Primary Care Settings In Australia Research Articles

Developing the EQUIPED approach to quality management using multi-grounded theory.

This study aimed to develop a theoretical approach to quality management for dietetics services operating in primary care settings in Australia. Multi-grounded theory was used to develop a theoretical approach to quality management across three phases. A preliminary approach was developed in the first phase using empirical data outlining quality management activities employed by primary care dietetics services. In the second phase, the preliminary approach was matched to theoretical data captured from the Australian National Safety and Quality in Primary and Community Healthcare Standards, the Quality in Nutrition Care Model for Dietitians, and complex adaptive systems theory. Central concepts were defined and described in the final phase. Seventeen small (n=7) and medium-large (n=10) dietetics services from all Australian states and territories, except Tasmania, participated. The theoretical approach to quality management comprised 107 rules organised into six attractors (culture, integrated care, evidence-based care, safe environment and care, client partnerships and personalised care) and 10 governance elements. Rules had one or more foci that aimed to: improve quality within the service (internally focused), improve care by influencing other healthcare professionals (externally focused), improve the client relationship (client-focused), or monitor and respond to external systems (system-focused). The theoretical approach developed in this study produced a set of rules that primary care dietetics services can use to inform quality management activities. The use of multi-grounded theory should be investigated in other healthcare disciplines and settings to address quality.

The Benefits and Challenges of Point-of-Care Testing in Rural and Remote Primary Care Settings in Australia

Point-of-care (POC) testing has significant potential application in rural and remote Australian communities where access to laboratory-based pathology testing is often poor and the burden of chronic, acute, and infectious disease is high. To explore the clinical, operational, cultural, and cost benefits of POC testing in the Australian rural and remote health sector and describe some of the current challenges and limitations of this technology. Evidence-based research from established POC testing networks for chronic, acute, and infectious disease currently managed by the International Centre for Point-of-Care Testing at Flinders University are used to highlight the experience gained and the lessons learned from these networks and, where possible, describe innovative solutions to address the current barriers to the uptake of POC testing, which include governance, staff turnover, maintaining training and competency, connectivity, quality testing, sustainable funding mechanisms, and accreditation. Point-of-care testing can provide practical and inventive opportunities to revolutionize the delivery of pathology services in rural and remote sectors where clinical need for this technology is greatest. However, many barriers to POC testing still exist in these settings, and the full potential of POC testing cannot be realized until these limitations are addressed and resolved.

The General Practice and Residential Aged Care Facility Concordance of Medication (GRACEMED) study

BackgroundThe lack of interoperable IT systems between residential aged care facilities (RACF) and general practitioners (GP) in primary care settings in Australia introduces the potential for medication discrepancies and other medication errors. The aim of the GRACEMED study is to determine the extent and potential severity of medication discrepancies between general practice and RACFs, and identify factors associated with medication discrepancies. MethodsA cross sectional study of medication discrepancies between RACF medication orders and GP medication lists was conducted in the Sydney North Health Network, Australia. A random sample of RACF residents was included from practice lists provided by the general practices. RACF medication orders and GP medication lists for the included residents were compared, and medication discrepancies between the two sources were identified and characterised in terms of discrepancy type, potential for harm and associated factors. Results31 GPs and 203 residents were included in the study. A total of 1777 discrepancies were identified giving an overall discrepancy rate of 72.6 discrepancies for every 100 medications. Omissions were the most common discrepancy type (35.2%,) followed by dose discrepancies (34.4%) and additions (30.4%). 48.5% of residents had a discrepancy with the potential to result in moderate harm and 9.8% had a discrepancy with the potential for severe harm. Number of medications prescribed was the only factor associated with medication discrepancies. ConclusionIncreased use of systems that allow information sharing and improved interoperability of clinical information is urgently needed to address medication safety issues experienced by RACF residents.

