Multidisciplinary Primary Care Research Articles

Characteristics of physical activity programs in the Brazilian primary health care system.

The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil.

In Memoriam: Philip W. Brickner, MD

Dr. Philip W. Brickner, the founding editor of the Journal of Long Term Home Health Care and immediate past editor of Care Management Journals, a pioneering figure in the field of community medicine for the homeless and homebound elderly, a prolific writer, and a charismatic mentor to countless trainees in medicine and social sciences, died on March 24, 2014, at his home in Riverdale, New York.Brickner received many awards from various organizations for his work at St. Vincent's Hospital and, notably, the Lifetime Achievement Award of the Health Care for the Homeless Clinicians Network. He was the author of more than 100 scientific papers, six books, 25 chapters, and many other letters and publications. His latest focus had been on the use of ultraviolet (UV) radiation on air systems for the control of tuberculosis (TB) transmission. This work has been supported by a $7 million grant for the Tuberculosis Ultraviolet Shelter Study. This work is now helping developing countries prevent airborne transmission of tuberculosis.Dr. Brickner was a graduate of the Swarthmore College and Columbia University College of Physicians and Surgeons and a proud alumnus of the Bellevue Hospital medicine training program in late 1950s under the famed director, Dickenson W. Richards, MD. After his training and early positions, Phil was poised to apply his deep convictions of care to the indigent in what was then the perfect medium of charitable medical endeavors, St. Vincent's Hospital. From the start, his passion resonated with the mission of the hospital's founders, The Sisters of Charity, as they had forged it in the 1800s.From its inception in 1968, the Department of Community Medicine at St. Vincent's Hospital in Greenwich Village was led by Dr. Brickner. He saw the great need of the many who suffered in the interstices of a flawed health care system. As a colleague reflected to me upon the news of Phil's passing, still remember my internship interview with Phil as I was graduating from Cornell Medical School when he told me that, 'St. Vincent's is a place where you can walk into the president's office and propose a plan to help a forgotten group, have no plan as to how to make money from it, and they won't kick you out of the office!' At that interview, the colleague chose St. Vincent's and has gone on to a distinguished career in geriatrics. Similar stories abound: personal accounts of physicians, nurses, health educators, social workers, and others all serving as testimony to Brickner's charisma and beliefs. To those who shared his sense of mission and devotion to the sick poor, he imparted the wisdom that they too would be rewarded by personal growth in their discipline, ability to write, and teach those who follow.Dr. Brickner and his colleagues started a hands-on health care service at homeless shelters. At the time, no such direct-care programs existed in New York City for this population. The indigent men (and women) served here were the start of the St. Vincent's single-room occupancy program who quickly grew to bring teams of physicians, nurses, and social workers to many of the singleroom occupancy hotels in the area at that time. In 1983, Brickner was chosen to direct the Health Care for the Homeless demonstration program of the Robert Wood Johnson Foundation, Pew Memorial Trust, and the U.S. Conference of Mayors. With his team from St. Vincent's Hospital, he helped develop projects in 19 cities and oversaw the implementation of multidisciplinary primary care efforts, which were based on the work in New York City. The program is regarded as an extraordinarily successful demonstration, having been replicated with the 1987 Stewart B. McKinney Homeless Assistance Act and now including 249 federally funded homeless health care projects nationally.In 1969, Brickner and colleagues began service to the frail homebound aged in Greenwich Village and Chelsea. It became known as the Chelsea-Village program and later grew to include many monolingual Chinese-speaking patients. …

Preliminary outcomes of a pilot physical therapy program for HIV-infected patients with chronic pain

