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Aim: To identify components of an online education intervention to improve preference for, and uptake of, long‐acting reversible contraception in women from culturally and linguistically diverse backgrounds (CALD). Issue Addressed: Women from culturally and linguistically diverse (CALD) backgrounds have greater rates of unintended pregnancies than those born locally and are less likely to use long‐acting reversible contraceptives (LARCs), which are highly effective at reducing unintended pregnancy. Increasing the uptake of LARC in women from CALD backgrounds may reduce the burden of unintended pregnancy in this high‐risk group. An online education intervention has been shown to be effective at increasing preference for and uptake of LARC in young women. We aimed to describe what women from CALD backgrounds thought were the potentially effective components of an online education intervention to increase preference for, and uptake of, long‐acting reversible contraception. Methods: This qualitative study involved semi‐structured interviews with six Australian English‐speaking women from each of Chinese, Indian, and Middle Eastern cultural backgrounds. Women were recruited through targeted Facebook advertising. Data were analysed using Braun and Clarke thematic analysis. Results: A total of 18 participants were interviewed. We have demonstrated the importance of messages tailored to cultural values, translating the video, widening the target audience to both men and women and using specific social media platforms. For all women, the video needs to highlight the covertness of contraceptive methods, alongside stating cost and approach to access. For Indian women, the video needs to highlight the effect of LARC methods on the menstrual period for Indian women and include basic information on women's health. For Middle Eastern women the video should be explicit about LARC not equating to abortion and emphasise the low efficacy of natural contraceptive methods. For Chinese women, the video should address the misconception that hormones damage the body. Regarding delivery of the video, it should be translated and delivered by a female doctor from the same culture. For Chinese women, the video should include women from the same culture sharing anecdotes and use WeChat and Chinese schools as a platform for dissemination. For Middle Eastern and Indian women government websites should be used for dissemination. The video should be made available to all decision‐makers in the reproductive planning process including male partners of Middle Eastern women, parents and peers of Chinese women, and for Indian women the male partner, family, and community leaders. Conclusions: There is a wide range of cultural adaptations that can be made to the online education videos about LARCs to improve uptake of LARCs and hence reduce the burden of unintended pregnancy in women from CALD grounds. So What?: Our findings will be used to modify an online education video about LARCs so that it is culturally appropriate for women from CALD backgrounds. [ABSTRACT FROM AUTHOR]

Background: Parents' Evaluation of Developmental Status, (PEDS), is a validated screening tool designed for primary health care clinicians to assess child development. Despite widespread use by local government child-nurse services, PEDS has not been tested in Australian general practice. We examined the effect of an intervention that aimed to use PEDS to improve documented assessment of child developmental status during routine general practice consultations. Methods: The study took place in a single general practice in Melbourne, Australia. The intervention included training of all general practice staff regarding PEDS processes and provision of PEDS questionnaires, scoring and interpretation forms. Mixed methods incorporated audits of clinical records of young children (1 to ≤ 5 years) before and after the intervention, and written questionnaires and a focus group (informed by the Theoretical Domains Framework and COM-B model) with receptionists, practice nurses and general practitioners. Results: Documented developmental status more than doubled after the intervention with almost one in three (30.4%) records documenting the PEDS tool. Overall, staff responses to questionnaires indicated that PEDS processes had been successfully implemented, half of the staff felt PEDS had developed their professional skills and clinicians expressed confidence using the tool (71%). Thematic analysis of the focus group transcript revealed divided reactions to PEDS screening with most barriers arising from general practitioners' motivation to use PEDS tools and perceptions of environmental constraints. Conclusions: A team-practice intervention that applied PEDS training and implementation, more than doubled documented rates of child developmental status during routine visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance and long-term sustainability of PEDS use in practices. [ABSTRACT FROM AUTHOR]

Background: Despite recommendations, long-acting reversible contraceptives (LARC) are not always offered as first-line contraceptives in general practice. This study aimed to describe pathways used by women for insertion of LARC. Methods: This is a secondary analysis of data from the Australian Contraceptives ChOice pRoject (ACCORd), a cluster randomised controlled trial set in 57 general practices in Melbourne, Australia. We investigated whether an educational intervention for general practitioners (GPs) and a rapid LARC insertion clinic increased LARC uptake. The main outcome measures were the type of health service, location/provider of intrauterine device (IUD) insertion; time to insertion; and distance travelled for IUD insertion. Results: During ACCORd, 149 women had LARC insertion. IUD training was reported by 37% of GPs, but only 12% inserted them. In contrast, 70% of GPs inserted implants and 95% of women accessed implant insertion through their own general practice. LARC rapid referral clinics were used by 52% (13/25) of intervention GPs, where 71% (41/56) of IUD insertions occurred in these clinics (but no implants). There was no difference in the mean time from referral to IUD insertion between women attending intervention and control GPs (mean days 37.6 vs 32.7; P = 0.61). GPs (including IUD inserters) used a variety of referral pathways for IUD insertion, including public and private clinics, and other GPs. Women travelled up to 90 km for IUD insertion. Conclusions: Although implant insertion has been integrated into general practice, few GPs insert IUDs. Where the option exists for GPs to refer to a LARC rapid referral clinic, the majority of IUD insertions will take place there. Establishing a network of such clinics Australia wide may both increase IUD uptake and address the extensive need for GP training in IUD insertion. LARC uptake is low in Australia compared with less effective contraceptives. The ACCORd study found that GP online education and availability of rapid referral to LARC insertion clinics results in increased IUD uptake by women. In contrast to implants, few GPs insert IUDs. Most women will have their IUDs inserted in rapid referral clinics when these are made available. Establishing a network of such clinics could address training needs and increase LARC uptake in Australia. [ABSTRACT FROM AUTHOR]

Problem: Women in rural and regional Australia experience a number of barriers to accessing sexual and reproductive health care including lack of local services, high costs and misinformation. Setting: Nurse‐led task‐sharing models of care for provision of long‐acting reversible contraception (LARC) and early medical abortion (EMA) are one strategy to reduce barriers and improve access to services but have yet to be developed in general practice. Key measures for improvement: Through a co‐design process, we will develop a nurse‐led model of care for LARC and EMA provision that can be delivered through face‐to‐face consultations or via telehealth in rural general practice in Australia. Strategies for change: A co‐design workshop, involving consumers, health professionals (particularly General Practitioners (GPs) and Practice Nurses (PNs)), GP managers and key stakeholders will be conducted to design nurse‐led models of care for LARC and EMA including implant insertion by nurses. The workshop will be informed by the 'Experience‐Based Co‐Design' toolkit and involves participants mapping the patient journey for service provision to inform a new model of care. Effects of change: Recommendations from the workshop will inform a nurse‐led model of care for LARC and EMA provision in rural general practice. The model will provide practical guidance for the set‐up and delivery of services. Lessons learnt Nurses will work to their full scope of practice to increase accessibility of EMA and LARC in rural Australia. [ABSTRACT FROM AUTHOR]

Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling. [ABSTRACT FROM AUTHOR]

