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Objectives: The objectives of this study were to examine the roles and needs of allied health professionals (AHPs) working in public healthcare settings in rural and regional Victoria, Australia in providing components of palliative care in their routine practice. Methods: A cross-sectional study was conducted between March and May 2023. Surveys were collected from AHPs working in public healthcare settings in the Loddon Mallee region of Victoria, Australia. Clinicians reported on the frequency of provision of care to patients with terminal illness, and their self-reported skill and confidence in providing interventions to patients with palliative care needs. Results: In total, 121 clinicians completed the survey. Almost every respondent reported they had provided care to patients with a terminal illness, with 41% of clinicians providing this care daily or weekly. The respondents were confident carrying out generalist interventions such as maintaining physical function but reported lower confidence in managing common symptoms of terminal illness such as loss of appetite, swallowing difficulties and changing communication needs. Two-thirds of respondents had not undertaken any training specific to palliative care, with many unaware of how to access palliative care-specific training. Conclusion: AHPs in rural and remote areas regularly provide care to patients with terminal illness. As the number of patients seen in non-specialist palliative care settings is likely to increase in rural and regional areas, the low self-reported confidence in providing common components of care, and the low uptake of palliative care-specific training must be addressed to ensure AHPs can provide high-quality care to people with terminal illness. What is known about the topic? Due to the increasing demand for palliative care services, this care is increasingly delivered by general non-specialist clinicians such as allied health professionals. What does this paper add? This study provides evidence for how often a surveyed population of allied health professionals in rural and regional Australia are providing care to people with a terminal illness, as well as their confidence, competence and learning needs. What are the implications for practitioners? High-quality care is needed at end-of-life, therefore rural and regional health services need to support allied health professionals to increase confidence and competence in providing palliative care. [ABSTRACT FROM AUTHOR]

Objective: In Australia, there is little evidence exploring why higher degrees by research (HDRs) are undertaken by surgeons. This study aims to describe the attitudes and experiences of surgical trainees and surgeons towards HDRs. Methods: A 23-question cross-sectional survey of surgical trainees and consultant surgeons from three Australian public hospitals was undertaken between August and December 2022. Data were analysed according to stage of career and HDR status and assessed using chi-squared test, with P < 0.05 considered significant. Results: Out of 270 participants, 72 (27%) completed the survey including 30 (42%) trainees and 42 (58%) consultants. Overall, 43 (60%) participants had completed or were undertaking a HDR, which was similar between trainees (n = 18) and consultants (N = 25; P = 0.968). A HDR was associated with more publications (P < 0.5). Respondents with a HDR were more likely to have a salaried academic position (50%) than those without (15%). There was no significant difference in academic appointments based on HDR attainment (P = 0.192). For surgical trainees, 93% rated the strengthening of resumes as the primary driver, compared with only 60% of consultants. For consultants, academic career aspirations and research interests were ranked the highest at 64% equally. Lack of time and competing nature of surgical training were equally ranked among all as the key barriers to completing a HDR. Conclusions: These results provide insight into the academic pursuits of surgeons with an understanding of the role HDRs play, including the different drivers for Masters and Doctorates. This is important for supporting future surgeons who seek to pursue research. What is known about the topic? The value of research is well-recognised as a crucial part of the surgical training pathway. Despite this, minimal contemporary evidence exists which explores the impact of higher degrees by research (HDR) on academic career pathways in the Australian context. What does this paper add? Contemporary evidence was obtained to understand why Australian surgeons undertake HDRs and how their completion impacts the surgical career pathway. What are the implications for practitioners? By understanding the role of HDRs in the surgical landscape, practitioners can ensure beneficial support for future academic surgeons is in place. [ABSTRACT FROM AUTHOR]

Background: Opioid use disorder is a public health concern in Australia. Opioid agonist treatment (OAT) is effective at treating and minimising harm from opioid use disorder, yet is underused in Australia due to client barriers. Although these barriers have been reported, the barriers that are most important to clients is unclear. The aim of this paper was to determine the most important OAT barriers to Australian clients. Methods: A cross-sectional, self-completed survey was given to 204 opioid-dependent clients who attended needle and syringe sites in Australia. Participants were given 15 OAT barrier statements, which they answered using a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree and 5 = strongly agree). The Likert scale data are presented using the count method and the mean Likert scores (for the whole sample and for subgroups). Results: The two methods determined that the four most important barriers to OAT were stigma, lack of support services, no flexibility and enjoy using opioids. Furthermore, those who used prescription opioids (compared with heroin) were female or non-binary (compared with male), were not currently using OAT (compared with current OAT), were younger (compared with older) and had high dependence scores (compared with low dependence scores) were impacted more by certain OAT barriers. Conclusions: Policies around improving support services, reducing stigma and increasing flexibility would be beneficial to reduce barriers to OAT in Australia. Second, certain groups were more vulnerable to OAT barriers, emphasising the importance to better tailor opioid treatment programs to these specific populations to increase treatment engagement. The aim of this paper was to determine the most important opioid agonist treatment barriers to Australian clients via a cross-sectional survey using a Likert scale. Results found that the most important barriers to opioid agonist treatment were stigma, lack of support services, no flexibility and enjoy using opioids. Furthermore, those who used prescriptions opioids were female or non-binary, were not currently using opioid agonist treatment, were younger and had high dependence scores were impacted more by certain treatment barriers. [ABSTRACT FROM AUTHOR]

Objective: Consumer-centred care is fundamental to high-quality health care, with allied health professionals playing a pivotal role in hospital settings. Allied health typically operates within standard weekday working-hours. Consumer preferences for receiving allied health services are largely unexplored but could inform whether weekend and/or out-of-hours services are required. This study aims to understand consumer preferences for hospital-based inpatient and outpatient allied health services. Methods: Using a cross-sectional survey and convenience sampling approach, consumers of a public health service in Melbourne, Australia were surveyed about preferences for allied health service delivery. Electronic health record reviews compared the accuracy of self-reported service delivery times. Descriptive statistics, concordance and predictive values were calculated. Responses to free-text survey items were analysed using content analysis. Results: Of 120 participants (79% response rate), most (69%) received allied health services, however, almost half of inpatient responders (44%) were unsure of the specific allied health professional involved. Audit results found moderate–high concordance overall (range, 77–96%) between self-reported and audit-identified allied health services by profession. Most inpatient responders had no strong day of week preference, equally selecting weekdays and weekend days, with most preferring services between 8 am and 4 pm. Outpatient responders (81%) preferred a weekday appointment between 8 am and 12 pm or before 8 am (29%) to complete scheduled activities early in the day. Conclusion: While provision of allied health services during standard working-hours was preferred by most consumers, some inpatient and outpatient consumers are receptive to receiving weekend and out-of-hours services, respectively. Decisions about offering these services should consider operational capacity and research evidence. What is known about the topic? Research on consumer acceptance of out-of-hours or weekend allied health services is lacking, with an assumption of consumer willingness and demand for these service models. What does this paper add? Hospital inpatients are generally indifferent to the day of allied health services, preferring weekday or weekend day equally, typically between 8 am and 4 pm, while outpatients favour weekday mornings. Although consumers reported that their needs were met by allied health services, there was a lack of awareness about the specific services they received. What are the implications for practitioners? Results highlight the importance of not only aligning service delivery with consumer preferences for timing, but also enhancing awareness and understanding of the available allied health services for consumers. [ABSTRACT FROM AUTHOR]

Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting. Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken. Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death. Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce. The law supports good end-of-life clinical practice by facilitating health care that aligns with the values and goals of patients, including those residing in residential aged care facilities. GPs and nurses here reported broad-ranging legal concerns relevant to providing end-of-life care within aged care, including substitute decision makers/family members wanting to overrule Advance Care Directives, requests for futile or non-beneficial treatment and conflict about decision-making. Participants' concerns can inform end-of-life legal training for aged care GPs and nurses. [ABSTRACT FROM AUTHOR]