Chronic pain in HIV-infected individuals is common and often undertreated. Physical therapy (PT) is an evidence-based nonpharmacologic treatment for chronic pain. Our objective is to present the results of a pilot PT program in an HIV pain/palliative care clinic, which is embedded within a Ryan White-funded multidisciplinary HIV primary care clinic. Medical records of HIV-infected patients participating in a PT program between November 2012 and July 2013 were retrospectively reviewed. Pain scores on a 0–10 scale and cost data were collected and analyzed. Among 43 patients referred, 27 collectively attended 86 sessions. Median age of enrolled patients was 54 (IQR 49–58). Sixteen (59%) were African-American and 20 (77%) had an undetectable HIV viral load. Mean pain score at initial visit was 6.5 (SD = 1.1). The average session-level decrease was 2.6 (SD = 1.7) and patient-level decrease was 2.5 (SD = 1.2). The largest payors were Medicare managed care (28%), Medicaid (21%), and Ryan White grant-related funds (18%). When the first four months of the program are excluded to account for slow start-up, the program's monthly net revenue during the remaining five months was $163. We present preliminary data from a low-cost pilot PT program integrated into an HIV clinic in a primary care setting associated with clinically significant improvements in pain. Further investigation into the implementation of such programs is essential.

Health care reform brings new opportunities

Health care reform brings new opportunities

Stories and metaphors in the sensemaking of multiple primary health care organizational identities

BackgroundThe Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms.MethodsWe conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis.ResultsThe core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change.ConclusionsIn order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time.

Infrastructure to support modern primary care: the NAPCRG debate update.

In December 2012, at the North American Primary Care Research Group (NAPCRG) conference in New Orleans (USA), associates of London Journal of Primary Care (LJPC) from London (UK) and Cleveland Ohio (USA) hosted a forum entitled ‘Local Health Communities for Integrated Care’. The forum was attended by senior practitioners/academics from different countries who debated the infrastructure needed to support collaboration at primary/community care level. They drew on lessons from West London's integrated care pilot1 and Cleveland's ‘Promoting Health across Boundaries’ initiative.2 Participants at the forum recognised international need for case studies of community-oriented integrated care (COIC), including primaryand community-care leadership of collaboration for integrated care, and continuous improvements of whole systems of care. In November 2013, at the NAPCRG conference in Ottawa (Canada), LJPC associates from Quebec (Canada) and London (UK) hosted a second forum to continue this conversation. In preparation for the Ottawa Forum, in October 2013 LJPC invited its readers to rank 11 aspects of integrated care in respect of their importance to research. Table 1 shows the results in order of most ‘votes’ overall (weighted formula). It also shows the first four (of 11) ‘votes’ of 61 respondents. Table 2 shows additional comments made by 30/61 respondents. Table 1 Priority aspects of integrated care to research Table 2 Additional comments made by 30 respondents about researching integrated care While ‘Patient Involvement’ and ‘Extended Multidisciplinary Primary Care Teams’ were perceived to be the most important aspects (and indeed 29/61 respondents gave them their first ‘vote’), the overall ranking pattern is more complicated. There is an argument for saying that all of these aspects are important, and their perceived importance may relate to their perceived neglect at present. Recognising the wide range of qualitative comments offered in Table 2, these initial results illustrate the range of research still needed to understand how the infrastructure of primary care can be developed, and, as discussions at the two conferences elaborated, more progress can be made in developing research that examines primary care in context.

Improving asthma care in rural primary care practices: a performance improvement project.

Rural areas are often underserviced health areas, lack specialty care services, and experience higher levels of asthma-related burden. A primary care, asthma-focused, performance improvement program was provided to a 6-county, rural-frontier region in Colorado to determine whether asthma care practices could be enhanced to become concordant with evidence-based asthma care guidelines. A pre-post, quasi-experimental design was used. A complex, multifaceted intervention was provided to multidisciplinary primary care teams in practices serving children and adults with asthma. Intervention elements included face-to-face trainings, clinical support tools, patient education materials, a website, and clinic visits. Performance improvement and behavior change indicators were collected through chart audits and surveys from the entire health care team. Participants included three health care organizations and their staff in 13 primary care practices. Overall, all team members reported statistically significant improvements in confidence levels for providing quality asthma care. Chart reviews of asthma patient encounters completed before and after the program demonstrated statistically significant improvements in asthma care practices for asthma control assessment (1% vs 20%), provision of asthma action plans (2% vs 29%), controller prescription (39% vs 71%), inhaler technique assessment (1% vs 18%), and arrangement of follow-up appointment (20% vs 37%). The asthma care-focused, multifaceted, complex, performance improvement intervention provided to rural primary health care teams lead to significant improvements in all indicators of quality asthma care provision to adults and children with asthma. However, significant barriers exist for rural practices to adopt evidence-based asthma care practices.

