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Publisher: JMIR Publications Inc.
Date: 19-09-2018
Abstract: epressive symptoms are common in people with type 2 diabetes mellitus (T2DM). Effective depression treatments exist however, access to psychological support is characteristically low. Web-based cognitive behavioral therapy (CBT) is accessible, nonstigmatizing, and may help address substantial personal and public health impact of comorbid T2DM and depression. he aim of this study was to evaluate the Web-based CBT program, myCompass, for improving social and occupational functioning in adults with T2DM and mild-to-moderate depressive symptoms. myCompass is a fully automated, self-guided public health treatment program for common mental health problems. The impact of treatment on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior was also examined. articipants with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited online via Google and Facebook advertisements targeting adults with T2DM and via community and general practice settings. Screening, consent, and self-report scales were all self-administered online. Participants were randomized using double-blind computerized block randomization to either myCompass (n=391) for 8 weeks plus a 4-week tailing-off period or an active placebo intervention (n=379). At baseline and postintervention (3 months), participants completed the Work and Social Adjustment Scale, the primary outcome measure. Secondary outcome measures included the Patient Health Questionnaire-9 item, Diabetes Distress Scale, Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. yCompass users logged in an average of 6 times and completed an average of .29 modules. Healthy Lifestyles users logged in an average of 4 times and completed an average of 1.37 modules. At baseline, mean scores on several outcome measures, including the primary outcome of work and social functioning, were near to the normal range, despite an extensive recruitment process. Approximately 61.6% (473/780) of participants completed the postintervention assessment. Intention-to-treat analyses revealed improvement in functioning, depression, anxiety, diabetes distress, and healthy eating over time in both groups. Except for blood glucose monitoring and medication adherence, there were no specific between-group effects. Follow-up analyses suggested the outcomes did not depend on age, morbidity, or treatment engagement. mprovement in social and occupational functioning and the secondary outcomes was generally no greater for myCompass users than for users of the control program at 3 months postintervention. These findings should be interpreted in light of near-normal mean baseline scores on several variables, the self-selected study s le, and s le attrition. Further attention to factors influencing uptake and engagement with mental health treatments by people with T2DM, and the impact of illness comorbidity on patient conceptualization and experience of mental health symptoms, is essential to reduce the burden of T2DM. ustralian New Zealand Clinical Trials Registry ACTRN12615000931572 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109& isReview=true (Archived by WebCite at 850eg8pi)
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.PEC.2017.07.008
Abstract: To describe the characteristics of primary care attendees with depressive symptoms who use mental health websites. 789 in iduals with depressive symptoms recruited and followed up annually for nine years. Self-reported written surveys included mental health, professional and self-help use, e-mental health interventions or therapeutic websites. Marginal logistic regression examined association between mental health website (MHW) use and patient's mental health, health services use, anti-depressant use and self-help strategies. 36% of participants used an MHW at least once. MHW users were more likely to be female, younger, highly educated and employed. MHW use increased with depressive symptom severity reported in 16% of assessments when minimal symptoms were present and 28% when severe symptoms were present. MHW use was associated with: GP mental health visits, psychologist and psychiatrist visits and other self-help strategies including self-help books and telephone helplines. Mental health websites were more likely to be used by those with severe depressive symptoms rather than those with mild depression as recommended in current guidelines. Whilst mental health websites offer potential to support the high volume of people with mild depression new strategies may be required to ensure uptake.
Publisher: JMIR Publications Inc.
