ORCID Profile
0000-0003-2477-1646
Current Organisations
University of Wollongong
,
Monash University
,
University of New South Wales
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Springer Science and Business Media LLC
Date: 29-07-2020
DOI: 10.1038/S41598-020-69552-4
Abstract: Cardiometabolic risk factors (CMRFs) demonstrate significant geographic variation in their distribution. The study aims to quantify the general contextual effect of the areas on CMRFs and the geographic variation explained by area-level socioeconomic disadvantage. A cross sectional design and multilevel logistic regression methods were adopted. Data included objectively measured routine pathology test data between years 2012 and 2017 on: fasting blood sugar level glycated haemoglobin total cholesterol high density lipoprotein urinary albumin creatinine ratio estimated glomerular filtration rate and body mass index. The 2011 Australian census based Index of Relative Socioeconomic Disadvantage (IRSD) were the area-level study variables, analysed at its smallest geographic unit of reporting. A total of 1,132,029 CMRF test results from 256,525 in iduals were analysed. After adjusting for in idual-level covariates, all CMRFs significantly associated with IRSD and the probability of higher risk CMRFs increases with greater area-level disadvantage. Though the specific contribution of IRSD in the geographic variation of CMRF ranged between 57.8 and 14.71%, the general contextual effect of areas were found minimal (ICCs 0.6–3.4%). The results support universal interventions proportional to the need and disadvantage level of populations for the prevention and control of CMRFs, rather than any area specific interventions as the contextual effects were found minimal in the study region.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/AH16298
Abstract: Objectives The aim of the present study was to determine the association between area-level socioeconomic disadvantage and glycaemic-related risk in health service users in the Illawarra–Shoalhaven region of New South Wales, Australia. Methods HbA1c values recorded between 2010 and 2012 for non-pregnant in iduals aged ≥18 years were extracted from the Southern.IML Research (SIMLR) database. In iduals were assigned quintiles of the Socioeconomic Indices for Australia (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) according to their Statistical Area 1 of residence. Glycaemic risk categories were defined as HbA1c 5.0–5.99% (lowest risk), 6.0–7.49% (intermediate risk) and ≥7.5% (highest risk). Logistic regression models were fit with glycaemic risk category as the outcome variable and IRSD as the study variable, adjusting for age and sex. Results Data from 29064 in iduals were analysed. Higher disadvantage was associated with belonging to a higher glycaemic risk category in the fully adjusted model (most disadvantaged vs least disadvantaged quintile odds ratio 1.74, 95% confidence interval 1.58, 1.93 P& .001). Conclusion In this geocoded clinical dataset, area-level socioeconomic disadvantage was a significant correlate of increased glycaemic-related risk. Geocoded clinical data can inform more targeted use of health service resources, with the potential for improved health care equity and cost-effectiveness. What is known about the topic? The rapid increase in the prevalence of Type 2 diabetes (T2D), both globally and nationally within Australia, is a major concern for the community and public health agencies. In idual socioeconomic disadvantage is a known risk factor for abnormal glucose metabolism (AGM), including T2D. Although small-area-level socioeconomic disadvantage is a known correlate of AGM in Australia, less is known of the association of area-level disadvantage and glycaemic-related risk in in iduals with AGM. What does this paper add? This study demonstrates a robust association between small-area-level socioeconomic disadvantage and glycaemic-related risk in regional New South Wales. The study demonstrates that it is feasible to use geocoded, routinely collected clinical data to identify communities at increased health risk. What are the implications for practitioners? The identification of at-risk populations is an essential step towards targeted public health policy and programs aimed at reducing the burden of AGM, its complications and the associated economic costs. Collaboration between primary care and public health in the collection and use of data described in the present study has the potential to enhance the effectiveness of both sectors.
Publisher: Springer Science and Business Media LLC
Date: 25-10-2023
Publisher: No publisher found
Publisher: No publisher found
Publisher: Wiley
Date: 22-11-2017
DOI: 10.1111/AJAG.12364
Abstract: To investigate older patients' encounters with general practice registrars (GPRs) to inform training and clinical practice. Cross-sectional analysis of data from GPR consultations across five regional training providers in Australia. Data were analysed using simple and multiple logistic regression models. Our analysis included details of 118 831 consultations, 20 555 (17.6%, 95% CI 17.4-17.8) with patients aged ≥65 years. Older patient encounters had an increased likelihood of including chronic disease (OR 1.77, 95% CI 1.70, 1.86) and more problems (OR 1.24, 95% CI 1.20, 1.27). However, in-consultation information or advice was less likely to be sought (OR 0.92, 95% CI 0.88, 0.97), and consultations were briefer (OR 0.99, 95% CI 0.99, 1.00). Our results suggest relatively limited GPR exposure to older patients coupled with less complex consultations than expected. Solutions will need to be carefully constructed not only to increase caseloads, but also to address training and supervision concerns.
Publisher: JMIR Publications Inc.
