Search

Background: Sonder's In-Home Withdrawal Service (IHWS) has been providing a unique home-based, multidisciplinary, wraparound withdrawal option for people with low-to-moderate levels of substance dependence since September 2019. This paper provides an evaluation of the service's overall impact on reducing substance use among clients through the delivery of this innovative service model. The evaluation explores the acceptability and feasibility of the service via client, stakeholder, and staff perspectives. Methods: A mixed-method design was used to evaluate the IHWS. Descriptive analysis of quantitative data was conducted using clinical assessments from client records and online feedback surveys. Qualitative data from client, staff, and stakeholder feedback surveys were analysed thematically. Results: Overall, 1166 referrals were received over the lifespan of the service, and a data set of 96 clients was included in the analysis. Self-reported measures showed that most clients decreased their substance use (89%), improved their psychological health status (75%), improved their physical health (65%), improved their quality of life (69%), and improved their understanding and ability to manage their alcohol and other drugs (AOD) use (84%). Client feedback suggests the service is providing a unique option for AOD withdrawal. Stakeholders commend the service's home-based setting, multidisciplinary and person-centred approach to care, and recommended expansion of the service to increase access for clients and reduce demand on inpatient settings. Conclusions: The IHWS is having a significant impact in reducing substance use and highlights the need for increased access to holistic approaches to withdrawal. This includes pre- and post-withdrawal support and the inclusion of multidisciplinary teams, and engaging lived experience practitioners. A focus on funding primary-based services is required to meet the rising costs of tertiary-based care and to better meet the needs of consumers. Individuals with low-to-moderate levels of substance dependence require targeted services to safely manage their withdrawal. This paper evaluates a holistic approach to withdrawal that broadens the common medicalised approach through pre- and post-withdrawal stages of care and support from a multidisciplinary team including lived experience practitioners. The service reduces levels of substance use while also improving overall quality of life, demonstrating the need for more withdrawal services to consider the inclusion of holistic approaches to substance dependence support. [ABSTRACT FROM AUTHOR]

Cervical cancer screening programs in Australia have been developed to detect early precancerous changes in women with a cervix aged between 25 and 74. Yet, many barriers remain to the uptake of cervical screening. Barriers include a lack of culturally appropriate service provision, physical access, poor health literacy, emotional difficulties, socio-economic disadvantage and not having access to a female service provider. In remote and very remote areas of Australia, additional barriers experienced by Aboriginal or Torres Strait Islander peoples include a distrust of healthcare providers and a lack of services, resulting in a much higher rate of diagnosis and death from cervical cancer. General practice nurses (GPNs) are well placed to conduct cervical screening tests (CSTs) after they have undertaken additional education and practical training. GPNs' increase in scope of practice is beneficial to general practice as it helps to remove some barriers to cervical screening. In addition, GPNs conducting CSTs reduce GP workload and burnout and increase teamwork. GPNs working in metropolitan clinics have greater access to training facilities, whereas those working in rural and remote clinics are required to travel potentially long distances to complete practical assessments. This highlights the need for training to be made available in rural and remote areas. The aim of this forum paper is therefore to generate further discussion on the need for training programs to be made available in rural and remote areas to aid the upskilling of GPNs. Low cervical cancer screening rates in regional, rural and remote areas result in a higher rate of cancer diagnosis and death. General practice nurses when upskilled are able to address barriers to cervical screening, especially in regional and rural areas. Localised training courses may assist general practice nurses to be upskilled in their region. [ABSTRACT FROM AUTHOR]

Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. The 2023–2024 budget allocated AU$445 million to further enable general practice-led, multidisciplinary teams, with integrated care located within practices, including employment of allied health professionals. Such team care models are recognised by The Royal Australian College of General Practitioners as vital to delivery of high-quality care for older adults. They are especially relevant for over 250,000 Australians who live with dementia in the community. However, not all allied health professionals are currently based within general practices. Future, sustainable general practice-led models of multidisciplinary care that connect patients with external allied health providers could be considered for a comprehensive and collaborative approach to care. Our focus is on people living with dementia, who are at greater risk of preventable vision impairment. Poor vision and/or ocular health can be detected and managed through regular eye examinations, which are predominantly delivered by community-based optometrists in Australia, in a primary care capacity. However, people living with dementia are also less likely to have regular eye examinations. In this paper, we highlight the value of ensuring access to primary eye care services as part of post-diagnosis dementia care. We illustrate the important role of primary care practitioners in building and sustaining connections with allied health professions, like optometry, through effective referral and interprofessional communication systems. This can help break down access barriers to dementia-friendly eye care, through promoting the importance of regular eye tests for people living with dementia. Access to allied health services offers significant benefits for people living with dementia, yet access is currently fragmented and inconsistent. People living with dementia are at greater risk of experiencing vision impairment, preventable through regular eye examinations usually provided by community-based optometrists in a primary care capacity. We encourage all primary care practitioners to 'think vision' when consulting with people living with dementia, and advocate for a schedule of regular eye tests post-diagnosis. This article belongs to the Collection Access to Primary Health Care. [ABSTRACT FROM AUTHOR]

Primary care settings are ideal for initiating advance care planning (ACP) conversations and assessing palliative and supportive care needs. However, time constraints and a lack of confidence to sensitively and efficiently initiate such discussions are noted barriers. The Advance Project implemented a national multicomponent training package to support Australian general practice nurses (GPNs) to work with GPs to initiate ACP and palliative care conversations in their practice. This paper reports on semistructured interviews conducted with 20 GPNs to explore barriers and facilitators to implementing the Advance Project model. Participants identified a range of factors that affected implementation, including lack of time, limited support from colleagues, lack of knowledge about systems and funding processes in general practice and a need for better alignment of the Advance Project resources and practices with general practice information management platforms. Barriers related to professional roles, particularly the lack of clarity and/or limitations in the scope of practice of GPNs, highlighted the importance of defining and supporting the roles that different primary health practice staff could play to support implementation of the model. The findings underline the need for complementary training in the Advance Project model for GPs and practice managers to enable a team-based approach to implementation. Primary care professionals often report barriers to initiating advance care planning (ACP) and palliative care (PC), affecting patients' end-of-life care experiences. This paper provides evidence to suggest that nurses working in general practice can be trained and are willing to initiate ACP and PC. By understanding barriers and facilitators to early implementation of the Advance Project model through a theoretical lens, changes were identified that could lead to successful implementation of ACP/PC assessment tools in general practice settings. [ABSTRACT FROM AUTHOR]

This paper examines the implications of the second sentence in Tudor Harts statement about inverse care – that its operation was strongest when exposed to market forces. In the Australian context, we briefly review some available evidence for inverse care in three groups – Aboriginal and Torres Strait Islander people and those living in remote and socioeconomically disadvantaged areas. We then discuss the extent to which these examples can be attributed to the operation of supply-and-demand within Australia's hybrid fee-for-service system in general practice. Our analysis suggests disparities in workforce supply and the ability of disadvantaged groups to seek preventive and proactive care are critical factors. These, in turn, suggest the need to fund general practice to be responsible for proactive and preventive care of disadvantaged population groups alongside broader structural reforms in workforce, education and taxation. This paper examines the implications of the second sentence in Tudor Harts statement about inverse care – that its operation was strongest when exposed to market forces. Examples of inverse care can be found in the disparities access to primary health care in Australia, which can be attributed to both supply-and-demand factors in Australia's hybrid market model of health care. Correcting these requires changes to the funding and workforce models, as well as specific actions at the service and community level. [ABSTRACT FROM AUTHOR]

