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This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care. [ABSTRACT FROM AUTHOR]

Background: The Partners in Recovery (PIR) program was implemented by the Australian Government Department of Health. Its overriding aim was to improve the coordination of services for people with severe and persistent mental illness, and who have complex needs that are not being met. The PIR capacity-building project (CBP) was funded to provide capacity building activities to the nationwide network of consortia that were set up in 2013 to deliver PIR over a 3-year period. The purpose of this paper is to describe the design and findings from an evaluation of the PIR CBP. Methods: The evaluation involved collecting feedback from consenting PIR staff via an online survey and follow-up semi-structured interviews. CBP activities included: state and national meetings; a web portal; teleconferences; webinars; a support facilitator mentor program; and tailored support from the CBP team. Results: The CBP made a positive contribution to the implementation and delivery of PIR. Staff highly valued activities that employed face-to-face interaction or provided informative knowledge exchange, and were appreciative of CBP staff being responsive and adaptable to their needs. Conclusions: From this evaluation, we recommend the following: identify relevant functions (e.g. prioritise networking), select the right mode of delivery (e.g. establish an online presence) and abide by key principles (e.g. be responsive to staff needs). This information is informing the mental health workforce capacity building activities that our team is currently undertaking. Capacity-building programs are necessary for advancing new public health initiatives, yet there remains limited evidence to inform best practices for delivering these in the context of mental health. This paper describes the design and findings of a capacity-building program developed to enhance the knowledge and skills of community-based mental health providers. From this evaluation, we recommend the following to ensure effective capacity-building programs: identify relevant functions (e.g. prioritise networking), select the right mode of delivery (e.g. establish an online presence) and abide by key principles (e.g. be responsive to staff needs). [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]

Australians were subject to a series of COVID-19 lockdown restrictions throughout 2020. Although accessing medical care was allowable, concerns were raised that people were avoiding healthcare services. We explored young Australians' reasons for delaying seeking sexual and reproductive health (SRH) care during the pandemic, using data from two cross-sectional surveys. The surveys included a question asking whether respondents had delayed accessing care during the pandemic. Free-text responses from young Australians (aged 18–29 years) were analysed using conventional content analysis. In all, 1058 under-30s completed a survey, with 262 (24.8%) reporting they had delayed seeking SRH care. Of these, 228 (87.0%) respondents provided a free-text comment. Participants who commented were predominantly female (86.4%) and had a median age of 23 years (interquartile range 20–26 years). Most commonly, respondents delayed testing for sexually transmissible infections, cervical cancer screening, and contraceptive care. Some delayed accessing care despite experiencing symptoms. Participants avoided seeking care due to concerns about contracting COVID-19, uncertainty about accessing care during restrictions and anxiety relating to accessing SRH care. Although some reported a reduced need for SRH care, others required but did not access care. Young people should be reassured that SRH issues are a valid reason to access services, especially when experiencing symptoms. Concerns about people delaying accessing healthcare services were raised early in the COVID-19 pandemic. This paper explores young people's perspectives on decisions to delay accessing care for their sexual and reproductive health, finding that although decreased sexual activity resulted in reduced need for care for some, others avoided seeking care despite experiencing symptoms or concerns about their health. Young people should be assured that their sexual and reproductive health remains a priority, even during a pandemic. [ABSTRACT FROM AUTHOR]

This qualitative descriptive study explored health consumers' preferences for receiving nutrition care in Australian primary care. The study was underpinned by a constructivist research paradigm. Semistructured telephone interviews were conducted with 25 health consumers (age 19–78 years; 19 female) from across Australia between May and August 2020. Content analysis, using an inductive approach revealed emergent themes. was used to reveal emergent themes. Five themes were identified in the data: (1) health consumers want to receive nutrition care from a qualified person; (2) nutrition care is viewed as important, and health consumers want to receive it in a format that meets their needs; (3) nutrition care should be low cost and available to everyone; (4) nutrition care services should be conveniently located; and (5) health consumers want nutrition care to be offered frequently, across their lifespan. Health consumers have a clear idea of how they would like to receive nutrition care in the primary care setting, but reported challenges to receiving this care within the current system. New models of service delivery are needed to meet the needs of health consumers. Diet-related chronic diseases are the leading cause of death and disability worldwide, and primary care provides an ideal setting to provide nutrition care to people at risk of chronic disease. This paper provides health consumer views on how the nutrition care model should be tailored to meet patient needs. The findings highlight the need for practice and healthcare system change to the current model of nutrition care in Australia to better meet the needs of patients. [ABSTRACT FROM AUTHOR]

