Australian Primary Health Care Research Articles

Transforming health care delivery: The role of primary health care nurses in rural and remote Australia.

This paper describes the policy context and approaches taken to improve access to primary health care in Australia by supporting nurses to deliver improved integrated care meeting community needs. In Primary Health Care (PHC), the nursing workforce are predominantly employed in the general practice sector. Despite evidence that nurse-led models of care can bridge traditional treatment silos in the provision of specialised and coordinated care, PHC nurses' scope of practice varies dramatically. Nurse-led models of care are imperative for rural and remote populations that experience workforce shortages and barriers to accessing health care. Existing barriers include policy constraints, limited organisational structures, education and financing models. The Australian Primary Health Care Nurses Association (APNA) received funding to implement nurse-led clinics as demonstration projects. The clinics enable PHC nurses to work to their full scope of practice, improve continuity of care and increase access to health care in under serviced locations. We reviewed a range of peer-reviewed literature, policy documents, grey literature and APNA provided sources, particularly those relevant to rural and remote populations. We argue more focus is needed on how to address variations in the scope of practice of the rural and remote PHC nursing workforce. Despite growing evidence for the effectiveness of nurse-led models of care, significant policy and financial barriers continue to inhibit PHC nurses working to their full scope of practice. If their potential to transform health care and increase access to health services is to be realised these barriers must be addressed.

Are remote health clinics primary health care focused? Validation of the Primary Health Care Engagement (PHCE) Scale for the Australian remote primary health care setting.

To test and validate a measure of primary health care (PHC) engagement in the Australian remote health context. PHC principles include quality improvement, community participation and orientation of health care, patient-centred continuity of care, accessibility, and interdisciplinary collaboration. Measuring the alignment of services with the principles of PHC provides a method of evaluating the quality of care in community settings. A two-stage design of initial content and face validity evaluation by a panel of experts and then pilot-testing the instrument via survey methods was conducted. Twelve experts from clinical, education, management and research roles within the remote health setting evaluated each item in the original instrument. Panel members evaluated the representativeness and clarity of each item for face and content validity. Qualitative responses were also collected and included suggestions for changes to item wording. The modified tool was pilot-tested with 47 remote area nurses. Internal consistency reliability of the Australian Primary Health Care Engagement scale was evaluated using Cronbach's alpha. Construct validity of the Australian scale was evaluated using exploratory factor analysis and principal component analysis. Modifications to suit the Australian context were made to 8 of the 28 original items. This modified instrument was pilot-tested with 47 complete responses. Overall, the scale showed high internal consistency reliability. The subscale constructs 'Quality improvement', 'Accessibility-availability' and 'population orientation' showed low levels of internal consistency reliability. However, the mean inter-item correlation was 0.31, 0.26 and 0.31, respectively, which are in the recommended range of 0.15 to 0.50 and indicate that the items are correlated and are measuring the same construct. The Australian PHCE scale is recommended as a tool for the evaluation of health services. Further testing on a larger sample may provide clarity over some items which may be open to interpretation.

Delphi Plus: A novel methodology for identifying evidence-based data standards for health service decision-making.

The underlying tenet of evidence-based decision-making in health services is assessing all the relevant evidence. Using the traditional qualitative and quantitative approaches to identifying evidence may not capture the full spectrum of factors that need to be addressed. A selective mixed-method approach may provide a comprehensive assessment of the relevant knowledge. This paper adds to the methodological literature by outlining a novel sequential, mixed-method, exploratory process for identifying evidence-based data standards that may be used for health service decision-making. The three-phase process, entitled Delphi Plus, engages peer-nominated topic-specific experts to assess all publicly available and practice-based items and, through a series of reviews, reach an evidence-based consensus on standards for decision-making. Each process phase is outlined in-depth and supplemented by practical learnings gained through its implementation. The Delphi Plus methodology provides the first comprehensive process for combining the published and practised data to develop evidence-based data standards. The routine use of Delphi Plus would provide a framework for benchmarking in health services, enabling greater monitoring and evaluation of client outcomes and improving quality care. This manuscript describes the process of implementing Delphi Plus and provides an example of data standards generated from its use, which directly inform the Australian Government's Primary Health Care 10 Year Plan.