Date: 10-05-2013
DOI: 10.2196/JMIR.2555
Publisher: Oxford University Press (OUP)
Date: 23-11-2021
Abstract: Relational continuity, ‘a therapeutic relationship between a patient and provider/s that spans health care events’, has been associated with improved patient outcomes. To evaluate whether an intervention incorporating patient enrolment and a funding model for higher-risk patients influenced patient-reported experience measures, particularly relational continuity. Cluster-randomized controlled trial over 12 months (1 August 2018–31 July 2019). Participating patients within intervention practices were offered enrolment with a preferred general practitioner, a minimum of 3 longer appointments, and review within 7 days of hospital admission or emergency department attendance. Intervention practices received incentives for longer consultations (dependent on reducing unnecessary prescriptions and tests), early post-hospital follow-up, and hospitalization reductions. The primary outcome was patient-reported relational continuity, measured by the Primary Care Assessment Tool Short Form. A total of 774 patients, aged 18–65 years with a chronic illness or aged over 65 years, from 34 general practices in metropolitan, regional, and rural Australia across 3 states participated. Response rates for questionnaires were & %. From a maximum of 4.0, mean baseline scores for relational continuity were 3.38 (SE 0.05) and 3.42 (SE 0.05) in control and intervention arms, respectively, with no significant between-group differences in changes pre-post trial. There were no significant changes in other patient-focussed measures. Patient-reported relational continuity was high at baseline and not influenced by the intervention, signalling the need for caution with policies incorporating patient enrolment and financial incentives. Further research is required targeting at-risk patient groups with low baseline engagement with primary care.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2021
DOI: 10.1186/S12875-021-01485-X
Abstract: With an ageing population and an increase in chronic disease burden in Australia, Patient Centred Medical Home (PCMH) models of care have been identified as potential options for primary care reform and improving health care outcomes. Adoption of PCMH models are not well described outside of North America. We examined the experiences of seven general practices in an Australian setting that implemented projects aligned with PCMH values and goals supported by their local Primary Health Network (PHN). Qualitative and quantitative data were collected over a twelve month period, including semi-structured interviews, participant observation, and practice data to present a detailed examination of a subject of study the implementation of PCMH projects in seven general practices. We conducted 49 interviews (24 pre and 25 post) with general practitioners, practice managers, practice nurses and PHN staff. Framework analysis deploying the domains of a logic model was used to synthesis and analyse the data. Facilitators in implementing successful, sustainable change included the capacity and willingness of practices to undertake change whole of practice engagement with a shared vision towards PCMH change engaged leadership training and support and structures and processes required to provide team-based, data driven care. Barriers to implementation included change fatigue, challenges of continued engaged leadership and insufficient time to implement PCMH change. Our study examined the experiences of implementing PCMH initiatives in an Australian general practice setting, describing facilitators and barriers to PCMH change. Our findings provide guidance for PHNs and practices within Australia, as well as general practice settings internationally, that are interested in undertaking similar quality improvement projects.
Publisher: The Royal Australian College of General Practitioners
Date: 09-2023
Publisher: No publisher found
Publisher: No publisher found
Publisher: No publisher found
DOI: 10.1111/AJR.12289}
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/PY16017
Abstract: Despite more nurses working in Australian general practice, there has been limited investigation exploring ways that general practitioners and registered nurses work together to deliver clinical care. However, it has been postulated that the small business structure, common in Australian general practices, might influence collaboration between these two groups of health professionals. This paper presents one theme from a larger qualitative study. Eight general practitioners and fourteen registered nurses working in general practice participated in semistructured face-to-face interviews between February and May 2015. Naturalistic inquiry was adopted to elicit and explore the narrative accounts of participants about working together in general practice. An inductive process of thematic analysis was used to identify, analyse and report patterns and themes. Ancillary costs associated with the employment of registered nurses in general practice and the time registered nurses took to undertake procedural services were a concern for general practitioners. Registered nurses did not always work to their full scope of practice and many felt that their expertise was not appropriately remunerated. Findings suggested that fee for service-funding models can negatively influence collaboration between general practitioners and registered nurses working in general practice.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/PY13024
Abstract: General practice training is a community of practice in which novices and experts share knowledge. However, there are barriers to knowledge sharing for general practioner (GP) registrars, including geographic and workplace isolation. Virtual communities of practice (VCoP) can be effective in overcoming these barriers using social media tools. The present study examined the perceived usefulness, features and barriers to implementing a VCoP for GP training. Following a survey study of GP registrars and supervisors on VCoP feasibility, a qualitative telephone interview study was undertaken within a regional training provider. Participants with the highest Internet usage in the survey study were selected. Two researchers worked independently conducting thematic analysis using manual coding of transcriptions, later discussing themes until agreement was reached. Seven GP registrars and three GP supervisors participated in the study (average age 38.2 years). Themes emerged regarding professional isolation, potential of social media tools to provide peer support and improve knowledge sharing, and barriers to usage, including time, access and skills. Frequent Internet-using GP registrars and supervisors perceive a VCoP for GP training as a useful tool to overcome professional isolation through improved knowledge sharing. Given that professional isolation can lead to decreased rural work and reduced hours, a successful VCoP may have a positive outcome on the rural medical workforce.
Publisher: Hindawi Limited
Date: 24-03-2021
DOI: 10.1111/HSC.13352
Publisher: Wiley
Date: 03-03-2015
DOI: 10.1111/JAN.12647
Abstract: To identify facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general (family) practice. Internationally, a shortage of doctors entering and remaining in general practice and an increasing burden of chronic disease has ersified the nurse's role in this setting. Despite a well-established general practice nursing workforce, little attention has been paid to the ways doctors and nurses collaborate in this setting. Integrative literature review. CINAHL, Scopus, Web of Life, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews and Trove (dissertation and theses) were searched for papers published between 2000 and May 2014. This review was informed by the approach of Whittemore and Knafl (2005). All included papers were assessed for methodological quality. Findings were extracted, critically examined and grouped into themes. Eleven papers met the inclusion criteria. Thematic analysis revealed three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities (2) respect, trust and communication and (3) hierarchy, education and liability. This integrative review has provided insight into issues around role definition, communication and organizational constraints which influence the way nurses and general practitioners collaborate in a team environment. Future research should investigate in more detail the ways doctors and nurses work together in general practice and the impact of collaboration on nursing leadership and staff retention.
Publisher: Elsevier BV
Date: 08-2020
Publisher: No publisher found
Publisher: MDPI AG
Date: 15-10-2019
Abstract: This study examined the association between neighbourhood socioeconomic disadvantage and serious mental illness (SMI)–type 2 diabetes (T2D) comorbidity in an Australian population using routinely collected clinical data. We hypothesised that neighbourhood socioeconomic disadvantage is positively associated with T2D comorbidity in SMI. The analysis considered 3816 in iduals with an SMI living in the Illawarra and Shoalhaven regions of NSW, Australia, between 2010 and 2017. Multilevel logistic regression models accounting for suburb (neighbourhood) level clustering were used to assess the association between neighbourhood disadvantage and SMI -T2D comorbidity. Models were adjusted for age, sex, and country of birth. Compared with the most advantaged neighbourhoods, residents in the most disadvantaged neighbourhoods had 3.2 times greater odds of having SMI–T2D comorbidity even after controlling for confounding factors (OR 3.20, 95% CI 1.42–7.20). The analysis also revealed significant geographic variation in the distribution of SMI -T2D comorbidity in our s le (Median Odds Ratio = 1.35) Neighbourhood socioeconomic disadvantage accounted for approximately 17.3% of this geographic variation. These findings indicate a potentially important role for geographically targeted initiatives designed to enhance prevention and management of SMI–T2D comorbidity in disadvantaged communities.
