ORCID Profile
0000-0003-0510-5314
Current Organisation
University of Melbourne
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Publisher: MDPI AG
Date: 06-03-2023
Abstract: This paper outlines practical tips for inclusive healthcare practice and service delivery, covering ersity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association’s ersity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on ersity in all its forms, and (l) build in idual and institutional commitments. The twelve tips are applicable across many aspects of ersity, providing a practical guide for all healthcare workers (HCWs) and students to improve practices. These tips guide healthcare facilities and HCWs in improving patient-centered care, especially for those who are often overlooked in mainstream service provision.
Publisher: Wiley
Date: 25-09-2021
DOI: 10.1111/AJR.12788
Abstract: There is a long‐standing undersupply of nursing and allied health professionals in rural Australia. Rural, mature‐aged people form an untapped section of rural communities that could help to address these workforce needs. There is little understanding of the supports required to assist rural, mature‐aged nursing and allied health students to complete their studies and enter the rural health workforce. To scope factors influencing rural, mature‐aged nursing and allied health students’ ability to access, participate, and succeed in higher education. A scoping review of the international rural nursing and allied health and education literature was undertaken. Five databases (CINAHL Complete, MEDLINE, Education Resources Information Center [ERIC], Embase, and Education Research Complete), key peer‐reviewed journals, and Australian grey literature were searched. Fourteen articles were included in the review. Ten studies described rural, mature‐aged nursing and allied health student characteristics, 6 described barriers to students participating and succeeding in higher education, and 4 described student supports. This review found limited evidence to guide higher education providers in attracting, supporting and retaining rural, mature‐aged nursing and allied health students. In particular, evidence of student supports is required beyond those manifested by students themselves or their family, to include offerings from university and government sources. Substantially more research attention is needed to understand the experiences of rural, mature‐aged nursing and allied health students, and supports required for this cohort to access, participate and successfully complete higher education.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Wiley
Date: 08-08-2023
DOI: 10.1111/AJR.12914
Abstract: To estimate the prevalence of atrial fibrillation (AF) in regional Victoria at two time points (2001–2003 and 2016–2018), and to assess the use of electrocardiogram rhythm strips in a rural, community‐based study for AF investigation. Repeated cross‐sectional design involving survey of residents of randomly selected households and a clinic. Predictors of AF were assessed using Firth penalised logistic regression, as appropriate for rare events. Goulburn Valley, Victoria. Household residents aged ≥16 years. Non‐pregnant participants aged 18+ were eligible for the clinic. Atrial fibrillation by 12 lead electrocardiogram (earlier study) or electrocardiogram rhythm strip (AliveCor® device) (recent study). The age standardised prevalence of AF was similar between the two studies (1.6% in the 2001–2003 study and 1.8% in the 2016–2018 study, 95% confidence interval of difference −0.010, 0.014, p = 0.375). The prevalence in participants aged ≥65 years was 3.4% (1.0% new cases) in the recent study. Predictors of AF in the earlier study were male sex, older age and previous stroke, while in the recent study they were previous stroke and self‐reported diabetes. AliveCor® traces were successfully classified by the in‐built algorithm (91%) vs physician (100%). The prevalence of AF among community‐based participants in regional Victoria was similar to predominantly metropolitan‐based studies, and was unchanged over time despite increased rates of risk factors. Electrocardiogram rhythm strip investigation was successfully utilised, and particularly benefited from physician overview.
Publisher: Research Square Platform LLC
Date: 09-09-2020
DOI: 10.21203/RS.3.RS-54114/V1
Abstract: Background Potentially avoidable hospitalisations are a proxy measure of effective primary care at a population level. Hospitalisations for the chronic health conditions of diabetes, congestive cardiac failure and chronic obstructive pulmonary disease account for half of the potentially avoidable hospitalisations for chronic diseases. These hospitalisations are higher in rural areas and socioeconomically disadvantaged areas. Scarce qualitative research has focussed on the identification of factors associated with potentially avoidable hospitalisation from the perspectives of health professionals or patients. This study sought to identify factors associated with potentially avoidable hospitalisations in a rural context from the perspectives of patients and health professionals. Methods Patients with chronic obstructive pulmonary disease, congestive cardiac failure or type 2 diabetes, admitted to a rural hospital in Australia, and health professionals involved in the care of patients with these conditions, were invited to participate in interviews between September and October 2019. Conversations were recorded, transcribed verbatim and analysed using thematic analysis. Results Nine patients and 16 health professionals participated in semi-structured interviews. Five themes were identified (representing factors associated with potentially avoidable hospitalisation) namely General Practitioner involvement, in idual patient factors, the influence of the rural locality, medication awareness and health service access. Within these themes, inter-related subthemes emerged including sub-optimal disease management plans, barriers to accessing general practice, poor mental health, patients living alone, healthcare costs, sub-optimal communication and poor connectivity between patients and beneficial services. Conclusion Factors associated with potentially avoidable hospitalisation in this rural area were complex and inter-related. These factors encompassed health service access and disease management, as well as socioeconomic disadvantage. Results suggest that improved indicators of access to effective health services, including primary care, are necessary to address potentially avoidable hospitalisation.