General practitioners’ perspectives regarding early developmental surveillance for autism within the australian primary healthcare setting: a qualitative study

BackgroundSignificant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics.MethodsA qualitative research methodology with semi-structured interviews and thematic inductive analysis underpinned by grounded theory was utilised. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program (“GP Surveillance for Autism”) were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software. Inductive interpretive approach was adopted and data were analysed thematically.ResultsTwenty-three GPs across the two sites (NSW: n = 11; Victoria: n = 12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded eight major themes and highlighted common enablers such as the role of GPs in early identification and subsequent supports, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental disabilities, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services.ConclusionsThe study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental disabilities, including autism.

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis.

Australia has achieved universal health insurance for its population since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, including inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key characteristics of good PC. We searched PubMed, Embase, Scopus and Web of Science using key terms related to PHC principles, attributes, system functioning and health care delivery modalities. We also used key PC terminologies used to assess key characteristics of good PC developed by WHO and key terms and attributes from Australia's health care landscape. We then integrated our search terms with the PHC Search Filters developed by Brown, L., et al. (2014). We restricted the search from 2013 to 2021. Two authors independently assessed study eligibility and performed a quality check on the extracted data. We presented findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified 112 articles on primary health care (PHC), represented from all Australian states and territories. Overall, Australian PHC has achieved comprehensiveness, access and coverage, quality of care, patient / person centeredness and service coordination indicators with exemplary evidence-base practice/knowledge translation and clinical decision-making practices at the PC settings. Yet, we identified complex and multilayered barriers including geographic and socio-economic berries and inequality, staff dissatisfaction/turn over, low adoption of person-centred care, inadequate sectoral collaboration, and inadequate infrastructure in rural and remote primary care units. Primary health care in Australia, which has evolved through major reforms, has been adapting to the complex health care needs of the socio-culturally diversified nation, and has achieved many of the PC attributes, including service diversity, accessibility, acceptability, and quality of care. Yet, there are persistent gaps in service delivery to socio-economically disadvantaged populations, including indigenous people, culturally and linguistically diverse (CALD) populations, and rural- and remote-residents. These challenges could be mitigated through system-wide and targeted policy-level intervention to further improve service delivery through effective and functional local health service coordination, sectoral integration, and improving health care providers' cultural competence.

Exploring nurse practitioner practice in Australian rural primary health care settings: A scoping review.

Australians in rural areas experience limited access to services and poorer health outcomes than residents of metropolitan areas. Nurse practitioners (NPs) were introduced in 2000 to reduce pressure on the health system, address workforce shortages and improve rural populations' access to health care services. This scoping review sought to identify, examine and synthesise research evidence of NP practice in Australian rural primary health care services to better understand how NPs are addressing service gaps in rural areas and to identify existing gaps in our knowledge. Peer-reviewed and grey literature from July 2012 to June 2022 was accessed from seven electronic databases, grey literature and hand searching of reference lists and citations. From 154 articles, 19 articles of relevance were identified. Several projects describe the processes required for success, whilst others reported the challenges and barriers encountered. Limited research evidence of rural NP practice exists with a significant gap about how roles operate and their value in primary health care. Uptake and envisaged benefits of rural primary health care NP roles have yet to be realised, with barriers to implementing and sustaining NP roles persisting. Low-level awareness with ambiguity at health service and community level adversely impact on systematic implementation of NP roles. Robust evaluations demonstrating the value of NP skills and practice are needed in combination with bipartisan support from all levels of health care and government providing adequate funding to enable effective implementation of NP roles in poorly resourced rural areas.

A snapshot of Australian primary health care nursing workforce characteristics and reasons they work in these settings: A longitudinal retrospective study.