Objective: Lung cancer patients from ethnic minorities have poorer outcomes than their Caucasian counterparts. We compared lung cancer intervals between culturally and linguistically diverse (CALD) and Anglo‐Australian patients to identify ethnic disparities. Methods: This was a prospective, observational cohort study comprising a patient survey and reviews of patients' hospital and general practice records. Across three states, 577 (407 Anglo‐Australian and 170 CALD) patients were recruited and their hospital records reviewed. The survey was returned by 189 (135 Anglo‐Australian and 54 CALD) patients, and a review was completed by general practitioners (GPs) of 99 (76 Anglo‐Australian and 23 CALD) patients. Survival and Cox regression analyses were conducted. Results: CALD patients had longer hospital diagnostic interval [median 30 days, 95% confidence interval (CI) 26–34] than Anglo‐Australian patients (median 17, 95% CI 14–20), p = 0.005, hazard ratio (HR) = 1.32 (95% CI 1.09–1.60). This difference persisted after relevant factors were taken into consideration, adjusted HR = 1.26 (95% CI 1.03–1.54, p = 0.022). CALD patients also reported longer prehospital intervals; however, these differences were not statistically significant. Conclusion: Target interventions need to be developed to address ethnic disparity in hospital diagnostic interval. [ABSTRACT FROM AUTHOR]

In Australia, there are many barriers to abortion, particularly for women living in regional, rural and remote areas. Telehealth provision of medical abortion is safe, effective and acceptable to patients and providers. In 2015, Marie Stopes Australia (MSA) launched an at-home telehealth model for medical abortion to which GPs could refer. Between April and November of 2017, we interviewed 20 GPs who referred patients to MSA's telehealth-at-home abortion service to better understand their experiences and perspectives regarding telehealth-at-home abortion. We found that there was widespread support and recognition of the benefits of telehealth-at-home abortion in increasing access to abortion and reducing travel and costs. However, the GPs interviewed lacked knowledge and understanding of the processes involved in medical abortion, and many were unaware of the availability of telehealth as an option until a patient requested a referral. The GPs interviewed called for increased communication between telehealth-at-home abortion providers and GPs. Increasing GP familiarity with medical abortion and awareness of the availability of telehealth-at-home abortion may assist people in accessing safe, effective medical abortion. To address barriers to abortion access in Australia, Marie Stopes Australia implemented a telehealth-at-home abortion service to which GPs could refer patients. Little was known about GPs' experiences with and opinions of this service. Through interviews, we found that GPs were supportive of and saw benefits for patients of the telehealth-at-home abortion service, but had limited knowledge about its use and desired more communication with abortion care providers. [ABSTRACT FROM AUTHOR]

Background: The Clinical Guideline for the Diagnosis and Management of Work-related Mental Health Conditions in General Practice (the Guideline) was published in 2019. The objective of this trial is to implement the Guideline in general practice.Trial Design: Implementing work-related Mental health conditions in general PRacticE is a hybrid III, parallel cluster randomised controlled trial undertaken in Australia. Its primary aim is to assess the effectiveness of a complex intervention on the implementation of the Guideline in general practice. Secondary aims are to assess patient health and work outcomes, to evaluate the cost-effectiveness of the trial, and to develop a plan for sustainability.Methods: A total of 86 GP clusters will be randomly allocated either to the intervention arm, where they will receive a complex intervention comprising academic detailing, enrolment in a community of practice and resources, or to the control arm, where they will not receive the intervention. GP guideline concordance will be assessed at baseline and 9 months using virtual simulated patient scenarios. Patients who meet the eligibility criteria (>18years, employed, and receiving care from a participating GP for a suspected or confirmed work-related mental health condition) will be invited to complete surveys about their health and work participation and provide access to their health service use data. Data on health service use and work participation compensation claim data will be combined with measures of guideline concordance and patient outcomes to inform an economic evaluation. A realist evaluation will be conducted to inform the development of a plan for sustainability.Results: We anticipate that GPs who receive the intervention will have higher guideline concordance than GPs in the control group. We also anticipate that higher concordance will translate to better health and return-to-work outcomes for patients, as well as cost-savings to society.Conclusions: The trial builds on a body of work defining the role of GPs in compensable injury, exploring their concerns, and developing evidence-based guidelines to address them. Implementation of these guidelines has the potential to deliver improvements in GP care, patient health, and return-to-work outcomes.Trial Registration: ACTRN12620001163998 , November 2020. [ABSTRACT FROM AUTHOR]

Aims: Parents' Evaluation of Developmental Status (PEDS) is a validated tool used to assess child development that has not previously been tested in Australian general practice. We examined the effect of a Quality-Improvement intervention in a single general practice in Melbourne, Australia, that aimed to use this tool to improve the documented assessment of child developmental surveillance during vaccination visits.Methods: Mixed methods incorporated audits of clinical records of children aged 1-5 years, before and after intervention, written questionnaires and a focus group (informed by the theoretical domains framework and Capability, Opportunity, Motivation-Behaviour (COM-B model)) with clinical and non-clinical staff.Results: After 6 months, developmental surveillance more than doubled and was documented in more than one in three visits (34.1%). Almost one in five (18.6%) vaccination visits included the PEDS tool. Overall, the tool was positively received with staff expressing high levels of comfort asking parents to complete it (92.8%), increasing development of professional skills (71.4% staff) and confidence (55% clinicians) detecting developmental delays. Thematic analysis of the focus group transcript revealed underlying barriers arising from the practice environment, staff capabilities and motivation.Conclusions: In a whole of practice Quality-Improvement intervention that applied PEDS training and implementation, including the receptionist in the medical team more than doubled documented rates of child developmental surveillance during vaccination visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance. [ABSTRACT FROM AUTHOR]

The nexus between social networks and illness behaviours is important in uptake of health care, however scant research has explored this relationship in South Asian migrants living with mental illness. We explored the interplay between culture, social networks and health seeking in Sri Lankan migrants and Anglo‐Australians living with depression. Forty‐eight in‐depth interviews were conducted and data were analysed through the theoretical prism of the network episode model. Results showed that social networks were important in negotiating care. Decisions to initiate care occurred along a continuum of choice and agency; some took charge of their care, others were coerced into care, however some Sri Lankan migrants were led through various informal channels of care. Selective activation of compatriots – those perceived to understand mental illness‐became increasingly important to participants through their illness careers. Compatriots were considered of greater benefit as participants progressed through depression than otherwise meaningful social networks based on ethnicity, culture and kinship. We argue that the role of social networks is pivotal in uptake of formal care, and engaging with communities to improve responses of social networks to mental illnesses may provide a bottom‐up avenue for improving uptake of mental health services in migrant communities. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is the leading cause of cancer mortality worldwide. Early diagnosis and treatment is a key factor in reducing mortality and improving patient outcomes. To achieve this, it is important to understand the diagnostic pathways of cancer patients. Patients from Culturally and Linguistically Diverse (CALD) are a vulnerable group for lung cancer with higher mortality rates than Caucasian patients. The aim of this study is to explore differences in the lung cancer diagnostic pathways between CALD and Anglo-Australian patients and factors underlying these differences.Methods: This is a prospective, observational cohort study using a mixed-method approach. Quantitative data regarding time intervals in the lung cancer diagnostic pathways will be gathered via patient surveys, General practitioner (GP) review of general practice records, and case-note analysis of hospital records. Qualitative data will be gathered via structured interviews with lung cancer patients, GPs, and hospital specialists. The study will be conducted in five study sites across three states in Australia. Anglo-Australian patients and patients from five CALD groups (i.e., Arabic, Chinese, Greek, Italian and Vietnamese communities) will mainly be identified through the list of new cases presented at lung multidisciplinary team meetings. For the quantitative component, it is anticipated that 724 patients (362 Anglo-Australian and 362 CALD patients) will be recruited to obtain a final sample of 290 (145 per group) assuming a 50% patient survey completion rate and a 80% GP record review completion rate. For the qualitative component, 60 interviews with lung cancer patients (10 Anglo-Australian and 10 patients per CALD group), 20 interviews with GPs, and 20 interviews with specialists will be conducted.Discussion: This is the first Australian study to compare the time intervals along the lung cancer diagnostic pathway between CALD and Anglo-Australian patients. The study will also explore the underlying patient, healthcare provider, and health system factors that influence the time intervals in the two groups. This information will improve our understanding of the effect of ethnicity on health outcomes among lung cancer patients and will inform future interventions aimed at early diagnosis and treatment for lung cancer, particularly patients from CALD backgrounds.Trial Registration: The project was retrospectively registered with Australian New Zealand Clinical Trials Registry (registration number: ACTRN12617000957392 , date registered: 4th July 2017). [ABSTRACT FROM AUTHOR]