Background: Maintaining sexual health and function is important to many older adults. Although older patients are regular users of primary care, opportunities to address sexual health concerns are missed. Building on interview studies, this research aimed to collect a larger number of older adults' perspectives to deepen understanding of sexual healthcare needs and formulate recommendations for the Australian primary care context. Methods: As part of the SHAPE2 Survey of older adults' sexual health information-seeking behaviours, participants (aged ≥60 years and living in Australia) were asked what sexual health issues were most important to them, and the barriers they experienced in managing their sexual health. Data were collected in 2021 in the form of free-text comments. The sub-set of comments that related to healthcare experiences were analysed using qualitative content analysis. Results: Out of 1470 survey participants, 864 responded to the relevant questions, and of these 107 wrote about healthcare experiences. Some comments described positive experiences seeking sexual health care; however, the majority outlined barriers to accessing support. Barriers were categorised into seven categories: patient embarrassment, barriers to rapport, uncertainty about finding solutions, ageism, barriers unique to minorities, needing general practitioners to initiate conversations and structural barriers. Conclusions: Older patients want general practitioners to initiate sexual health conversations as part of routine care, and, crucially, sexual issues raised by the patient should be legitimised and treated with due attention. Although challenges, such as time, embarrassment and pressing health concerns, may hamper sexual health discussions, it is important that this area of holistic care is given more attention. Sexual health is an aspect of holistic care that is often missed for older patients. Using 107 free-text comments from survey participants aged ≥60 years, we investigate the barriers in accessing sexual health care in the Australian primary care setting. The findings highlight the need for practitioners to initiate sexual health conversations with their older patients. [ABSTRACT FROM AUTHOR]

Practice nurses in Australia are now funded to facilitate chronic condition management, including self-management support. Chronic disease management requires an established rapport, support and proactivity between general practitioners, patients and the practice nurses. To achieve this, training in shared decision making is needed. e-Learning supports delivery and achievement of such policy outcomes, service improvements and skill development. However, e-learning effectiveness for health care professionals' is determined by several organisational, economic, pedagogical and individual factors, with positive e-learning experience linked closely to various supports. This paper reinforces previous studies showing nurses' expanding role across general practice teams and reports on some of the challenges of e-learning. Merely providing practice nurses with necessary information via web-based learning systems does not ensure successful learning or progress toward improving health outcomes for patients. [ABSTRACT FROM AUTHOR]

The final report of the National Health and Hospital Reform Commission (NHHRC) called for a strengthened consumer voice and empowerment. This has salience for the development of health policy concerning chronic illnesses. This paper compares the recommendations for chronic illness care made in the NHHRC final report with suggestions made by people with chronic illness and family carers of people with chronic illness in a recent Australian study. Sixty-six participants were interviewed in a qualitative research project of the Serious and Continuing Illness Policy and Practice Study (SCIPPS). Participants were people with type II diabetes mellitus, chronic obstructive pulmonary disease or chronic heart failure. Family carers were also interviewed. Content analysis was undertaken and participants' recommendations for improving care were compared with those proposed in the NHHRC final report. Many suggestions from the participants of the SCIPPS qualitative research project appeared in the NHHRC final report, including the need to improve care coordination, health literacy and the experience of Indigenous Australians. The research project also identified important issues of family carers, immigrants and people with multiple illnesses, which were not addressed in the NHHRC final report. More specific attention is needed in health reform to improve the experience of family carers, Indigenous peoples, immigrants to Australia and people with multiple illnesses. To align more closely with their needs, health reform must be explicitly informed by the voices of people with chronic illness and their family carers. The NHHRC recommendations must be supplemented with proposals that address the needs of these people for support and the problems associated with poor care coordination. [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]