Objectives: To examine: the impact of the coronavirus disease 2019 (COVID-19) pandemic on access to health services by middle-aged and older Australians; and the use of telehealth services during the COVID-19 pandemic and its ongoing usefulness. Methods: A cross-sectional survey was conducted among participants who completed the COVID-19 supplement in the 45 and Up Study 2020 Survey. Multivariable logistic regression analysis was used to examine the association between socio-demographic characteristics and health conditions with missed/delayed access to health services, changes in health outcomes resulting from missed/delayed access, and use of telehealth services. Results: Data for 45 071 participants were analysed (56% female, 72% aged ≥65 years). Almost half (42.2%) reported they had missed/delayed access to health care due to COVID-19; mainly for dental services (26.1%), visits to a general practitioner (GP) (16.3%) and specialists (12.6%). Missed/delayed visits to GPs and specialists were more likely among females, participants from non-English-speaking backgrounds, with disability/illness, living in outer regional/remote areas or with chronic health conditions. People with a disability or high/very high psychological distress were twice as likely to report worse health as a result of missed/delayed care. Half (48.0%) the study participants used telehealth during the COVID-19 pandemic and 81.9% indicated telehealth would be useful post-pandemic. Conclusions: The COVID-19 pandemic impacted access to healthcare services, particularly for people with a disability, and chronic or mental health issues who also reported worse health. This may account for their higher use of telehealth services as an alternate way of accessing health care. Ongoing evaluation of telehealth services for vulnerable groups post-pandemic is required. What is known about the topic ? The COVID-19 pandemic has had a significant impact on healthcare usage and access. What does this paper add? This paper identifies the impact of access to health care during the COVID-19 pandemic on vulnerable subgroups within middle-aged and older Australians, including those with chronic and mental health issues. Telehealth is an acceptable way to facilitate access to services for these groups. What are the implications for practitioners? Practitioners are strategically positioned to provide alternatives to face-to-face visits during times of limited access and identify those who are in most need of additional care by way of telehealth intervention. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate COVID-19 vaccine hesitancy, acceptance, and unmet informational needs in a cancer population during the first phase of the coronavirus disease 2019 (COVID-19) vaccination rollout in Australia. Methods: A cross-sectional survey was conducted in a large tertiary hospital in Queensland, Australia, between 10 May and 31 July 2021. The survey assessed health beliefs, experiences of the COVID-19 pandemic, COVID-19 vaccine hesitancy and informational needs. Results: COVID-19 was perceived to be a significant threat to both physical and mental health. While 57.9% (n = 110) of respondents believed the COVID-19 vaccines were safe and 64.2% (n = 122) believed they were effective, more than half (52.6%; n = 100) agreed that they worried about vaccine side effects. Most respondents (84.2%; n = 160) planned to receive the COVID-19 vaccine; however, feelings of hesitancy remained. There was a statistically significant association between those aged under 60 years (P = 0.003), those with previous vaccine hesitancy (P = 0.000), those who felt they had not received adequate information (P = 0.000) and vaccine hesitancy. Requested information pertained to interactions with cancer treatments, those with a history of blood clotting and information for those undergoing bone marrow transplantation. Conclusions: There is a need for tailored COVID-19 vaccine communication that is responsive to the concerns of people with cancer. This will be beneficial during current and future vaccination rollouts. What is known about topic? People with cancer are a COVID-19 vaccine priority group, as they are at increased risk of morbidity and mortality from this disease. There is currently a dearth of information regarding COVID-19 vaccine hesitancy, acceptance, or informational needs for this population. What does this paper add? This paper has shown that although vaccine refusal rates were low in this population, feelings of hesitancy remained. Women, those in younger age categories, those with previous vaccine hesitancy and those who felt they had not received adequate information had stronger vaccine hesitancy and higher refusal rates. What are the implications for practitioners? There is a need for tailored information and open communication regarding COVID-19 vaccines and people with cancer. There is an opportunity to build upon established relationships of trust between cancer patients and their clinicians. [ABSTRACT FROM AUTHOR]

Objective: To examine implicit bias in employees at a cancer centre using an Australian race (Aboriginal–white) Implicit Association Test (IAT), in an attempt to understand a potential factor for inequitable outcomes of First Nations Australians cancer patients. Methods: All employees at an Australian cancer centre were invited to take part in a web-based, cross-sectional study using an Australian race IAT. The results were analysed using Welch t-tests, linear regression and ANOVA. Results: Overall, 538/2871 participants (19%) completed the IAT between January and June 2020. The mean IAT was 0.147 (s.d. 0.43, P < 0.001, 95% CI 0.11–0.18), and 60% had a preference for white over First Nations Australians. There was no significant mean difference in IAT scores between sub-groups of gender, age or clinical/non-clinical employees. 21% of employees (95% CI 17.65–24.53) had moderate to strong preference for white over First Nations Australians, compared to 7.1% with moderate to strong preference for First Nations over white Australians (95% CI 5.01–9.09). Conclusions: Inequitable cancer survival for First Nations patients has been well established and cancer is now the leading cause of mortality. This paper documents the presence of racial bias in employees at one cancer centre. We argue that this cannot be understood outside the history of colonialism and its effects on First Nations Australians, healthcare workers and our society. Further research is required to evaluate measures of racism, its effect on health care, and how to eliminate it. What is known about this topic? Australian cancer care providers deliver inequitable access and outcomes for First Nations Australians. Systemic and personal racism experienced by First Nations patients are thought to contribute to these inequities. What does this paper add? This paper documents the presence of cancer centre employee racial bias and reiterates the need for further research to document the effect of racism on cancer care outcomes for First Nations patients. What are the implications for practitioners? Healthcare practitioners, similar to other Australians, have implicit bias against First Nations Australians. Previous studies suggest that the presence of bias affects treatment options and outcomes for people of colour. In order to eliminate racism and associated inequities in cancer care services, multi-faceted anti-racism approaches are required. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to conduct a learning and development needs analysis of quality improvement partnership capabilities of staff and consumers on partnership committees at an Australian metropolitan hospital and health service. Objectives were to compare consumer and staff self-rated capability importance, performance, and learning needs; to investigate if years of partnership experience influenced ratings; and to ascertain staff and consumer preferred learning strategies. Methods: An online cross-sectional survey was adapted from the Hennessy–Hicks Training Needs Analysis questionnaire. Participants self-rated the importance of, and their performance on, 10 capabilities, across four domains, of an internationally validated co-produced capability development framework. They also rated preferences regarding learning approaches and media. Results: A total of 199 members from 41 committees (174 staff; 25 consumers; response rate 35.38%) participated. There was a statistically significant learning and development need across all capabilities (P < 0.01). The highest learning need was for influencing organisational systems and policy (mean = −0.96; s.d. = 1.23), followed by equalising power and leadership (mean = −0.91; s.d. = 1.22), and then implementing partnership best practices (mean = −0.89; s.d. = 1.22). There were no statistically significant differences between consumers and staff on ratings, or correlations between years of partnership experience and ratings (P < 0.01). A combination of learning approaches was preferred, followed by learning through experience. Self-reflection was least preferred, which is concerning given it may promote equalising power and leadership. Face-to-face then videoconferencing were the preferred learning media. Conclusions: Continuous co-learning for staff and consumers about QI partnerships is essential. Committee members needed more feedback regarding their influence and to be engaged in innovative co-design practices. What is known about the topic? Staff and consumer capabilities are essential for effective collaboration on quality improvement (QI) committees, however, research is lacking. What does this paper add? This learning and development needs analysis provides direction for effective design of education and support programs. What are the implications for practitioners? Staff and consumers should continuously develop QI partnership capabilities together, and through multiple learning approaches. Increased exposure to innovative co-design strategies is needed to enhance capabilities and influence on organisational systems and policies. Sharing power and leadership was also a high learning need with self-reflection being vital. [ABSTRACT FROM AUTHOR]

Introduction. Education on health care for patients with diverse sexual orientation, sex characteristics and gender identities is lacking in Aotearoa's medical schools. Aim. This study surveyed fifth-year medical students at the University of Otago Wellington (UOW) about confidence in providing health care to lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) patients to identify learning needs. Methods. This anonymous crosssectional survey was designed with input from an advisory group (community members, education, research and subject matter experts). It was administered on paper during class, using Likert scales (level of agreement) and open-ended questions. All fifth-year medical students at the UOW campus were invited to participate in May 2021. Data were analysed in Microsoft Excel (Microsoft Corporation) and free-text comments were analysed using template analysis. Results. In total, 74.7% (71/95) of students completed a survey. Participants lacked knowledge and confidence in their consultation skills with LGBTQIA+ patients and did not feel they had enough teaching in this area. Most (=78.8%) were comfortable with common terms, but half or fewer could explain intersex, gender affirmation and Takatāpui. Free-text comments revealed learning needs relating to consultation skills, ways to approach this topic with sensitivity, and a desire to learn more about the cultural context. Discussion. Medical students view LGBTQIA+ health care as an important topic and want opportunities to improve knowledge and confidence in this area. Students lack confidence in consulting with LGBTQIA+ patients, suggesting that more education focused on practical experience and interactions with real patients would be of benefit. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore allied health professional (AHP) managers' implementation of the right to request part-time hours on return from maternity leave in Queensland Health (QH) hospitals. Methods: Qualitative data were collected via interviews with AHP managers from a cross-section of professions with variations in workforce size and gender composition. Interviews were audio recorded, transcribed and analysed thematically. Results: Twenty-one of a potential 40 AHP managers agreed to participate in the study (response rate 53%). The main finding was that the implementation of part-time work arrangements was being driven by regulation and work was being managed without complementary changes to established workplace practices or adequate organisational support. Conclusion: The use of regulatory instruments to implement part-time work in organisations without complementary work redesign, change management and organisational support suggests that there are significant barriers to this type of flexible working arrangement (FWA) becoming accepted workplace practice for AHPs in QH. A whole-of-organisation approach is needed to make FWA a reality. What is known about the topic?: Research has underlined the importance of implementation and management rather than simply the adoption of FWA policies. However, there have been few reports about AHP management of part-time hours on return from maternity leave. What does this paper add?: This paper provides information specifically about the management response to part-time work entitlements for AHP in QH. It indicates that managers are implementing part-time work because it is a regulatory requirement, but often without a substantive commitment to FWA complementary redesign of services or sufficient organisational support. What are the implications for practitioners?: Complementary work redesign measures and resources are needed to make workplaces genuinely flexible rather than just superficially consistent with regulatory requirements. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic continues to exert a significant toll on the Australian primary healthcare system. Although wellbeing challenges faced by hospital-based healthcare workers are widely discussed, less is known about the experiences of general practitioners (GPs) during the initial phases of the pandemic. This paper reports qualitative survey data from Australian GPs, examining their workplace and psychosocial experiences during the initial months of the pandemic. Methods: An Australia-wide, cross-sectional, online survey of frontline healthcare workers was conducted in 2020. A qualitative approach using content analysis was utilised to examine responses to four free-text questions from GPs. Results: A total of 299 GPs provided 888 free-text responses. The findings reveal that general practice was overlooked and undervalued within the pandemic response, resulting in negative impacts on GP wellbeing. Four themes were identified: (1) marginalisation of GPs; (2) uncertainty, undersupported and undervalued in the workplace; (3) isolation and disrupted personal lives; and (4) strategies to support GPs during times of crises. Key concerns included poor access to personal protective equipment, occupational burnout and poor wellbeing, insufficient workplace support, and conflicting or confusing medical guidelines. Conclusions: Primary healthcare constitutes an essential pillar of the Australian healthcare system. This study presents the many factors that impacted on GP wellbeing during the COVID-19 pandemic. Enabling GP voices to be heard and including GPs in decision-making in preparation for future crises will enhance the delivery of primary care, reducing the burden on hospital services, and help sustain a safe and effective health workforce long term. The COVID-19 pandemic caused significant challenges and wellbeing issues for healthcare workers such as general practitioners (GPs), especially during the initial months in 2020. A large nationwide survey of Australian healthcare workers was undertaken in 2020 to understand their experiences, from which 299 GPs provided free-text survey responses for qualitative analysis. This analysis showed GPs felt marginalised, undervalued and under-supported while working in risky work conditions, pointing to a need for GP voices to be heard to safeguard their wellbeing. [ABSTRACT FROM AUTHOR]