Date: 27-11-2017
Publisher: Springer Science and Business Media LLC
Date: 05-11-2009
Publisher: Cambridge University Press (CUP)
Date: 2023
DOI: 10.1017/S1463423623000038
Abstract: Current treatment guidelines advise that the deprescribing of antidepressants should occur around 6 months post-remission of symptoms. However, this is not routinely occurring in clinical practice, with between 30% and 50% of antidepressant users potentially continuing treatment with no clinical benefit. To support patients to deprescribe antidepressant treatment when clinically appropriate, it is important to understand what is important to patients when making the decision to reduce or cease antidepressants in a naturalistic setting. The current study aimed to describe the self-reported reasons primary care patients have for reducing or stopping their antidepressant medication. Three hundred and seven participants in the diamond longitudinal study reported taking an SSRI/SNRI over the life of the study. Of the 307, 179 reported stopping or tapering their antidepressant during computer-assisted telephone interviews and provided a reason for doing so. A collective case study approach was used to collate the reasons for stopping or tapering. Reflexive thematic analysis of patient-reported factors revealed five overarching themes 1. Depression 2. Medication 3. Healthcare system 4. Psychosocial, and 5. Financial. These findings are used to inform suggestions for the development and implementation of antidepressant deprescribing discussions in clinical practice.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.CCT.2018.12.014
Abstract: Primary care in Australia is undergoing significant reform, with a particular focus on cost-effective tailoring of mental health care to in idual needs. Link-me is testing whether a patient-completed Decision Support Tool (DST), which predicts future severity of depression and anxiety symptoms and triages in iduals into care accordingly, is clinically effective and cost-effective relative to usual care. The trial is set in general practices, with English-speaking patients invited to complete eligibility screening in their general practitioner's waiting room. Eligible and consenting patients will then complete the DST assessment and are randomised and stratified according to predicted symptom severity. Participants allocated to the intervention arm will receive feedback on DST responses, select treatment priorities, assess motivation to change, and receive a severity-matched treatment recommendation (information about and links to low intensity services for those with mild symptoms, or assistance from a specially trained health professional (care navigator) for those with severe symptoms). All patients allocated to the comparison arm will receive usual GP care plus attention control. Primary (psychological distress) and secondary (depression, anxiety, quality of life, days out of role) outcomes will be assessed at 6 and 12 months. Differences in outcome means between trial arms both across and within symptom severity group will be examined using intention-to-treat analyses. Within trial and modelled economic evaluations will be conducted to determine the value for money of credentials of Link-me. Findings will be reported to the Federal Government to inform how mental health services across Australia are funded and delivered in the future.
Publisher: JMIR Publications Inc.
Date: 13-12-2018
Abstract: sychological distress among taxi drivers is 5 times higher than that in the general population, and more than half of all drivers have experienced 3 or more potentially traumatic events in their lifetime. Nevertheless, help-seeking for mental health problems in this male-dominated, predominately immigrant workforce is low. Mobile technologies have the potential to increase mental health awareness, teach self-help skills, and encourage help-seeking in this hard-to-reach population. his study aimed to assess the feasibility, acceptability, and potential efficacy of italic Driving to Health /italic , a mobile phone–friendly mental health website app designed for people working as taxi drivers. rivers (n=46) were recruited from the Melbourne Airport Taxi Holding Yard to participate in a single-arm trial. Self-reported, paper-based assessments were completed at baseline and at 1 month. Feasibility was measured by completion rates, representativeness of study participants, and levels of use. Acceptability was assessed by measuring users’ perception of the quality of the app and anticipated levels of future use. The efficacy of italic Driving to Health /italic to increase awareness, self-help behaviors, and intentions to seek help was assessed using the user version of the Mobile App Rating Scale (uMARS) and the General Help-Seeking Questionnaire (GHSQ). Psychological symptoms were measured using the short form of the Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using complete case analysis. n total, 42 participants comprising drivers from 10 different countries of origin, and 14 different languages, completed pre- and poststudy measures (42/46, 91% completion rate). Just under half (45%) of all users used the app more than once with an average visit of 4 min 8 seconds. Responding to the uMARS, 62% (26/42) of the participants said that they would recommend the app to many people. Nearly all (40/42, 95%) participants said that italic Driving to Health /italic increased awareness of their own mental health 86% (36/42) said that it increased their mental health knowledge and 76% (32/42) said that it increased their self-help behaviors. Increases in help-seeking intentions on the GHSQ were not significant, and increases on all 3 scales of DASS-21 were not reliable or meaningful. his study suggests that italic Driving to Health /italic is an acceptable and feasible electronic health intervention for a hard-to-reach population. Our findings also suggest that italic Driving to Health /italic results in increases in mental health awareness, behaviors, and willingness to seek help.
Publisher: Springer Science and Business Media LLC
Date: 04-2010
Publisher: JMIR Publications Inc.
Date: 24-05-2019
DOI: 10.2196/12793
Publisher: JMIR Publications Inc.