Background: Autistic adults experience barriers to accessing health care, such as service provider communication not meeting their needs, healthcare facilities causing sensory discomfort and feeling fear or anxiety regarding their healthcare visit. The Academic Autism Spectrum Partnership in Research and Education (AASPIRE) developed and trialled an online healthcare toolkit to reduce such barriers and improve healthcare interactions between autistic adults and their primary care providers in the United States. This preliminary study aimed to explore experiences of autistic adults using the AASPIRE Healthcare Toolkit in Australia. Methods: Semi-structured interviews were conducted with six autistic adults about their experiences and perceptions of utilising the toolkit in an Australian healthcare setting. Results: Participants identified that the toolkit facilitated their interactions with health professionals by providing structure to appointments, supplementing new knowledge and increasing individual confidence. They also offered suggestions to tailor the toolkit for use in Australia. Conclusions: Future research should seek to explore the experiences of autistic adults using a version of the toolkit adapted for Australian use, as well as exploring the views of health professionals utilising it. Autistic adults often experience barriers to accessing health care and have negative healthcare experiences. We wanted to know if an online healthcare toolkit developed with autistic adults to improve healthcare interactions between them and their primary care providers in the US, could be used in Australia. We interviewed six Australian autistic adults about using the toolkit, with positive feedback. An Australian-adapted healthcare toolkit may potentially improve the healthcare experiences of autistic adults living in Australia. [ABSTRACT FROM AUTHOR]

Historical interferon and ribavirin therapies for hepatitis C virus have been replaced by modern treatments with improved efficacy and tolerability. Despite the availability of direct-acting antiviral therapy, evidence demonstrates poor uptake in Australia. Presently, the barriers and facilitators influencing uptake of direct-acting antiviral therapy are not fully understood, especially in a primary healthcare environment. Our study aimed to discover methods of improving uptake of treatment in the community. We conducted 15 semi-structured, face-to-face interviews in a metropolitan, primary healthcare clinic in Australia. Interviews were recorded, transcribed and subsequently analysed using thematic content analysis. We identified patient-related and healthcare system-related barriers and facilitators to commencing treatment. This included established themes from current literature, and novel themes unique to direct-acting antiviral therapy and primary care. Overall, our study reinforces the importance of public health campaigns to promote community awareness and emphasises the concomitant role of mental health in fostering treatment uptake. Informed by our findings, we suggest further research on an integrated model of care, focused on the domains of disease awareness, patient engagement and treatment adherence. Hence, a community-oriented approach, driven by primary healthcare, ultimately underpins a successful public strategy to improve outcomes for patients affected by hepatitis C. [ABSTRACT FROM AUTHOR]

Miscarriage occurs in one in four pregnancies in Australia and commonly results in adverse psychosocial sequelae, such as clinically significant levels of depression and anxiety. Women also commonly report a lack of support, understanding and acknowledgement of their loss. Research has shown that poor health care support experiences serve to exacerbate adverse psychosocial outcomes. This study explored the support experiences of women affected by miscarriage and their views on what support is needed, when it is needed and who should provide it, as well as their recommendations for improvement. Sixteen Australian women were purposively sampled to participate in qualitative semi-structured interviews. Interview data was analysed using content analysis. Approximately half the women reported positive experiences with healthcare providers, but, despite this, almost all pointed to areas where support was lacking. Insensitive comments and lack of emotional awareness were common. Participants suggested areas for increased clinician support, including mentioning the possibility of miscarriage earlier in routine pregnancies, offering more information before and at the time of miscarriage, providing emotionally sensitive care and offering follow up and psychological support. Women wanted healthcare providers to be proactive in offering support, information and emotionally sensitive care at the time of miscarriage, rather than having to seek it out themselves. Suggestions to improve support after miscarriage included mentioning the possibility of miscarriage earlier, offering more information about miscarriage and psychological support options. Miscarriage is a distressing event for women, who rely on their healthcare providers to offer them support, which is often felt to be inadequate. This study looked at what supports are needed after miscarriage, the timing of the support and who should be providing it, yielding multiple areas for improvement. Women wanted their healthcare providers to be more emotionally sensitive and proactive in offering support, including mentioning miscarriage earlier and providing more information and psychological support options. [ABSTRACT FROM AUTHOR]