This article aimed to provide a snapshot of demographics and professional characteristics of nursing and midwifery workforce in Australian primary health care (PHC) settings during 2015-2019 and factors that influenced their decisions to work in PHC. Longitudinal retrospective survey. Longitudinal data that were collected from a descriptive workforce survey were retrieved retrospectively. After collation and cleaning, data from 7066 participants were analysed using descriptive and inferential statistics in SPSS version 27.0. The majority of the participants were female, aged between 45 and 64 years old and working in general practice. There was a small yet steady increase in the number of participants in the 25-34 age group and a downward trend in the percentage of postgraduate study completion among participants. While factors perceived most/least important to their decision to work in PHC were consistent during 2015-2019, these factors differed among different age groups and postgraduate qualification holders. This study's findings are both novel and supported by previous research. It is necessary to tailor recruitment and retention strategies to nurses/midwives' age groups and qualifications to attract and retain highly skilled and qualified nursing and midwifery workforce in PHC settings.

Corrigendum to “Approaches to Delivering Appropriate Care to Engage and Meet the Complex Needs of Refugee and Asylum Seekers in Australian Primary Healthcare: A Qualitative Study”

Corrigendum to “Approaches to Delivering Appropriate Care to Engage and Meet the Complex Needs of Refugee and Asylum Seekers in Australian Primary Healthcare: A Qualitative Study”

Experiences of Primary Healthcare Workers in Australia towards Women and Girls Living with Female Genital Mutilation/Cutting (FGM/C): A Qualitative Study.

Female genital mutilation/cutting (FGM/C) is a harmful cultural practice with significant health consequences for affected women and girls. Due to migration and human mobility, an increasing number of women with FGM/C are presenting to healthcare facilities of western countries (including Australia) where the practice is non-prevalent. Despite this increase in presentation, the experiences of primary healthcare providers in Australia engaging and caring for women/girls with FGM/C are yet to be explored. The aim of this research was to report on the Australian primary healthcare providers' experiences of caring for women living with FGM/C. A qualitative interpretative phenomenological approach was utilised and convenience sampling was used to recruit 19 participants. Australian primary healthcare providers were engaged in face-to-face or telephone interviews, which were transcribed verbatim and thematically analysed. Three major themes emerged, which were: exploring knowledge of FGM/C and training needs, understanding participants' experience of caring for women living with FGM/C, and mapping the best practice in working with women. The study shows that primary healthcare professionals had basic knowledge of FGM/C with little or no experience with the management, support, and care of affected women in Australia. This impacted their attitude and confidence to promote, protect, and restore the target population's overall FGM/C-related health and wellbeing issues. Hence, this study highlights the importance of primary healthcare practitioners being skilled and well-equipped with information and knowledge to care for girls and women living with FGM/C in Australia.

Telehealth's future in Australian primary health care: a qualitative study exploring lessons learnt from the COVID-19 pandemic.

During the COVID-19 pandemic, telehealth emerged as a means of safely providing primary healthcare (PHC) consultations. In Australia, changes to telehealth funding led to the reconsideration of the role of telehealth in the ongoing provision of PHC services. To investigate GPs', registered nurses' (RNs), nurse practitioners' (NPs), and allied health (AH) clinicians perceptions of the sustainability of telehealth in PHC post-pandemic. Semi-structured interviews were undertaken with 33 purposively selected clinicians, including GPs (n = 13), RNs (n = 5), NPs (n = 9), and AH clinicians (n = 6) working in PHC settings across Australia. Participants were drawn from responders to a national survey of PHC providers (n = 217). The thematic analysis approach reported by Braun and Clarke was used to analyse the interview data. Data analysis revealed that the perception of providers was represented by the following two themes: lessons learnt; and the sustainability of telehealth. Lessons learnt included the need for rapid adaptation to telehealth, use of technology, and the pandemic being a catalyst for long-term change. The sustainability of telehealth in PHC comprised four subthemes around challenges: the funding model, maintaining patient and provider safety, hybrid service models, and access to support. Providers required resilience and flexibility to adapt to telehealth. Funding models must reward providers from an outcome focus, rather than placing limits on telehealth's use. Hybrid approaches to service delivery will best meet the needs of the community but must be accompanied by support and education for PHC professionals.