Date: 27-09-2018
DOI: 10.2196/10035
Publisher: Physicians Postgraduate Press, Inc
Date: 14-04-2015
DOI: 10.4088/JCP.14M09075
Publisher: BMJ
Date: 09-2021
DOI: 10.1136/BMJOPEN-2021-052547
Abstract: To identify and characterise activities for deprescribing used in general practice and to map the identified activities to pioneering principles of deprescribing. Primary care. Medline, EMBASE (Ovid), CINAHL, Australian New Zealand Clinical Trials Registry (ANZCTR), Clinicaltrials.gov, ISRCTN registry, OpenGrey, Annals of Family Medicine, BMC Family Practice, Family Practice and British Journal of General Practice (BJGP) from inception to the end of June 2021. Included studies were original research (randomised controlled trial, quasi-experimental, cohort study, qualitative and case studies), protocol papers and protocol registrations. Screening and data extraction was completed by one reviewer 10% of the studies were independently reviewed by a second reviewer. Coding of full-text articles in NVivo was conducted and mapped to five deprescribing principles. Fifty studies were included. The most frequently used activities were identification of appropriate patients for deprescribing (76%), patient education (50%), general practitioners (GP) education (48%), and development and use of a tapering schedule (38%). Six activities did not align with the five deprescribing principles. As such, two principles (engage practice staff in education and appropriate identification of patients, and provide feedback to staff about deprescribing occurrences within the practice) were added. Activities and guiding principles for deprescribing should be paired together to provide an accessible and comprehensive guide to deprescribing by GPs. The addition of two principles suggests that practice staff and practice management teams may play an instrumental role in sustaining deprescribing processes within clinical practice. Future research is required to determine the most of effective activities to use within each principle and by whom.
Publisher: Wiley
Date: 21-05-2009
DOI: 10.1111/J.1440-1584.2009.01057.X
Abstract: To quantify the financial impact of rural clinical placements on medical, nursing and allied health students in rural Australia. The Careers in Health Tracking Survey provided data on whether students were employed, usual weekly hours of employment and a range of covariates, such as age, sex, course of study, marital status, dependents and rural or urban origin. A total of 121 students from a range of health professions completed the Careers in Health Tracking Survey while on rural placement at the Northern Rivers University Department of Rural Health. Survey data. Forty-one per cent of respondents were working immediately before their clinical placements. Nursing students worked the longest hours by far and were significantly more financially disadvantaged than both medical and allied health students (P < 0.01). Scholarship support was unevenly distributed, with nursing and allied health students being relatively under-supported in relation to lost earnings. Recruitment of students can be an effective strategy to address the rural health workforce shortage throughout Australia. However, there are a number of financial disincentives for students to undertake rural clinical placements. Additional support for some disciplines is needed to provide equitable distribution of scholarship support to offset this financial burden. Establishing an employment scheme for students on rural clinical placements and a scholarship for income replacement where employment is not available would also alleviate income loss.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.JAD.2010.10.032
Abstract: The proposed DSM-V criteria for posttraumatic stress disorder (PTSD) specifically require both active avoidance and emotional numbing symptoms for a diagnosis. In DSM-IV, since both are included in the same cluster, active avoidance is not essential. Numbing symptoms overlap with depression, which may result in spurious comorbidity or overdiagnosis of PTSD. This paper investigated the impact of requiring both active avoidance and emotional numbing on the rates of PTSD diagnosis and comorbidity with depression. We investigated PTSD and depression in 835 traumatic injury survivors at 3 and 12 months post-injury. We used the DSM-IV criteria but explored the potential impact of DSM-IV and DSM-V approaches to avoidance and numbing using comparison of proportion analyses. The DSM-V requirement of both active avoidance and emotional numbing resulted in significant reductions in PTSD caseness compared with DSM-IV of 22% and 26% respectively at 3 and 12 months posttrauma. By 12 months, the rates of comorbid PTSD in those with depression were significantly lower (44% vs. 34%) using the new criteria, primarily due to the lack of avoidance symptoms. These preliminary data suggest that requiring both active avoidance and numbing as separate clusters offers a useful refinement of the PTSD diagnosis. Requiring active avoidance may help to define the unique aspects of PTSD and reduce spurious diagnoses of PTSD in those with depression.
Publisher: JMIR Publications Inc.
Date: 03-08-2017
DOI: 10.2196/RESPROT.7348
Publisher: Springer Science and Business Media LLC
Date: 18-08-2009
Publisher: JMIR Publications Inc.