Objective: To describe self-reported general and psychological health for allied health practitioners at an Australian acute public health service over three time points within the coronavirus disease 2019 (COVID-19) pandemic. Methods: This study collected data from cross-sectional online surveys at three time points: May–June 2020 (T 1), October–November 2020 (T 2) and November–December 2021 (T 3). The self-report questionnaire consisted of demographic questions, a general health question and the 21-item version of the Depression Anxiety Stress Scales (DASS-21). Results: A total of 308 responses were received (T 1 n = 135, T 2 n = 78, T 3 n = 95) from representatives of eight allied health professions. The proportion of allied health practitioners reporting poor general health significantly increased over time, as did mean scores on all DASS-21 sub-scales. General health status was also significantly associated with DASS-21 subscale scores. Anxiety scores increased significantly between T 1 and T 2, while depression scores increased significantly between T 2 and T 3. Significant increases in stress scores were recorded across all time intervals. Between T 1 and T 3, the proportion of allied health practitioners reporting moderate, severe, or extremely severe symptoms increased for depression (10.3–30.9%), anxiety (5.2–18.2%) and stress (13.3–36.3%). Conclusion: The general and psychological health of allied health practitioners appears to be worsening as the COVID-19 pandemic continues. Organisational strategies to support the health of the allied health workforce in acute care settings must address the cumulative effects of prolonged pressure on their general and psychosocial health. Support strategies need to be responsive to changes in psychological wellbeing at different phases of the pandemic. What is known about the topic? Many cross-sectional studies report poor psychosocial wellbeing during the COVID-19 pandemic. What does this paper add? Here we provide evidence about the long-term and declining general and psychological health status of Australian allied health practitioners during the COVID-19 pandemic. What are the implications for practitioners? The psychological wellbeing of allied health practitioners has declined as the COVID-19 pandemic continues. There is an urgent need for initiatives targeting allied health practitioners that support their wellbeing and ongoing ability to provide high quality patient care. [ABSTRACT FROM AUTHOR]

Objectives: To compare outpatient attendance rates for Aboriginal and Torres Strait Islander ('Aboriginal') and non-Aboriginal patients at a large metropolitan health service in Melbourne, Australia, and to describe the barriers and enablers experienced by urban-dwelling Aboriginal patients in attending hospital outpatient appointments. Methods: This study used a mixed-method approach. Proportions of referred patients who booked and attended outpatient appointments were extracted from a health service database. Aboriginal versus non-Aboriginal cohorts were compared using chi-squared tests. Eleven patients, one parent of a patient and two community nurses were interviewed by telephone to investigate perceived barriers and enablers to attending outpatient appointments among Aboriginal patients. Results: Outpatient referrals were greater among Aboriginal than non-Aboriginal people; however, referrals were significantly less likely to result in an outpatient clinic booking and attendance for Aboriginal compared to non-Aboriginal people. Interview participants reported several barriers to attending appointments, related to logistical, quality of care and cultural factors. Suggested facilitators to make appointment attendance easier included: provision of transport support, improving clinic scheduling, utilising a variety of appointment reminder formats, providing food in waiting rooms, flexible appointment timing options, outreach services, access to Aboriginal support workers, improving communication and relationships with Aboriginal people, cultural awareness training for staff and the provision of culturally appropriate spaces. Conclusion: Some barriers faced by Aboriginal patients in attending hospital outpatient appointments in urban areas can be addressed through implementation of enablers suggested by participants. Data have informed the development of a tailored, inclusive, culturally and consumer-focused appropriate hospital outpatient service model of care. What is known about the topic? Health outcomes are poorer and burden of disease greater among Aboriginal and Torres Strait Islander people than non-Aboriginal and Torres Strait Islander people. What does this paper add? Compared to non-Aboriginal and Torres Strait Islander people, among Aboriginal and Torres Strait Islander people in urban settings, more outpatient referrals are made, but these referrals are significantly less likely to result in an outpatient clinic booking and attendance. Barriers and enablers to urban-dwelling Aboriginal and Torres Strait Islander people attending outpatient hospital appointments relate to logistical, quality of care and cultural factors. What are the implications for practitioners? Identifying and understanding the barriers and enablers to healthcare access for urban-dwelling Aboriginal and Torres Strait Islander people provides a foundation on which practitioners and organisations can facilitate urban hospital outpatient service development, with the aim to better support healthcare engagement and appointment attendance. [ABSTRACT FROM AUTHOR]

Background: Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient reasons for presenting for medical care after hours, and reasons for selection of specific services across a health system. Methods: A cross-sectional survey was conducted across the Australian Capital Territory. Patients voluntarily completed questionnaires in waiting rooms during the after-hours periods of one weekday and one weekend in 2019 at 28/51 extended hours GPs, 3/3 medical deputising services (MDS), 3/3 nurse-led walk-in-clinics (WICs), and 2/2 public emergency departments (EDs). Results: Of 3371 presentations, 1992 patients completed a survey, with 58% from GPs (n = 1149), 16% from WIC (n = 317), 10% from MDS (n = 193), and 17% from EDs (n = 333). Most patients presented with self-rated new issues (n = 987, 49.5%) and were uncertain of the urgency of their issues (n = 723, 36.7%). Common reasons for presenting to WIC, MDS, and EDs included the problem occurring after hours, and patients concern about the issue. Common reasons for presenting to GP were related to personal preference for after-hours care. Conclusions: Patients present to after-hours medical services for both perceived need and convenience. Most patients appear to be self-selecting after-hours services appropriately aligned with advertised services; except for GP patients who were attending after hours for care that is often non-urgent and could be seen in usual working hours. This study should be replicated to account for local health systems, and coronavirus disease 2019 (COVID-19)-related changes to health care. Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). Our survey shows that patient-perceived urgency and need for care are drivers towards ED and other community services. In contrast, most patients chose after-hours GP for convenience. Public messaging could be adapted to encourage appropriate and timely access to care after hours. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to explore and compare the perceptions of research capacity and culture (RCC) in metropolitan and non-metropolitan New South Wales (NSW) Local Health Districts (LHDs). Methods: The Research Capacity and Culture Tool was delivered online to clinicians and health managers. A 10-point Likert scale of success or skill at organisational, team and individual level of research capacity was used. An independent t -test assessed differences in domain means between non-metropolitan and metropolitan LHDs. Results: A total of 1243 participants responded. Responses to the survey indicated the perception of individual's research skills were greater than the perception of RCC at both the team and organisational levels. Participants from metropolitan locations had significantly higher mean scores across all three domains compared with non-metropolitan locations (P < 0.001). Conclusion: Results indicated the perception of individual's research skills were greater than the team and organisational levels. Participants from metropolitan locations had significantly higher perceptions of RCC across all three domains compared with non-metropolitan locations. This was the largest study to date in Australia investigating RCC in NSW LHDs, and the first study to explore multiple professions across multiple organisations while comparing metropolitan and non-metropolitan settings. This research may inform targeted strategies for building research capacity in NSW LHDs. What is known about the topic? Challenges exist in the current healthcare system to provide the infrastructure and resources to build capacity and embed a culture of research. What does this paper add? This study was significant in its reach across NSW and its perspective of capturing multiple professions. What are the implications for practitioners? Factors found to be consistent across the state may be suggestive of prioritisation for further investigation and implementation at the state and/or national level. [ABSTRACT FROM AUTHOR]