Publisher: Wiley
Date: 05-11-2019
DOI: 10.1111/AJR.12526
Abstract: Increased exposure to post-graduate rural medical training is associated with increased likelihood of future rural practice. Training rotations in rural emergency departments provide a possible avenue for such exposure, but have been under-investigated. This study aimed to compare junior medical officers' emergency department experiences in a metropolitan and a rural hospital to inform rural health workforce initiatives. Mixed-method case-study design. Two 10-week periods in the respective emergency departments. Four junior medical officers at the rural site and 22 junior medical officers at the metropolitan hospital. Caseloads extracted from electronic medical records and training experience. Data were collected over 142 days. The average number of patients seen per day, per junior medical officer, was significantly higher at the rural hospital emergency department (7.2 patients per day) in comparison with the metropolitan hospital (4.3 patients per day). Junior medical officers at the rural hospital saw relatively more lower acuity patients. The seven junior medical officers who were interviewed provided consistently positive responses regarding their training experiences in both locations. This was particularly evident in the rural hospital and was attributed to one-on-one supervision. Most junior medical officers agreed that their expectations for support and learning opportunities were met and/or exceeded. However, junior medical officers reported feeling more supported at the rural hospital due to direct contact and communication with senior medical officers. Placement in a smaller hospital emergency department did not disadvantage the junior medical officers' training in this case-study and provided a positive rural training experience. These findings support workforce policies which encourage rural hospital emergency department training.
Publisher: Springer Science and Business Media LLC
Date: 19-08-2019
Publisher: Wiley
Date: 27-03-2017
DOI: 10.1111/JOCN.13598
Abstract: To explore the nature of collaboration between registered nurses and general practitioners in Australian general practice. There is international recognition that collaboration between health professionals can improve care coordination, enhance health outcomes, optimise the work environment and reduce healthcare costs. However, effective collaboration requires a clear understanding of each team member's role. A qualitative approach guided by Naturalistic Inquiry was used to elicit and interpret participant narratives. Eight general practitioners and fourteen registered nurses working in general practice were purposefully recruited. Data were collected via in idual, semi-structured face-to-face interviews during February to May 2015. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Data revealed three overarching themes. This study presents the data for the overarching theme 'Understanding the general practice registered nurse's role'. Many general practitioner participants lacked clarity around the role and scope of practice of the registered nurse. At the same time, nursing participants often articulated their role as an assistant rather than as an independent health professional. This limited collaboration and the nurses' role within the team. Collaboration was enhanced when general practitioners actively sought an understanding of the registered nurses scope of practice. Clarifying the nurses' role promotes collaboration and supports nurses to work to the full extent of their practice. This is important in terms of optimising the nurses' role within the team and reinforcing their professional identity. Identification of key issues around understanding the nurses' role may help inform strategies that improve collaboration and workplace relations.
Publisher: Springer Science and Business Media LLC
Date: 21-08-2012
Publisher: AMPCo
Date: 20-05-2021
DOI: 10.5694/MJA2.51093
Publisher: No publisher found
DOI: 10.1071/PY14099}
Publisher: Research Square Platform LLC
Date: 29-03-2021
DOI: 10.21203/RS.3.RS-55427/V1
Abstract: Background: There is international interest in whether improved primary care can lead to a more rational use of health resources and whether the use of a national digital health record system by primary health care professionals can help achieve this goal. This trial (CHIME-GP) will investigate whether a multifaceted education intervention in an Australian general practice setting on the use of a national digital health record system leads to reductions in health-service utilisation and costs. Methods: The trial will be undertaken in Australian general practices. The aim of the research is to evaluate the effectiveness of a web-based educational intervention for general practitioners, regarding use of a national digital health record system, My Health Record (MHR), and rational use of medicines, pathology and imaging. Our target is to recruit 120 general practitioners from urban and regional regions across Australia. We will use a mixed methods approach incorporating a three-arm pragmatic cluster randomised parallel trial and a prospective qualitative inquiry. The effect of the intervention in each arm will be assessed, using the other two arms as controls. The evaluation will synthesise the results embedding qualitative pre ost interviews in the quantitative results to investigate implementation of the intervention, clinical behaviour change and mechanisms such as attitudes, that may influence change. The primary outcome will be an economic analysis of the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the six months following the intervention compared with six months prior to the intervention. Secondary outcome measures include the rates per 100 consultations of selected prescriptions, pathology and radiology test ordering six months pre and post intervention and comparison of knowledge assessment tests pre and post intervention. Discussion: The trial will produce robust health economic analyses on the evidence on educational intervention in reducing unnecessary prescribing, pathology and imaging ordering, and in improving the use of MHR. In addition, the study will contribute to the evidence-base concerning the implementation of interventions to improve the quality of care in primary care practice. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12620000010998. Registered on 09 January 2020.www.ANZCTR.org.au/ACTRN12620000010998.aspx
Publisher: The Royal Australian College of General Practitioners
Date: 02-2022
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/PY14099
Abstract: There are many aspects of the communities of practice (CoP) framework that are applicable to the development of a practice-based research network (PBRN), where the focus is upon building primary health-care workers’ research capacity and research questions. However, there is limited literature focussed on the application of CoP principles applied to research capacity building in Australia. The purpose of this paper is to demonstrate, through a case study, how a developing PBRN, the Illawarra and Southern Practice Research Network, successfully applied the theoretical foundation of CoP to develop a PBRN in a time- and resource-limited context.