Trans and gender-diverse individuals experience poor mental health, and face significant barriers when trying to access appropriate mental health care. Most seek treatment from mainstream primary care services, who have an ethical duty to provide care to all. Primary care practitioners can ameliorate traumatic harms by identifying helpful strategies and avoiding inappropriate or harmful strategies. However, there is limited robust, culturally sensitive evidence informing clinicians about the appropriateness and efficacy of psychological interventions for trans and gender-diverse clients. This forum article argues that the epistemological and ontological frameworks underlying psychotherapies can impact the therapeutic relationship, and are therefore important factors to consider in primary care practice with trans and gender-diverse clients. Our paper synthesises selected psychotherapies into four clusters. Each cluster is accompanied by discussion of the potential or demonstrated benefits and limitations of the underlying framework, in the context of primary care with trans and gender-diverse clients. We also explore power dynamics in therapeutic relationships with trans and gender-diverse clients, and the challenges these factors pose to developing a shared understanding of the client's needs and preferences. The article concludes with some practical considerations for managing these issues in primary care. Trans and gender-diverse individuals tend to experience poor mental health, often exacerbated by culturally unsafe services in primary care. This paper offers four key frameworks for understanding and anticipating the potential benefits and harms of different psychological therapies when caring for trans and gender-diverse clients. The article concludes with recommendations for implementing the frameworks in practice, and discussion of the scope for involving peer workers in multidisciplinary care teams. [ABSTRACT FROM AUTHOR]

Background: People with lived experience of severe mental illness (PWLE) live around 20 years less than the general population. Most deaths are due to preventable health conditions. Improved access to high-quality preventive health care could help reduce this health inequity. This study aimed to answer the question: What helps PWLE access preventive care from their GP to prevent long-term physical conditions? Methods: Qualitative interviews (n = 10) and a focus group (n = 10 participants) were conducted with PWLE who accessed a community mental health service and their carers (n = 5). An asset-based framework was used to explore what helps participants access and engage with a GP. A conceptual framework of access to care guided data collection and analysis. Member checking was conducted with PWLE, service providers and other stakeholders. A lived experience researcher was involved in all stages of the study. Results: PWLE and their carers identified multiple challenges to accessing high-quality preventive care, including the impacts of their mental illness, cognitive capacity, experiences of discrimination and low income. Some GPs facilitated access and communication. Key facilitators to access were support people and affordable preventive care. Conclusion: GPs can play an important role in facilitating access and communication with PWLE but need support to do so, particularly in the context of current demands in the Australian health system. Support workers, carers and mental health services are key assets in supporting PWLE and facilitating communication between PWLE and GPs. GP capacity building and system changes are needed to strengthen primary care's responsiveness to PWLE and ability to engage in collaborative/shared care. People with lived experience of severe mental illness (PWLE) experience poorer physical health and worse access to preventive care than the general population. This paper provides information from a lived experience perspective on how PWLE in Sydney, Australia have been able to access preventive care from a GP. These results highlight the importance of supporting PWLE to access effective preventive care across their journey and suggest specific areas for improvement in GP capabilities and care coordination/shared care. [ABSTRACT FROM AUTHOR]

Background: The impact of Australia's diverse population on the aged care sector has been acknowledged, with the Royal Commission into Aged Care Quality and Safety findings providing evidence of the importance of population diversity for consumer-directed and person-centred care. Similarly, the Aged Care Quality Standards and Aged Care Diversity Framework acknowledge the diversity of Australia's ageing population and potential implications for equitable access to care and the ensuing importance of culturally appropriate and culturally safe care. This paper reports on the development of informational web pages and utilisation findings for use by the aged care workforce supporting diverse populations. Methods: Content was created for the End of Life Directions for Aged Care website, based on rapid review findings relating to barriers and limitations for people accessing equitable care in the aged care and palliative care sectors. Results: Website pages containing embedded links to useful content and resources for health professionals and care workers who work with older diverse adults are shown to be well received among users. Conclusions: As Australia's future population will age with increasing diversity markers, with implications for aged care and palliative care service provision, workforce access to up-to-date, relevant and evidence-informed information on best practice non-clinical support for individuals from diverse backgrounds towards the end of life promotes a person-centred care approach. Access data shows that the website content is being utilised increasingly over time and suggests that it is filling a gap in comprehensive and accessible end of life resources that have been missing from the Australian aged care and palliative care workforce. Consumer-directed and person-centred care is crucial in appropriately servicing all older adults, given each older adult has a diverse background, which impacts their aged care experiences. This paper reports on the development of web pages designed to support the knowledge and information needs of the aged care workforce. There is a need for such resources within this sector to inform culturally appropriate and safe care. [ABSTRACT FROM AUTHOR]