Date: 17-10-2019
Abstract: eople with type 2 diabetes mellitus (T2DM) often experience mental health symptoms that exacerbate illness and increase mortality risk. Access to psychological support is low in people with T2DM. Detection of depression is variable in primary care and can be further h ered by mental health stigma. Electronic mental health (eMH) programs may provide an accessible, private, nonstigmatizing mental health solution for this group. his study aims to evaluate the efficacy over 12 months of follow-up of an eMH program (myCompass) for improving social and occupational functioning in a community s le of people with T2DM and self-reported mild-to-moderate depressive symptoms. myCompass is a fully automated and self-guided web-based public health program for people with depression or anxiety. The effects of myCompass on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior were also examined. dults with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited via online advertisements, community organizations, and general practices. Screening, consent, and self-report questionnaires were administered online. Eligible participants were randomized to receive either myCompass (n=391) or an attention control generic health literacy program (Healthy Lifestyles n=379) for 8 weeks. At baseline and at 3, 6, and 12 months postintervention, participants completed the Work and Social Adjustment Scale, the Patient Health Questionnaire-9 item, the Diabetes Distress Scale, the Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Glycosylated hemoglobin measurements were obtained at baseline and 6 and 12 months postintervention. total of 38.9% (304/780) of the trial participants completed all postintervention assessments. myCompass users logged in on an average of 6 times and completed an average of 0.29 modules. Healthy Lifestyles users logged in on an average of 4 times and completed an average of 1.37 modules. At baseline, the mean scores on several outcome measures, including the primary outcome of work and social functioning, were close to the normal range, despite a varied and extensive recruitment process. Intention-to-treat analyses revealed slightly greater improvement at 12 months in work and social functioning for the Healthy Lifestyles group relative to the myCompass group. All participants reported equivalent improvements in depression anxiety, diabetes distress, diabetes self-management, and glycemic control across the trial. he Healthy Lifestyles group reported higher ratings of social and occupational functioning than the myCompass group, but no differences were observed for any secondary outcome. Although these findings should be interpreted in light of the near-floor symptom scores at baseline, the trial yields important insights into how people with T2DM might be engaged in eMH programs and the challenges of focusing specifically on mental health. Several avenues emerge for continued investigation into how best to deal with the growing mental health burden in adults with T2DM. ustralian New Zealand Clinical Trials Registry Number (ACTRN) 12615000931572 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109& isReview=true
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2010
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.PSYCHRES.2012.09.037
Abstract: Military veterans with posttraumatic stress disorder (PTSD) frequently report exposure to multiple other traumas in addition to their military experiences. This study aimed to examine the impact of exposure-related factors for military veterans with PTSD on recovery after participation in a group-based treatment program. Subjects included 1548 military veterans with PTSD participating in specialist veterans' PTSD programs across Australia. The study included measures of PTSD, depression, anxiety and alcohol use. Analyses of variance found higher combat exposure was associated with more severe PTSD at intake. No differences in PTSD intake severity were evident in those with additional non-military trauma. Severity of combat exposure did not affect treatment outcomes, although those with low combat exposure and additional non-military trauma (which included high rates of molestation) did report reduced symptom improvement. These findings have implications for considerations of optimal interventions for those with lower levels of combat exposure and additional non-military trauma.
Publisher: JMIR Publications Inc.
Date: 14-02-2018
Abstract: obile applications (apps) are emerging as tools with the potential to revolutionise the treatment of mental health conditions such as depression. At the forefront of community health sector, general practitioners (GPs) are in a unique position to guide the integration of technology and depression management, however little is currently known about how primary care patients with depressive symptoms are currently using apps. he aim of this study was to explore the natural patterns of mobile app use amongst patients with depressive symptoms, in order to facilitate understanding of the potential role for mobile apps in managing depressive symptoms in the community. emi-structured phone interviews were conducted with primary care patients in Victoria, Australia, who reported symptoms of depression and were enrolled in a larger randomized controlled trial of depression care. Interviews explored current depression management strategies and the use of mobile apps (if any). Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was iteratively conducted using QSR NVivo 11 Pro to identify emergent themes. total of 16 participants aged between 20 to 58 years took part in the interviews, with 11 reporting the use of at least one mobile app to manage depressive symptoms and 5 reporting no app use. A variety of apps were described including relaxation, mindfulness, cognitive, exercise, gaming, social media and wellbeing apps to aid with depressive symptoms. Amongst users, there were four main patterns of app use: skill acquisition, social connectedness, inquisitive trial, and safety netting. Factors that influenced app use included accessibility, perceptions of technology and personal compatibility. Healthcare providers also had a role in initiating app use. obile apps are being utilised for self-management of depressive symptoms by primary care patients. This study provided insight into the natural patterns and perspectives of app use, which enhances understanding of how this technology may be integrated into the toolbox for the management of depression.