Objective: To explore out-of-pocket (OOP) costs within specialties and individual specialists, and use of Medicare Benefits Schedule (MBS) data for potential price transparency initiatives. Methods: We conducted a cross-sectional descriptive study of claims for a 10% random sample of Medicare enrolees for out-of-hospital MBS-billed subsequent and initial consultations between 1 January 2014 and 31 December 2014, specific to cardiologist, oncologist and ophthalmologists (with at least 10 patient visits in 2014). Our main outcomes were the number of locations per provider, number of unique OOP consultation costs per provider and provider-location, and the proportion of bulk-billed visits for these visits. Results: We studied 970 cardiologists, 913 ophthalmologists and 376 oncologists. At least 67% of specialists across each specialty had at least two practice locations: cardiologists had a median of three (interquartile range [IQR]: 2–4) and ophthalmologists and oncologists both had a median of two (IQR: 1–3). For subsequent consultations, cardiologists had a median of three unique costs per location (IQR: 2–3), whereas ophthalmologists had a median of four unique costs per location (IQR: 3–5). In contrast, oncologists had a median of one unique cost per location (IQR: 1–2) (57.6% of oncologists' provider-locations charged only the bulk-billing amount). Conclusions: Specialists have distinct fee lists that can vary based on location. Summary statistics on price transparency websites based on a single amount (like a median or mean OOP charge) might mask substantial variation in costs and lead to bill shock for individual patients. What is known about the topic? Australia has high out-of-pocket (OOP) medical costs. Statistics on price transparency websites could mask specialist variability. What does this paper add? Most specialists have a discrete tiered 'fee list' they charge, which can vary across locations. Specialists with high OOP costs may still bulk-bill many patients. What are the implications for practitioners? Publishing a specialist's fee list would be most transparent, allowing users to see a range of potential OOP costs. Additionally, individual specialists would avoid being labelled the highest charging provider, which might hide their lowest fees to prospective patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate complaints from patients, their families, and caregivers concerning nursing and midwifery care using the Healthcare Complaints Analysis Tool. Methods: A prospective cross-sectional study with data coded against the domains and categories outlined in the Healthcare Complaints Analysis Tool. Complaints were received between June and December 2020 to nursing and midwifery services of a health service in Melbourne, Australia. Data were extracted, and complaints de-identified. The content was analysed using the Healthcare Complaints Analysis Tool, including three main domains and seven problem categories. Results: A total of 69 written complaints were received: 45% were from patients, 49% from family members, and 6% from friends. Coding of complaints against the taxonomy in the Healthcare Complaints Analysis Tool resulted in 214 complaint categories. Almost half (49.5%) of the complaints pertained to the Relationship domain (including aspects of Patients' Respect and Rights, Communication, and Listening), 34.6% to the Clinical domain and 15.9% to Management. The severity of the incidents described in the complaints were: 32.6% low severity, 51.6% medium severity, and 15.8% high severity. Despite having been categorised by the health service as relating to nursing or midwifery, 38% included other healthcare professionals, and 13% of the complainants (n = 9) did not refer to nurses or midwives at all. Conclusions: Assessing consumer complaints with a validated taxonomy may offer ways to target areas of care and service provision that need improvement and highlight other areas performing well. Ongoing data collection and analysis may also inform training and information needs at the individual or service management level. What is known about this topic? Complaints to healthcare services, an important data source to inform quality and safety of healthcare provision, are generally addressed on a case-by-case basis, and their collective use is under-utilised for service improvement. What does this paper add? The Healthcare Complaints Analysis Tool (HCAT) allowed for a nuanced analysis of the common communication problems in nursing and midwifery health care enabling a more comprehensive response. What are the implication for practitioners? Assessing consumer complaints with the HCAT provides opportunities to target areas of care and service provision that need improvement and highlight other areas that are performing well. [ABSTRACT FROM AUTHOR]

Objectives: Using Google online reviews, this study investigated why patients were satisfied or dissatisfied with their public dental clinic in Victoria, Australia. Methods: This mixed methods study gathered Google reviews published by users pre-March, 2021. The reviews were coded and subthemes and major themes were identified. The most common reasons why patients gave reviews were tabulated and stratified according to star rating, remoteness and accessibility index classification, and socio-economic status. Results: Of the 522 reviews included in this study, in 317 (60.7%) satisfaction was expressed. Compliments and complaints were documented. A total of 53 subthemes were identified. Major themes included Treatment, Staff, Communication and Professionalism, Patient Factors and Non-Clinical Reasons. From the reviews, more patients were satisfied with general unspecified treatment (n = 195; 14.7%) and dissatisfied with reception staff (n = 64; 4.8%). More reviews were generated by patients who visited clinics in major cities and lower socio-economic areas. Conclusion: This study found that most patients expressed satisfaction and identified reasons why patients were satisfied or dissatisfied. Consumer feedback, including compliments and complaints, is an integral aspect of monitoring and improving health service quality. It is important to continue seeking feedback and improve accordingly. What is known about the topic? Research has identified common factors for patient satisfaction or dissatisfaction with dental clinics including: facilities and location, waiting list time, cost, gentleness during procedures, communication, and staffing. What does this paper add? This study identified causes of patient satisfaction and dissatisfaction with Victorian public dental clinics. The focus is on the Victorian public dental system because almost half of the eligible population for public dental services are not utilising them. What are the implications for practitioners? Practitioners can use this study to self-reflect and improve the quality of health service delivery. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to describe the prevalence of cognitive impairment in hospital inpatients, the associated need for assistance with activities of daily living (ADL) and carer perceptions of hospital care. Methods: A prospective cross-sectional observational study was conducted in a large metropolitan teaching hospital in Brisbane, Australia. Participants were inpatients aged ≥65 years and their carers. Cognitive impairment was measured by clinician auditors using the validated 4 'A's test (4AT), with a score >0 indicating cognitive impairment (1–3, probable dementia; >3, probable delirium). The need for supervision and/or assistance with ADL was recorded from daily nursing documentation. Carers were invited to complete a brief questionnaire. Results: In all, 92 of 216 older inpatients (43%) had cognitive impairment, including 52 (24%) with probable delirium. The need for supervision and/or assistance with ADL increased significantly with 4AT score. Fifty-two carers of patients with cognitive impairment reported feeling welcome and that care was safe. They identified opportunities for better information, greater support and more inclusion of carers. Conclusions: Cognitive impairment is common in older inpatients and is associated with increased care needs. Workforce planning and health professional training need to acknowledge the needs of patients with cognitive impairment. There are opportunities for greater support and more involvement of carers. What is known about the topic?: Cognitive impairment due to delirium and dementia increases with age, and is common in older medical and surgical inpatients. However, cognitive impairment remains under-recognised by healthcare staff. Australian guidelines now recommend routine screening using valid tools, and including carers, when appropriate, when assessing, caring for and communicating with people with cognitive impairment. What does this paper add?: This cross-sectional study using the validated 4AT showed 43% of hospital inpatients aged ≥65 years had cognitive impairment. Participants with cognitive impairment had higher care needs and much longer hospitalisations. Carers of people with cognitive impairment reported unmet information needs in hospital and had limited involvement in assessment and care. What are the implications for practitioners?: Cognitive impairment is common in older inpatients. Hospitals and healthcare professionals must be prepared and equipped to recognise cognitive impairment, and address the accompanying patient and carer needs. [ABSTRACT FROM AUTHOR]

Background Rising demand for sexual health services requires publicly funded service providers to ensure they are seeing members of priority populations. Sydney Sexual Health Centre in New South Wales, Australia developed an innovative online triage tool called 'Am I OK?' to support this goal. Methods This paper outlines the findings of a review that examined the use of the triage tool using retrospective cross-sectional analysis of 2017 data. Results The tool has achieved its purpose in ensuring that non-priority populations are referred to other services, consequently saving a significant amount (approximately 6months equivalent) of phone triage nurse time. Conclusion More work may need to be done to ensure that the tool is not creating a barrier for priority populations wishing to access the service. [ABSTRACT FROM AUTHOR]

Objective: Although there is some research on women's choice of birthplace, most of this research has been conducted overseas. This study explored factors influencing the decision to use public or private maternity services within regional Australia. Methods: This cross-sectional study consisted of a community-based, anonymous, online questionnaire focused on factors influencing a woman's choice of birth location and included adult females who had given birth in the past 2 years within two regional areas. Descriptive statistics were used to analyse demographic characteristics and factors influencing decisions regarding birthplace. Pearson's Chi-squared test was used to compare public and private births for multiple variables. Binary logistic regression was used to determine the odds ratio for each potential factor based on whether participants with private health insurance (PHI) elected to birth in the public or private regional hospitals. Open coding was used to group responses to open ended questions into themes. Results: Data from 510 questionnaires were analysed. The three most frequently reported factors influencing a woman's decision about birthplace were financial reasons, the ability to choose their doctor and not having PHI. Women with PHI who opted for birth in the public system were almost four-fold more likely to select access to intensive care services and 2.6-fold more likely to select a preference for a low-intervention birth as one of their top five most influential factors. The results highlight that women want access to midwifery continuity of care. Conclusion: This study provides insights into the factors influencing a woman's complex decision about where and with whom to birth and how health insurance affects that decision, an area where there is a paucity of peer-reviewed literature. This research highlights the importance of being able to choose one's doctor and the desire for access to midwife-led models of care, and provides evidence to advocate for improved access to additional models of care in the private sector. What is already known?: The viability of regional private maternity hospitals is in question because, once the birth rate goes below a certain threshold, providing private obstetric service becomes unviable. Closure of regional private hospitals means less choice in regional areas. Minimal information is available about the factors influencing a woman with PHI to give birth in the public system, and much of the evidence is anecdotal. What does this paper add?: This study provides insight into how PHI status and other factors influence a woman's decision to birth in the public versus private sector, an area where there is a paucity of peer-reviewed literature. It also highlights a desire from women for access to midwifery continuity of care in the private system. What are the implications for practitioners?: This research provides evidence to advocate for improved access to additional models of care, especially for midwifery-led care in the private sector. [ABSTRACT FROM AUTHOR]