There is a push for greater promotion of dementia risk reduction (DRR) by primary care practitioners (PCPs). The aims of this study were to understand the views of non-medically trained Australian contributors in a Massive Open Online Course (MOOC) about dementia prevention regarding the role of PCPs in promoting DRR and to consider the implications of those views for developing implementation strategies. Discussion board posts of MOOC enrollees were analysed regarding the actions that organisations, communities and/or governments should take to help people work towards DRR. Of the 1641 eligible contributors to the discussion, 160 (10%) indicated that PCPs had a role in promoting DRR. This subset of participants particularly wanted earlier identification of risk by PCPs and a discussion about DRR. Some participants thought PCPs did not currently prioritise DRR, lacked knowledge about DRR and faced Medicare and resource restrictions to promoting DRR. We suggest that PCPs need: better publicity for their role in promoting DRR; to prioritise DRR; knowledge about DRR; and to take advantage of existing opportunities to promote DRR quickly. The findings of this study should be considered when attempting to implement DRR guidelines in primary care. Guidelines say primary care practitioners (PCPs) should promote dementia risk reduction (DRR) with their patients, but what does the Australian public think? One in 10 contributors to a Preventing Dementia Massive Open Online Course discussion board spontaneously agreed with the guidelines, although they thought PCPs did not prioritise DRR, lacked knowledge and faced Medicare and resource restrictions to promoting DRR. Dementia risk reduction needs to be better publicised, understood and prioritised within primary care. [ABSTRACT FROM AUTHOR]

This study assessed Australian clinical practice guidelines for life-limiting index conditions for the extent to which they acknowledged comorbidities and framed management recommendations within the context of older age and reduced life expectancy. A comprehensive search identified current, evidence-based Australian guidelines for chronic life-limiting conditions directed at general practitioners. Guideline content was analysed qualitatively before comorbidity acknowledgements were quantified using a 17-item checklist. Full guidelines were quality appraised using AGREE-II. Ten documents covering chronic obstructive pulmonary disease, heart failure, cancer pain, dementia and palliative care in aged care were identified. Most guidelines addressed one 'comorbid' condition and prompted clinicians to consider patient quality of life and personal preferences. Fewer addressed burden of treatment and half suggested modifying treatments to account for limited life expectancy, age or time horizon to benefit. Half warned of potential adverse drug interactions. Guidelines were of moderate to very high quality. Guidelines naturally prioritised their index condition, directing attention to only the most common comorbidities. However, there may be scope to include more condition-agnostic guidance on multimorbidity management. This might be modelled on the 'guiding principles' approach now emerging internationally from organisations such as the American Geriatrics Society in response to increasing multimorbidity prevalence and evidence limitations. [ABSTRACT FROM AUTHOR]

General practice is arguably the ideal setting to initiate advance care planning (ACP), but there are many barriers. This pilot study was designed to assess the feasibility, acceptability and perceived utility of a nurse-facilitated screening interview to initiate ACP with older patients in general practice. Patients were recruited from four general practices in Sydney, Australia. General practice nurses administered the ACP screening interview during routine health assessments. Patients and nurses completed a follow-up questionnaire consisting of questions with Likert responses, as well as open-ended questions. Descriptive statistics and content analysis were used to analyse the data. Twenty-four patients participated; 17 completed the follow-up questionnaire. All patients found the ACP screening interview useful and most felt it would encourage them to discuss their wishes further with their family and general practitioner. Several patients were prompted to consider legally appointing their preferred substitute decision-maker. All six participating nurses found the screening interview tool useful for initiating discussions about ACP and substitute decision-making. This nurse facilitated screening tool provides a simple, acceptable and feasible approach to introducing ACP to older general practice patients during routine health assessments. [ABSTRACT FROM AUTHOR]

Major system change involving closer supervision of trainee GP registrars in Australia is warranted. Change management guidelines recommend involving stakeholders in developing change. The views of those involved in general practice training about current and potential supervisory practice were explored. Semi-structured interviews were conducted with a lead medical educator from nine Australian regions. Focus groups were conducted with GP supervisors and GP registrars. Transcripts from the interviews and focus groups were analysed using conventional content analysis, with themes emerging inductively from the data. The findings were that over 1–3 months, a registrar could progress from their supervisor observing all consultations through to the registrar only calling when they identify the need for help. There is strong support from registrars for this change to closer supervision, but less support from supervisors and educators. Barriers to the proposed change include high clinical demand competing with teaching capacity, inadequate payment for closer supervision and supervisors lacking skills or motivation to have a more active role in registrar supervision. If funding and logistic barriers to change are addressed, a change to a closer level of supervision is possible. A pilot study to further refine the change is indicated. [ABSTRACT FROM AUTHOR]