Objective. Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations. Methods. A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ⩾70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentations were classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non- PAGP-type groups. Results. There were 744 519 presentations to the ED by older people, of which 103 471 (13.9%) were classified as PAGP-type presentations. The volume of such presentations declined over the study period from 20 893 (14.9%) in 2008 to 20 346 (12.8%) in 2012. External injuries were the most common diagnoses (13 761; 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion. Older people made a significant number of PAGP-type presentations to theEDduring the period 2008-12. A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care. [ABSTRACT FROM AUTHOR]

Pregnancy is a critical stage of life requiring urgent attention when taking a lifespan approach to obesity prevention. Excessive gestational weight gain (GWG) is highly predictive of overweight and obesity later in life for women and their offspring. This discussion describes the challenges faced by health professionals (general practitioners, midwives, allied health) in primary care in Australia when addressing GWG, presents evidence that supports reprioritising GWG and highlights strategies that can be used to address GWG. The revised National Health and Medical Research Council antenatal care guidelines (to be formally released in early 2018) indicate it will be the responsibility of health professionals in antenatal care to initiate conversations about GWG with women. Women are open to discussing this sensitive topic and health professionals in primary care have an opportunity to be proactive in addressing barriers that have hindered conversations about GWG in the past so that women are supported to manage their weight during pregnancy. [ABSTRACT FROM AUTHOR]

The papers in this special issue explore a range of issues and opportunities across the spectrum of sexual and reproductive health in primary care, including in relation to contraception access; support for unintended pregnancies; abortion care; preconception, pregnancy, postpartum and interconception care; and issues relating to informed consent. The special issue takes a reproductive life course perspective through consideration of both pregnancy prevention and pregnancy preparation. [ABSTRACT FROM AUTHOR]

[1] It is therefore imperative that women are able to access effective methods of contraception, support in pregnancy planning, and abortion care so they can achieve their reproductive life goals. [1] Over 60% of unintended pregnancies, and almost 30% of all pregnancies, end in abortion (noting that nearly half of all abortions performed globally are unsafe). Graph: Danielle Mazza, MD, MBBS, FRACGP, DRANZCOG, Grad Dip Women's Health, GAICD, CF Graph: Jessica R. Botfield, BN, MPH, MIPH, PhD Contraception, preconception care, and abortion are integral and intertwined aspects of women's reproductive health. [Extracted from the article]

Background: Depression is prevalent globally. While the uptake of mental health services is poor in the general community, the lack of service engagement is particularly profound in migrant and refugee communities. To understand why there is under-utilisation cross-cultural comparisons of how people make sense of mental illnesses such as depression are essential. Aims: To verify how differing cultural aetiologies about depression influence mental health service use, this study investigated illness representational models of depression held by Sri Lankan migrants and Anglo-Australians living with depression. Methods: In-depth interviews (n = 48) were conducted with Sri Lankan migrants and Anglo-Australians living with depression to explore their illness beliefs. Data were analysed using Leventhal’s illness representational model. Results: Significant overlaps in illness representational models were noted but distinctive differences were found between causal and chronicity beliefs; Sri Lankan migrants more frequently endorsed depression as a time-limited condition underpinned by situational factors, whereas Anglo-Australians endorsed a chronic, biopsychosocial model of depression. Discussion and conclusion: Findings highlight the importance of forging a shared understanding of patient beliefs in the clinical encounter to ensure that interventions are coherent with illness beliefs or at least work towards improving mental health literacy. Differences in illness beliefs also provide insights into possible interventions. For example, psychosocial interventions that align with their illness beliefs may be more suited to Sri Lankan migrants than pharmaceutical or psychological ones. [ABSTRACT FROM AUTHOR]

Background Recurrent vulvovaginal candidiasis ( VVC) is a difficult-to-manage condition that affects 5-8% of women of reproductive age. Current treatment regimes have high relapse rates, resulting in poor quality of life for the women affected. Aim To compare the quality and content of current guidelines concerned with recurrent VVC and to develop a summary of recommendations to assist in the management of women with this condition. Methods Relevant clinical guidelines were identified through a search of several databases ( MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE II instrument. Guideline recommendations were extracted, compared and contrasted. Results The identified guidelines were of mixed quality. This is not related to the level of evidence supporting them but is because of poor stakeholder involvement, applicability and lack of clarity concerning editorial independence. Current international guidelines for recurrent VVC are consistent in terms of their definition of the condition, diagnostic techniques and utilising induction and maintenance therapy as the treatment of choice. However, the regimen suggested by most guidelines (fluconazole weekly for six months) is not particularly effective; only 42.9% of patients are disease free after 12 months. An alternative regimen put forward by one of the guidelines cites a 77% cure rate after 12 months. Most guidelines lacked specific recommendations for the induction part of induction and maintenance treatment. Conclusion The current most recommended treatment of recurrent VVC is sub-optimal. Studies performed on a larger scale are required to identify more effective treatments. [ABSTRACT FROM AUTHOR]

Background Australia's abortion rates are among the highest in the developed world. Efficacy of the most commonly used form of contraception (oral contraceptives and condoms) relies on regular user compliance. Long-acting reversible contraception (LARC) virtually eradicates contraceptive failure as it is not user-dependent; however, its uptake has been low. Aim To provide an overview of barriers to LARC use in Australia and potential strategies to overcome these barriers. Method A roundtable of Australian experts was convened to share clinical perspectives and to explore the barriers and potential strategies to increase LARC use. Results Three broad barriers to LARC uptake were identified. (i) A paucity of Australian research exists that impedes closure of evidence gaps regarding contraceptive prescription and use. Systematic data collection is required. (ii) Within primary care, lack of familiarity with LARC and misperceptions about its use, lack of access to general practitioners (GPs) trained in LARC insertion/removal and affordability impede LARC uptake. Potential strategies to encourage LARC use include, GP education to promote informed choice by women, training in LARC insertions/removals, effective funding models for nurses to perform LARC insertions/removals, and rapid referral pathways. (iii) At the health system level, primary care incentives to provide LARC to women and health economic analyses to inform government policy changes are required. Conclusions Although LARC decreases unintended pregnancies by eliminating user compliance issues, its uptake is low in Australia. Strategies that promote LARC uptake by targeting specific barriers may effectively reduce Australia's high unintended pregnancy rate. [ABSTRACT FROM AUTHOR]

Background: Strong evidence supports an early return to work after injury as a way to improve recovery. In Australia, General Practitioners (GPs) see about 96 % of injured workers, making them the main gatekeepers to workers' entitlements. Most people with compensable injuries in Australia are certified as "unfit to work" by their GP, with a minority of patients certified for modified work duties. The reasons for this apparent dissonance between evidence and practice remain unexplored. Little is known about the factors that influence GP sickness certification behaviour in Australia. The aim of this study is to describe the factors influencing Australian GPs certification practice through qualitative interviews with four key stakeholders. Methods: From September to December 2012, 93 semi-structured interviews were undertaken in Melbourne, Australia. Participants included GPs, injured workers, employers and compensation agents. Data were thematically analysed. Results: Five themes describing factors influencing GP certification were identified: 1. Divergent stakeholder views about the GP's role in facilitating return to work; 2. Communication between the four stakeholder groups; 3. Conflict between the stakeholder groups; 4. Allegations of GPs and injured workers misusing the compensation system and 5. The layout and content of the sickness certificate itself. Conclusion: By exploring GP certification practice from the perspectives of four key stakeholders, this study suggests that certification is an administrative and clinical task underpinned by a host of social and systemic factors. The findings highlight opportunities such as practice guideline development and improvements to the sickness certificate itself that may be targeted to improve GP sickness certification behaviour and return to work outcomes in an Australian context. [ABSTRACT FROM AUTHOR]