Improving access to community services: Role of the Alzheimer Society in primary care–based memory clinics

Background: It well documented that community services and resources can mitigate the negative impacts associated with the caregiving role. However, primary care providers’ knowledge of and referral to local support services tends to be limited. This presentation will describe the role of the Alzheimer Society (AS) in 11 memory clinics based within multidisciplinary group primary care practices (Family Health Teams, FHT) and explore the impacts associated with this partnership. Thesememory clinics serve approximately 424 medical practices with a combined patient base of over 661,000. Methods: Thirty-six team members including 11 AS representatives across 11 FHTs were interviewed to describe the role of the AS within the memory clinics and to identify key lessons learned and impacts associated with this partnership. Results: The role of the AS varied dependent on existing resources available within the FHT and the care gaps the AS was able to fill; most commonly this included the administration of standardized tools (cognitive testing, caregiver burden and stress, depression, functional status, and risk), provision of information about dementia, AS education programs and support groups and other community services. Preliminary data indicate significant increases in the number of referrals to the AS from six months prior to the involvement of the AS to six months following AS involvement (20 vs. 126 across 9 FHTs; 530% increase in referrals). AS involvement was credited with improving the quality of dementia care by increasing awareness of and timely/ earlier access to AS programs and community services, reducing stigma associated with accessing the AS, reducing burden of care for health care providers as they provide valuable information otherwise not available and are reliable source of collateral information (eyes and ears within the community) and are a efficient use of existing resources. Few challenges were associated with this partnership, which was described as a ’win-win’ opportunity.Conclusions: Partnerships between theAS and primary care-basedmemory clinics provide a significant opportunity for enhancing dementia care through better integration and coordination with community services, access to information and services at the time of diagnosis, and facilitated access to services throughout the disease process.

Mandalas as a visual research method for understanding primary care for depression

Depression is a complex problem, commonly but not always successfully managed in primary care. We know relatively little about the system of primary care for depression particularly at the level of organisations. In this paper, we describe the use of mandalas as a visual data collection method within an in-depth programme of participatory action research undertaken in six primary care organisations in Victoria, Australia. We draw on mandala images, selected and discussed by 49 multidisciplinary primary health care professionals and demonstrate how they can be employed as an effective graphic elicitation method. We conclude that mandalas offer an innovative approach for qualitative data collection for two reasons. First, they can engage busy research participants in a reflective space. Second, using the mandalas as an elicitation method generates meaningful data: it provides new insights, reveals unrecognised aspects of practice, generates new learning, gives physical form to tacit processes and enables complex information to become accessible; all within short timeframes.

The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints.

BackgroundThe Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia.MethodsSixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government.ResultsWhile respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services’ responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse “dilemmatic space” in their work.ConclusionsThe absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health’s recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and social movements. Further research on the value of community control of PHC services and the types of policy, resource and managerial environments that support action on social determinants is warranted by this study’s findings.

Health promotion in Australian multi-disciplinary primary health care services: case studies from South Australia and the Northern Territory

This paper reports on the health promotion and disease prevention conducted at Australian multi-disciplinary primary health care (PHC) services and considers the ways in which the organizational environment affects the extent and type of health promotion and disease prevention activity. The study involves five PHC services in Adelaide and one in Alice Springs. Four are managed by a state health department and two by boards of governance. The study is based on an audit of activities and on 68 interviews conducted with staff. All the sites undertake health promotion and recognize its importance but all report that this activity is under constant pressure resulting from the need to provide services to people who have health problems. We also found an increased focus on chronic disease management and prevention which prioritized individuals and behavioural change strategies rather than addressing social determinants affecting whole communities. There was little health promotion work that reflected a salutogenic approach to the creation of health. Most activity falls under three types: parenting and child development, chronic disease prevention and mental health. Only the non-government organizations reported advocacy on broader policy issues. Health reform and consequent reorganizations were seen to reduce the ability of some services to undertake health promotion. The paper concludes that PHC in Australia plays an important role in disease prevention, but that there is considerable scope to increase the amount of community-based health promotion which focuses on a salutogenic view of health and which engages in community partnerships.