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/S0004-9514(07)70045-4
Abstract: Is the physiotherapy workforce significantly older in 2001 than 1986? What is the cumulative attrition of the workforce to 2001 and what is the predicted attrition by 2026? Is the workforce becoming masculinised? Is the workforce working longer hours? Observational study using Australian Bureau of Statistics census data from 1986 to 2001 to predict workforce characteristics in 2026. All physiotherapists who responded to the 1986, 1991, 1996 and 2001 censuses: 5928, 7106, 8788 and 10039 respondents in each year respectively. The physiotherapy workforce has aged significantly since 1986 (p < 0.001), and women are older than men (p < 0.001). Forty-one percent of the 2001 physiotherapy workforce is predicted to retire by 2026, although around one-third of physiotherapists continue working after age 65. While physiotherapy remains a female-dominated profession, the proportion of males is increasing and has risen from 16% in 1986 to 27% in 2001. Physiotherapists are working longer hours than they did in the past, and while this is partly due to the increasing proportion of males in the workforce, generation X and Y females are also more likely to work longer hours than their predecessors. The retirement of older, mostly female, physiotherapists may exacerbate existing workforce shortages, particularly in the public and aged care sectors. However, the growing proportion of male physiotherapists and their generally higher workforce participation may go some way to improving labour force capacity overall.
Publisher: Wiley
Date: 06-2007
DOI: 10.1111/J.1834-7819.2007.TB00479.X
Abstract: The dental workforce, like the Australian population, is ageing. As the large baby boomer cohort retires dental shortages will likely increase. Australian Bureau of Statistics census data from 1986 to 2001 were used to examine ageing of the dental workforce and attrition of dentists aged 50 years and over. The number of dentists to retire was projected over the next 20 years. Since 1986, the dental workforce has aged significantly (p < 0.01). About half of the current dental workforce is projected to retire by 2026. Generation X dentists are significantly less likely to work long hours than the baby boomer cohort of dentists (p 41 per week) than male baby boomer dentists (p < 0.01). Ageing of the workforce will have an impact on dentistry later than on some other professions due to the 35 per cent of dentists who work beyond 65 years of age. Nonetheless, existing dental shortages are likely to be exacerbated over the short term by the 22 per cent of dentists projected to retire over the next 10 years.
Publisher: JMIR Publications Inc.
Date: 12-2020
DOI: 10.2196/16729
Abstract: People with type 2 diabetes mellitus (T2DM) often experience mental health symptoms that exacerbate illness and increase mortality risk. Access to psychological support is low in people with T2DM. Detection of depression is variable in primary care and can be further h ered by mental health stigma. Electronic mental health (eMH) programs may provide an accessible, private, nonstigmatizing mental health solution for this group. This study aims to evaluate the efficacy over 12 months of follow-up of an eMH program (myCompass) for improving social and occupational functioning in a community s le of people with T2DM and self-reported mild-to-moderate depressive symptoms. myCompass is a fully automated and self-guided web-based public health program for people with depression or anxiety. The effects of myCompass on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior were also examined. Adults with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited via online advertisements, community organizations, and general practices. Screening, consent, and self-report questionnaires were administered online. Eligible participants were randomized to receive either myCompass (n=391) or an attention control generic health literacy program (Healthy Lifestyles n=379) for 8 weeks. At baseline and at 3, 6, and 12 months postintervention, participants completed the Work and Social Adjustment Scale, the Patient Health Questionnaire-9 item, the Diabetes Distress Scale, the Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Glycosylated hemoglobin measurements were obtained at baseline and 6 and 12 months postintervention. A total of 38.9% (304/780) of the trial participants completed all postintervention assessments. myCompass users logged in on an average of 6 times and completed an average of 0.29 modules. Healthy Lifestyles users logged in on an average of 4 times and completed an average of 1.37 modules. At baseline, the mean scores on several outcome measures, including the primary outcome of work and social functioning, were close to the normal range, despite a varied and extensive recruitment process. Intention-to-treat analyses revealed slightly greater improvement at 12 months in work and social functioning for the Healthy Lifestyles group relative to the myCompass group. All participants reported equivalent improvements in depression anxiety, diabetes distress, diabetes self-management, and glycemic control across the trial. The Healthy Lifestyles group reported higher ratings of social and occupational functioning than the myCompass group, but no differences were observed for any secondary outcome. Although these findings should be interpreted in light of the near-floor symptom scores at baseline, the trial yields important insights into how people with T2DM might be engaged in eMH programs and the challenges of focusing specifically on mental health. Several avenues emerge for continued investigation into how best to deal with the growing mental health burden in adults with T2DM. Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000931572 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109& isReview=true
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.JANXDIS.2016.05.003
Abstract: Survivors of traumatic events may develop a range of psychopathology, across the internalizing and externalizing dimensions of disorder and associated personality traits. However, research into personality-based internalizing and externalizing trauma responses has been limited to cross-sectional investigations of PTSD comorbidity. Personality typologies may present an opportunity to identify and selectively intervene with survivors at risk of posttraumatic disorder. Therefore this study examined whether personality prospectively influences the trajectory of disorder in a broader trauma-exposed s le. During hospitalization for a physical injury, 323 Australian adults completed the Multidimensional Personality Questionnaire-Brief Form and Structured Clinical Interview for DSM-IV, with the latter readministered 3 and 12 months later. Latent profile analysis conducted on baseline personality scores identified subgroups of participants, while latent change modelling examined differences in disorder trajectories. Three classes (internalizing, externalizing, and normal personality) were identified. The internalizing class showed a high risk of developing all disorders. Unexpectedly, however, the normal personality class was not always at lowest risk of disorder. Rather, the externalizing class, while more likely than the normal personality class to develop substance use disorders, were less likely to develop PTSD and depression. Results suggest that personality is an important mechanism in influencing the development and form of psychopathology after trauma, with internalizing and externalizing subtypes identifiable in the early aftermath of injury. These findings suggest that early intervention using a personality-based transdiagnostic approach may be an effective method of predicting and ultimately preventing much of the burden of posttraumatic disorder.