Background: Access to publicly funded abortion in Australia is limited, with a considerable proportion carried out by private providers. There are no nationally reported data on public abortion services, and referral pathways are poorly coordinated between hospital and primary care sectors. HealthPathways is an online system for use in primary care that provides information on referral pathways to local services. The aim of this study was to describe abortion referral pathways for each HealthPathways portal in Australia. Methods: A review of Australian HealthPathways content on abortion was undertaken between January and June 2022. For each HealthPathways portal, data were extracted on referral options to abortion services. Results: Overall, 17 out of 34 Australian HealthPathways consented to be included. Nearly half (47%) had no public services listed for surgical abortion, and 35% had no public services for medical abortion. The majority (64% for surgical abortion, 67% for medical abortion) emphasised that public services should be considered only as a last resort. There was variation in information regarding gestation-specific options, the time-critical nature of referrals, and the importance of women's own preference when deciding between medical or surgical abortion. Conclusion: Despite few remaining legal restrictions to abortion, many regions across Australia either do not have public abortion services or do not provide information about them. There is an urgent need for transparency around public abortion service availability, clear guidelines to support referral pathways, and commitment from State and Federal governments to expand the availability of accessible, no-cost abortion in Australia. Access to publicly funded abortion in Australia is limited, and there are no nationally reported data on service availability. Despite few remaining legal restrictions to abortion, this study found that many regions across Australia either do not have public abortion services or do not provide information about them. There is an urgent need for transparency around public abortion and commitment from State and Federal governments to expand the availability of accessible, no-cost abortion in Australia. [ABSTRACT FROM AUTHOR]

Background: Most oral contraception options require a doctor's prescription in Australia; however, there are many models of direct pharmacy access that have been successfully implemented internationally. Despite these advancements, the most preferable OTC model for consumers is yet to be explored in the international literature, and no prior studies have determined the potential benefits of implementation in Australia. The aim of this study was to explore women's perspectives and preferences for models of direct pharmacy access to oral contraceptive pills (OCPs). Methods: Women participants (n = 20) aged 18–44 residing in Australia were recruited via posts on a community Facebook page and participated in semi-structured telephone interviews. Interview questions were guided by Andersen's Behavioural Model of Health Service Use. Data were coded and thematically analysed in NVivo 12, using an inductive process to develop themes. Results: Participants' perspectives and preferences in relation to direct pharmacy OCP access were characterised by: (1) the importance of autonomy, accessibility and decreasing stigma; (2) confidence and trust in pharmacists; (3) health and safety concerns regarding OTC access; and (4) the need for varying OTC models to cater for both experienced and first-time users. Conclusion: Women's perspectives and preferences regarding direct pharmacy OCP access can be used to inform potential pharmacy practice advancements in Australia. While direct pharmacy OCP access is at the nexus of heated political debate in Australia, the potential benefits of being able to access OCPs directly from a pharmacist are evidently salient to women. Australian women's preferred OTC availability models were identified. Most oral contraceptive pills (OCPs) require a doctor's prescription in Australia, however, there are many models of over-the-counter (OTC) pharmacy access that have been successfully trialled internationally. This study produced new knowledge detailing women's perspectives of OTC access to OCPs in Australia, in addition to describing their preferred attributes of different OTC models. Findings on women's concerns with OTC OCP access (and how to address them) can shape any future OTC OCP trials in Australia. [ABSTRACT FROM AUTHOR]

Background The unprecedented rates of global migration present unique challenges to mental health services in migrant receiving countries to provide efficacious and culturally salient treatment for mental health conditions including depression. This review aimed to identify and evaluate the effectiveness of depression interventions specifically directed towards first-generation immigrant populations. Methods We conducted a systematic review of original research published between 2000 and 2013 that investigated depression interventions in first generation immigrants. Results Fifteen studies were included; the majority focused on Latino immigrants living in the United States (US). Twelve studies investigated the use of psychotherapies; the remainder examined collaborative care models and physical exercise-based interventions. Cognitive Behavioral Therapy and Behavioral Activation tended to improve depressive symptoms, especially when culturally adapted to suit clients while Problem Solving Therapy improved depressive symptomology with and without adaptations. Collaborative care and exercise did not significantly improve depressive symptoms. Conclusion Depression may be effectively treated by means of psychotherapies, especially when treatments are culturally adapted. However the reviewed studies were limited due to methodological weaknesses and were predominantly undertaken in the US with Latino patients. To improve generalizability, future research should be undertaken in non-US settings, amongst diverse ethnic groups and utilize larger sample sizes in either randomized clinical trials or observational cohort studies. [ABSTRACT FROM AUTHOR]

Aims To report a descriptive study of fertility-awareness knowledge, attitudes, and practice of infertile women seeking fertility assistance. Background Previous research has suggested that poor fertility-awareness may be a contributing cause of infertility among women seeking fertility assistance at assisted reproductive technology clinics. The actual practices and attitudes towards fertility-awareness in this particular group of women are unknown. Design A cross-sectional questionnaire-based survey. Methods The study was conducted over 6 months, from 2007-2008, of women on admission to two assisted reproductive technology clinics in a major city in Australia. Results Two hundred and four of 282 distributed questionnaires were completed (response rate = 72·3%). Eighty-three per cent had attempted conception for 1 year or more, 86·8% actively tried to improve their fertility-awareness from one or more sources of the information, 68·2% believed they had timed intercourse mainly within the fertile window of the menstrual cycle in their attempts at conception, but only 12·7% could accurately identify this window. Ninety-four per cent believe that a woman should receive fertility-awareness education when she first reports trouble conceiving to her doctor. Conclusions Most women seeking assistance at assisted reproductive technology clinics attempt timed intercourse within the fertile window of the menstrual cycle. However, few accurately identify this window, suggesting that poor fertility-awareness may be a contributing cause of infertility. [ABSTRACT FROM AUTHOR]

Background: To better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strategies. Methods: A draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. We piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. Five authors classified the strategies in each abstract individually. Final categorisation was then carried out in a face-to-face consensus meeting involving three authors. Results: The implementation strategies described in 71 conference abstracts were classified. Approximately 15.5% of abstracts utilised strategies that could not be categorised using the draft taxonomy. Of those strategies that could be categorised, the majority were professionally focused (57%). A total of 41% of projects used only one implementation strategy, with 29% using two and 31% three or more. The three most commonly used strategies were changes in quality assurance, quality improvement and/or performance measurement systems, changes in information and communication technology, and distribution of guideline materials (via hard-copy, audio-visual and/or electronic means). Conclusions: Further refinement of the draft taxonomy is required to provide hierarchical dimensions and granularity, particularly in the areas of patient-focused interventions, those concerned with audit and feedback and quality improvement, and electronic forms of implementation, including electronic decision support. [ABSTRACT FROM AUTHOR]