Publisher: Springer Science and Business Media LLC
Date: 24-05-2020
DOI: 10.1186/S12889-020-08912-1
Abstract: People living in rural and remote communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. The aim of this paper was to describe the characteristics and outcomes of studies investigating innovative models of care for people living with chronic disease in rural areas of developed countries where a metropolitan comparator was included. An integrative systematic review was undertaken. P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses (PRISMA) method was used to understand the empirical and theoretical data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom. Literature searching revealed 620 articles published in English between 1st January 2000 and 31st March 2019. One hundred sixty were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease 27% (43) diabetes mellitus 8% (12) chronic obstructive pulmonary disease and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations. This integrated review reveals that the published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease.
Publisher: Springer Science and Business Media LLC
Date: 02-01-2021
DOI: 10.1186/S12875-020-01341-4
Abstract: Most people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care, including older people and people living with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice, or none. A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate in the adult survey. Most people had attended a single general practice (78.9%), while 14.4% attended more than one practice and 6.7% attended no practices in the previous 12 months. Compared with utilisation of a single general practice, multiple general practice attendance in the previous year was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97–0.99), residence in the regional centre aOR 2.90(2.22–3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22–2.21) and no out of pocket costs aOR 1.36(1.04–1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p 0.001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p = 0.006) than single practice attendees. Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
Publisher: Springer Science and Business Media LLC
Date: 30-05-2018
Publisher: Research Square Platform LLC
Date: 03-12-2019
Abstract: Background People living in rural and remote communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. This review aims to describe the state of knowledge regarding innovative models of care and clinical outcomes for people living with chronic disease in rural areas in developed countries where a metropolitan comparator is included. Methods An integrative systematic review was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to understand data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom Results Literature searching revealed 620 articles published in English between 1st January 2000 and 31st March 2019. 160 were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease 27% (43) diabetes mellitus 8% (12) chronic obstructive pulmonary disease and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations. Conclusions This integrated review reveals that the published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease.
Publisher: Research Square Platform LLC
Date: 10-07-2020
DOI: 10.21203/RS.3.RS-38624/V1
Abstract: Background: Most Australians visit a General Practitioner annually and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care such as older people or those with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year. Methods: A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16 + were eligible to participate. Results: Compared with utilisation of a single general practice, multiple general practice attendance in the past year (14.3%) was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97–0.99), residence in the regional centre aOR 2.90(2.22–3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22–2.21) and no out of pocket costs aOR 1.36(1.04–1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p 0.001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p = 0.006) than single practice attendees. Conclusions: Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
Publisher: Research Square Platform LLC
Date: 16-03-2020
Abstract: Background People living in rural communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. This review aims to describe the state of knowledge regarding innovative models of care and clinical outcomes for people living with chronic disease in rural areas in developed countries where a metropolitan comparator is included. Methods An integrative systematic review was undertaken. P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses (PRISMA) method was used to understand data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom Results Literature searching revealed 620 articles published in English between 2000 and 2019. 160 were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease 27% (43) diabetes mellitus 8% (12) chronic obstructive pulmonary disease and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations. Conclusions This integrated review reveals published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease.