Publisher: No publisher found
DOI: 10.1111/JAN.12647}
Publisher: SAGE Publications
Date: 03-10-2018
Abstract: Electronic medical records are increasingly used for research with limited external validation of their data. This study investigates the validity of electronic medical data (EMD) for estimating diabetes prevalence in general practitioner (GP) patients by comparing EMD with national Bettering the Evaluation and Care of Health (BEACH) data. A “decision tree” was created using inclusion/exclusion of pre-agreed variables to determine the probability of diabetes in absence of diagnostic label, including diagnoses (coded/free-text diabetes, polycystic ovarian syndrome, impaired glucose tolerance, impaired fasting glucose), diabetic annual cycle of care (DACC), glycated haemoglobin (HbA1c) 6.5%, and prescription (metformin, other diabetes medications). Via SQL query, cases were identified in EMD of five Illawarra and Southern Practice Network practices (30,007 active patients from 2 years to January 2015). Patient-based Supplementary Analysis of Nominated Data (SAND) sub-studies from BEACH investigating diabetes prevalence (1172 GPs 35,162 patients November 2012 to February 2015) were comparison data. SAND results were adjusted for number of GP encounters per year, per patient, and then age–sex standardised to match age–sex distribution of EMD patients. Cluster-adjusted 95% confidence intervals (CIs) were calculated for both datasets. EMD diabetes prevalence (T1 and/or T2) was 6.5% (95% CI: 4.1–8.9). Following age–sex standardisation, SAND prevalence, not significantly different, was 6.7% (95% CI: 6.3–7.1). Extracting only coded diagnosis missed 13.0% of probable cases, subsequently identified through the presence of metformin/other diabetes medications (*without other indicator variables) (6.1%), free-text diabetes label (3.8%), HbA1c result* (1.6%), DACC* (1.3%), and diabetes medications* (0.2%). While complex, proxy variables can improve usefulness of EMD for research. Without their consideration, EMD results should be interpreted with caution. Enforceable, transparent data linkages in EMRs would resolve many problems with identification of diagnoses. Ongoing data quality improvement remains essential.
Publisher: Springer Science and Business Media LLC
Date: 28-08-2021
DOI: 10.1186/S13063-021-05438-8
Abstract: There is an international interest in whether improved primary care can lead to a more rational use of health resources. There is evidence that educational interventions can lead to improvements in the quality of rational prescribing and test ordering. A new national platform for shared medical records in Australia, My Health Record (MHR), poses new opportunities and challenges for system-wide implementation. This trial (CHIME-GP) will investigate whether components of a multifaceted education intervention in an Australian general practice setting on rational prescribing and investigation ordering leads to reductions in health-service utilisation and costs in the context of the use of a national digital health record system. The trial will be undertaken in Australian general practices. The aim of the research is to evaluate the effectiveness of components of a web-based educational intervention for general practitioners, regarding rational use of medicines, pathology and imaging in the context of the use of the MHR system. Our target is to recruit 120 general practitioners from urban and regional regions across Australia. We will use a mixed methods approach incorporating a three-arm pragmatic cluster randomised parallel trial and a prospective qualitative inquiry. The effect of each education component in each arm will be assessed, using the other two arms as controls. The evaluation will synthesise the results embedding qualitative pre ost interviews in the quantitative results to investigate implementation of the intervention, clinical behaviour change and mechanisms such as attitudes, that may influence change. The primary outcome will be an economic analysis of the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the 6 months following the intervention compared with 6 months prior to the intervention. Secondary outcome measures include the rates per 100 consultations of selected prescriptions, pathology and radiology test ordering 6 months pre- and post-intervention, and comparison of knowledge assessment tests pre- and post-intervention. The trial will produce robust health economic analyses on the evidence on educational intervention in reducing unnecessary prescribing, pathology and imaging ordering, in the context of MHR. In addition, the study will contribute to the evidence-base concerning the implementation of interventions to improve the quality of care in primary care practice. ClinicalTrials.gov ACTRN12620000010998 . Registered on 09 January 2020 with the Australian New Zealand Clinical Trials Registry
Publisher: Wiley
Date: 19-10-2023
DOI: 10.1111/AJR.13053
Publisher: Informa UK Limited
Date: 22-05-2017
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/PY12101
Abstract: The ageing population and increasing prevalence of chronic illness have contributed to the need for significant primary care reform, including increased use of multidisciplinary care and task substitution. This cross-sectional study explores conditions under which older patients would accept having health professionals other than their general practitioner (GP) involved in their care for chronic disease management (CDM). Ten practices were randomly s led from a contiguous major city and inner regional area. Questionnaires were distributed to consecutive patients aged 60 years and over in each practice. Agency theory was used to inform analyses. Statistical analysis was undertaken using Wald’s test, growth modelling and linear regression, controlling for the clustered design. The response rate was 53% (n = 272). Most respondents (79%) had at least one chronic health condition. Respondents were more comfortable with GP than with practice nurse management in the CDM scenario (Wald’s test = 105.49, P 0.001). Comfort with practice nurse CDM was positively associated with increased contact with their GP at the time of the visit (β = 0.41, P 0.001), negatively associated with the number of the respondent’s chronic conditions (β = –0.13, P = 0.030) and not associated with the frequency of other health professional visits. Agency theory suggests that patients employ continuity of care to optimise factors important in CDM: information symmetry and goal alignment. Our findings are consistent with the theory and lend support to ensuring that interpersonal continuity of care is not lost in health care reform. Further research exploring patients’ acceptance of differing systems of care is required.