Journal Watch: Our Expert Highlights the Most Important Research Articles Across the Spectrum of Topics Relevant to the Field of Pain Management

Pain ManagementVol. 3, No. 3 News & ViewsFree AccessJournal Watch: Our expert highlights the most important research articles across the spectrum of topics relevant to the field of pain managementJohn D LoeserJohn D LoeserUniversity of Washington, WA, USASearch for more papers by this authorPublished Online:30 Apr 2013https://doi.org/10.2217/pmt.13.19AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail This is a superb treatise on the history, growth and development of acute pain medicine (APM). It lays out the reasons for such a service, and indeed, a potential specialty. Clearly a subdivision of anesthesiology, the movement to articulate APM as a specialty helps to clarify the differences between the management of acute and chronic pain, and the type of training and experience that each area requires. The authors have thoroughly described the role that APM can play in modern healthcare and have provided an example of what every hospital should aspire to for patient safety and comfort. The authors discuss the education and training of acute pain physicians and the support personnel that are required to run an effective service. The use of protocols to determine patient management is emphasized. A brief section on cost–effectiveness lays out the issues for APM. In the oncoming era of the Accountable Care Organization in the USA, justifying the costs of one’s service is critical. I believe that the authors have staked out a valid claim for the development of a new subspecialty of anesthesiology while making it quite clear that chronic pain management belongs in a different medical domain, even though they do not really address the issues for chronic pain at all.The authors set out to determine if anxiety and social stressors predicted 12-month outcomes in a multidisciplinary primary care intervention. They also looked at whether early changes (within the first 3 months) predicted 12-month outcomes. The 250 subjects for this study were musculoskeletal pain patients involved in a randomized clinical trial of a combined medication and behavioral intervention versus care as normal. A prior study had demonstrated that patients randomized to the intervention arm manifested moderate relief of pain and significantly decreased depression. This study looked for predictive variables at baseline. Anxiety was assessed using the Generalized Anxiety Disorder-7 scale, social stress was measured with Patient Health Questionnaire-9. The Symptom Checklist-20 and Brief Pain Inventory were used to assess depression and pain levels. Anxiety severity at baseline, as well as early improvement in anxiety, were independent predictors of both depression and pain severity at 12 months. Social stressors at baseline or their reduction by 3 months did not predict depression or pain severity at 12 months. This study emphasizes the importance of addressing comorbid anxiety in the successful treatment of chronic pain patients. There is always more than occult pathology that the pain physician must address.This rodent study addresses a proposed mechanism for allodynia and comes to the fascinating conclusion that Na+–K+–Cl- cotransporter 1 (NKCC1) plays an important role in the genesis of this sensory abnormality. It is well known that stimulation of peripheral nociceptors leads to increased c-Fos labeling in spinal cord regions that are involved in nociceptive information processing. By contrast, light stimulation of abdominal skin does not result in c-Fos labeling or pain behavior. However, if the mouse is given intracolonic capsaicin, lightly stroking the abdominal skin leads to pain behavior and increased c-Fos labeling in the spinal cord nociceptive regions. Previous work by these authors has shown that the afferent activity in low-threshold sensory fibers activates nociceptive sensory fibers via NKCC1 enhanced primary afferent depolarization. In this study, the NKCC1 blocking agent bumetanide was administered intrathecally and markedly reduced both the allodynia and the c-Fos expression after intracolonic capsaicin. It has been suggested that NKCC1 is the principal determinant of intracellular chloride in dorsal root ganglion neurons, and upregulation of this agent could result in exaggerated primary afferent depolarization sufficient to produce depolarization of nociceptor terminals – that is, presynaptic inhibition becomes presynaptic excitation. The search for mechanisms of chronic pain states is illuminated by this study.Financial & competing interests disclosureThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.No writing assistance was utilized in the production of this manuscript.FiguresReferencesRelatedDetails Vol. 3, No. 3 Follow us on social media for the latest updates Metrics Downloaded 245 times History Published online 30 April 2013 Published in print May 2013 Information© Future Medicine LtdPDF download

Implementing a knowledge application program for anxiety and depression in community-based primary mental health care: a multiple case study research protocol.