Publisher: Portico
Date: 06-2022
Publisher: MDPI AG
Date: 12-06-2023
DOI: 10.3390/HEALTHCARE11121721
Abstract: It is unclear how well self-rated oral health (SROH) reflects actual oral health status in the rural Australian population. Therefore, this study aimed to compare the clinically assessed oral health status and SROH of adults living in rural Australia. The data were from 574 participants who took part in the Crossroads II cross-sectional study. Three trained and calibrated dentists evaluated the oral health status of participants based on WHO criteria. SROH was assessed with the question ‘Overall, how would you rate the health of your teeth and gums?’, with a score ranging from excellent = 5 to poor = 1. A logistic regression analysis (LRA) was performed, allowing us to assess factors associated with SROH. The mean age of participants was 59.2 years (SD 16.3), and 55.3% were female. The key results from the LRA show poorer SROH in those with more missing teeth (OR = 1.05 95% CI 1.01–1.08), more decayed teeth (OR = 1.28 95% CI: 1.11–1.46), and more significant clinical attachment loss of periodontal tissue (6mm or more) (OR = 2.63 95% CI: 1.29–5.38). This study found an association between negative SROH and clinical indicators used to measure poor oral health status, suggesting that self-rated oral health is an indicator of oral health status. When planning dental healthcare programs, self-reported oral health should be considered a proxy measure for oral health status.
Publisher: Research Square Platform LLC
Date: 11-12-2020
DOI: 10.21203/RS.3.RS-38624/V4
Abstract: Background: Most Australians visit a General Practitioner annually and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care such as older people or those with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year. Methods: A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate. Results: Compared with utilisation of a single general practice, multiple general practice attendance in the past year (14.3%) was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97-0.99), residence in the regional centre aOR 2.90(2.22-3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22-2.21) and no out of pocket costs aOR 1.36(1.04-1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p .001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p=0.006) than single practice attendees. Conclusions: Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
Publisher: Research Square Platform LLC
Date: 29-10-2020
DOI: 10.21203/RS.3.RS-38624/V3
Abstract: Background: Most Australians visit a General Practitioner annually and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which canaBackground:Most people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care, including older people and people living with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice, or none. Methods: A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate in the adult survey. Results: Most people had attended a single general practice (78.9%), while 14.4% attended more than one practice and 6.7% attended no practices in the previous 12 months. Compared with utilisation of a single general practice, multiple general practice attendance in the previous year was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97-0.99), residence in the regional centre aOR 2.90(2.22-3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22-2.21) and no out of pocket costs aOR 1.36(1.04-1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p .001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p=0.006) than single practice attendees. Conclusions: Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall. reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care such as older people or those with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year. Methods A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate. Results Compared with utilisation of a single general practice, multiple general practice attendance in the past year (14.3%) was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97-0.99), residence in the regional centre aOR 2.90(2.22-3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22-2.21) and no out of pocket costs aOR 1.36(1.04-1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p .001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p=0.006) than single practice attendees. Conclusions Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
Publisher: JMIR Publications Inc.
Date: 15-12-2020
Abstract: he COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. he objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. he Joanna Briggs Institute’s scoping review methodology guided the review of the literature. he search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. ncluded programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers.
Publisher: Research Square Platform LLC
Date: 21-09-2020
DOI: 10.21203/RS.3.RS-38624/V2
Abstract: Background: Most people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care such as older people or those with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice or none.Methods: A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate in the adult survey.Results: Most people had attended a single general practice (78.9%), while 14.4% attended more than one practice and 6.7% attended no practices in the previous 12 months. Compared with utilisation of a single general practice, multiple general practice attendance in the previous year was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97-0.99), residence in the regional centre aOR 2.90(2.22-3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22-2.21) and no out of pocket costs aOR 1.36(1.04-1.79)). Reasons for multiple general practice attendance were reported as availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p .001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p=0.006) than single practice attendees.Conclusions: Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
Publisher: MDPI AG
Date: 28-10-2022
DOI: 10.3390/NU14214557
Abstract: This study examined the changes in the prevalence of obesity and associated lifestyle factors using data from repeated cross-sectional, self-reported surveys (Crossroads I: 2001–2003 and Crossroads II: 2016–2018, studies) and clinic anthropometric measurements collected from regional and rural towns in the Goulburn Valley, Victoria. Given that past community studies have only focused categorically on dietary intake, or assessed caloric energy intake, we examined the difference in broad dietary practices at two different times. Clinical assessments from randomly selected household participants aged ≥18 years were analyzed. Differences in obesity prevalence were calculated for each in idual variable. Logistic regression was used to determine the odds ratios (95% confidence intervals (CI)) with and without adjustment for key lifestyle factors. There were 5258 participants in Crossroads I and 2649 in Crossroads II surveys. Obesity prevalence increased from 28.2% to 30.8% over 15 years, more among those who ate fried food, but decreased significantly among rural dwellers (31.7: 27.0, 36.8% versus 25.1: 22.9, 27.5%) and those who had adequate fruit intake (28.5: 25.0, 32.3% to 23.9: 21.8, 26.2%). Obesity was associated with older age (≥35 years), use of fat-based spreads for bread (adjusted odds ratio, aOR:1.26: 1.07, 1.48) and physical inactivity. The increase in obesity prevalence especially in the rural towns, was associated with unhealthy dietary behaviour which persisted over 15 years. Understanding and addressing the upstream determinants of dietary intake and choices would assist in the development of future health promotion Programs.