Publisher: Oxford University Press (OUP)
Date: 09-2007
Abstract: To identify ageing and retirement patterns of the pharmacy workforce since 1986 and the implications of those changes for future workforce planning. Australian Bureau of Statistics census data from 1986 to 2001 were used to examine ageing of the pharmacy workforce and attrition of pharmacists aged 50 years and over. The number of pharmacists to retire was projected over the next 20 years. The Australian pharmacy workforce has aged significantly since 1986 (P & 0.01). Forty-one per cent of pharmacists practising in 2001 are predicted to retire by 2026. Baby boomer pharmacists were more likely to work long hours (49+ per week) in 2001 than in 1986, and than generation X pharmacists in 2001. The proportion of women in pharmacy has increased from 39% in 1986 to over 50% in 2001. Women are still more likely to work part-time than males, although they are less likely to do so than they were in 1986. Conversely, the proportion of male pharmacists working part-time is rising. With baby boomer and older cohorts currently making up 65% of the pharmacy workforce, their retirement will place increased pressure on a profession already facing severe shortages. The growing proportion of female pharmacists and their generally lower workforce participation mean the potential for continued pharmacy shortages.
Publisher: JMIR Publications Inc.
Date: 09-12-2018
Abstract: -mental health (eMH) interventions are now widely available and they have the potential to revolutionize the way that health care is delivered. As most health care is currently delivered by primary care, there is enormous potential for eMH interventions to support, or in some cases substitute, services currently delivered face to face in the community setting. However, randomized trials of eMH interventions have tended to recruit participants using online recruitment methods. Consequently, it is difficult to know whether participants who are recruited online differ from those who attend primary care. his paper aimed to document the experience of recruiting to an eMH trial through primary care and compare the characteristics of participants recruited through this and other recruitment methods. ecruitment to the SpringboarD randomized controlled trial was initially focused on general practices in 2 states of Australia. Over 15 months, we employed a comprehensive approach to engaging practice staff and supporting them to recruit patients, including face-to-face site visits, regular contact via telephone and trial newsletters, and development of a Web-based patient registration portal. Nevertheless, it became apparent that these efforts would not yield the required s le size, and we therefore supplemented recruitment through national online advertising and promoted the study through existing networks. Baseline characteristics of participants recruited to the trial through general practice, online, or other sources were compared using the analysis of variance and chi square tests. etween November 2015 and October 2017, 780 people enrolled in SpringboarD, of whom 740 provided information on the recruitment source. Of these, only 24 were recruited through general practice, whereas 520 were recruited online and 196 through existing networks. Key barriers to general practice recruitment included perceived mismatch between trial design and diabetes population, prioritization of acute health issues, and disruptions posed by events at the practice and community level. Participants recruited through the 3 different approaches differed in age, gender, employment status, depressive symptoms, and diabetes distress, with online participants being distinguished from those recruited through general practice or other sources. However, most differences reached only a small effect size and are unlikely to be of clinical importance. ime, labor, and cost-intensive efforts did not translate into successful recruitment through general practice in this instance, with barriers identified at several different levels. Online recruitment yielded more participants, who were broadly similar to those recruited via general practice.