General practice care plans are designed to improve the management of chronic illness, facilitating multidisciplinary care and enabling GPs and consumers to work collaboratively. Evidence suggests that they work well for chronic physical illnesses, but it is unclear if they operate as intended for people with mental disorders. The aims of this study were to: (1) compare rates of creation and review of GP care plans for mental disorders and type II diabetes; and (2) examine consumer experiences. Secondary analysis of 109 589 recorded encounters from a national cross-sectional study in Australian general practice (2006–16) demonstrated that encounters involving creation of a care plan for depression or anxiety were significantly higher than those for diabetes, bipolar disorder and schizophrenia. Rates of review were commensurate with creation of plans for diabetes, but not for mental disorders. Eighteen people with a GP care plan completed an online survey about their experiences, reporting that care plans facilitated access to allied health professionals, but did not improve the quality of care they received. Findings suggest that care plans are underutilised for people with low prevalence mental disorders, and while they offer financial benefits to consumers, they may not result in ongoing, collaborative care. [ABSTRACT FROM AUTHOR]

This systematic narrative review of qualitative studies examined health service barriers and facilitators in Australia for refugees after resettlement. Twelve qualitative studies published between 2006 and 2017 involving more than 500 participants were included in the review. Approximately half of all participants were healthcare professionals. A meta-synthesis approach was used to compare and combine findings from across studies. Few facilitators were identified. Barriers to accessing health services were commonly attributed to refugees, but several barriers were associated with healthcare professionals and health services. Barriers attributed to healthcare professionals included gaps in knowledge and skills; poor cultural competency; poor communication skills; and time constraints. Understanding such barriers is the first step in developing strategies to overcome them. The skills and knowledge of healthcare professionals are important to facilitating access to healthcare among this vulnerable population. [ABSTRACT FROM AUTHOR]

Diabetes contributes considerably to the health disparities in the Aboriginal population. To address the lack of Aboriginal-specific diabetes education tools, Feltman was designed for health professionals to deliver diabetes prevention and management information. This qualitative study aims to explore how this resource was used and its perceived effect on diabetes prevention and management in Victorian Aboriginal communities. Convenience sampling was used to recruit 18 participants (n = 6 were Aboriginal) who had attended Feltman training between 2010 and 2016. Semi-structured interviews conducted via telephone or face-to-face were audio-recorded, transcribed and analysed via content analysis. Content analysis identified three main categories regarding Feltman : (1) utilisation in Aboriginal and mainstream health services; (2) as a comprehensive, engaging tool that supports understanding of diabetes; and (3) the barriers and challenges to Feltman 's use. Overall, Feltman was regarded as a culturally appropriate diabetes education tool that is visual, tactile, engaging, supportive of health literacy and perceived to enhance Community members' understanding of diabetes prevention and management. This is the first study to provide insight into Feltman 's implementation; adding to the evidence-base for Aboriginal-specific diabetes education tools. [ABSTRACT FROM AUTHOR]

The Drug and Alcohol Withdrawal Network (DAWN) is a home-based withdrawal service based in Perth, Western Australia. Literature on outcomes, costs and client attitudes towards this type of home-based detoxification in Australia is sparse. Therefore, this study assessed these factors for clients enrolled over a 5-year period (July 2011–June 2016). Client experience was explored through semi-structured interviews with 10 clients. Over the study period, 1800 clients (54% male, mean age 38 years) were assessed, and there were 2045 episodes of care. Although most first-episode clients (52%) listed alcohol as the primary drug of concern, the proportion listing methamphetamine increased from 4% in 2011–12 to 23% in 2015–16. In 94% (n = 639) of withdrawal detoxification episodes with completed surveys, clients used their 'drug of primary concern' most days or more often at baseline; this had reduced to 23% (n = 149) at the conclusion of detoxification. Five-year direct costs were A$4.8 million. Clients valued the person-centred holistic approach to care, including linking with other health providers. Barriers included low awareness of the program and difficulties finding an appropriate support person. Further exploration of cost-effectiveness would substantiate the apparently lower per client cost, assuming medical suitability for both programs, for home-based relative to inpatient withdrawal. [ABSTRACT FROM AUTHOR]

General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisation governance has the potential to assist nurses to work at an advanced level, but significant financial, structural and cultural barriers may be too difficult for organisational governance resources alone to overcome. In addition to utilising resources, it may be useful for general practices to undertake a review of how they function as a team and reflect upon their practice culture. [ABSTRACT FROM AUTHOR]