Objective: To date, there has been little research that has comprehensively analysed dental treatment under general anaesthesia (DGA) at Perth Children's Hospital (PCH) for dental emergencies (dental pain and sepsis). This cross-sectional descriptive analysis of the PCH dental department analysed the demographic of children admitted and the type of treatment used, and assessed the cost. Methods: This was a retrospective descriptive study analysing the dental records of patients ranging from 2 to 16 years of age at PCH in Western Australia. Of the 310 cases randomly selected from the 2018–19 study period, 202 were admitted for DGA. Two outcome measures were derived: cumulative count of treatment mix and cost analysis. Results: The mean (±s.d.) age at the time of admission was 6.2 ± 2.6 years and the mean (±s.d.) decayed (d/D), missing, (m/M) and filled (f/F) teeth (dmft/DMFT) was 2.1 ± 0.8. Of the 429 teeth affected, 282 were molars. Treatments were grouped therapeutically; of the 856 treatments performed, 465 were extractions (54%). The total cost, consisting of direct and indirect costs, was A$313 823, and equated to an approximate mean (±s.d.) of A$1554 ± 109 per case. Conclusion: Untreated dental caries was the most common cause for hospital admission. Most cases presenting at the emergency department were young children (<7 years old) who underwent extractions under DGA. What is known about the topic?: The Child Dental Benefits Schedule (CDBS) was introduced to improve access and affordability to oral health care for children without private dental insurance. However, a significant number of children are still being admitted to hospital for emergency dental treatment. What does this paper add?: Despite the availability of the CDBS, untreated dental caries remains one of the most common reasons for dental emergency in the PCH. What are the implications for practitioners?: Not only are direct costs a burden on the health budget, but indirect and intangible costs also affect children and their families. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women; however, little is known about it after menopause. We aimed to learn more about BV in Australian postmenopausal women. Methods: We conducted an online survey (July–September 2021). Participants were recruited via social media and professional networks and asked about demographic characteristics, sexual history and BV experiences. Outcomes of interest were the proportion who had heard of BV, had BV ever, or had BV after menopause. Factors associated with these outcomes were assessed using logistic regression. Results: Of 906 participants, 83% were included in the analysis. Overall, 37.9% had heard of BV, 11.0% reported having a BV diagnosis ever, 6.3% reported having a BV diagnosis after menopause and 4.4% reported having a BV diagnosis only after menopause. Multivariable analysis found that among all women the odds of having a BV diagnosis after menopause were increased for those who had BV before menopause, had douched in the past 12 months, or had a previous STI diagnosis. Among those in a sexual relationship, a BV diagnosis after menopause was associated with a BV diagnosis before menopause, or being in a sexual relationship of 5 years or less in duration. About half who reported BV after menopause described recurrences, distress, and a detrimental effect on sexual relationships. Conclusions: BV in postmenopausal women is associated with sexual activity, and impacts negatively on their lives. Research into BV should not be limited to reproductive age women. Bacterial vaginosis is the most common cause of vaginal discharge in reproductive age women, yet little is known about it in postmenopausal women. This survey of Australian postmenopausal women found that women continue to report bacterial vaginosis after menopause, it affects their quality of life, and it is associated with sexual activity. Women of all ages are susceptible to bacterial vaginosis, research should not be limited to younger women, and developing an appropriate testing method should be a research priority. [ABSTRACT FROM AUTHOR]

Background: Patients presenting with dental pain are common in general practice, despite dental infections being most appropriately managed with dental treatment to address the cause of the infection. Although antibiotics are not appropriate for the management of localised toothache without signs of systemic spread, general practitioners (GPs) often prescribe antibiotics and analgesics for the management of dental pain. The aim of this study was to explore GPs' perceptions and management of dental presentations in Australia. Methods: Twelve semi-structured interviews were conducted with GPs across Victoria, Australia, between October 2022 and January 2023. Data were thematically analysed. Results: The study found that dental pain was the most common presenting complaint for patients attending general practice with a dental problem. Five major themes were identified in this study: knowledge, beliefs about capabilities, emotion, environmental context and resources, and social influences/social professional role and identity. In terms of knowledge and capabilities, GPs would advise patients to seek dental care, as they are aware that antibiotics would not resolve the underlying issue. Challenges for GPs included limited training in oral and dental treatment, as well as emotions, such as patient anxiety and phobia resulting in patients seeking dental care through a GP rather than a dentist. Barriers due to the context, such as access to dental care, long waiting lists within the public dental system and cost, were some of the reasons patients present to general practice rather than a seeing a dentist. Furthermore, issues that influenced GPs' antibiotic prescribing included patients' expectations for antibiotics to treat their dental pain, as well as dentists advising their patients to attend their GP for antibiotics prior to dental treatment. Conclusions: This study identified factors that influenced GPs' management of patients with dental conditions. To address these issues, it is imperative to develop interventions addressing patients' knowledge around oral health, as well as providing improved access to dental care for these patients. Patients with dental pain often seek treatment from general practitioners (GPs), even though the problem often requires dental treatment rather than antibiotics and/or pain relief medications. This study looked at GPs' management of patients with dental problems, and identified barriers as to why patients would see a GP instead of a dentist. Understanding these reasons will help develop interventions to better educate patients in oral health, and provide better access to dental care to patients with oral conditions. [ABSTRACT FROM AUTHOR]

Backgound. This study describes patient characteristics and presentations to community-based primary care medical services in the after-hours period. Methods. A cross-sectional survey completed by practitioners was voluntarily conducted over one weeknight and weekend in 2019 at 31 of 51 extended hours general practices (GP), three of three medical deputising services and three of three nurse-led walk-in clinics (WICs). Results. Of 3371 community-based after-hours presentations, 934 consultation records were obtained (overall response: 28%). Emergency departments reported 524 triage code 4 and 5 patients within the study period. Problems managed in community-based after-hours services were most often rated as non-urgent (n = 482; 51.6%) and new (n = 606; 64.9%). The most common community-based after-hours presentations were diagnostic or disease related (e.g. infections or injury; n = 667; 59.5%). The most common body systems impacted were respiratory (n = 329; 29.6%), skin (n = 164; 16.4%) and general/unspecified (e.g. fever; n = 164; 16.4%). Community-based after-hours services reported different types of presentations, with medical deputising services reporting more urgent presentations, GPs reporting more procedural presentations and walk-in clinics reporting more skin-related issues (e.g. wound care). Conclusions. Community-based after-hours medical services contribute significantly to after-hours medical care in the ACT. Patients are self-selecting community-based after-hours medical services appropriately based on problems managed by practitioners. [ABSTRACT FROM AUTHOR]

Background: Many colorectal cancer (CRC) survivors experience ongoing sequelae from their cancer treatment. Limited evidence exists regarding how CRC survivors and general practitioners (GPs) manage these sequelae in the community. This study aimed to explore the experiences and perspectives of CRC survivors and GPs on current approaches to monitoring and managing sequelae of CRC treatment. Methods: We conducted a mixed-methods study using cross-sectional national surveys and qualitative interviews with CRC survivors and GPs to explore: (1) treatment sequelae experienced by CRC survivors, (2) how these were monitored and managed by general practitioners, and (3) suggestions to improve ongoing management of the treatment sequelae. Survey responses were reported descriptively. Qualitative data were thematically analysed using an interpretive descriptive approach. Results: Seventy participants completed surveys: 51 CRC survivors and 19 GPs, and four interviews were conducted with GPs. CRC survivors experienced a range of treatment sequelae, but often did not discuss these with their GPs (experienced vs discussed: 86% vs 47% for fatigue/lack of energy, 78% vs 27% for psychological/emotional concern, 63% vs 22% for impaired sleep, 69% vs 29% for weight loss/gain, 59% vs 16% for sexual and intimacy concerns). GPs reported inadequate information transfer from cancer services and workload as major barriers to optimal care. Conclusions: System-level changes that facilitate adequate information transfer from cancer services to GPs upon CRC treatment completion, as well as addressing time constraint issues essential for comprehensive monitoring and management of CRC treatment sequelae, could enhance the care of CRC survivors in the community setting. Many colorectal cancer survivors face various post-treatment challenges that impact their daily lives. How these are treated within the primary care setting remains poorly understood. This study found that colorectal cancer survivors commonly experienced various challenges after cancer treatment, such as fatigue, changed bowel habits and psychological difficulties, but often did not discuss them with their general practitioners. Potential ways to better identify and address these common post-treatment challenges for colorectal cancer survivors are needed. [ABSTRACT FROM AUTHOR]

Introduction. Patient encounter tools provide feedback and potentially reflection on general practitioner (GP) registrars' in-practice learning and may contribute to the formative assessment of clinical competencies. However, little is known about the perceived utility of such tools. Aim. To investigate the perceived utility of a patient encounter tool by GP registrars, their supervisors, and medical educators (MEs). Methods. General practice registrars, supervisors and MEs from two Australian regional training organisations completed a cross-sectional questionnaire. Registrars rated how Registrar Clinical Encounters in Training (ReCEnT), a patient encounter tool, influenced their reflection on, and change in, clinical practice, learning and training. Supervisors' and MEs' perceptions provided contextual information about understanding their registrars' clinical practice, learning and training needs. Results. Questionnaires were completed by 48% of registrars (n = 90), 22% of supervisors (n = 182), and 61% of MEs (n = 62). Most registrars agreed that ReCEnT helped them reflect on their clinical practice (79%), learning needs (69%) and training needs (72%). Many registrars reported changing their clinical practice (54%) and learning approaches (51%). Fewer (37%) agreed that ReCEnT influenced them to change their training plans. Most supervisors (68%) and MEs (82%) agreed ReCEnT reports helped them better understand their registrars' clinical practice. Similarly, most supervisors (63%) and MEs (68%) agreed ReCEnT reports helped them better understand their registrars' learning and training needs. Discussion. ReCEnT can prompt self-reflection among registrars, leading to changes in clinical practice, learning approaches and training plans. Reaching its potential as an assessment for learning (as opposed to an assessment of learning) requires effective engagement between registrars, their supervisors and MEs. [ABSTRACT FROM AUTHOR]