Publisher: Springer Science and Business Media LLC
Date: 04-2021
DOI: 10.1186/S12913-021-06307-5
Abstract: Effective person-centred interventions are needed to support people living with mental-physical multimorbidity to achieve better health and wellbeing outcomes. Depression is identified as the most common mental health condition co-occurring with a physical health condition and is the focus of this intervention development study. The aim of this study is to identify the key components needed for an effective intervention based on a clear theoretical foundation, consideration of how motivational interviewing can inform the intervention, clinical guidelines to date, and the insights of primary care nurses. A multimethod approach to intervention development involving review and integration of the theoretical principles of Theory of Planned Behavior and the patient-centred clinical skills of motivational interviewing, review of the expert consensus clinical guidelines for multimorbidity, and incorporation of a thematic analysis of group interviews with Australian nurses about their perspectives of what is needed in intervention to support people living with mental-physical multimorbidity. Three mechanisms emerged from the review of theory, guidelines and practitioner perspective the intervention needs to actively ‘engage’ patients through the development of a collaborative and empathic relationship, ‘focus’ on the patient’s priorities, and ‘empower’ people to make behaviour change. The outcome of the present study is a fully described primary care intervention for people living with mental-physical multimorbidity, with a particular focus on people living with depression and a physical health condition. It builds on theory, expert consensus guidelines and clinician perspective, and is to be tested in a clinical trial.
Publisher: SAGE Publications
Date: 12-2010
DOI: 10.3109/00048674.2010.513674
Abstract: Objective: Following the February 2009 Victorian bushfires, Australia's worst natural disaster, the Australian Centre for Posttraumatic Mental Health, in collaboration with key trauma experts, developed a three-tiered approach to psychological recovery initiatives for survivors with training specifically designed for each level. The middle level intervention, designed for delivery by allied health and primary care practitioners for survivors with ongoing mild-moderate distress, involved a protocol still in draft form called Skills for Psychological Recovery (SPR). SPR was developed by the US National Center for PTSD and US National Child Traumatic Stress Network. This study examined health practitioner perceptions of the training in, and usefulness of, SPR. Methods: From a range of disciplines 342 health practitioners attended one of 25 one-day workshops on the delivery of SPR. Perceptions of evidence-based care and attitudes to manualized interventions were assessed at the commencement of the workshop. Following the workshop, participants’ perceptions of their confidence in applying, and perceived usefulness of, each module were assessed. A subset of 20 participants recorded their ongoing use of SPR recording 61 cases. Results: The vast majority of participants rated the SPR modules as useful for survivors of disasters and expressed confidence in implementing the intervention following the training. Participants’ pre-workshop attitudes towards evidence-based care and manualized interventions affected their perceptions of the usefulness of the protocol. The ‘Promoting positive activities’ and ‘Rebuilding healthy social connections’ modules were least influenced by variations in these perceptions. Conclusions: This study provides preliminary evidence that SPR is perceived by health providers from varying disciplines and paradigms as an acceptable and useful intervention for disaster survivors with moderate levels of mental health difficulties. Future SPR dissemination efforts may benefit from focusing on modules with the strongest evidence base and which are most amenable to practitioner acceptance and uptake.
Publisher: JMIR Publications Inc.
Date: 21-05-2019
DOI: 10.2196/12246
Publisher: Physicians Postgraduate Press, Inc
Date: 11-2012
DOI: 10.4088/JCP.10M06640
Publisher: Informa UK Limited
Date: 04-2011
DOI: 10.3109/09540261.2011.559456
Abstract: Although symptoms characteristic of post-traumatic stress disorder (PTSD) have been noted in military personnel for many centuries, it was not until 1980 that the disorder was formally recognized and became the focus of legitimate study. This paper reviews our current state of knowledge regarding the prevalence and course of this complex condition in past and present members of the defence forces. Although rates vary across conflicts and countries, there is no doubt that PTSD affects substantial numbers of personnel and results in considerable impairment in functioning and quality of life. The paper goes on to discuss recent attempts to build resilience and to promote adjustment following deployment, noting that there is little evidence at this stage upon which to draw firm conclusions. Finally, effective treatment for PTSD is reviewed, with particular reference to the challenges posed by this population in a treatment setting.
Publisher: JMIR Publications Inc.