Background: Despite strong evidence of the benefits of preconception interventions for improving pregnancy outcomes, the delivery and uptake of preconception care and periconceptional folate supplementation remain low. General practitioners play a central role in the delivery of preconception care. Understanding general practitioners' perceptions of the barriers and enablers to implementing preconception care allows for more appropriate targeting of quality improvement interventions. Consequently, the aim of this study was to examine the barriers and enablers to the delivery and uptake of preconception care guidelines from general practitioners' perspective using theoretical domains related to behaviour change. Methods: We conducted a qualitative study using focus groups consisting of 22 general practitioners who were recruited from three regional general practice support organisations. Questions were based on the theoretical domain framework, which describes 12 domains related to behaviour change. General practitioners' responses were classified into predefined themes using a deductive process of thematic analysis. Results: Beliefs about capabilities, motivations and goals, environmental context and resources, and memory, attention and decision making were the key domains identified in the barrier analysis. Some of the perceived barriers identified by general practitioners were time constraints, the lack of women presenting at the preconception stage, the numerous competing preventive priorities within the general practice setting, issues relating to the cost of and access to preconception care, and the lack of resources for assisting in the delivery of preconception care guidelines. Perceived enablers identified by general practitioners included the availability of preconception care checklists and patient brochures, handouts, and waiting room posters outlining the benefits and availability of preconception care consultations. Conclusions: Our study has identified some of the barriers and enablers to the delivery and uptake of preconception care guidelines, as perceived by general practitioners. Relating these barriers to a theoretical domain framework provides a clearer understanding of some of the psychological aspects that are involved in the behaviour of general practitioners towards the delivery and uptake of preconception care. Further research prioritising these barriers and the theoretical domains to which they relate to is necessary before a methodologically rigorous intervention can be designed, implemented, and evaluated. [ABSTRACT FROM AUTHOR]

Background While initial Human Papillomavirus ( HPV) vaccine uptake estimates are encouraging, especially in the school-aged population, it is unclear to what extent general practitioners ( GPs) have been recommending and administering the vaccine to adult women and what the uptake has been. Methods A mixed methods study of Australian GPs consisting of a knowledge and attitudes questionnaire and an audit which assessed overall vaccination rates since commencement of the Australian National HPV program and in the last 50 female patients aged 27-45 years who consulted them. Results GPs have a good level of knowledge regarding HPV vaccination and are strongly committed to it for women until 27 years but are much less so for women aged 27-45 years. From 2007 to 2010, only 1.9% of women aged 27-45 who consulted the GPs commenced HPV vaccination. Of those, however, the majority completed all three doses. Higher rates of commencement of HPV vaccination (11.4%) were demonstrated by auditing the last 50 consecutive patients seen by the GP. In this group of women, 63% had received a Pap test in the last two years. Female GPs had significantly higher rates of vaccination. Conclusions There is relatively low HPV vaccine uptake in women aged 27-45. Once HPV vaccination is commenced, however, completion rates are high in women in this age group. Low uptake may be due to lack of opportunistic awareness raising in relevant consultations. Clear guidance together with further exploration of patient factors and GP barriers and enablers would assist implementation of HPV vaccination. [ABSTRACT FROM AUTHOR]

Background: Despite strong evidence of the benefits of preconception interventions to improve pregnancy outcomes, the delivery and uptake of preconception care in general and periconceptional folate supplementation in particular remains low. The aim of this study was to determine women's views of the barriers and enablers to the uptake of preconception care and periconceptional folate supplementation. Methods: Focus groups were undertaken in 2007 with 17 women of reproductive age (18-45 years). To identify key issues and themes within the data, focus groups were analysed using an inductive process of thematic analysis. Results: Most women were unaware of the need to attend for preconception care and were surprised at the breadth of issues involved. Women also felt general practitioners (GPs) should be more proactive in promoting preconception care availability but acknowledged that they themselves had to be thinking about pregnancy or becoming pregnant to be receptive to it. Barriers to periconceptional folate supplementation included confusion about reasons for use, dose, duration, timing and efficacy of folate use. Enablers included the desire to do anything they could to ensure optimum pregnancy outcomes, and promotional material and letters of invitation from their GP to advise them of the availability and the need for preconception care. Conclusion: A number of important barriers and enablers exist for women regarding the delivery and uptake of preconception care and periconceptional folate supplementation. It is essential that these patient perspectives are addressed in both the implementation of evidence based clinical practice guidelines and in the systematic design of an intervention to improve preconception care delivery. [ABSTRACT FROM AUTHOR]

Background: The prevalence of type 2 diabetes mellitus (T2DM) continues to rise worldwide. More women from developing countries who are in the reproductive age group have diabetes resulting in more pregnancies complicated by T2DM, and placing both mother and foetus at higher risk. Management of these risks is best achieved through comprehensive preconception care and glycaemic control, both prior to, and during pregnancy. The aim of this review was to compare the quality and content of current guidelines concerned with the preconception care of women with diabetes and to develop a summary of recommendations to assist in the management of diabetic women contemplating pregnancy. Methods: Relevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE instrument. Guideline recommendations were extracted, compared and contrasted. Results: All guidelines were assessed as being of high quality and strongly recommended for use in practice. All were consistent in counselling about the risk of congenital malformation related to uncontrolled blood sugar preconceptionally, ensuring adequate contraception until glycaemic control is achieved, use of HBA1C to monitor metabolic control, when to commence insulin and switching from ACE inhibitors to other antihypertensives. Major differences were in the targets recommended for optimal metabolic control and opinion regarding the usage of metformin as an adjunct or alternative treatment before or during pregnancy. Conclusions: International guidelines for the care of women with diabetes who are contemplating pregnancy are consistent in their recommendations; however some are more comprehensive than others. Having established current standards for the preconception care of diabetic women, there is now a need to focus on guideline implementation through an examination of the barriers and enablers to successful implementation, and the applicability of the recommendations in the local setting. [ABSTRACT FROM AUTHOR]

Presents information on the management of dysmenorrhoea, a painful menstrual flow, in teenage girls. Causes of dysmenorrhoea; Medications and treatment for the pain; Comparison between primary and secondary dysmenorrhoea.

Aim: To synthesise and map current evidence on nurse and midwife involvement in task‐sharing service delivery, including both face‐to‐face and telehealth models, in primary care. Design: This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. Data Source/Review Methods: Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse‐led models. Results: One hundred peer‐reviewed articles (as 99 studies) were deemed eligible for inclusion. Task‐sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse‐led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost‐effective, and increase system efficiencies with supportive training, clinical set‐up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy. Conclusion: Nurse‐led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task‐sharing models with nurses to be feasible and effective. Impact: Nurse‐led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost‐effective. Increased utilisation of nurse‐led models should be considered to address health system challenges and improve access to essential primary healthcare services globally. Reporting Method: This review is reported against the PRISMA‐ScR criteria. Patient or Public Contribution: No patient or public contribution. Protocol registration: The study protocol is published in BJGP Open (Moulton et al., 2022). [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To describe key features of a co‐designed nurse‐led model of care intended to improve access to early medication abortion and long‐acting reversible contraception in rural Australian general practice.Co‐design methodology informed by the Experience‐Based Co‐Design Framework.Consumers, nurses, physicians and key women's health stakeholders participated in a co‐design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six‐step process for thematic analysis.Fifty‐two participants took part in the co‐design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient‐approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications.Our approach to experience‐based co‐design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse‐led model of care.The co‐designed nurse‐led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice.Nurse‐led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse‐led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025.Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.Two consumer representatives contributed to the development of the co‐design methodology as members of the ORIENT Intervention Advisory Group Governance Committee. [ABSTRACT FROM AUTHOR]