Telehealth use in Australian primary healthcare during COVID-19: a cross-sectional descriptive survey

ObjectiveThis study aimed to investigate Australian primary healthcare professionals’ experiences of the rapid upscaling of telehealth during COVID-19.DesignA cross-sectional survey.Participants and settingTwo hundred and seventeen general practitioners, nurses and allied...

Network evaluation of an innovation platform in continuous quality improvement in Australian Indigenous primary healthcare

BackgroundFrom 2014 to 2019, the Centre for Research Excellence in Integrated Quality Improvement (CRE-IQI) was evaluated as an innovation platform focusing on continuous quality improvement in Indigenous Australian primary healthcare. Although social network analysis (SNA) is a recognized method for evaluating the functioning, collaboration and effectiveness of innovation platforms, applied research is limited. This study applies SNA to evaluate the CRE-IQI’s functioning as an innovation platform.MethodsTwo surveys (2017, 2019) were conducted using social survey and network methods. Survey items covered respondent characteristics, their perceptions of the CRE-IQI’s performance, and its impact and sociometric relationships. Members’ relationship information was captured for the CRE-IQI at three time points, namely start (retrospectively), midpoint and final year, on three network types (knew, shared information, collaborated). SNA software was used to compute standard network metrics including diameter, density and centrality, and to develop visualizations. Survey and network results were addressed in a workshop held by members to develop improvement strategies.ResultsThe response rate was 80% in 2017 and 65% in 2019 (n = 49 and 47, respectively). Between 2017 and 2019, respondents’ mean ratings of the CRE-IQI’s functioning and achievements in meeting its goals were sustained. They perceived the CRE-IQI as multidisciplinary, having effective management and governance, and incorporating Indigenous research leadership, representation and ways of working. Respondents recognized high levels of trust amongst members, rated “good communication and coordination with participants” highly, and “facilitating collaboration” as the CRE’s most strongly recognized achievement. In collaboration and information-sharing networks, average path length remained low in 2017 and 2019, indicating good small-world network properties for relaying information. On average, respondents shared information and collaborated with more CRE members in 2017 than 2019. However, in both 2017 and 2019 there were new collaborations and information-sharing outside of direct collaborations. CRE-IQI outcomes included: evidence generation; knowledge transfer and skills development in quality improvement; research capacity-building, career development; mentoring; grant support; development of new projects; health service support; and policy impact.ConclusionsThis study shows the utility of network analysis in evaluating the functioning, and collaboration, at the individual, organizational and health system levels, of an innovation platform, and adds to our understanding of factors enabling successful innovation platforms.

Approaches to delivering appropriate care to engage and meet the complex needs of refugee and asylum seekers in Australian primary healthcare: A qualitative study.

This study aimed to provide insight and learnings from Australian general practitioners in facilitating positive interactions with refugee and asylum seeker patients and the role they play in helping those community members engage with healthcare. We conducted semi-structured individual remote interviews with 12 general practitioners (GPs) who worked in areas with high refugee and migrant populations. Interview transcripts were coded inductively and deductively, based on the research questions, using Thematic Analysis. Extensive debriefing and discussion took place within the research team throughout data collection and analysis. Creating a culturally safe environment was an initial step taken by GPs to minimise the inherent power imbalance, in addition to applying the principles of trauma-informed care (TIC) to appropriately listen and respond to their patients' needs and individual social circumstances. GPs at times were involved in using their role to advocate on behalf of their patient and played a key role in helping build their patients' health systems literacy. This study highlights the important role that GPs play in advocating and engaging refugee and asylum seeker patients, as well as helping them navigate the healthcare system. Whilst GPs practice can be made more efficient through experience and time; to deliver the care required GPs need to provide care in response to the individual's capacity and social circumstances. Enabling time and the application of the principles of TIC and cultural safety may allow for GPs to provide the quality of care that is needed in supporting patients from refugee and asylum seeker backgrounds.

Evaluation of the Brief Coping Orientation to Problems Experienced scale and exploration of coping among primary health care nurses during COVID-19.