Date: 15-01-2020
DOI: 10.2196/13133
Abstract: Psychological distress among taxi drivers is 5 times higher than that in the general population, and more than half of all drivers have experienced 3 or more potentially traumatic events in their lifetime. Nevertheless, help-seeking for mental health problems in this male-dominated, predominately immigrant workforce is low. Mobile technologies have the potential to increase mental health awareness, teach self-help skills, and encourage help-seeking in this hard-to-reach population. This study aimed to assess the feasibility, acceptability, and potential efficacy of Driving to Health, a mobile phone–friendly mental health website app designed for people working as taxi drivers. Drivers (n=46) were recruited from the Melbourne Airport Taxi Holding Yard to participate in a single-arm trial. Self-reported, paper-based assessments were completed at baseline and at 1 month. Feasibility was measured by completion rates, representativeness of study participants, and levels of use. Acceptability was assessed by measuring users’ perception of the quality of the app and anticipated levels of future use. The efficacy of Driving to Health to increase awareness, self-help behaviors, and intentions to seek help was assessed using the user version of the Mobile App Rating Scale (uMARS) and the General Help-Seeking Questionnaire (GHSQ). Psychological symptoms were measured using the short form of the Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using complete case analysis. In total, 42 participants comprising drivers from 10 different countries of origin, and 14 different languages, completed pre- and poststudy measures (42/46, 91% completion rate). Just under half (45%) of all users used the app more than once with an average visit of 4 min 8 seconds. Responding to the uMARS, 62% (26/42) of the participants said that they would recommend the app to many people. Nearly all (40/42, 95%) participants said that Driving to Health increased awareness of their own mental health 86% (36/42) said that it increased their mental health knowledge and 76% (32/42) said that it increased their self-help behaviors. Increases in help-seeking intentions on the GHSQ were not significant, and increases on all 3 scales of DASS-21 were not reliable or meaningful. This study suggests that Driving to Health is an acceptable and feasible electronic health intervention for a hard-to-reach population. Our findings also suggest that Driving to Health results in increases in mental health awareness, behaviors, and willingness to seek help.
Publisher: SAGE Publications
Date: 12-2010
DOI: 10.3109/00048674.2010.509858
Abstract: In the field of traumatic stress, chemoprophylaxis is a term that is often used but rarely well understood. There has been no shortage of debate on the issue, but few rigorous studies to ground the discussion. The purpose of the current paper is to explore the issues surrounding this contentious area. Databases including PubMed, PsychArticles and Web of Knowledge were searched using the key words ‘chemo or pharmaco’, ‘prevention or prophylaxis’, and ‘PTSD or post-traumatic stress’. Relevant journals and reference lists of the papers obtained through this search were scanned for additional references. Studies that investigated the use of pharmacotherapy to prevent the onset of post-traumatic stress disorder were considered for this paper. Studies that examined the treatment of established PTSD were excluded. A total of 15 empirical studies were included in the review (including five randomized controlled trials), and twice as many non-data-driven papers. Evidence for the prophylactic use of alcohol, morphine, propranolol, and hydrocortisone is presented, followed by a discussion of the many challenges of using pharmacological interventions in this context. While attention to this issue has increased in recent times, the dearth of empirical data has done little to further the field. Larger studies are indicated following small trials with medications such as propranolol and hydrocortisone. There remain a number of ethical and practical questions to be answered before the widespread use of chemoprophylaxis can be recommended.
Publisher: Springer Science and Business Media LLC
Date: 20-07-2017
Publisher: Springer Science and Business Media LLC
Date: 04-09-2007
Abstract: Australia is currently experiencing widespread shortages of psychiatrists. The changing nature of the workforce and increasing demand mean that these shortages are unlikely to ease. This study aims to identify demographic change and retirement patterns of the Australian psychiatry workforce from 1995 to 2003, and the implications of those changes for future workforce planning. Data from the Australian Institute of Health and Welfare (AIHW) Medical Labour Force Survey from 1995 to 2003 is used to examine ageing of the psychiatry workforce and attrition of psychiatrists aged 50 years and over. Future attrition from the workforce is projected to 2025. Sixty two percent of psychiatrists practicing in the year 2000 are predicted to have retired by 2025. Most psychiatrists continue to work until late in life, with only 18 per cent retiring before age 65. The psychiatry workforce aged significantly between 1995 and 2003 (p 0.001), with men older than women in both years. A reduction in hours worked by psychiatrists reflects both the increasing proportion of females and the older members of the profession reducing their hours in preparation for retirement. The impact of ageing of the workforce may be more immediate for psychiatry than for some other health professions. With the growing proportion of females and their typically lower workforce participation, more than one younger psychiatrist will be required to replace each of the mostly male retirees.
Publisher: JMIR Publications Inc.
Date: 23-04-2018
DOI: 10.2196/MHEALTH.9502
No related grants have been discovered for Susan Fletcher.