The study aimed to explore Indigenous narrative accounts of healthcare access within qualitative research papers, to better understand Indigenous views on culturally safe healthcare and health communication represented in that literature. A systematic literature review of peer-reviewed academic qualitative studies identified 65 papers containing Indigenous respondents' views on accessing healthcare. Analysis included all Indigenous voice (primary quotations) and author findings describing healthcare access across these studies. Healthcare communication, or 'talk', emerged as a key theme. Indigenous clients valued talk within healthcare interactions; it was essential to their experience of care, having the power to foster relationships of trust, strengthen engagement and produce positive outcomes. By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client's level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system [ABSTRACT FROM AUTHOR]

Background: The study explored the experiences and perceptions of GPs regarding the management of chronic non-cancer pain (CNCP). Specifically, participants were asked to identify perceived enablers and barriers to CNCP care and how the care of patients with CNCP may be improved. Methods: The study utilised a qualitative descriptive methodology. General practice in Western Australia. The sample was purposive with 12 Australian GPs from predominantly metropolitan locations and with experience in managing CNCP. Semi structured interviews were conducted. Each interview was of 45–60 min duration. All interviews were audio recorded and transcribed using a secure transcription service. Thematic analysis developed themes inductively and deductively. Results: Themes emerged regarding: the importance of a holistic and personalised approach; the important role of a coordinating GP; the need for an evidence-based approach to opioid management; concerns relating to access to multidisciplinary services; the importance of clinician and patient education regarding CNCP; and an acknowledgement of the challenges for doctors and patients in managing CNCP. Conclusions: Currently, the management of CNCP in Australia is challenging. Notable challenges include: difficulties with continuity of patient care; challenges with patient expectations of treatment, in particular opioid medications; difficulty with access to the health services required to enable holistic care; and the need for improved pain education in the community. The breadth of these challenges suggests there is a need for supportive organisational and structural considerations in the healthcare system to enable optimal care of CNCP in the community. Access to specialist services for chronic non-cancer pain is problematic ins In Australia, resulting in general practitioners bearing much of the burden of care that requires a holistic and multidimensional approach. In this paper, 12 general practitioners in Western Australia described, through qualitative interviews, the challenges of caring for patients with chronic pain including fragmentation of care, difficulty with access to recommended services, mismatched patient and practitioner expectations and inadequate GP and community knowledge about chronic pain. These findings could assist in planning better services for chronic pain. [ABSTRACT FROM AUTHOR]

Background: Conciliatory attitudes, respect for medical professionals and avoidance of being direct can make health consultations with Burma-born patients difficult to navigate. Coupled with linguistic barriers, this may make the sensitive nature of many women's health consultations challenging. Little is known about current practices for obtaining informed consent in this context. The objectives of this study were to explore current practices, barriers and strategies to obtaining informed consent in medical consultations with women born in Burma. Methods: Purposive and snowball sampling was used to recruit health practitioners (n = 15, 2 male, 13 female) of different ages, years of professional experience, and country of origin, from clinics in Victoria that see a high volume of Burma-born patients. Thirty to sixty minute semi-structured interviews were conducted with four general practitioners, eight nurses and three interpreters, and de-identified audio recordings were transcribed for inductive thematic analysis. Results: Five key themes were generated: (1) cultural cognisance; (2) influence of community; (3) skilful navigation of communication; (4) favourable consultation attributes; and (5) individual tailoring of consent conversations. Differing cultural expectations, and linguistic and educational barriers, were highlighted as challenges to obtaining informed consent, whereas thoughtful utilisation of non-verbal communication, and intentional customisation of consent conversations were identified as facilitators. Conclusion: The findings of this study provide practical ways to optimise the informed consent process within the Australian primary healthcare context, and reinforce that accepted Western-based practices for obtaining informed consent are not a 'one-size-fits-all' process. The increasing cultural and linguistic diversity of Australian society necessitates a better understanding of the practise of cross-cultural medicine. The findings from this study suggest that accepted Western culture-based practices for obtaining informed consent cannot be universally upheld as ideals. Practical insights from this paper help to inform Australian clinicians on how to optimise cross-cultural informed consent with women born in Burma. [ABSTRACT FROM AUTHOR]