Publisher: Elsevier BV
Date: 05-2023
Publisher: SERDI
Date: 2016
Abstract: Background: Older patients’ views regarding undergoing nutrition screening within General Practice settings have not been evaluated to date. Objectives: To identify perceptions of older patients related to their experiences of having a nutrition screening process performed using the Mini Nutritional Assessment Short Form (MNA-SF®), accompanied by a clinical care pathway. Methods: Patients aged ≥75 years were invited to attend repeat screening between 6 months and one year following a first screening (n=143). Patients who were identified to be malnourished or at risk at baseline (n=44) were invited to participate in an in idual interview to identify their perceptions of the MNA-SF® and the applicability of a nutrition resource kit that had been provided to them. Results: Nutritional status improved in the group identified to be malnourished/at risk at baseline (p= 0.01). Interviews indicated that the MNA-SF® process was well-received but that patients did not perceive themselves as being in need of nutrition support. Conclusion: This study demonstrates that introduction of routine nutrition screening of older patients attending General Practice can feasibly be implemented using the MNA-SF® and is acceptable to patients. It is recommended that this model of care be adopted in order to improve early identification of nutritional risk and facilitate referral to appropriate services.
Publisher: Wiley
Date: 09-2016
DOI: 10.1111/NEP.12887
Publisher: MDPI AG
Date: 18-09-2019
Abstract: General practice electronic health record (EHR) data have significant potential for clinical research. This study demonstrates the feasibility of utilising longitudinal EHR data analysis to address clinically relevant outcomes and uses the relationship between lipid medication prescription and all-cause mortality in the elderly as an exemplar for the validity of this methodology. EHR data were analysed to describe the association of lipid medication use, non-use or cessation with all-cause mortality in patients aged ≥75 years. Survival analysis with Cox regression was used to calculate hazard ratios, which were adjusted for confounders. There was no significant difference in all-cause mortality among patients according to their use, non-use, or cessation of lipid medications. The outcomes of this study correlate well with the results of other research works. This single-practice study demonstrates the feasibility and potential of analysing EHR data to address important clinical issues such as the relationship between all-cause mortality and lipid medication prescription in the elderly.
Publisher: Research Square Platform LLC
Date: 25-02-2020
Abstract: Background With an ageing population and an increase in chronic disease burden in Australia, Patient Centred Medical Home (PCMH) models of care have been identified as potential options for primary care reform and improving health care outcomes. Adoption of PCMH models are not well described outside of North America. We examined the experiences of seven general practices in an Australian setting that implemented projects aligned with PCMH values and goals supported by their local Primary Health Network (PHN). Method Qualitative and quantitative data were collected over a twelve month period, including semi-structured interviews, participant observation, and practice data to present a detailed examination of a subject of study the implementation of PCMH projects in seven general practices. We conducted 49 interviews with general practitioners, practice managers, practice nurses and PHN staff. Framework analysis deploying the domains of a logic model was used to synthesis and analyse the data. Findings Facilitators in implementing successful, sustainable change included the capacity and willingness of practices to undertake change whole of practice engagement with a shared vision towards PCMH change engaged leadership training and support and structures and processes required to provide team-based, data driven care. Barriers to implementation included change fatigue, challenges of continued engaged leadership and insufficient time to implement PCMH change. Conclusion Our study examined the experiences of implementing PCMH initiatives in Australian general practice setting, describing facilitators and barriers to PCMH change. Our findings provide guidance for PHNs and practices within Australia, as well as general practice settings internationally, that are interested in undertaking similar quality improvement projects.
Publisher: Public Library of Science (PLoS)
Date: 28-08-2015
Publisher: SAGE Publications
Date: 09-01-2017
Abstract: An emerging body of research involves observational studies in which survival analysis is applied to data obtained from primary care electronic health records (EHRs). This systematic review of these studies examined the utility of using this approach. An electronic literature search of the Scopus, PubMed, Web of Science, CINAHL, and Cochrane databases was conducted. Search terms and exclusion criteria were chosen to select studies where survival analysis was applied to the data extracted wholly from EHRs used in primary care medical practice. A total of 46 studies that met the inclusion criteria for the systematic review were examined. All were published within the past decade (2005–2014) with a majority ( n = 26, 57%) being published between 2012 and 2014. Even though citation rates varied from nil to 628, over half ( n = 27, 59%) of the studies were cited 10 times or more. The median number of subjects was 18,042 with five studies including over 1,000,000 patients. Of the included studies, 35 (76%) were published in specialty journals and 11 (24%) in general medical journals. The many conditions studied largely corresponded well with conditions important to general practice. Survival analysis applied to primary care electronic medical data is a research approach that has been frequently used in recent times. The utility of this approach was demonstrated by the ability to produce research with large numbers of subjects, across a wide range of conditions and with the potential of a high impact. Importantly, primary care data were thus available to inform primary care practice.
Publisher: American Academy of Family Physicians
Date: 2023
Publisher: JMIR Publications Inc.
Date: 07-01-2015
DOI: 10.2196/RESPROT.3613
Publisher: Wiley
Date: 18-04-2016
DOI: 10.1111/AJR.12289
Publisher: SAGE Publications
Date: 12-10-2016
Abstract: Electronic medical data (EMD) from electronic health records of general practice computer systems have enormous research potential, yet many variables are unreliable. The aim of this study was to compare selected data variables from general practice EMD with a reliable, representative national dataset (Bettering the Evaluation and Care of Health (BEACH)) in order to validate their use for primary care research. EMD variables were compared with encounter data from the nationally representative BEACH program using χ 2 tests and robust 95% confidence intervals to test their validity (measure what they reportedly measure). The variables focused on for this study were patient age, sex, smoking status and medications prescribed at the visit. The EMD s le from six general practices in the Illawarra region of New South Wales, Australia, yielded data on 196,515 patient encounters. Details of 90,553 encounters were recorded in the 2013 BEACH dataset from 924 general practitioners. No significant differences in patient age ( p = 0.36) or sex ( p = 0.39) were found. EMD had a lower rate of current smokers and higher average scripts per visit, but similar prescribing distribution patterns. Validating EMD variables offers avenues for improving primary care delivery and measuring outcomes of care to inform clinical practice and health policy.