Many older adults living in their own homes are at nutrition risk which, left untreated, can lead to the state of malnutrition. To reduce the prevalence of malnutrition among community-living older adults (CLOAs), risk factors should be identified and addressed early via malnutrition screening. The aim of this study was to identify barriers and enablers to malnutrition screening of CLOAs from the perspective of dietitians. Ninety-two dietitians working for government, not-forprofit and private organisations in Australia provided written comments to open-ended survey questions. Textual data were analysed using content analysis, resulting in four key categories of organisational, staff, screening and CLOA factors. Insufficient time to screen and lack of knowledge by non-dietetic staff and CLOAs about malnutrition were identified as the strongest barriers. Organisational factors of screening policy and procedures and the provision of education and training emerged as the strongest enablers. The findings from this study can provide guidance to organisations and healthcare practitioners considering the implementation of routine malnutrition screening of CLOAs. Increased awareness about malnutrition and the associated outcomes may help to reduce nutrition risk among CLOAs. [ABSTRACT FROM AUTHOR]

Involving consumers in research enhances its quality and appropriateness, and is required within many research funding schemes. While the rationale for consumer involvement is understood, its implementation is unclear. The researcher investigated views of a group of Australia's leading researchers (n = 38) about the role of consumers in their research using a brief survey administered at the Australia National Health and Medical Research (NHMRC) Translation Conference in 2014. Interpretive content analysis was used for data analysis. Respondents noted the importance of consumer involvement in the planning and design of research, to ensure its relevance to the community as end-users of research outcomes. Therefore, consumers were seen as central to research translation by the respondents. Many respondents perceived empathy for the experiences of others as a fundamental researcher skill. Despite strong acknowledgement of the benefits of consumer involvement in research, gaps exist between the rhetoric and practice of consumer involvement beyond consultative roles. Power over decisions made about research processes and ownership of research are continuing barriers to greater consumer involvement in research. Structural changes to how research is funded, evaluated and reported provide a means of addressing these gaps. NHMRC leadership is needed to promote these changes. [ABSTRACT FROM AUTHOR]

Australian data suggest up to 15% of people with intellectual disability (ID) have asthma. The inhaled route of administration is optimal for the management of obstructive airways diseases; however, correct inhaler use requires dexterity and particular breathing patterns and potentially represents a problem in this population due to physical and cognitive deficits. Understanding the nature and extent of inhaler use in persons with ID is important, as correct inhaler technique is imperative for optimal clinical outcomes; however, currently no evidence base exists to inform health professionals. This study describes respiratory medication use, reported prevalence of asthma, and asthma management practices undertaken in a clinic sample of Australian adults with ID. Results showed a prevalence of retrospectively reported asthma of 6%, with 86% of asthma patients prescribed inhaled medication. A review of patient records also indicated omission of some recommended asthma management strategies. [ABSTRACT FROM AUTHOR]

The Australian health system has been subjected to rapid changes in the last 20 years to meet increasingly unmet health needs. Improvement of the efficiency and comprehensiveness of community-based services is one of the solutions to reducing the increasing demand for hospital care. Competent managers are one of the key contributors to effective and efficient health service delivery. However, the understanding of what makes a competent manager, especially in the community health services (CHS), is limited. Using an exploratory and mixed-methods approach, including focus group discussions and an online survey, this study identified five key competencies required by senior and mid-level CHS managers in metropolitan, regional and rural areas of Victoria: Interpersonal, communication qualities and relationship management; Operations, administration and resource management; Knowledge of the health care environment; Leading and managing change; and Evidence-informed decision-making. This study confirms that core competencies do exist across different management levels and improves our understanding of managerial competency requirements for middle to senior CHS managers, with implications for current and future health service management workforce development. [ABSTRACT FROM AUTHOR]

The growing evidence on the benefits and risks of complementary and alternative medicine (CAM) and its high rate of use (69% of Australians) - particularly for chronic or recurrent conditions - means increasing attention on CAM. However, few people disclose CAM use to their GP, and health professionals tend to inadequately discuss CAM-related issues with their patients, partly due to insufficient knowledge. As clinical and non-clinical chronic condition management guidelines are a means to educate primary health care practitioners, we undertook a content analysis of guidelines relevant to two common chronic conditions - cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) - to assess their provision of CAM-related information. Ten current Australian guidelines were reviewed, revealing scant CAM content. When available, the CAM-relevant information was brief, in some cases unclear, inconclusive and lacking in direction to the GP or health care provider. Although we focus on CVD and T2DM, we argue the value of all chronic condition management guidelines integrating relevant evidence-informed information and advice on CAM risks, benefits and referrals, to increase GP awareness and knowledge of appropriate CAM therapies, and potentially to facilitate doctor-client discussion about CAM. [ABSTRACT FROM AUTHOR]