This special issue highlights programs, policies and approaches to comprehensive primary health care that are influenced by the spirit of the Inverse Care Law. There are still significant gaps in research, including how the inverse care law affects different groups of patients and their carers within specific settings. The papers in this issue make an important contribution, but we cannot assume that the importance of the inverse care law in determining health outcomes has been demonstrated, is known, and is accepted in all settings. A strength of Tudor Hart's original research was its clear clinical relevance, and demonstrating the nature and the impact of the inverse care law in clinical settings should remain a priority. [ABSTRACT FROM AUTHOR]

In this paper, whānau Māori highlight how a Kaupapa Māori-centred intervention (the Harti Hauora Tamariki tool, hereafter Harti tool) has improved interactions with health services. The Harti tool is undergoing a randomised control trial (RCT) at Waikato Hospital in New Zealand. As part of the RCT, the authors engaged in a series of qualitative interviews with whānau members of tamariki Māori (children aged 0–5 years) admitted to Waikato Hospital's paediatric ward. Whānau who met at least one criteria for New Zealand's domains of deprivation were included. Using a Kaupapa Māori approach to the study, participants shared their views on barriers and facilitators to accessing health resources and primary care services. The interviews conducted highlight how the Harti tool, when administered in a culturally appropriate and respectful manner that prioritised relationship-building, enabled better connection to healthcare services. Prevalent in our analysis were connections to wider determinants of health and ways to reduce existing health inequities. To conclude the paper, how the Harti tool has enhanced feelings of being in control of health, with the potential to reduce the likelihood of a hospital readmission, is highlighted. [ABSTRACT FROM AUTHOR]

There is a growing population of people from refugee backgrounds settling in Australia. They have often been forced to flee from their homes in violent circumstances and may have spent many years in refugee camps with poor health support. There are multiple barriers to their effective access to health services. Community engagement with this community can be tokenistic and difficult to effect. This paper highlights the importance of developing a meaningful strategy for community engagement that is not 'one-size-fits-all', which is achieved over time. There is a rich resource available to health practitioners if engagement with refugee-background communities is managed according to the set of trauma-informed and structural principles outlined in this paper. [ABSTRACT FROM AUTHOR]

This paper reports on a study that aimed to understand how remote area nurses implemented primary health care principles in the Australian remote health care setting. Twenty-four Registered Nurses and Nurse Practitioners who worked in remote health services without inpatient facilities were interviewed using constructivist grounded theory methods. Findings revealed that nurses in this study aimed to practice in a way that was guided by Indigenous empowerment and social justice. However, some nurses questioned elements of their practice such as 'chasing' people for appointments or routine screening required by clinical guidelines that may not reflect the values of Indigenous peoples. Nurses expressed concern that they may be reinforcing past colonising practices and their actions may be considered paternalistic rather than empowering. Nurses in this study wanted to develop partnerships and provide nursing care that aligned with the health and wellbeing expectations of communities. However, ways of communicating the needs of communities and the development of partnerships between health providers and communities need to be developed. The present study calls for further research from the perspective of remote community members in order to develop ways of sharing knowledge about health and wellbeing between remote area nurses and communities. Remote Area Nurses provide all aspects of care for communities including acute care and health promotion. However, some nurses question whether their priorities and actions are in line with that of communities. This paper discusses nurses concerns about whether their actions are best practice or paternalistic. [ABSTRACT FROM AUTHOR]