Mental Health Nurses Supporting the Routine Assessment of Anxiety of Older People in Primary Care Settings: Insights from an Australian Study

Anxiety in older age is a worldwide problem and co-associated with other mental health problems, physical health conditions, disability, reduced quality of life and increased healthcare utilisation. Yet the symptoms of anxiety are often unrecognised in older people, challenging early diagnosis and increasing the risk of older people developing more chronic and disabling illness. This article reports on research led by mental health nurses and a primary care nurse that supported primary care practitioners to undertake a routine assessment of anxiety in older people in Australia. The Geriatric Anxiety Inventory-Short Form was incorporated into the annual, in-depth 75 years and older, health assessment that is undertaken in primary care settings and funded by Australia’s Medicare. An initial feasibility study demonstrated good acceptance levels of the routine assessment by the primary care practitioners. These findings suggest fertile ground for the everyday use of the routine assessment in primary care settings in Australia, with transferability internationally in low-, middle- and high-income global communities. Mental health nurses can play a key role in supporting primary care nurses to recognise and respond to anxiety in older people. Illness prevention and health promotion activities are low cost and have the potential to make a difference worldwide to the health of people across the lifespan.

An evaluation of the fall prevention practice of community-based occupational therapists working in primary care

IntroductionOccupational therapy in primary care settings in Australia is developing. This study aimed to examine current practice in preventing falls among older people living in the community pri...

P03.09 Implementing sexual health ‘spaced education’ for undergraduate medical students in new south wales, australia

Introduction Most STIs are managed in primary care settings in Australia, so the New South Wales (NSW) STI Programs Unit supports sexual health education of professionals in these settings. However each NSW undergraduate medical school curriculum is different and is inconsistently taught. To support some consistency in teaching, the Workforce Education Development Group (WEDG) University of Sydney (USyd) agreed to develop and implement a sexual health module for medical students using spaced education (Qstream). Spaced education has been shown to improve knowledge acquisition, increase long-term knowledge retention and change behaviour. Methods The University of NSW and USyd Medical School Academic Departments of General Practice agreed to pilot the module during undergraduate primary care clinical attachments. Sixteen clinical scenarios with questions, model answers, references, and links to key resources were developed. Results Forty two undergraduate medical students completed the pilot providing mostly positive feedback about the delivery method (interactive, daily reminders, retesting knowledge) and content (realistic clinical scenarios). The main criticism was the desire for more case studies to compliment or fill gaps in prior learning. The sexual health module is now offered during 5th and 6th year Primary Care attachments at UNSW and is a required learning activity during 3rd year Community Health block at USyd. From August 2014–March 2015, 88 students from UNSW have commenced the course with a 50% completion rate. From October – December 2014, all 61 medical students at USyd completed the course with 64% finding the course very helpful or helpful. Feedback since module implementation remains positive with mobile friendliness, reminders, gradual learning and scenario rationales all rated highly. Conclusion Spaced education has proven adaptable to sexual health education and was accepted as beneficial and a positive style of learning about sexual health. Other NSW undergraduate programs have now been offered the module. Disclosure of interest statement The NSW STI Programs Unit is funded by NSW Health. No pharmaceutical grants were received in the development of this project.

Values and valuing mental health nursing in primary care: what is wrong with the ‘before and on behalf of’ model?

Accessible summary The present model of employment specified in the Mental Health Nurse Incentive Program (MHNIP) is closely aligned to a traditional practice nurse model whereby the nurse is employed to assist and extend medical practice. Mental health nurses working within MHNIP typically possess post graduate qualifications and a breadth of experience characteristic of a specialist and advanced practitioner in mental health. Mental health nurses ought to enjoy the same status, level of remuneration, professional esteem and accountability of other health professionals. AbstractThe Mental Health Nurse Incentive Programme (MHNIP) provides funding to organizations to enable mental health nurses (MHNs) to provide care to people with complex needs in primary care settings in Australia. The programme is based on a ‘for and on‐behalf of’ practice nursing model whereby the MHN is presumed to have no specialist knowledge, skills or professional autonomy, and rather extends the reach of medicine. This paper provides a profile of MHNs working in the MHNIP derived from an online survey. A content analysis of responses establishes that nurses who work within MHNIP are highly experienced, and have extensive postgraduate qualifications particularly in psychotherapy. Nurses have negotiated a range of complex employment and contractual arrangements with organizations and pushed the boundaries of the programme to realize good outcomes. The ‘practice nurse model’ of employment and the underpinning assumptions about MHNs and their skill set relative to other professions is critically examined. Changes to the programme funding mechanism and programme specifications are recommended.