Aim. The aim of the study was to establish whether two previously described barriers to effective in-consultation assistance-seeking by general practice (GP) vocational specialist trainees (ie concern about patient impressions of their competence, and discomfort presenting to supervisors in front of patients) influenced the frequency of trainee in-consultation assistanceseeking from their supervisor. Methods. This was a cross-sectional study nested in the Registrar Clinical Encounters in Clinical Training ongoing cohort study of Australian GP trainees. Trainee participants completed contemporaneous records of 60 consecutive patient consultations, including whether supervisory assistance was sought. Trainees also completed a cross-sectional survey including items eliciting their beliefs about patient impressions and their own discomfort in seeking in-consultation supervisory assistance. These were factors of interest in multivariable logistic regression analyses; the outcome factor in both regression models was the seeking of inconsultation supervisory assistance. Results. In 2018, 778 trainees (778/876, response rate 89%) completed the cross-sectional survey. No association was found between the odds of inconsultation help-seeking and perceived decrease in patient impressions of trainee competence (OR = 1.09; 95% CI: 0.91, 1.31; P = 0.36) or higher comfort presenting outside patients' hearing (OR = 0.9; 95% CI: 0.77, 1.05; P = 0.19). Discussion. Contrary to expected utility models of helpseeking, trainees may not consider personal discomfort or impression management to be important enough, compared to patient safety and other considerations, to influence decisions regarding in-consultation help-seeking. Clinical supervisors should, nevertheless, consider the potential personal costs to trainees and maintain trainee self-esteem and confidence by providing in-consultation assistance in front of patients as comfortably and effectively as possible. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Among academic medical disciplines, Family Medicine (FM) research is notable for its breadth of health-care content areas, making it particularly susceptible to interdisciplinary collaboration. AIM: This study characterises the degree and typology of such collaborations, and determines whether collaboration patterns are associated with citation frequency and funding. METHODS: This cross-sectional study describes collaboration patterns for publications from 2015 indexed in Web of Science and authored by faculty from United States (US) departments of family medicine (DFMs). We determined mean number of total and FM authors per publication, and percentage of publications with FM first or last authors. Publications were categorised by inclusion of non-FM faculty author(s) and number of DFMs represented. RESULTS: Overall, 919 FM faculty from 109 DFMs authored a total of 1872 unique publications in 2015. There was an average of 6.8 authors per publication with 1.4 authors being FM faculty. FM faculty were first author on 26.2% and last author on 29.2% of publications. Of all publications, 0.9% were single FM Author; 1.0% were same DFM; 0.3% were multiple DFMs; 72.4% were single FM Author+non-FM; 19.3% were same DFM+non-FM; 6.0% were multiple DFMs+non-FM. FM publications with non-FM faculty authors showed higher citation rates, higher rates of funding, and lower rates of having no funding source. DISCUSSION: Most FM publications involved non-FM faculty authors. Collaborations involving non-FM authors were correlated with higher impact publications and projects that were more likely to have been funded. [ABSTRACT FROM AUTHOR]

Objective. Fostering a research culture and enhancing research capacity within the workforce is essential for any health service aiming to provide evidence-based care. This study aims to explore the research culture and capacity in a community health service setting and provide a comparison to previous published research in other health service settings. Methods. Participants were invited to complete a survey consisting of demographics and the Research Capacity and Culture (RCC) tool. Median and interquartile ranges were calculated for each RCC item and compared to three Australian and one international comparison. Results. A total of 73 staff members from Metro North Community and Oral Health service participated. The team-level scores for the RCC were overall the lowest. Comparison to previously published research using the RCC indicated marginally higher scores for individual-level items in our study across all domains. Individual-level items were very weak to weakly correlated with the team and organisation-level RCC items. Strong to very strong correlations were found between a majority of the team and organisation-level items. Conclusions. Team-level scores were substantially lower when compared to individual and organisational levels. The item 'team leaders that support research' was positively correlated with various organisation-level items, indicating that if the respondent perceived the team leader as a low supporter of research the respondent perceived several organisation items also poorly. As an important stakeholder in enabling research in a health service, organisations should investigate the challenges experienced by team leaders in facilitating research and the support or training they may need. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to investigate allied health professionals' (AHPs') perspectives preand post-implementation of an electronic medical record (EMR) in a tertiary health service in Australia and examine factors influencing user acceptance. Methods. Data were collected preand post-EMR implementation via cross-sectional online surveys based on the Unified Theory of Acceptance and Usage of Technology (UTAUT). All AHPs at a large tertiary hospital were invited to complete the surveys. Data analysis included descriptive analysis, Mann--Whitney U tests for pre-post item- and construct-level comparison and content analysis of free-text responses. The theoretical model was empirically tested using partial least squares structural equation modelling. Results. AHPs had positive attitudes toward EMR use both pre- and post-implementation. Compared to pre-implementation, AHPs felt more positive post-implementation about system ease of use and demonstrated decreased anxiety and apprehension regarding EMR use. AHPs felt they had adequate resources and knowledge to use EMR and reported real-time data accessibility as a main advantage. Disadvantages of EMR included an unfriendly user interface, system outages and decreased efficiency. Conclusions. As AHPs increase EMR system familiarity, their positivity towards its use increases. An understanding of what influences AHPs when implementing new compulsory technology can inform change management strategies to improve adoption. [ABSTRACT FROM AUTHOR]

Background: The 75+ health assessment has been identified as a suitable trigger to introduce advance care planning (ACP) to general practice patients. Australian general practitioners (GPs) were surveyed to explore their perceptions, attitudes and practices in introducing ACP during 75+ health assessments. Methods: A cross-sectional postal survey of Australian GPs covering their personal, professional and workplace characteristics, their current practice regarding ACP within a 75+ health assessment, and their attitude towards ACP. Multivariate logistic regression was used to analyse the factors associated with routinely discussing ACP as part of the 75+ health assessment. Results: A total of 185 (19.2%) out of 964 eligible GPs returned a completed survey. Most GPs reported that patients interested in ACP were supported by the GPs or the practice nurse. Two factors, (1) attitude that ACP is an essential component of the 75+ health assessment, and (2) regional or rural location of the practice, had a statistically and clinically significant association with the GP's self-reported discussion of ACP during 75+ health assessments. Conclusions: GPs showed a high level of support and involvement in discussing ACP during 75+ health assessments. ACP support during 75+ health assessments was often provided directly by the GP or via the practice nurse. Given the international evidence that ACP training programs improve skills and knowledge, and foster positive attitudes towards ACP, there is an important need to continue funding ACP training programs for GPs and practice nurses. The 75+ health assessment has been identified as a suitable trigger to introduce advance care planning (ACP) to general practice patients. Our cross-sectional survey of 185 Australian GPs showed that (1) most patients interested in ACP were supported by general practices, and (2) the attitude that ACP is an essential component of the 75+ health assessment and regional/rural location were associated with GPs' discussion of ACP during 75+ health assessments. More support and funding may be required to follow up on these important discussions. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to assess and compare the psychological wellbeing of Australian hospital clinical staff at three timepoints during the coronavirus disease 2019 (COVID-19) pandemic. Methods. An anonymous, online, cross-sectional survey was conducted at three timepoints during the COVID-19 pandemic (T1: May–June 2020; T2: October–December 2020; T3: November 2021–January 2022). The surveys were completed by nurses, midwives, doctors and allied health staff employed at a large metropolitan tertiary health service located in Melbourne, Australia. The Depression, Anxiety and Stress Scale (DASS-21) assessed respondents’ psychological wellbeing in the past week. General linear models were used to measure the effects of survey timepoint on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics. Results. A total of 1470 hospital clinical staff completed at least one survey (T1: 668 (14.7%), T2: 358 (7.9%) and T3: 444 (9.8%)). Respondents’ sociodemographic characteristics were similar across the three timepoints and within professional discipline groups. Respondents’ psychological wellbeing was worse at T3 compared to the earlier survey timepoints. Adjusting for respondent characteristics, depression, anxiety and stress scores were significantly higher for respondents of the third survey compared to the first (P < 0.001). Conclusions. There was a significant and persistent negative impact on the psychological wellbeing of hospital clinical staff in Australia across waves of the COVID-19 pandemic. Hospital clinical staff would benefit from ongoing and continued wellbeing support during and after pandemic waves. [ABSTRACT FROM AUTHOR]

Objective. This study is the first to investigate the incidence of personal importation of prescription medicines among Australians aged 45 years or older, and the reasons driving this behaviour. Methods. An online survey was distributed to Australians, aged 45 years or older, who were taking prescription medicines. Recruitment was conducted via Qualtrics. The survey was completed by 1180 respondents. Results. In our sample, 1.8% of respondents had imported prescription medicines in the previous 12 months, 21.9% had not taken, or had delayed taking, a prescribed medicine due to cost, 21.9% described medicines as unaffordable/very unaffordable, and 17.7% took some budgetary measure to pay for their medicines. The most significant predictors (P < 0.001) of importation were doctors raising it as an option (1.0% vs 42.9%), awareness of the Personal Importation Scheme (0.8% vs 22.6%), believing that importing was safe (1.6% vs 20.9%), paying more than the maximum PBS co-payment for any individual medicine (0.4% vs 8.1%), higher monthly spend on medicines (1.0% vs 6%), and delaying or not taking a medicine due to cost (0.9% vs 5.0%). Almost half (44.4%) would consider importing medicines to save money. Conclusions. Potentially hundreds of thousands of Australians are importing prescription medicines from abroad, and many Australians indicate they are willing to import medicines to save money. [ABSTRACT FROM AUTHOR]