Approximately one in three Australian women with an unintended pregnancy will have an abortion, yet significant barriers remain to ensure the delivery of equitable and timely medical abortion services, including lack of trained providers, high out-of-pocket costs, abortion stigma, conscientious objection and large geographical distance to services. Practice nurses can be suitably trained to provide early medical abortion in general practice; however, there remain several key limitations to the implementation of nurse-led models of care. This forum article discusses these limitations, including issues concerning legislation, funding models, lack of access to medical abortion training, practice structure and systems, and makes recommendations as to how increased access to medical abortion in Australia can be achieved. Significant barriers remain to ensure the delivery of equitable and timely medical abortion services. The provision of early medical abortion in general practice by practice nurses is safe and effective and provides the opportunity to increase access in Australia. Key changes to legislation, nursing training, funding models and primary care systems are required to ensure this essential service is accessible and equitable. [ABSTRACT FROM AUTHOR]

Background: Approximately half of the opioids prescribed by Australian GP and GP registrars are for chronic non-cancer pain-despite limited therapeutic benefit, and serious risks of harm. Understanding the factors driving non-evidence-based opioid prescribing may improve GP training and education.Objective: To explore attitudes, beliefs, knowledge and self-reported factors influencing the opioid-prescribing decisions of Australian GP registrars.Methods: Telephone interviews were undertaken with 20 GP registrars in 2018-19. Interviews were 30-60 minutes in duration, audio-recorded and de-identified. Braun and Clarke's 6-phase framework was adopted for reflexive thematic analysis of data and managed using QSR NVivo software.Results: Twenty registrars were recruited; 8 men and 12 women. Three themes were identified.Support and Supervision: Difficult chronic pain consultations negatively affected the registrar well-being. Registrars role modelled their supervisors' opioid-prescribing practices, even if they perceived it to be unsafe.Confidence: Registrars lacked confidence in initiating, prescribing and weaning opioids, recognizing drug-seeking behaviours and declining to prescribe-but felt confident in their knowledge of opioid pharmacology.Safety: Registrars were aware of evidence-based prescribing recommendations and risk reduction strategies but struggled to translate this into practice.Conclusions: Non-evidence-based opioid prescribing by Australian GP registrars is multifactorial. Emotionally difficult pain consultations, poor supervision and low prescriber confidence may contribute to unsafe prescribing. Improving registrar prescribing may require interventions to improve risk reduction, training in communication and role modelling by supervisors. [ABSTRACT FROM AUTHOR]

Background: Over the last three decades, Australian opioid-prescribing rates and related morbidity and mortality have dramatically increased. Opioids are frequently prescribed by general practitioners (GPs) to manage chronic non-cancer pain, despite evidence-based recommendations from the Centre for Disease Control, National Institute for Health and Care Excellence and World Health Organization widely cautioning their use. Little is known about the factors influencing the opioid prescribing decisions of Australian GPs, especially when not evidence based.Objective: To explore the opioid prescribing knowledge, attitudes and practices of Australian GPs.Methods: Semi-structured interviews with 20 GPs recruited from the Monash University practice-based research network in metropolitan, southeastern Melbourne. Thematic analysis was used to identify emergent themes. Data were managed using QSR NVivo. Ethics approval was granted by Monash University.Results: Three key themes emerged. GP attitudes towards opioid use for chronic pain varied by age of patient and goals for therapy. Use of opioids for elderly patients was positively perceived. GPs were reluctant to use opioids in younger patients due to fears of addiction and difficulty weaning. GPs felt obliged to prescribe opioids recommended by specialists, even if they believed the opioids were unsafe.Conclusion: This study identified and described the patient-centred nature of GP opioid prescribing decisions. Patient age and perceived age-related opioid harm were important factors influencing prescribing decisions. Future work should inform interventions that value GP autonomy while still encouraging a collaborative inter-speciality approach to managing chronic pain patients with opioids. [ABSTRACT FROM AUTHOR]

Background: The use of community antibiotic stewardship programmes (ASPs) is rising; however, their effectiveness when pharmacists are involved is uncertain.Objectives: To assess the effectiveness of ASPs involving pharmacists at improving antibiotic prescribing by general practitioners (GPs).Methods: Medline, Embase, Emcare, PubMed, PsycINFO, Cochrane CENTRAL, CINAHL Plus and Web of Science databases were searched to February 2018. Randomized and non-randomized studies of ASPs involving pharmacists as interventionists to GPs were included. Primary outcomes were absolute changes in GPs' antibiotic prescribing rate (APR) and antibiotic prescribing adherence rate (APAR) according to recommendations/guidelines. Meta-analysis used random effects models.Results: Fifteen studies reporting 18 trials were included in the meta-analysis: 8 assessed the APR and 10 the APAR. APR reductions (OR 0.86, 95% CI 0.78-0.95, moderate-certainty evidence) and APAR improvements (OR 1.96, 95% CI 1.56-2.45, high-certainty evidence) were observed at 6 months median intervention follow-up. High-quality randomized trials reduced the APR (OR 0.92, 95% CI 0.90-0.94) and increased the APAR (OR 2.55, 95% CI 2.16-3.01). Interventions were successful in decreasing the APR (OR 0.93, 95% CI 0.90-0.95) and increasing the APAR (OR 1.72, 95% CI 1.04-2.84) when implemented by a pharmacist-GP team. Interventions involving pharmacist-infectious disease professional teams also decreased the APR (OR 0.81, 95% CI 0.66-1.0) and increased the APAR (OR 2.36, 95% CI 1.87-2.96). GP education plus prescribing feedback, and group meetings were effective in both outcomes, whereas GP education, academic detailing and workshop training were effective in APAR outcome. However, substantial heterogeneity was demonstrated.Conclusions: ASPs involving pharmacists are effective in decreasing antibiotic prescribing and increasing guideline-adherent antibiotic prescribing by GPs. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article focusing on the National Institute for Clinical Excellence Guidelines on timing intercourse and ovulation.

Introduction Influenza vaccination has been shown to be safe and effective against influenza and in the prevention of complicating secondary respiratory illnesses. However, its uptake in young children remains low. This study explored the views, attitudes and practices of parents and primary care providers (PCPs) on their knowledge and acceptance of influenza vaccination in children under 5. Methods Using a cross-sectional qualitative research design, we conducted 30 in-depth interviews with PCPs (i.e., general practitioners, practice nurses, maternal and child health nurses, and pharmacists) and five focus groups with parents (n = 50) between June 2014 and July 2015 in Melbourne, Australia. Data were thematically analysed. Results Parents thought the vaccine could cause influenza, and influenza vaccination was not necessary for their children as they needed to build their own ‘immunity’. Parents said that they would consider vaccinating their children if recommended by their GP and if the influenza vaccine was part of the immunisation schedule. PCPs also expressed concerns regarding the efficacy of the vaccine as well as out-of-pocket costs incurred by families, and uncertainty regarding the mortality and morbidity of influenza in otherwise healthy children. However, they said they would recommend the vaccine to high-risk groups (e.g. children with chronic disease(s), and asthma). Conclusion Despite the established safety of influenza vaccines, barriers to uptake include concerns regarding the iatrogenic effects of vaccination, its administration schedule, and knowledge of influenza severity. Updated information on influenza and the efficacy of the vaccine, and incorporating influenza vaccination into the immunisation schedule may overcome some of these barriers to increase influenza vaccination in this vulnerable cohort. [ABSTRACT FROM AUTHOR]