Publisher: No publisher found
Publisher: CSIRO Publishing
Date: 06-06-2023
DOI: 10.1071/PY23013
Publisher: The Royal Australian College of General Practitioners
Date: 03-2020
Publisher: Public Library of Science (PLoS)
Date: 10-2019
Publisher: Research Square Platform LLC
Date: 07-2022
DOI: 10.21203/RS.3.RS-1760829/V1
Abstract: Objective(s): To identify if gender and parenting factors are associated with burnout in Australian general practice (GP) registrars. Design: Cross sectional study. The main outcome measure was the Maslach Burnout Inventory, included as part of the GPRA (General Practice Registrars Australia) biannual online survey.Participants: GP registrars, 2019 cohort, undertaking fellowship training in Australia Results: In 2019 a total of 366 GP registrars completed the online survey. Over 75% of registrars experienced moderate to high levels of burnout (emotional exhaustion scale). Several demographic factors were associated with an increased risk for reporting higher levels of burnout. Increasing age was associated with lower levels of personal accomplishment (P-value .01), being female was associated with higher levels of emotional exhaustion (p-value .001) and increasing numbers of children were associated with lower levels of burnout, independent of hours worked (p-value .001). Conclusion : This study suggests that being a parent is associated with a reduced risk of burnout, irrespective of hours worked. However, being female and increased age were associated with increased levels of burnout. With increasing numbers of females entering medical training, and the decreasing desirability of general practice training, this paper examines the complexities around parenting during training and associations with burnout. There is a need to examine this interaction further to understand the causation for these findings, and to ensure appropriate policies, opportunities and workplace supports are developed to ensure GP training is optimised to attract and support the next generation.
Publisher: BMJ
Date: 10-2023
Publisher: Public Library of Science (PLoS)
Date: 05-12-2019
Publisher: No publisher found
Publisher: Medknow
Date: 2014
Publisher: AMPCo
Date: 31-08-2020
DOI: 10.5694/MJA2.50747
Publisher: Oxford University Press (OUP)
Date: 08-03-2017
Abstract: An increased incidence of chronic and complex conditions in the community is placing pressure on human resources in general practice. Improving collaboration between GPs and registered nurses may help alleviate workforce stressors and enhance health outcomes. To explore the facilitators and challenges of collaboration between GPs and registered nurses in Australian general practice. Eight GPs and 14 registered nurses from general practices in New South Wales, Australia, participated in semi-structured face-to-face interviews. Recordings were transcribed verbatim and underwent thematic analysis. The overarching theme 'Understanding collaboration in general practice' comprises four sub-themes, namely (i) interpreting collaboration in general practice, (ii) modes of communication, (iii) facilitators of collaboration and (iv) collaboration in practice. Our findings suggest that regular, formal avenues of communication, professional development and non-hierarchical environments facilitated collaboration between nurses and GPs. Implementing strategies to promote these features has the potential to improve inter-professional collaboration and quality of care within primary care.
Publisher: No publisher found
DOI: 10.1111/JOCN.13598}
Publisher: No publisher found
Publisher: No publisher found
DOI: 10.1071/PY12101}
Publisher: Springer Science and Business Media LLC
Date: 08-01-2019
Publisher: Elsevier BV
Date: 04-2017
Abstract: To investigate consumers' knowledge about commonly purchased over-the-counter (OTC) products containing ibuprofen. Customers buying two popular OTC ibuprofen-containing products (Nurofen The survey was completed by 262 respondents, most of whom were older than 50 years of age female well-educated with adequate functional health literacy. The majority correctly identified ibuprofen as an active ingredient and knew the correct intervals between doses. However, almost a third couldn't correctly identify the maximum daily dose and were unaware of some contraindications. Furthermore, fewer than half recognised potential side effects. Those who hadn't completed high school were significantly less likely to seek medical advice (when required) and significantly less likely to know when it was safe to take these products. The gaps in consumer knowledge, especially about the maximum daily dose, contraindications and potential side effects may be placing consumers at risk of experiencing ibuprofen-related adverse events. Implications for public health: Improving consumer knowledge to address these gaps in their understanding about the safe use of popular OTC ibuprofen-containing products is an important public health concern.
Publisher: No publisher found
Publisher: Informa UK Limited
Date: 05-2012
DOI: 10.1080/14739879.2012.11494102
Abstract: The training of future general practitioners (GPs) in the management of older and chronically ill patients is assuming increasing significance with population ageing. Such training, however, may be h ered by the reluctance of older patients to consult GP trainees for chronic problem care. This paper reports on a cross-sectional study investigating the attitudes of older patients to GP trainees, to inform strategies to improve older patient-trainee interaction. The primary hypothesis tested was that older patients' acceptance of trainees for their chronic disease management would be improved by strengthening the relational link with their regular GP around trainee consultations. The survey instrument was distributed to 1900 patients aged 60 and over from 38 training practices in five Australian states using a stratified, randomised cluster s ling process. Generalised estimating equation models were used to undertake logistic regression for analysis. The response rate was 47.9% (n=911). Eighty-three percent were happy to see a trainee for a minor problem. Of respondents with a chronic/complex condition, 25.4% were comfortable with independent trainee chronic/complex care, increasing to 77.9% if their usual GP was called in to double-check management. Modelling confirmed increased likelihood of comfort with trainee chronic/complex care with involvement of the regular GP (P<0.001). Strong agreement that their regular doctor was happy for them to see a trainee was associated with frequency of trainee visits (P=0.002) satisfaction with trainee consultations (P<0.001) and comfort in independent trainee chronic/complex care (P<0.001). There is the potential to develop models of trainee chronic/complex care that maintain older patient satisfaction and retain the favourable patient outcomes associated with interpersonal continuity. Strengthening interpersonal continuity of care with the patient's usual GP around trainee consultations, and open communication regarding having trainees involved in their care, appear key to such models. Further research involving prospective trials is required.
Publisher: SAGE Publications
Date: 2018
Abstract: Aim of the Study: This review aims to systematically synthesize the body of literature examining the association between neighborhood socioeconomic disadvantage and serious mental illness (SMI)–type 2 diabetes (T2D) co-occurrence. Methods: We conducted an electronic search of four databases: PubMed, Scopus, Medline, and Web of Science. Studies were considered eligible if they were published in English, peer reviewed, quantitative, and focused on the association between neighborhood disadvantage and SMI-T2D comorbidity. Study conduct and reporting complied with PRISMA guidelines, and the protocol is made available at PROSPERO (CRD42017083483). Results: The one eligible study identified reported a higher burden of T2D in persons with SMI but provided only a tentative support for the association between neighborhood disadvantage and SMI-T2D co-occurrence. Conclusion: Research into neighborhood effects on SMI-T2D comorbidity is still in its infancy and the available evidence inconclusive. This points to an urgent need for attention to the knowledge gap in this important area of public health. Further research is needed to understand the health resource implications of the association between neighborhood deprivation and SMI-T2D comorbidity and the casual pathways linking them.