The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access. Methods. A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use. Results. Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31–0.36, P < 0.05) than English-speaking people. Among those using telehealth, people requiring interpreter services were 13% less likely to use videoconference than phone (OR adjusted 0.87, 95% CI 0.77–0.98, P < 0.005). Conclusion. There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to address the acceptance of mHealth applications for a dental screening app that facilitates patient information entry and captures dental photos remotely to assist in caries diagnosis in preschool children in Australia. Methods. All participants were recruited through the ORIGINS Project, a community-based interventional birth cohort study in Western Australia. Forty-two primary caregivers, who were the users of a teledental screening app, were given a questionnaire with 17 questions; these were constructed based on the theme of the Technology Acceptance Model: perceived ease of use (PE), perceived usefulness (PU), behavioural intention to adopt (BI), anxiety (ANX), attitude toward a behaviour (ATB), and self-efficacy (SE). Cronbach's alpha was estimated to determine internal consistency. Path analysis was employed to quantify the relationship between each theme. Results. The mean values for most themes indicated high satisfaction with the intervention among caregivers (scores out of 5): PE (4.54 ± 0.55), PU (4.65 ± 0.49), BI (4.40 ± 0.65), ATB (4.23 ± 0.70), SE (4.36 ± 0.64). Results indicated high consistency in response in the PE, PU, ATB, and SE (a = 0.74-0.84) and moderate consistency was observed in ANX and BI (a = 0.50-0.62). The overall intention of using the dental screening app was significantly related to both PU and ATB (P < 0.05); in addition, the SE and PE also positively affected the PU. Conclusion. The perceived usefulness and attitude toward behaviours influenced the overall behavioural intention of the participants to use the telehealth model in dental screening. Recognising these relationships indicates community readiness for implementing the telehealth application in the dental program and enables identification of areas for improving its diffusion. [ABSTRACT FROM AUTHOR]

Introduction. Low back pain (LBP) is common and a significant cause of morbidity. Many patients receive inappropriate imaging for LBP in primary care. Aim. To explore the incidence and type of spinal imaging conducted for LBP patients referred from general practice for specialist surgical opinion, and evaluate whether imaging conformed to clinical guidelines. Methods. Audit of a sequential cohort (n = 100) of new LBP patients referred from primary care for specialist opinion at a suburban Australian capital city independent Spinal Centre. Results. In the 6 months before referral, 90% (95% CI 83–95%) of patients underwent spinal imaging. Imaging was performed in 95% of those who did and 79% of those who did not meet guidelines for radiological investigation. 35% of patients were inappropriately imaged and 3% inappropriately not imaged. Spinal computed tomography (CT) imaging was used in 52% of patients, magnetic resonance imaging (MRI) in 42% and image-guided lumbar spinal interventional procedures in 28%. Discussion. Most patients with LBP referred for surgical opinion have diagnostic radiological investigations whether or not it is indicated by clinical guidelines. The more frequent use of spinal CT compared to MRI may be due to idiosyncrasies of the Australian Medicare Benefits Schedule (MBS) rebate system. The findings of this pilot study provide support for the changes recommended by the 2016 MBS Review Taskforce on LBP that permit GP access to subsidised lumbar MRI, while constraining access to lumbar CT, and provide novel data about spinal imaging and practice in this cohort of patients. [ABSTRACT FROM AUTHOR]

Objective. Nursing workplace injuries related to staff-assisted patient/resident movement occur frequently, however, little is known about the programs that aim to prevent these injuries. The objectives of this study were to: (i) describe how Australian hospitals and residential aged care services provide manual handling training to staff and the impact of the coronavirus disease 2019 (COVID-19) pandemic on training; (ii) report issues relating to manual handling; (iii) explore the inclusion of dynamic risk assessment; and (iv) describe the barriers and potential improvements. Method. Using a cross-sectional design, an online 20-min survey was distributed by email, social media, and snowballing to Australian hospitals and residential aged care services. Results. Respondents were from 75 services across Australia, with a combined 73 000 staff who assist patients/residents to mobilise. Most services provide staff manual handling training on commencement (85%; n = 63/74), then annually (88% n = 65/74). Since the COVID-19 pandemic, training was less frequent, shorter in duration, and with greater online content. Respondents reported issues with staff injuries (63% n = 41), patient/resident falls (52% n = 34), and patient/resident inactivity (69% n = 45). Dynamic risk assessment was missing in part or in whole from most programs (92% n = 67/73), despite a belief that this may reduce staff injuries (93% n = 68/73), patient/resident falls (81% n = 59/73) and inactivity (92% n = 67/73). Barriers included insufficient staff and time, and improvements included giving residents a say in how they move and greater access to allied health. Conclusion. Most Australian health and aged care services provide clinical staff with regular manual handling training for staff‐assisted patient/resident movement, however, issues with staff injuries, as well as patient/resident falls and inactivity, remain. While there was a belief that dynamic in‐the‐moment risk assessment during staff‐assisted patient/ resident movement may improve staff and resident/patient safety, it was missing from most manual handling programs. [ABSTRACT FROM AUTHOR]

Objective. Professional accountability programs are designed to promote professional behaviours between co-workers and improve organisational culture. Peer messengers play a key role in professional accountability programs by providing informal feedback to hospital staff about their behaviour. Little is known about the experiences of messengers. This study examined the experiences of staff who delivered messages to peers as part of a whole-of-hospital professional accountability program called ‘Ethos’. Methods. Ethos messengers (EMs) across eight Australian hospitals were invited to complete an online survey. The survey consisted of 17 close-ended questions asking respondents about their experiences delivering messages to peers and their perceptions of the Ethos program. Four open-ended questions asked respondents about rewarding and challenging aspects of being a peer messenger and what they would change about the program. Results. Sixty EMs provided responses to the survey (response rate, 41.4%). The majority were from nursing and medical groups (53.4%) and had delivered 1–5 messages to staff (57.7%). Time as an EM ranged from less than 3 months to more than 12 months. A majority had been an EM for more than 12 months (80%; n = 40). Most agreed they had received sufficient training for the role (90.1%; n = 48) and had the skills (90.1%; n = 48), access to support (84.9%; n = 45) and time to fulfil their responsibilities (70.0%; n = 30). Approximately a third (34.9%; n = 15) of respondents indicated that recipients were ‘sometimes’ or ‘never’ receptive to messages. Challenging aspects of the role included organising a time to talk with staff, delivering feedback effectively and communicating with peers who lacked insight and were unable to reflect on their behaviour. Conclusions. Skills development for peer messengers is key to ensuring the effectiveness and sustainability of professional accountability programs. Training in how to deliver difficult information and respond to negative reactions to feedback was identified by EMs as essential to support their ongoing effectiveness in their role. [ABSTRACT FROM AUTHOR]

Introduction. Physical activity (PA) in older people is associated with improved morbidity and mortality outcomes. Increasing numbers of older people are choosing to live in retirement villages, many of which promote themselves as providing opportunities for activity. Aim. To explore the characteristics of PA village residents were undertaking and the associated individual and village factors. Methods. Health, functional and wellbeing information was collected from 577 residents recruited from 34 villages in Auckland, New Zealand, using an International Resident Assessment Instrument and customised survey tools containing items on self-reported PA. Managers from villages completed a survey on village characteristics and facilities. Results. The mean age (s.d.) of village residents was 82 (7) years, and 325 (56%) reporting doing one or more hours of PA in the 3 days prior to assessment. Moderate exercise was performed by 240 (42%) village residents, for a mean (s.d.) of 2.7 (3.4) h per week. The most common activities provided by villages included: bowls/petanque (22, 65%) and exercise classes (22, 65%), and walking was the most common activity undertaken (348, 60%). Factors independently associated with PA included individual factors (gender, fatigue, constipation, self-reported health, number of medications, moving to village for safety and security, utilising village fitness programme, use of the internet, and satisfaction with opportunities to be active) and village-related factors (access to unit, and ownership model). Discussion. PA uptake is determined by many factors at both personal (physical and psychosocial) and environmental levels. Clinicians should focus on individualised PA promotion in those with identified risk factors for low levels of PA. [ABSTRACT FROM AUTHOR]

Introduction. In Aotearoa New Zealand, lead maternity carers (LMCs) provide maternity care through pregnancy and birth, until 6 weeks’ postpartum. An early LMC connection in pregnancy is associated with better maternal and perinatal health outcomes. However, hapū māmā (pregnant women) may experience barriers to engaging with LMC, delaying screening, risk assessments, and education. These barriers contribute to inequitable health outcomes for Māori māmā and pēpi (Māori mothers and babies). A pro-equity approach to maternity care is warranted. Aim. To investigate the LMC plan at the first point of contact with a primary care provider once pregnancy is confirmed, as well as selected risk factors to maternal and perinatal health for Māori and non-Māori hapū māmā. Methods. Data entered by primary care providers into the Best Start-Pregnancy Tool were analysed for 482 pregnant women from November 2020 to December 2021. Results. Most hapū māmā planned for midwifery care. About one-third of hapū māmā had engaged with a midwife before their first GP visit after a confirmed pregnancy. Māori hapū māmā were more likely to present with risk factors to maternal and perinatal health than non-Māori hapū māmā. Discussion. Primary healthcare providers have an expectation to connect hapū māmā to a LMC by 10 weeks’ gestation. More research is needed to identify how to best support Māori hapū māmā to access a LMC early in pregnancy. The Best Start Kōwae is an accessible online tool (currently in an implementation phase) for primary care providers and LMCs that promotes equitable health outcomes for Māori māmā and pēpi. [ABSTRACT FROM AUTHOR]

The article focuses on trend in general practice towards diversification of the GP's professional role. Topics include examines in addition to clinical practice, many GPs choose to work in other health areas and considered this intention manifests in general practice training, with GP trainees expressing interest in developing portfolio careers.