Background: Although the Human Papillomavirus (HPV) vaccine is registered in Australia for females aged 9 to 45 years, females aged 27 to 45 years have shown limited vaccine uptake. Our study explored general practitioners' (GPs) views concerning HPV vaccination of females in this age group, with particular focus on the barriers and the facilitators to the delivery of the HPV vaccine.Methods: Semi-structured telephone interviews were conducted with 24 randomly selected general practitioners from metropolitan Melbourne. Questions were based on a theoretical framework that explained the barriers and facilitators to professional behaviour change.Results: According to the GPs, the major barriers to the uptake of the HPV vaccine included the cost of the vaccine, time constraints, and the three-dose schedule. Other barriers that were identified included GPs' and patients' beliefs that females in this age group were at low risk of contracting HPV, lack of awareness about the vaccine, and uncertainty about the benefits of this vaccine for females in this age group. In contrast, the facilitators that were identified included the availability of the vaccine on site, the availability of vaccine clinics or nurses for administering the vaccine, the availability of information related to the vaccine either on site or online, and positive opinions from experts in the field.Conclusions: Our study has identified some of the barriers and facilitators to the delivery and uptake of the HPV vaccine in females aged 27 to 45 years, as perceived by GPs. Further studies should be conducted to determine which of these should be targeted or prioritised for intervention. The views of women in this age group should also be considered as these would also be influential in designing effective intervention strategies for improving the delivery and uptake of the HPV vaccine. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effect of health assessments on permanent residential aged care admission for older Australian women with and without dementia. Methods: A total of 1427 older Australian women who had a health assessment between March 2002 and December 2013 were matched with 1427 women who did not have a health assessment in the same period. Linked administrative datasets were used to identify health assessment use, admission to permanent residential aged care, and dementia status. Outcome was time to residential aged care admission from the matched date of health assessment. Results: Women who had health assessments were less likely to be admitted to residential aged care in the short term (100 days), irrespective of dementia status (subdistribution hazard ratio [SDHR] = 0.35, 95% CI = [0.21, 0.59] for women with dementia; SDHR = 0.39, 95% CI = [0.25, 0.61] for women without dementia). However, there were no significant differences at 500‐ and 1000‐days follow‐up. At 2000‐days follow‐up, women who had a health assessment were more likely to be admitted to residential aged care, regardless of dementia status (SDHR = 1.41, 95% CI = [1.12, 1.79] for women with dementia; SDHR = 1.55, 95% CI = [1.32, 1.82] for women without dementia). Conclusions: Benefits from health assessments may depend on the recency of the assessment, with women less likely to be admitted to residential aged care in the short term after a health assessment. Our results add to a growing body of literature suggesting that health assessments may provide benefits to older people, including those with dementia. Geriatr Gerontol Int 2023; 23: 595–602. [ABSTRACT FROM AUTHOR]

Background: Almost one in four women in Australia experience an unintended pregnancy during their lifetime; of these, approximately 30% currently end in abortion. Although early medical abortion (EMA) up to 9 weeks gestation is becoming more widely available in Australia, it is still not commonly offered in primary care. The aim of this study was to investigate the barriers and facilitators to the provision of EMA in primary care. Methods: A sample of 150 general practitioners (GPs) and 150 registered nurses (RNs) working in Australia responded to a best–worst scaling survey designed to answer the following question: what are the most important facilitators and barriers to the provision of EMA in primary care? Results: GPs believe that the lack of clinical guidelines, the amount of information provision and counselling required, and the fact that women who are not their patients may not return for follow-up are the most important barriers. For RNs, these three barriers, together with the stigma of being known as being involved in the provision of EMA, are the most important barriers. The formation of a community of practice to support the provision of EMA was identified by both professions as the most important facilitator. Conclusions: Having access to a community of practice, enhanced training and reducing stigma will encourage the provision of EMA. Although clinical guidelines are available, they need to be effectively disseminated, implemented and endorsed by peak bodies. Primary care practices should consider using task sharing and developing patient resources to facilitate the provision of information and counselling. Although available, early medical abortion is not commonly offered in general practice. When asked, GPs and RNs reported that lack of clinical guidelines, the need to provide information and counselling, and follow-up issues were important barriers to the provision of early medical abortion, whereas having access to a community of practice was the most important facilitator. Guidelines are available, but require dissemination and implementation. Task sharing and appropriate remuneration will encourage more GPs to offer early medical abortion, so it is seen as an essential service. [ABSTRACT FROM AUTHOR]

Background: The lack of access to and uptake of postpartum contraception is a key contributor to an estimated 121 million unintended pregnancies worldwide. Research on counselling and women's preferences for postpartum contraception is scarce in Australia. We therefore aimed to explore Australian women's experiences of, and preferences for, accessing postpartum contraceptive counselling. Method: In this qualitative study, English-speaking women of reproductive age (18–40 years) with at least one child under the age of 5 years were recruited via social media to participate in a semi-structured telephone interview. Interviews focussed on women's experiences of, and preferences for, postpartum contraception. The interviews were audio-recorded, transcribed, coded and thematically analysed. Results: Twenty women participated. Most did not receive in-depth contraceptive counselling antenatally or postnatally, though had brief discussions with their GPs or obstetricians at the 6-week postnatal check. Participants felt some counselling throughout their antenatal and postnatal care would have been useful, particularly those who experienced medical complications perinatally. Most participants expressed a general preference for their GP or a midwife to provide such counselling, rather than an obstetrician or nurse, and they noted characteristics such as compassion, trust and care as being particularly important. Conclusion: The provision of postpartum contraceptive counselling could be enhanced in Australia. Contraceptive uptake in the postpartum period may be promoted by ensuring consistent and routine provision of contraceptive counselling for women antenatally and postnatally by their maternity carers. Access to postpartum contraception can reduce unintended pregnancies and enhance interconception health. Findings from our study suggest there is no consistent provision of postpartum contraception counselling to women; however, women are interested in receiving this both antenatally and postnatally from GPs and midwives. Contraceptive uptake in the postpartum period may be promoted by ensuring consistent and routine provision of contraceptive counselling for women antenatally and postnatally by their maternity carers. [ABSTRACT FROM AUTHOR]

Preconception care (PCC) is effective in reducing modifiable risk factors and optimising maternal health. Primary care services such as general practices in Australia are an appropriate setting to provide PCC. However, PCC is not routinely provided in most of these settings, and many reproductive-aged women and men are not aware of the need for PCC. In this forum article, we discuss the factors that hinder PCC provision in Australian general practices and make recommendations on how access to PCC services can be broadened in Australia, including the potential opportunity for general practice nurses to contribute to the provision of PCC. The preconception period refers to the period before a woman becomes pregnant and there is evidence that maintaining optimal health during this period is important for the mother and baby. General practices in Australia are an appropriate setting to provide preconception care, which involves providing education to help improve health during the preconception period. In this article, we discuss the factors that hinder preconception care provision in Australian general practices and make recommendations on how access to preconception care services can be broadened in Australia, including the potential opportunity for general practice nurses to contribute to the provision of preconception care. [ABSTRACT FROM AUTHOR]