Publisher: MDPI AG
Date: 02-06-2021
Abstract: Background: Complex, ongoing social factors have led to a context where metabolic syndrome (MetS) is disproportionately high in Aboriginal Australians. MetS is characterised by insulin resistance, abdominal obesity, hypertension, hypertriglyceridemia, high blood-sugar and low HDL-C. This descriptive study aimed to document physical activity levels, including domains and intensity and sedentary behaviour, and MetS risk factors in the Perth Aboriginal (predominately Noongar) community. Methods: The Global Physical Activity Questionnaire (GPAQ), together with a questionnaire on self-reported MetS risk factors, was circulated to community members for completion during 2014 (n = 129). Results: Data were analysed using chi-squared tests. The average (SD) age was 37.8 years (14) and BMI of 31.4 (8.2) kg/m2. Occupational, transport-related and leisure-time physical activity (PA) and sedentary intensities were reported across age categories. The median (interquartile range) daily sedentary time was 200 (78, 435), 240 (120, 420) and 180 (60, 300) minutes for the 18–25, 26–44 and 45+ year-olds, respectively (p = 0.973). Conclusions: An in-depth understanding of the types, frequencies and intensities of PA reported for the Perth Aboriginal community is important to implementing targeted strategies to reduce the prevalence of chronic disease in this context. Future efforts collaborating with community should aim to reduce the risk factors associated with MetS and improve quality of life.
Publisher: Springer Science and Business Media LLC
Date: 19-05-2022
DOI: 10.1186/S12909-022-03406-7
Abstract: Research capacity building (RCB) initiatives have gained steady momentum in health settings across the globe to reduce the gap between research evidence and health practice and policy. RCB strategies are typically multidimensional, comprising several initiatives targeted at different levels within health organisations. Research education and training is a mainstay strategy targeted at the in idual level and yet, the evidence for research education in health settings is unclear. This review scopes the literature on research education programs for nurses and allied health professionals, delivered and evaluated in healthcare settings in high-income countries. The review was conducted systematically in accordance with the Joanna Briggs Institute scoping review methodology. Eleven academic databases and numerous grey literature platforms were searched. Data were extracted from the included full texts in accordance with the aims of the scoping review. A narrative approach was used to synthesise findings. Program characteristics, approaches to program evaluation and the outcomes reported were extracted and summarised. Database searches for peer-reviewed and grey literature yielded 12,457 unique records. Following abstract and title screening, 207 full texts were reviewed. Of these, 60 records were included. Nine additional records were identified on forward and backward citation searching for the included records, resulting in a total of 69 papers describing 68 research education programs. Research education programs were implemented in fourteen different high-income countries over five decades. Programs were multifaceted, often encompassed experiential learning, with half including a mentoring component. Outcome measures largely reflected lower levels of Barr and colleagues’ modified Kirkpatrick educational outcomes typology (e.g., satisfaction, improved research knowledge and confidence), with few evaluated objectively using traditional research milestones (e.g., protocol completion, manuscript preparation, poster, conference presentation). Few programs were evaluated using organisational and practice outcomes. Overall, evaluation methods were poorly described. Research education remains a key strategy to build research capacity for nurses and allied health professionals working in healthcare settings. Evaluation of research education programs needs to be rigorous and, although targeted at the in idual, must consider longer-term and broader organisation-level outcomes and impacts. Examining this is critical to improving clinician-led health research and the translation of research into clinical practice.
Publisher: JMIR Publications Inc.