Mental health nurses in primary care: quantitative outcomes of the Mental Health Nurse Incentive Program

The Mental Health Nurse Incentive Program (MHNIP) is a funding scheme in Australia that enables mental health nurses to work in primary care settings with people with complex mental health problems for as long as necessary. This study examined the outcomes of the programme as reported by nurses. Nurses provided profiles of 64 people with whom they worked, including measures of symptoms and problems on admission to the programme and at a second point in time. The findings showed that people had high levels of symptom severity and distress on admission, and they experienced significant improvements in all problem areas except physical health over their time working with the nurse. The MHNIP appears to be addressing the needs of people with highly complex needs, but more sensitive measures of outcome ought to be routinely collected. The Mental Health Nurse Incentive Program (MHNIP) provides a funding mechanism for credentialed mental health nurses to work in primary care settings in Australia with people with complex and serious psychosocial and mental health problems. This project explored the extent to which the programme contributed to positive outcomes. Sixty-four service user profiles were provided by nurses working within the programme, including the Health of the Nation Outcome Scales (HoNOS), on admission and at the last review point. Mean total HoNOS scores on admission were higher than those typically seen on admission to inpatient care in Australia. Significant reductions in all problem areas except physical health problems were found at the last review point for this sample. These findings support the viewpoint that MHNIP is addressing the needs of people with the most complex needs in primary care and is achieving clinically significant outcomes.

Mental health nurses in primary care: Qualitative outcomes of the Mental Health Nurse Incentive Program

The Mental Health Nurse Incentive Program (MHNIP) is a government-funded programme, which, since 2007, has enabled mental health nurses to work in primary care settings in Australia in collaboration with general practitioners (GPs) or private psychiatrists. To date, small-scale qualitative studies have explored outcomes of the programme from the point of view of nurses, consumers, and the perceptions of GPs. This study reports on an on-line survey of credentialed mental health nurses perceptions of outcomes of the MHNIP. Two hundred and twenty five nurses who worked in MHNIP provided detailed narrative responses that were examined using thematic content analysis. The most commonly-cited outcomes were reductions in symptoms or improved coping, improved relationships, and enhanced community participation. Other reported outcomes included reduced hospitalization or use of state-funded mental health services, better use of health services, the continuation or establishment of meaningful occupation, improved physical health and medication management, less use of coercive interventions, and greater independence.

Management of osteoporosis in primary care in Australia

This study reviewed factors influencing osteoporosis management in primary care settings in Australia and examined risk profiles of patients (n = 37,957) for osteoporosis. Only 29.7% of patients with a prior fracture were currently on specific medication for osteoporosis. The results highlight the need for further exploration of barriers to osteoporosis management. Osteoporosis management in primary care is suboptimal even for high-risk people with a history of prior fracture. This study reviewed factors influencing the management of individuals at risk for osteoporosis in primary care settings in Australia and examined risk profiles of patients for osteoporosis. Patients (n = 37,957, mean age 71) were recruited over a 12-month period (February 2006-Jan 2007) and interviewed. With regard to risk factors for osteoporosis, 12.6% of patients reported a history of prior minimal trauma fracture, 7.5% reported a family history of osteoporosis, 7.4% reported they were current smokers, 11.4% reported low dietary calcium intake, 31.8% reported no regular weekly physical exercise and 10.3% reported current use of glucocorticoids. Of those with a prior fracture, only 29.7% were currently on specific medication for osteoporosis. Radiography (n = 17,754) demonstrated a prior vertebral fracture in 30.1%, but only 3.8% of the 17,754 patients reported current use of specific osteoporosis medication. This study has confirmed low rates of treatment in primary care even in individuals who have already suffered a prior fracture or have other risk factors. This study highlights the need for further exploration of barriers to osteoporosis management in the primary care setting.