record data on completed alcohol histories (repeated at 3, 6, 9, and 12-months post-intervention). Survey and interview data will also be collected from clinicians, patients, and primary health network staff to assess acceptability and feasibility of the intervention. The study will explore how the implementation strategies and resources can improve alcohol screening and management among low-income patients in general practice.
Publisher: Springer Science and Business Media LLC
Date: 14-09-2021
DOI: 10.1186/S12909-021-02916-0
Abstract: 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). Mixed-method data collection was conducted after in idual 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. 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. 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.
Publisher: Emerald
Date: 15-04-2019
DOI: 10.1108/JICA-07-2018-0047
Abstract: The purpose of this paper is to appraise the development, implementation and acceptance of HealthPathways (HP), specifically in Type 2 Diabetes Mellitus (T2DM), at different levels of the health system in a large metropolitan Local Health District in Australia. This study used a programmatic approach and mixed methods including literature reviews, site visits, semi-structured interviews of stakeholders and General Practitioners (GPs), and surveys (GPs and patients) to better understand the development, implementation and acceptance of T2DM pathways. Results from this study indicate that 63 percent ( n =37) of all survey respondents use HP and nearly half (47 percent) use HP in caring for a patient with diabetes. More than 80 percent of the health professionals found HP a useful tool, which has improved the quality of care, keeps them informed and supports diagnostics process. The use of website has led to an improvement in referral quality (69 percent), has assisted in the provision of more healthcare in the community (87 percent) and made their job easier. Thematic analysis from stakeholder interviews ( n =12) emphasizes the importance of established collaborations and the need for standardized tools with common priorities and transparency in processes. This study has provided insight into the details of delivery of integrated healthcare using HP. It provides a preliminary analysis of the lessons learnt for the implementation of HP. The results of this study will be ideally placed to inform future policy amendments in the area of integrated healthcare as well as serving as a guide on implementing HP in the future.
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2022-064375
Abstract: Implementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents’/caregivers’ experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting. This qualitative study involves using a convenience selection process of the full s le of parents/caregivers that participated in the main programme, ‘General Practice Surveillance for Autism’, a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically. Twelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed. All interviews were completed over the phone. There were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient–doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers. The findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting. ANZCTR (ACTRN12619001200178).
Publisher: Therapeutic Guidelines Limited
Date: 02-2021
Publisher: Informa UK Limited
Date: 26-10-2012
Publisher: Royal College of General Practitioners
Date: 06-06-2023
Abstract: Background: Brief interventions (BIs) are effective for reducing harmful alcohol consumption, but their use in primary care is less frequent than clinically indicated. The REducing AlCohol-related Harm (REACH) Project aimed to increase the delivery of BIs in primary care. Aim: The aim of this paper is to assess the effectiveness of the REACH program in increasing alcohol BIs in general practice and explore the implementation factors that improve or reduce uptake by clinicians. Design and Setting: This paper reports on a sequential, explanatory mixed-methods study of the implementation of the REACH project in six general practice clinics serving low-income communities in Melbourne, Australia. Method: We conducted time-series analyses using routinely-collected patient records and semi-structured interviews, guided by the Consolidated Framework for Implementation Research. Results: The six intervention sites significantly increased their rate of recorded alcohol status (56.7% to 60.4%), whereas there was no significant change in the non-intervention practices (344 sites, 55.2% to 56.4%). Conclusion: REACH resources were seen as useful and acceptable by clinicians and staff. National policies that support the involvement of primary care in alcohol harm reduction helped promote ongoing intervention sustainability.
Publisher: Elsevier BV
Date: 12-2022
Publisher: Springer Science and Business Media LLC
Date: 08-03-2021
DOI: 10.1186/S12905-021-01226-3
Abstract: In Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migrant women’s contraceptive method choice and practices will help cater to their decision-making needs in a culturally sensitive and responsive way. A qualitative study design underpinned by critical realism approach was used to explore Chinese migrant women’s perceptions and experiences of choosing contraceptive methods. Semi-structured interviews were conducted with 22 women who self-identified as being ethnically Chinese and had been living in Australia for no more than 10 years. The interview guide was adapted from the Ottawa Decision Support Framework. Majority of the interviews were conducted in Mandarin Chinese. Transcribed data was analysed using thematic analysis method. Four major themes were identified, including: ‘every medicine is part poison: hormonal contraceptives cause harm to the body’ ‘intrauterine device, a device used in the past for married women’ ‘it takes two (or one) to decide, depending on the relationship dynamics and contraception preferences’ and ‘it is not necessary to seek medical advice in choosing contraceptive methods’. Our findings suggest that Chinese migrant women’s perceptions and experiences of choosing contraceptive methods are influenced by complex personal, cultural, societal and inter-relational factors. Chinese migrant women were cautious of using hormonal methods due to fears of side-effects, including reduced or absent menstrual bleeding. Women were also reluctant to consider intrauterine devices as options due to associating them with past experiences of other women and themselves and also fears of potential complications. There was a reluctant attitude towards seeking medical advice regarding contraception due to beliefs that needing to use contraception is not an illness requiring treatment. Such findings are likely to be useful in increasing healthcare professionals’ and policy makers’ understanding of Chinese migrant women’s contraceptive method preferences, beliefs and behaviours. They also help to develop culturally and linguistically sensitive strategies, which goes beyond the provision of contraceptive counselling, in assisting Chinese migrant women’s decision-making needs.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH19215