Background: People with severe mental illness have a higher rate of premature death than the general population, largely due to primary care preventable diseases. There has been little research on the health profile of this population attending Australian general practices. Methods: In this nationwide cross-sectional study, MedicineInsight data for adult patients regularly attending general practices in 2018 were analysed to estimate the prevalence of schizophrenia or bipolar disorders (SBD) and investigate the health profile of people with SBD compared with other patients. Multilevel models clustered by practice (n = 565) and patient, and practice characteristics were created. Results: The prevalence of recorded SBD was 1.91% (95% CI = 1.88%–1.94%) among the 618 849 patients included. Patients with recorded SBD were more likely than other patients to have records of health risk factors, particularly smoking (aOR = 3.8, 95% CI = 3.6–3.9) and substance use (aOR = 5.9, 95% CI = 5.6–6.3), and higher probabilities of comorbidities including cardiovascular diseases (aOR = 1.3, 95% CI = 1.2–1.4), cancer (aOR = 1.1, 95% CI = 1.0–1.2), diabetes mellitus type 2 (aOR = 2.2, 95% CI = 2.0–2.3), chronic kidney diseases (aOR = 1.7, 95% CI = 1.5–2.0), chronic liver diseases (aOR = 3.3, 95% CI = 2.6–4.0) and chronic respiratory diseases (aOR = 1.7, 95% CI = 1.7–1.8). Conclusions: The higher prevalence of health risk factors and comorbidities among patients with recorded SBD underscores the need for proactive health risk monitoring and preventive care to address this health inequity. People with severe mental illness die about 20 years earlier than those in the general population, mostly due to preventable diseases. Data on those who attend general practice in Australia are lacking. This study describes higher rates of socioeconomic disadvantage, risk factors such as smoking and chronic diseases such as diabetes mellitus type 2 relative to other patients. The results add further weight to the call for more proactive preventive care for people with severe mental illness to address this health inequity. [ABSTRACT FROM AUTHOR]

Background: GPs are integral to the COVID-19 vaccination rollout, providing education and administering vaccines. We sought to describe how counselling relating to COVID-19 vaccination was impacting Australian general practice consultations. Methods: We conducted an online, mixed-methods, cross-sectional survey of Australian community-based primary care from 7 to 15 July 2021. This survey, number 15 in a series of recurrent cross-sectional surveys conducted over a 14-month period, explored how counselling relating to COVID-19 vaccination was impacting general practice consultations, through multiple selection and open text responses; it also included questions on respondent and practice characteristics, and pandemic-related stress and strain. We calculated descriptive statistics for quantitative variables, and analysed free-text responses using an inductive content analysis approach. Results: We received 73 responses (72 GPs) across all states/territories. Discussions with patients about COVID-19 vaccines and vaccination were common, increasing the duration of routine consultations by 6 min on average (s.d. 2.9). Respondents described the impact of the resulting time pressures, and the stress and challenges of participating in COVID-19 vaccine communication and administration. Although our results are illuminating, they are limited by the small sample, with some different characteristics from national estimates, an uncertain response rate and the inability to pilot the survey prior to distribution. Conclusions: The significant impact on general practice consultation from COVID-19 vaccine counselling is on a background of ongoing pandemic-related stress and strain. With a strong track record of population vaccination, GPs are well-placed to deliver COVID-19 immunisations to the Australian population. However, they must be represented in planning and coordination, to reduce the overall burden on primary care. The COVID-19 vaccination program is a crucial element of the Australian pandemic management plan and goal to return to 'normal' life, and primary care is a vital player in vaccine provision. Integrating new population-wide vaccinations into existing general practice has had a significant, but not well-documented, impact on primary care. Our study describes the experiences of general practice in Australia nearly 5 months into the vaccine rollout. [ABSTRACT FROM AUTHOR]

Mobile phones play an irreplaceable role in modern people’s lives. However, the radiofrequency electromagnetic radiation produced by mobile phones has also caused increasing concern. A cross-sectional study was conducted to investigate the effect of radiofrequency electromagnetic radiation produced by mobile phones on semen parameters in 1634 men who underwent semen examination at the Department of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University, China. Analysis of variance and multivariate linear regression were used to explore differences among different groups. A P < 0.05 was considered statistically significant. The results showed significant associations among different groups of daily mobile phone use time and daily duration of phone calls in the percentage of progressively motile spermatozoa (P = 0.004 and P = 0.007), rapid progressively motile spermatozoa (P = 0.012 and P = 0.006) and total motile spermatozoa (P = 0.004 and P = 0.046). After adjustments for the confounding effects of age and body mass index by multiple linear regression, the results showed that the daily duration of mobile phone use had a negative effect on sperm motility. However, there was no statistically significant correlation between daily phone call duration and sperm motility. Therefore, the daily duration of mobile phone use may negatively affect sperm motility and impair male fertility. [ABSTRACT FROM AUTHOR]

Introduction. Obesity is a multifaceted clinical and public health issue affecting over 34% of New Zealand adults. The Ministry of Health has positioned general practice as the best-suited location for addressing the health effects of obesity. Previous literature has identified barriers to the delivery of effective obesity management in general practice. Aim. To explore Waikato GP perspectives to determine areas for improving the care of adults with weight problems. Methods. A short exploratory questionnaire was used to collect data from 29 GPs across the Waikato region. Descriptive statistics and content analysis were used. Results. The majority of GPs reported: they would wait for their patient to raise the issue of their weight; would offer weight advice themselves as a first option before considering referral; did not view general practice as best suited in tackling the obesity epidemic; and utilised bariatric surgery as a referral option while noting the inequities in access. Discussion. The survey identified barriers to discussing weight with patients and in finding effective treatment options. Psychosocial and sociocultural aspects were recognised as contributing factors to obesity, but not highlighted as available treatment options. Bariatric surgery was reported as a viable option for treatment, but with barriers to access in the public system. This study found strong trends and themes, which identify an urgent need for further exploration into weight management pathways in New Zealand. [ABSTRACT FROM AUTHOR]

Background: Disclosure of sexual orientation to others (outness) might be associated with sexual and mental health among gay and bisexual men (GBM) attending university. We aimed to characterise outness and investigate factors correlated with outness among GBM attending university in China.Methods: Between September 2018 and March 2019, GBM attending university were recruited in six cities in China. Information on sociodemographic characteristics, outness and sexual behaviours were collected using a self-administered questionnaire. Each participant was tested for HIV/STIs. Correlates of outness were assessed using multivariable logistic regression.Results: A total of 400 GBM attending university were recruited, of whom 251 (62.8%) had disclosed their sexual orientation. Men who served as student leaders (adjusted odds ratio [AOR]=2.28, 95% CI: 1.46-3.54) and donated blood (AOR 1.85, 95% CI: 1.05-3.24) were more likely to disclose their sexual orientation, whereas men who had sex with a female (AOR 0.19, 95% CI: 0.05-0.74) and had group sex (AOR 0.52, 95% CI: 0.30-0.89) were less likely to disclose their sexual orientation. Mental health status, HIV/STI infections were not associated with outness.Conclusions: GBM attending university who disclosed their sexual orientation were more likely to be involved with student work and less likely to engage in high-risk sexual behaviours. More attention and education could focus on non-disclosing GBM men attending university through peer education or other ways. [ABSTRACT FROM AUTHOR]

Objective. Examine the use of priority and provisional approval pathways by the Australian Therapeutic Goods Administration (TGA) for evaluating new medicines. Methods. This observational study assessed all new medicines approved by the TGA between 1 January 2018 and 18 October 2021. It examined how frequently priority and provisional approval pathways are being used, the conditions which the medicines are being approved to treat, how long medicines are spending in the approval pathways, the additional therapeutic value of the medicines being approved through these pathways and how the use of the pathways compares with similar regulatory pathways used by Health Canada. Results. The TGA approved 138 new medicines in the time period under study, of which 33 were approved through either the priority or provisional approval pathways. Sixteen were approved to treat cancer. It took the TGA a mean of 130 (95% CI 118, 143) and 144 (95% 101, 188) working days for priority and provisional pathways, respectively. Therapeutic evaluations were available for 16 of these medicines and 11 offered little to no therapeutic gain over existing medicines. There was moderate agreement between the TGA and Health Canada in their use of these pathways (Kappa = 0.5458, 95% CI 0.3900, 0.7016). Conclusions. The priority and provisional approval pathways are now being used by the TGA for about one-third of all new medicine approvals. Although the medicines approved in these ways are moving through the review process more quickly than those approved through the standard approval pathway, the majority of these medicines, for which an evaluation of therapeutic value is available, do not offer any substantial additional therapeutic value over existing medicines. [ABSTRACT FROM AUTHOR]

Introduction. Dr Ian McWhinney argued that the behaviour of patients should be classified in parallel with the taxonomy of disease. Therefore, he proposed a Taxonomy of Patient Behaviour, taking the doctor–patient contact as the reference point. Aim. To assess McWhinney’s Taxonomy of Patient Behaviour and explore its associations with patient age and gender, type, modality and the weekday of the appointment, in the context of the coronavirus disease 2019 (COVID-19) pandemic. Methods. This was a cross-sectional study in a Community Health Centre in Florianópolis, Brazil. We retrospectively collected data from electronic medical records and analysed 4 consecutive weeks of our clinical encounters where every appointment had the patient’s motivation for seeking their medical appointment coded as: ‘limit of tolerance’, ‘limit of anxiety’, ‘heterothetic’, ‘administrative’, or ‘no illness’. Results. There were 647 appointments. The frequencies of the taxonomic classifications were: 27.8% ‘administrative’, 26.6% ‘limit of tolerance’, 21.8% ‘limit of anxiety’, 18.1% ‘no illness’, and 5.7% ‘heterothetic’. Female patients had more consultations classified as ‘heterothetic’ and ‘limit of anxiety’. ‘Limit of tolerance’ and ‘heterothetic’ were more frequent in face-to-face appointments than in remote (on-line) consultations, and most of the ‘limit of anxiety’ consultations were same-day appointments. The average patient age was slightly higher on appointments classified as ‘heterothetic’ and lower on ‘limity of anxiety’ appointments. Discussion. The COVID-19 pandemic may have influenced the higher ‘administrative’ and ‘limit of anxiety’ frequency presentations. We hope to encourage other family doctors to adopt this system during their consultations and teaching functions and, perhaps, inspire more complex investigations. [ABSTRACT FROM AUTHOR]