BackgroundAnxiety and depressive disorders are increasingly recognized as a health care policy priority. Reducing the treatment gap for common mental disorders requires strengthening the quality of primary mental health care. We developed a knowledge application program designed to improve the organization and delivery of care for anxiety and depression in community-based primary mental health care teams in Quebec, Canada. The principal objectives of the study are: to implement and evaluate this evidence-based knowledge application program; to examine the contextual factors associated with the selection of local quality improvement strategies; to explore barriers and facilitators associated with the implementation of local quality improvement plans; and to study the implementation of local quality monitoring strategies.MethodsThe research design is a mixed-methods prospective multiple case study. The main analysis unit (cases) is composed of the six multidisciplinary community-based primary mental health care teams, and each of the cases has identified at least one primary care medical clinic interested in collaborating with the implementation project. The training modules of the program are based on the Chronic Care Model, and the implementation strategies were developed according to the Promoting Action on Research Implementation in Health Services conceptual framework.DiscussionThe implementation of an evidence-based knowledge application program for anxiety and depression in primary care aims to improve the organization and delivery of mental health services. The uptake of evidence to improve the quality of care for common mental disorders in primary care is a complex process that requires careful consideration of the context in which innovations are introduced. The project will provide a close examination of the interplay between evidence, context and facilitation, and contribute to the understanding of factors associated with the process of implementation of interventions in routine care. The implementation of the knowledge application program with a population health perspective is consistent with the priorities set forth in the current mental health care reform in Quebec. Strengthening primary mental health care will lead to a more efficient health care system.

Knowledge flow and exchange in interdisciplinary primary health care teams (PHCTs): an exploratory study

Improving the process of evidence-based practice in primary health care requires an understanding of information exchange among colleagues. This study explored how clinically oriented research knowledge flows through multidisciplinary primary health care teams (PHCTs) and influences clinical decisions. This was an exploratory mixed-methods study with members of six PHCTs in Ontario, Canada. Quantitative data were collected using a questionnaire and analyzed with social network analysis (SNA) using UCINet. Qualitative data were collected using semi-structured interviews and analyzed with content analysis procedures using NVivo8. It was found that obtaining research knowledge was perceived to be a shared responsibility among team members, whereas its application in patient care was seen as the responsibility of the team leader, usually the senior physician. PHCT members acknowledged the need for resources for information access, synthesis, interpretation, or management. Information sharing in interdisciplinary teams is a complex and multifaceted process. Specific interventions need to be improved such as formalizing modes of communication, better organizing knowledge-sharing activities, and improving the active use of allied health professionals. Despite movement toward team-based models, senior physicians are often gatekeepers of uptake of new evidence and changes in practice.

The Challenges of Establishing an Integrative Medicine Primary Care Clinic in Sydney, Australia

In May 2006, a multidisciplinary community-based integrative medicine (IM) clinic was established in Sydney, Australia. It was designed to offer a wide range of IM services, for primary care and to serve as a referral center. The aim of this study was to determine which factors were successful and which ones posed challenges for establishing this kind of clinic. A study of the first 4 years of this primary care integrative medicine clinic was undertaken, using mixed methods--both qualitative and quantitative. Consistent with success factors identified in the literature, the clinic had an open-minded culture, credible supporters, suitable facilities, and clinically competent practitioners. Throughout the 4 years of its existence, the clinic strove to create an economically sustainable environment and to develop the service. As time progressed, it became evident that at least half of the practitioners needed to be biomedical doctors for the practice to remain viable. The challenges encountered were creating an economically sustainable clinic, managing high staff and practitioner turnover, finding the right balance between practitioners and services offered, developing an integrative medicine team, and building research capacity to evaluate the clinic and patient outcomes. Although many integrative medicine clinics fail to survive the first few years, after 4 years, this multidisciplinary primary care clinic had succeeded in establishing a viable health care service offering both integrative medicine and conventional, traditional, complementary, and alternative medicine. Finding the right mix of staff members and following up with evaluations to track progress are important.

Assessing methods for measurement of clinical outcomes and quality of care in primary care practices

PurposeTo evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC) practices.MethodsThis project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30) were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources.ResultsSeven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening.ConclusionsMultiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were willing to participate in and consent to, the collection and linkage of information from multiple sources that would be required for such assessments.