Date: 09-03-2022
DOI: 10.2196/26515
Abstract: The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. The Joanna Briggs Institute’s scoping review methodology guided the review of the literature. The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers.
Publisher: Wiley
Date: 21-02-2022
DOI: 10.1111/AJR.12852
Abstract: To determine the contextual factors influencing research and research capacity building in rural health settings. Qualitative study using semi‐structured telephone interviews to collect data regarding health professionals’ research education and capacity building. Analysis involved inductive coding using Braun and Clark’s thematic analysis and deductive mapping to the Consolidated Framework for Implementation Research (CFIR). Victorian rural health services and university c uses. Twenty senior rural health managers, academics and/or research coordinators. Participants had at least three years’ experience in rural public health, health‐related research or health education settings. Contextual factors influencing the operationalisation and prioritisation of research capacity building in rural health services. Findings reflected the CFIR domains and constructs: intervention characteristics (relative advantage) outer setting (cosmopolitanism, external policies and incentives) inner setting (implementation climate, readiness for implementation) characteristics of in iduals (self‐efficacy) and process (planning, engaging). Findings illustrated the implementation context and the complex contextual tensions, which either prevent or enhance research capacity building in rural health services. Realising the Australian Government’s vision for improved health service provision and health outcomes in rural areas requires a strong culture of research and research capacity building in rural health services. Low levels of rural research funding, chronic workforce shortages and the tension between undertaking research and delivering health care, all significantly impact the operationalisation and prioritisation of research capacity building in rural health services. Effective policy and investment addressing these contextual factors is crucial for the success of research capacity building in rural health services.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2022
DOI: 10.1057/S41285-022-00181-9
Abstract: Access to healthcare and health seeking behaviours of rural people often hinge on the existing relationships between healthcare providers and (prospective) healthcare users. However, rich micro-level health professional-healthcare user relationships and the unique relational context of rural settings are largely missing from dominant rural healthcare access conceptual frameworks. We argue rural healthcare access conceptualisations require revisiting from a relational perspective to ensure future healthcare access policy accounts for the relational nature of healthcare in rural contexts. Ethics of care is a moral theory informed by feminism which rejects liberal in idualist notions and emphasises interdependence. We used Held’s ethics of care characteristics to examine Russell and colleagues’ healthcare access framework and dimensions for rural and remote populations. This process revealed Held’s ethics of care characteristics are only somewhat evident across Russell et al.’s dimensions: most evident in the acceptability and accommodation dimensions, and most absent in the availability and affordability dimensions. Future rural healthcare access frameworks need to pay further attention to the relational aspects of rural healthcare, particularly around the availability and affordability of healthcare, to bolster future efforts to improve healthcare access for rural people.
Publisher: Wiley
Date: 25-10-2019
DOI: 10.1111/AJR.12565
Abstract: High-quality data regarding the prevalence of chronic disease in rural areas are essential in understanding the challenges faced by rural populations and for informing strategies to address health care needs. This study compared the prevalence of a range of self-reported chronic conditions and utilisation of GP services and emergency department in a regional Victorian setting between two studies conducted in the same region in 2001-2003 and 2014. Repeat cross-sectional studies conducted over a decade apart. The projects were conducted in the Goulburn Valley in regional Victoria. The earlier study randomly selected households from local government lists. The later study randomly selected householders from the telephone directory. Participants were asked whether they had been diagnosed with a range of chronic health conditions and how often they had visited a general practitioner or emergency department in the past 12 months. The age-standardised prevalence of depression was higher in the 2014 study than the 2001-2003 study in men (increased by 8.0% (95% CI 4.5, 11.5%)) and women (increased by 13.7% (95% CI 8.4, 19.0%)). Similarly, the prevalence of age-standardised diabetes and hypertension was higher in 2014 than 2001-2003 (men increased by 3.6% (95% CI 0.7, 6.5% (diabetes)) and 13.6% (95% CI 8.6, 18.6% (hypertension)), women increased by 3.1% (95% CI 0.3, 6.5% (diabetes)) and 8.4% (95% CI 2.3, 14.5% (hypertension))). The results of this study indicate that the prevalence of self-reported depression, diabetes and hypertension has increased in this regional Victorian area over the past 13 years. The reasons for these observed increases and the subsequent impact on the health care needs of regional communities warrants further investigation.
No related grants have been discovered for Kristen Glenister.