AimTo explore primary health care nurses’ coping strategies and evaluate the psychometric properties of the Brief COPE scale.BackgroundPrimary health care nurses are experiencing significant COVID‐19‐related psychological impacts. Beyond understanding the impacts, there is a need to explore coping strategies.MethodsThis online cross‐sectional survey was completed by 359 Australian primary health care nurses between October and December 2020.ResultsFactor analysis revealed seven factors (support, disengagement and venting, humour, positive reframing, acceptance, substance use, and spiritual/religious beliefs)(Cronbach’s alpha >0.69). There was an association between age, years of nursing and years of primary health care nursing and the factors of ‘support’, ‘disengagement and venting’ and ‘positive reframing’. Years of experience were also associated with the factor ‘humour’. Urban respondents had higher scores for the ‘support’ factor.ConclusionsThe Brief COPE scale is a valid and reliable tool for assessing primary health care nurses' coping. As demographic characteristics impact the coping strategies that nurses use, supports need to be tailored to optimise their impact.Implications for nursing managementNurse managers need to consider the workforce demographics when designing and implementing support strategies. The Brief COPE can identify current coping strategies and inform interventions to build coping capacity.

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

Diet, Fertility and the Australian Primary Health Care Setting — A Review

Background: The relationship between diet and fertility continues to emerge, yet interventions underutilise this evidence within Australian primary health care (PHC). Infertility affects approximately 9% of the world’s population and 16% of Australian couples trying to conceive naturally. Current PHC practices do not address nor encourage improved diet for sperm and oocyte quality, ovulation and sperm production. Due to a lack of resources and training, general practitioners typically refer these individuals to fertility clinics for medical management. As a result, Australia ranks as the 6th highest global utiliser of assisted reproductive technology, with annual costs to treat infertility exceeding $46,000,000. Aim: To synthesise current evidence for the diet-fertility relationship and identify suitable PHC interventions for improving fertility related lifestyle risk factors. Method: A database search for published peer reviewed articles using MEDLINE, Scopus, Google Scholar, PubMed and Global Health was carried out, and narratively synthesised. Results: Poor diet, central adiposity and unhealthy weight are modifiable risk factors impacting fertility, and common amongst the Australian adult population. There are opportunities to address these risk factors by modifying existing lifestyle modification programs to improve the overall fertility profile of this demographic within PHC. Conclusion: It is possible to optimise fertility through lifestyle interventions that encompass dietary modification. Health and fertility treatment costs can potentially be improved if changes to diet and lifestyle are consistently addressed as first line management for infertility within PHC for appropriate individuals. Understanding evidence for interventions have importuning implications for policy and practice. Further work needs to describe how fertility lifestyle interventions can successfully translate into PHC practice.

Contribution of socio-economic factors in the spread of antimicrobial resistant infections in Australian primary healthcare clinics

ObjectivesTo effectively contain antimicrobial-resistant (AMR) infections, we must better understand the social determinates of health that contribute to transmission and spread of infections. MethodsWe used clinical data from patients attending primary healthcare clinics across three jurisdictions of Australia (2007–2019). Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) isolates and their corresponding antibiotic susceptibilities were included. Using multivariable logistic regression analysis, we assessed associations between AMR prevalence and indices of social disadvantage as reported by the Australian Bureau of Statistics (i.e., remoteness, socio-economic disadvantage and average person per household). ResultsThis study reports 12 years of longitudinal data from 43 448 isolates from a high-burden low-resource setting in Australia. Access to health and social services (as measured by remoteness index) was a risk factor for increased prevalence of third-generation cephalosporin-resistant (3GC) E. coli (odds ratio 5.05; 95% confidence interval 3.19, 8.04) and methicillin-resistant S. aureus (MRSA) (odds ratio 5.72; 95% confidence interval 5.02, 6.54). We did not find a positive correlation of AMR and socio-economic disadvantage or average person per household indices. ConclusionRemoteness is a risk factor for increased prevalence of 3GC-resistant E. coli and MRSA. We demonstrate that traditional disease surveillance systems can be repurposed to capture the broader social drivers of AMR. Access to pathogen-specific and social data early and within the local regional context will fill a significant gap in disease prevention and the global spread of AMR.