Abstract: Background In Australia, there are many culturally and linguistically erse communities and Chinese migrants make up one of the largest. Yet, little is known about healthcare providers’ (HCPs) unique experiences in providing contraceptive care for Chinese migrant women. There is minimal research into the HCPs’ perceptions of challenges or opportunities in engaging Chinese migrant women in informed and shared decision-making processes during contraceptive counselling. The aim of this study is to explore HCPs’ experiences of providing contraceptive care for Chinese migrant women, their perceptions of women’s care needs when choosing contraceptive methods, as well as their own needs in supporting women’s decision-making. Methods: Semi-structured interviews were conducted with 20 HCPs in Sydney, Australia who had substantial experience in providing contraceptive services to Chinese women who were recent migrants. Transcribed audio-recorded data were analysed using thematic analysis. Results: Four main themes were identified, including: ‘Are you using contraception?’: the case for being proactive and opportunistic ‘Getting the message across’: barriers to communication ‘Hormones are unnatural?’: women favouring non-hormonal methods and ‘Word of mouth’: social influence on contraceptive method choice. Conclusions: In order to facilitate informed choice and shared decision-making with Chinese migrant women during contraceptive counselling, broader health system and community-level strategies are needed. Such strategies could include improving HCPs’ cultural competency in assessing and communicating women’s contraceptive needs providing professional interpreting services and translated materials and improving women’s health literacy, including their contraceptive knowledge and health system awareness.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.IJMEDINF.2017.06.002
Abstract: Integrated primary care requires systems and service integration along with financial incentives to promote downward substitution to a single entry point to care. Integrated Primary Care Centres (IPCCs) aim to improve integration by co-location of health services. The Informatics Capability Maturity (ICM) describes how well health organisations collect, manage and share information manage eHealth technology, implementation, change, data quality and governance and use "intelligence" to improve care. Describe associations of ICM with systems and service integration in IPCCs. Mixed methods evaluation of IPCCs in metropolitan and rural Australia: an enhanced general practice, four GP Super Clinics, a "HealthOne" (private-public partnership) and a Community Health Centre. Data collection methods included self-assessed ICM, document review, interviews, observations in practice and assessment of electronic health record data. Data was analysed and compared across IPCCs. The IPCCs demonstrated a range of funding models, ownership, leadership, organisation and ICM. Digital tools were used with varying effectiveness to collect, use and share data. Connectivity was problematic, requiring "work-arounds" to communicate and share information. The lack of technical, data and software interoperability standards, clinical coding and secure messaging were barriers to data collection, integration and sharing. Strong leadership and governance was important for successful implementation of robust and secure eHealth systems. Patient engagement with eHealth tools was suboptimal. ICM is positively associated with integration of data, systems and care. Improved ICM requires a health workforce with eHealth competencies technical, semantic and software standards adequate privacy and security and good governance and leadership.
Publisher: Springer Science and Business Media LLC
Date: 20-08-2013
Publisher: The Royal Australian College of General Practitioners
Date: 10-2018
Publisher: Springer Science and Business Media LLC
Date: 08-01-2021
DOI: 10.1186/S12875-020-01347-Y
Abstract: To optimise medication use in older people, it is recommended that clinicians evaluate evidence on potential benefits and harms of medicines in light of the patients’ overall health, values and goals. This suggests general practitioners (GPs) should attempt to facilitate patient involvement in decision-making. In practice this is often challenging. In this qualitative study, we explored GPs’ perspectives on the importance of discussing patients’ goals and preferences, and the role patient preferences play in medicines management and prioritisation. Semi-structured interviews were conducted with GPs from Australia ( n = 32). Participants were purposively s led to recruit GPs with variation in experience level and geographic location. Transcribed audio-recordings of interviews were coded using Framework Analysis. The results showed that most GPs recognised some value in understanding older patients’ goals and preferences regarding their medicines. Most reported some discussions of goals and preferences with patients, but often this was initiated by the patient. Practical barriers were reported such as limited time during busy consultations to discuss issues beyond acute problems. GPs differed on the following main themes: 1) definition and perception of patients’ goals, 2) relationship with the patient, 3) approach to medicines management and prioritisation. We observed that GPs preferred one of three different practice patterns in their approach to patients’ goals in medicines decisions: 1) goals and preferences considered lower priority – ‘Directive’ 2) goals seen as central – ‘Goal-oriented’ 3) goals and preferences considered but not explicitly elicited – ‘Tacit’. This study explores how GPs differ in their approach to eliciting patients’ goals and preferences, and how these differences are operationalised in the context of older adults taking multiple medicines. Although there are challenges in providing care that aligns with patients’ goals and preferences, this study shows how complex decisions are made between GPs and their older patients in clinical practice. This work may inform future research that investigates how GPs can best incorporate the priorities of older people in decision-making around medicines. Developing practical support strategies may assist clinicians to involve patients in discussions about their medicines.
No related grants have been discovered for Chun Wah Michael Tam.