Background: Despite strong evidence of the benefits of preconception interventions for improving pregnancy outcomes, the delivery and uptake of preconception care and periconceptional folate supplementation remain low. General practitioners play a central role in the delivery of preconception care. Understanding general practitioners' perceptions of the barriers and enablers to implementing preconception care allows for more appropriate targeting of quality improvement interventions. Consequently, the aim of this study was to examine the barriers and enablers to the delivery and uptake of preconception care guidelines from general practitioners' perspective using theoretical domains related to behaviour change.Methods: We conducted a qualitative study using focus groups consisting of 22 general practitioners who were recruited from three regional general practice support organisations. Questions were based on the theoretical domain framework, which describes 12 domains related to behaviour change. General practitioners' responses were classified into predefined themes using a deductive process of thematic analysis.Results: Beliefs about capabilities, motivations and goals, environmental context and resources, and memory, attention and decision making were the key domains identified in the barrier analysis. Some of the perceived barriers identified by general practitioners were time constraints, the lack of women presenting at the preconception stage, the numerous competing preventive priorities within the general practice setting, issues relating to the cost of and access to preconception care, and the lack of resources for assisting in the delivery of preconception care guidelines. Perceived enablers identified by general practitioners included the availability of preconception care checklists and patient brochures, handouts, and waiting room posters outlining the benefits and availability of preconception care consultations.Conclusions: Our study has identified some of the barriers and enablers to the delivery and uptake of preconception care guidelines, as perceived by general practitioners. Relating these barriers to a theoretical domain framework provides a clearer understanding of some of the psychological aspects that are involved in the behaviour of general practitioners towards the delivery and uptake of preconception care. Further research prioritising these barriers and the theoretical domains to which they relate to is necessary before a methodologically rigorous intervention can be designed, implemented, and evaluated. [ABSTRACT FROM AUTHOR]

Background: To better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strategies.Methods: A draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. We piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. Five authors classified the strategies in each abstract individually. Final categorisation was then carried out in a face-to-face consensus meeting involving three authors.Results: The implementation strategies described in 71 conference abstracts were classified. Approximately 15.5% of abstracts utilised strategies that could not be categorised using the draft taxonomy. Of those strategies that could be categorised, the majority were professionally focused (57%). A total of 41% of projects used only one implementation strategy, with 29% using two and 31% three or more. The three most commonly used strategies were changes in quality assurance, quality improvement and/or performance measurement systems, changes in information and communication technology, and distribution of guideline materials (via hard-copy, audio-visual and/or electronic means).Conclusions: Further refinement of the draft taxonomy is required to provide hierarchical dimensions and granularity, particularly in the areas of patient-focused interventions, those concerned with audit and feedback and quality improvement, and electronic forms of implementation, including electronic decision support. [ABSTRACT FROM AUTHOR]

Background: Return to work (RTW) is important for recovery post-injury. Fear of (re)injury is a strong predictor of delayed RTW, and therefore much attention has been given to addressing injured workers' fear beliefs. However, RTW is a socially-negotiated process and it may be important to consider the wider social context of the injured worker, including the beliefs of the key people involved in their RTW journey.Methods: This paper involves data collected as part of a wider study in which semi-structured interviews explored RTW from the perspectives of 93 key stakeholders: injured workers, GPs, employers and insurance case managers in Victoria, Australia. Inductive analysis of interview transcripts identified fear of (re)injury as a salient theme across all stakeholder groups. This presented an opportunity to analyse how the wider social context of the injured worker may influence fear and avoidance behaviour. Two co-authors performed inductive analysis of the theme 'fear of (re)injury'. Codes identified in the data were grouped into five categories. Between and within category analysis revealed three themes describing the contextual factors that may influence fear avoidance and RTW behaviour.Results: Theme one described how injured workers engaged in a process of weighing up the risk of (re)injury in the workplace against the perceived benefits of RTW. Theme two described how workplace factors could influence an injured workers' perception of the risk of (re)injury in the workplace, including confidence that the source of the injury had been addressed, the availability and suitability of alternative duties. Theme three described other stakeholders' reluctance to accept injured workers back at work because of the fear that they might reinjure themselves.Conclusions: Our findings illustrate the need for a contextualised perspective of fear avoidance and RTW behaviour that includes the beliefs of other important people surrounding the injured worker (e.g. employers, family members, GPs). Existing models of health behaviour such as The Health Beliefs Model may provide useful frameworks for interventions targeting the affective, cognitive, social, organisational and policy factors that can influence fear avoidance or facilitate RTW following injury. [ABSTRACT FROM AUTHOR]

Background: Electronic health record datasets have been used to determine the prevalence of musculoskeletal complaints in general practice but not to examine the associated characteristics and healthcare utilisation at the primary care level. Aim: To describe the prevalence and characteristics of patients presenting to general practitioners with musculoskeletal complaints. Design and setting: A five-year analysis within three Primary Health Networks (PHNs) in Victoria, Australia. Method: We included patients with at least one face-to-face consultation 2014 to 2018 inclusive and a low back (≥ 18 years), and/or neck, shoulder or knee (≥ 45 years) complaint determined by SNOMED codes derived from diagnostic text within the medical record. We determined prevalence, socio-demographic characteristics and diagnostic codes for patients with an eligible diagnosis; and number of consultations within one year of diagnosis. Results: 324,793/1,294,021 (25%) presented with at least one musculoskeletal diagnosis, of whom 41% (n = 133,279) fulfilled our inclusion criteria. There were slightly more females (n = 73,428, 55%), two-thirds (n = 88,043) were of working age (18–64 years) and 83,816 (63%) had at least one comorbidity. Over half had a low back diagnosis (n = 76,504, 57%) followed by knee (n = 33,438, 25%), shoulder (n = 26,335, 20%) and neck (n = 14,492, 11%). Most codes included 'pain' and/or 'ache' (low back: 58%, neck: 41%, shoulder: 32%, knee 26%). Median (IQR) all-cause consultations per patient within one year of diagnosis was 7 (4–12). Conclusion: The burden of MSK complaints at the primary care level is high as evidenced by the prevalence of people with musculoskeletal complaints presenting to a general practitioner, the preponderance of comorbidities and the numerous consultations per year. Identification and evaluation of strategies to reduce this burden are needed. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to present the views of four stakeholder groups, namely general practitioners (GP), employers (EMP), injured workers (IW) and compensation agents (CA), about the content and usability of the draft of thenew Victorian sickness certificate. Methods. A cross-sectional mixed-methods qualitative study was conducted in GP clinics and community settings in Melbourne, Australia. Interviews were conducted with GPs, EMPs and IWs and one focus group discussion was completed with CAs (n = 29). Data were collected between October and December 2013. Thematic analysis was performed. Results. All stakeholders viewed the new draft certificate as an improvement on the old one. GPs saw the certificate as a form of communication, whereas EMPs and CAs saw it as a therapeutic device. GPs continued to certify based on incapacity and provided little information about what IWs could do on return to work. All groups said that assessments for mental health needed more clarity and specificity. GPs, EMPs and CAs also said that the new certificates must be electronically available and integrated into existing medical software to streamline uptake. Conclusions. To ensure appropriate use of the new certificate, stakeholders must share a common understanding about its purpose and the certificate must be incorporated into existing medical software. Content on mental health assessment, an area of continued difficulty, needs additional refinement. Thenewcertificate replaced the old certificate inMarch 2015; after it has been established in clinical practice, an impact evaluation should be completed to determine whether GPs are certifying capacity and earlier return to work. [ABSTRACT FROM AUTHOR]

To assess the availability of over-the-counter emergency contraceptive pills in the Australian community pharmacy setting. Representative national telephone survey. Only 70% of the 233 pharmacies surveyed stocked ulipristal acetate (UPA) emergency contraceptive pills, compared to levonorgestrel, which was stocked in 98%. When ulipristal acetate was stocked, it was on average $13 more expensive. Despite being recommended as the first-line oral emergency contraceptive, UPA is less likely to be available, and when available, it is likely to be more expensive. These findings support anecdotal reports UPA is challenging to access and less commonly used. Strategies are urgently required to improve equitable access to all methods of oral emergency contraception within the Australian community pharmacy setting and ensure pharmacists are aware of key differences between the available methods. This will ensure that they are prepared to facilitate shared decision making based on the individual needs of each woman. [ABSTRACT FROM AUTHOR]