A review of primary healthcare practitioners' views about nutrition: implications for medical education.

This study aimed to review literature that reports on the perspectives and opinions of Australian and New Zealand primary healthcare practitioners on their role in nutrition counselling of their patients. A systematic search of relevant articles reporting on attitudes towards nutrition counselling by Australian and New Zealand doctors/physicians, nurses including midwives, pharmacists and dentists was conducted. The search included literature from the past ten years until March 2021 and identified 21 relevant papers, with most of the studies including medical practitioners and nurses. Three main themes were identified from qualitative and quantitative data, which included education and training, practitioner experiences and challenges. Consistent with previous literature, health care practitioners acknowledged their important role in the provision of dietary advice to patients. Challenges that influenced the provision of this advice included insufficient education and training, time constraints and limited knowledge and confidence. Time constraints during normal consultations led to a low priority of nutrition counselling. An absence of assessment opportunities to demonstrate nutrition competence and limited coverage of specific nutrition-related advice during training were also reported. Primary healthcare practitioners acknowledge the importance of playing a role in the provision of nutrition advice but require education and access to evidence-based information that can be utilised effectively within the time constraints of standard consultations. Medical education curricula can be improved to provide more emphasis on nutrition education, including relevant assessment opportunities.

Beyond dispensing: Better integration of pharmacists within the Australian primary healthcare system

A well-integrated primary health care system helps address the health needs of an ageing population with complex multiple health conditions. In Australia pharmacists provide services to maximise health gains from medication use, although they are not well integrated into primary care. Using the case of Australia, this study investigates why integrating pharmacists in primary care has not been addressed at the national level and also identifies strategies that could promote policy change. Using a unique dataset generated via 33 semi-structured interviews with healthcare leaders and policymakers across relevant disciplines, we undertake a systematic and comprehensive analysis of the policy with the Multiple Stream Framework. This framework examines the policy process with five elements: problem, policy, and political streams; policy entrepreneur; and policy window. The problem stream shows that the primary healthcare system struggles to cope with the increasing healthcare demand and the prevalence of medication-related problems. The policy stream suggests that the consumers would benefit from an integration of pharmacists into primary care to solve these problems; however, policy proposals cannot survive under current circumstances. The political stream reveals the political barriers come from conflicts among interest groups within the profession and the healthcare sector. To advocate their pet policy, policy entrepreneurs should have stronger roles in shaping the “policy idea” to gain its acceptance among the policy community, and to reduce political barriers. Strategies to overcome the barriers include evidence accumulation, role development in light of population needs, and interorganisational collaboration across members of the healthcare network.

The impact of COVID-19 on the delivery of care by Australian primary health care nurses.

This qualitative study describes the impact of the first wave of the COVID-19 pandemic on the provision of care by Australian primary health care (PHC) nurses. Participants were purposefully recruited following completion of a national survey about PHC nurses' experiences during the pandemic. Twenty-five semi-structured interviews were conducted by two experienced researchers and professionally transcribed. The mean duration of interviews was 38.5min. Thematic analysis revealed three themes about the impact of COVID-19 on PHC nurses' provision of care. These were: workplace adjustments, changes in healthcare delivery and concerns about long-term health impacts of COVID-19. The sudden disruption and de-stabilisation of care delivery was reported as significantly impacting on initial service provision, although participants reported adapting quickly and finding new ways to deliver care. The impact of the pandemic on high risk communities and mental health support needs of clients created additional challenges, although some participants reported positive outcomes such as increased confidence of some clients to provide self-care. There were concerns about the potential long-term health impact on communities due to reduced levels of cancer screening, disrupted management of chronic conditions and reduced opportunistic health assessments. Findings from this study demonstrated how PHC nurses played an important role in the continued provision of PHC by adapting quickly to changed circumstances, adjusting and modifying clinical activities, and by monitoring for future potential negative outcomes from the pandemic. These findings are important for the future management of pandemics and inform the long-term planning of PHC services.