Appealing to Altruism is Not Enough: Motivators for Participating in Health Services Research

This pilot study sought to identify motivators and barriers to participating in a longitudinal survey; we interviewed patients and practitioners at a multidisciplinary primary care clinic where the proposed project would be based. While altruism motivates participation in medical research, we found that for many potential participants, the opportunity to benefit directly was the primary, and sometimes the only motive to participate or encourage participation in the research project. Patients often wanted direct feedback from their individual results, and they expected to provide consent before the results were forwarded to other parties such as their practitioners. Similarly, some practitioners were more likely to support the project if participation benefited patients directly. Other factors were also identified that influenced the acceptability and perceived risks and benefits of participating. More work is needed to understand these motivators and how patients might benefit directly from participating in health services research, especially when direct medical benefit is not possible.

Is it time to abandon paper? The use of emails and the Internet for health services research – a cost‐effectiveness and qualitative study

A multidisciplinary primary care clinic in Sydney, Australia, was planning to use electronic questionnaires to measure patient-reported outcomes. Semi-structured interviews with 20 patients were undertaken to explore, among other things, practical issues regarding different questionnaire formats. The response rates and costs of email versus postal invitations were also evaluated. Compared with postal invitations, email invitations offered a cost-effective and practical alternative, with a greater proportion of patients volunteering for an interview. Assuming the interface is well-designed and user-friendly, many patients were happy to use the Internet to answer questionnaires. Most patients thought alternate formats should also be offered. Patients discussed advantages and disadvantages of the Internet format. Although more younger patients and females had given the clinic an email address; both sexes, and young and old patients, expressed strong preferences for either wanting or not wanting to use the Internet. Researchers should consider using email invitations as a cost-effective first-line strategy to recruit patients to participate in health services research. Internet questionnaires are potentially cheaper than paper questionnaires, and the format is acceptable to many patients. However, for the time being, concurrent alternate formats need to be offered to ensure wider acceptability and to maximize response rates.

Professionals’ perceptions of type 2 diabetes in primary care during a service redesign

AbstractThe purpose of this study was to survey primary health care professionals’ perceptions of type 2 diabetes, an evaluation during a service redesign. Management of people with type 2 diabetes has been led by hospital based secondary care. The objective of the service redesign was to transfer the management of the majority of people with type 2 diabetes from secondary care to general practitioner (GP) led, multidisciplinary primary care (comprising the GP, practice nurses, dietitians and podiatrists) delivered closer to the patients. Prior to implementation, all primary health care professionals undertook accredited educational preparation and there was infrastructure development by the creation of new posts and streamlining of IT systems to support the planned change.The study aim was to examine health care professionals’ perspectives of diabetes, its management, the value of clinical guidelines and the impact of practice organisation.A cross-sectional survey design was used. Primary health care pro...

Motivators, enablers, and barriers to building allied health research capacity

PurposeA sound, scientific base of high quality research is needed to inform service planning and decision making and enable improved policy and practice. However, some areas of health practice, particularly many of the allied health areas, are generally considered to have a low evidence base. In order to successfully build research capacity in allied health, a clearer understanding is required of what assists and encourages research as well as the barriers and challenges.Participants and methodsThis study used written surveys to collect data relating to motivators, enablers, and barriers to research capacity building. Respondents were asked to answer questions relating to them as individuals and other questions relating to their team. Allied health professionals were recruited from multidisciplinary primary health care teams in Queensland Health. Eighty-five participants from ten healthcare teams completed a written version of the research capacity and culture survey.ResultsThe results of this study indicate that individual allied health professionals are more likely to report being motivated to do research by intrinsic factors such as a strong interest in research. Barriers they identified to research are more likely to be extrinsic factors such as workload and lack of time. Allied health professionals identified some additional factors that impact on their research capacity than those reported in the literature, such as a desire to keep at the “cutting edge” and a lack of exposure to research. Some of the factors influencing individuals to do research were different to those influencing teams. These results are discussed with reference to organizational behavior and theories of motivation.ConclusionSupporting already motivated allied health professional individuals and teams to conduct research by increased skills training, infrastructure, and quarantined time is likely to produce better outcomes for research capacity building investment.