Publisher: The Royal Australian College of General Practitioners
Date: 07-2019
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/14739879.2009.11493812
Abstract: With the population ageing, it is imperative for training practices to provide general practice registrars (GPRs) with sound experience in managing the health problems of older persons, especially chronic conditions. However, it is reported that a significant proportion of these patients will be resistant to consulting registrars, with concerns regarding disruption of continuity of care being a significant factor. The challenge for training practices is to identify approaches to engage registrars in the management of older patients whilst maintaining patient satisfaction. This paper presents a review of the literature on patient attitudes to GPRs to better understand the nature and magnitude of the challenge, and to identify important research gaps. Major electronic medical literature databases were searched for relevant articles using search terms including general practice, registrar, doctor-patient relationship, patient attitudes and elderly, for the period from January 1980 to March 2009. The studies were analysed by methodology, content and theme. A total of 15 studies were identified that directly addressed patients' attitudes to GPRs. Whilst there appeared to be an overall high acceptance of registrars by patients, increasing patient age was associated with more negative attitudes towards registrars, reduced trust and decreased satisfaction with communication. Presentations for chronic or emotional problems were associated with reduced willingness to consult registrars. Patients generally appreciated an ongoing involvement with their usual GP. These findings have implications for training practices and research directions. Demonstrating continuity of care through shared chronic disease management between supervisors and registrars is a possible model that meets registrars' training and patients' continuity needs. There is a need for quality research on the type and magnitude of problems affecting GPR encounters with older patients and, based on results from these studies, to create and assess models of registrar training involving older patients, that meet patients' needs for continuity of care.
Publisher: SAGE Publications
Date: 2020
Abstract: Aim: The aim of this study was to examine the association between neighborhood characteristics and type 2 diabetes (T2D) comorbidity in serious mental illness (SMI). We investigated associations of neighborhood-level crime, accessibility to health care services, availability of green spaces, neighborhood obesity, and fast food availability with SMI-T2D comorbidity. Method: A series of multilevel logistic regression models accounting for neighborhood-level clustering were used to examine the associations between 5 neighborhood variables and SMI-T2D comorbidity, sequentially adjusting for in idual-level variables and neighborhood-level socioeconomic disadvantage. Results: In iduals with SMI residing in areas with higher crime rates per 1000 population had 2.5 times increased odds of reporting T2D comorbidity compared to the in iduals with SMI residing in lower crime rate areas after controlling for in idual and areal level factors (95% CI 0.91-6.74). There was no evidence of association between SMI-T2D comorbidity and other neighborhood variables investigated. Conclusion: Public health strategies to reduce SMI-T2D comorbidity might benefit by targeting on in iduals with SMI living in high-crime neighborhoods. Future research incorporating longitudinal designs and/or mediation analysis are warranted to fully elucidate the mechanisms of association between neighborhoods and SMI-T2D comorbidity.
Publisher: RCN Publishing Ltd.
Date: 23-01-2017
Abstract: Background Before beginning any research project, novice researchers must consider which methodological approach will best address their research questions. The paucity of literature describing a practical application of naturalistic inquiry adds to the difficulty they may experience. Aim To provide a practical ex le of how naturalistic inquiry was applied to a qualitative study exploring collaboration between registered nurses and general practitioners working in Australian general practice. Discussion Naturalistic inquiry is not without its critics and limitations. However, by applying the axioms and operational characteristics of naturalistic inquiry, the authors captured a detailed 'snapshot' of collaboration in general practice in the time and context that it occurred. Conclusion Using qualitative methods, naturalistic inquiry provides the scope to construct a comprehensive and contextual understanding of a phenomenon. No in idual positivist paradigm could provide the level of detail achieved in a naturalistic inquiry. Implications for practice This paper presents a practical ex le of naturalistic inquiry for the novice researcher. It shows that naturalistic inquiry is appropriate when the researcher seeks a rich and contextual understanding of a phenomenon as it exists in its natural setting.
Publisher: CSIRO Publishing
Date: 14-09-2022
DOI: 10.1071/AH20322
Abstract: Objective This study reviewed the maternity leave policies in Australian general practice speciality training and compared them to hospital-based speciality training policies. Methods Nine general practice regional training organisations’ maternity leave policies were audited and compared to 11 Australian hospital speciality training maternity leave policies. Data pertaining to each component of Cheung’s health policy analysis tool were reviewed. Results Across all specialities there was a lack of evidence-informed policy design and evidence-based goal setting. Compared with other specialities, general practice was the only speciality where trainees did not receive paid maternity leave. Conclusions This study highlights the need to improve maternity leave policies in line with evidence and best practice for both general practice and hospital-based speciality registrars. What is known about the topic? There is an increasing number of females graduating from medical degrees and planning parenting and speciality medical training simultaneously. The balance of these two roles is dependent on the policies and protocols of the training providers, who need to ensure that parenting and a medical career are compatible. What does this paper add? This paper reports on the findings of an audit of the current maternity leave policies for general practice and hospital-based medical registrar trainees in Australia. It identifies key areas within the policies that need to be addressed. What are the implications for practitioners? This paper identifies that all policies lack evidence of being evidence based in their design. This audit has demonstrated that most policies do not meet the World Health Organization’s recommendations for maternity leave. Specifically, general practice trainees are the only doctors who do not have a policy that requires paid maternity leave. However, as the training of general practice registrars moves towards being undertaken by the Royal Australian College of General Practitioners, there is an opportunity for a review of this policy so that it becomes aligned with other Australian medical registrar training policies.
Publisher: Hindawi Limited
Date: 26-02-2018
DOI: 10.1111/HSC.12561
Abstract: Demographic trends suggest that the sustainability of the general practitioner (GP) Residential Aged Care Facility (RACF) workforce, worldwide and in Australia, is under threat, compromising the ongoing care of chronically ill RACF residents. It is therefore important to ascertain current GP attitudes towards this work, to better understand and hypothesise means of reversing this trend. To this end, during 2014 the views of 26 GPs and GP Registrars working in rural and regional New South Wales, Australia, were captured during focus group discussions and one-on-one interviews. Analysis of the qualitative date revealed that GP attitudes towards RACF visiting fell into five key themes: pleasure, duty, remuneration and logistics, hesitation, and frustration. The data also revealed that the overriding emotion GPs felt about RACF visitation was frustration with the avoidable delays and inefficiencies associated with the work. Despite the pleasure GPs derived from their work in RACFs and their sense of obligation to be involved, their hesitation and frustration was compounded by the work's perceived poor remuneration. This research suggests that the barriers to GP participation in RACF visiting were managerial rather than attitudinal, and that a strategic focus upon improving administrative and logistical support is needed.
Publisher: Springer Science and Business Media LLC
Date: 20-01-2023
DOI: 10.1186/S12909-023-04043-4
Abstract: To identify if gender and parenting factors are associated with burnout in Australian general practice (GP) registrars. Cross sectional study. The main outcome measure was the Maslach Burnout Inventory, included as part of the GPRA (General Practice Registrars Australia) biannual online survey. Participants: GP registrars, 2019 cohort, undertaking fellowship training in Australia. In 2019 a total of 366 GP registrars completed the online survey. Over 75% of registrars experienced moderate to high levels of burnout (emotional exhaustion scale). Several demographic factors were associated with an increased risk for reporting higher levels of burnout. Increasing age was associated with lower levels of personal accomplishment ( P -value 0.01), being female was associated with higher levels of emotional exhaustion ( p -value 0.001) and increasing numbers of children were associated with lower levels of burnout, independent of hours worked ( p -value 0.001). This study suggests that being a parent is associated with a reduced risk of burnout, irrespective of hours worked. However, being female and increased age were associated with increased levels of burnout. With increasing numbers of females entering medical training, and the decreasing desirability of general practice training, this paper reviews the complexities around parenting during training and associations with burnout. There is a need to examine this interaction further to understand the causation for these findings, and to ensure appropriate policies, opportunities and workplace supports are developed to ensure GP training is optimised to attract and support the next generation.
Publisher: The Royal Australian College of General Practitioners
Date: 08-2018
Publisher: No publisher found
DOI: 10.1111/AJAG.12364}
Publisher: No publisher found
Publisher: No publisher found
Publisher: JMIR Publications Inc.
Date: 08-02-2016
DOI: 10.2196/JMIR.4510
Publisher: Wiley
Date: 05-2014
Publisher: No publisher found
DOI: 10.2196/JMIR.2555}
Publisher: Springer Science and Business Media LLC
Date: 29-07-2019
Publisher: No publisher found
DOI: 10.1111/HSC.12561}
Publisher: MDPI AG
Date: 16-06-2020
Abstract: Background: Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. Methods: Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for in idual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. Results: Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91–0.96) and obesity (OR 0.91, CI 0.88–0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4–1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. Conclusion: The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and in idual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.
Publisher: No publisher found
DOI: 10.2196/JMIR.4510}
Publisher: Springer Science and Business Media LLC
Date: 11-02-2015
DOI: 10.1007/S10916-015-0224-4
Abstract: With the advancement in technology and availability of the Internet, online health education could become one of the media for health education. As health education is to persuade patients on health behavioural change, understanding perceived benefits of online health education is an important aspect to explore. The aim of this study is to explore consumers and health professionals opinion on online health education. Literature review was conducted and identified the benefits of online health education (OHE). Survey was conducted to health consumers and health professionals. Descriptive analyses were performed using SPSS Version 19.0. The analysis of the literature has identified a set of 12 potential benefits of OHE which had been used to understand the perceptions of the effectiveness of OPE sites and these have been validated in the study. This study has the practical implication as the study identified OHE effectiveness, which definitely can assist health practitioners on health education, which can lead to better health outcome.
Publisher: The Royal Australian College of General Practitioners
Date: 2019
Publisher: Cambridge University Press (CUP)
Date: 29-01-2015
DOI: 10.1017/S1463423614000589
Abstract: Develop and pilot test evidence-based resources for general practice training practices to enhance older patients’ (65+ years) interactions with General Practice Registrars (GPRs). In Australia, general practice trainees, referred to as GPRs, see fewer older patients and patients with chronic conditions than doctors who have completed their specialist GP training. This reduces learning opportunities for GPRs in the management of these important patient groups. Therefore, developing effective strategies to improve GPR–older patient interaction is critical to primary care training, to meet the current and future needs of an ageing population. Adopting a social marketing approach, GPR practice resources were developed to address knowledge and attitudinal barriers at the practice and patient level to improve older patient comfort, and willingness to engage, with GPR care. Two focus groups with older patients ( n =18) and interviews with staff of training practices ( n =12) were utilised to pre-test resources. Amended resources were pilot tested and evaluated in a naturalistic GPR training practice setting using a structured patient questionnaire ( n =44). Pilot evaluation suggests improved comfort and willingness of older patients to interact with GPRs. In all, 54% of survey participants indicated they would be more likely to make an appointment with a Registrar in the future as a result of exposure to the resources. In all, 40% of patients would feel comfortable having a GPR manage a complex or chronic condition, which compares favourably with 28% of similarly aged patients in previous research. The use of tailored, engaging and informative GPR resources for older patients and practice staff may be an important contributor to addressing the growing problem of ensuring GPRs are adequately engaged in treating older patients. The adoption of a social marketing framework was instrumental in enhancing the acceptance and effectiveness of this intervention.
Publisher: No publisher found
DOI: 10.1071/PY16017}
No related grants have been discovered for Andrew Bonney.