Background: For Aboriginal and Torres Strait Islander women, the premature burden of cardiovascular disease is affecting their capacity to fulfil roles in society, and promote the health and wellbeing of future generations. In Australia, there is limited understanding of the difference in primary preventive cardiovascular care experienced by women, despite knowledge of sex and gender differentials in health profile and receipt of guideline-based acute care. This paper sought to explore the health profile and receipt of assessment and management of cardiovascular risk for Aboriginal and Torres Strait Islander women accessing preventive primary health care, and investigate gender differentials. Method: Records of 1200 current clients, 50% women, aged 18–74 years from three Aboriginal Health Services in central and South Australia for the period 7/2018–6/2020 were reviewed. Results: Twelve percent had documented cardiovascular disease. Compared with men, women with no recorded cardiovascular disease had a greater likelihood of being overweight or obese, a waist circumference indicative of risk, diabetes, and depression. Women were less likely to report being physically active. Conclusions: The research concluded that gaps exist in the provision and recording of guideline-recommended primary preventive care regardless of sex. These are stark, given the evident burden. Variance in cardiovascular risk and disparities in care have been documented for women; however, the knowledge about gaps in care is less explored for sub-populations, such as Indigenous populations. This study explores the health profile and receipt of preventive risk assessment and management in primary health services for Aboriginal and Torres Strait Islander women compared with men, finding women and men alike experience gaps in the provision of care to meet identified health needs. [ABSTRACT FROM AUTHOR]

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

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]

People from a refugee background have significant unmet health needs including complex physical and psycho-social presentations. They can experience low trust, unfamiliarity with the health system and reliance on family and friends to access care. To address these needs, Australia has specialised refugee health services in each state and territory. The majority of these services transition patients to primary care, but this transition, although necessary, is difficult. Most primary care and specialised health professionals share a high degree of commitment to refugee patients; however, despite best efforts, there are gaps. More integrated health services can start to address gaps and promote continuity of care. A previous study has described 10 principles that are associated with successful integration; this paper references five of those principles (continuum of care, patient focus, geographic coverage, information systems and governance) to describe and map out the outcomes of an integrated model of care designed to deliver specialist refugee health in primary care. The Co-location Model is a partnership between a refugee health service, Primary Health Networks, a settlement agency and general practices. It has the potential to deliver benefits for patients, greater satisfaction for health professionals and gains for the health system. Newly resettled people from a refugee background have significant unmet health needs. We know that primary care is well placed to provide patient-centred care and that an integrated health model is essential to address this complexity. However, little is known about the successful processes for effective health system integration. This paper explores the principles and partnerships necessary to implement an effective health system integration model of specialist refugee health with mainstream primary care. [ABSTRACT FROM AUTHOR]

This exploratory study examined general practitioners' (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs' life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility's end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs. This paper is on a topic of increasing policy importance. With the aging of the population, the pressure on our aged care facilities will become intense. This paper highlights how GPs, the main source of clinical supervision in residential aged care, do their job and what the issues are that facilitate and impede their participation. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged the mental health of communities worldwide, with the triple pressures of financial insecurity, lockdowns, and worry about the infection. Australia rapidly deployed resources to protect the mental wellbeing of the community through supplementing existing services, supporting at-risk groups, investing in social supports, embracing technology, and supporting the health workforce. This paper describes the Australian Government's investment in mental health during the COVID-19 pandemic in relation to the 10 priority areas identified in Australia's National Mental Health Pandemic Response Plan. The COVID-19 pandemic and associated public health measuresgenerated substantial and ongoing challenges for the mental health and wellbeing of Australian communities. Australian Government funded initiatives were rapidly instituted between different levels of government and with community mental health organisations. These policy actions aimed to provide agile responses to promote community resilience and strengthen services for vulnerable groups, including older people, those with existing mental health conditions, Aboriginal and Torres Strait Islander peoples, and health and essential service providers. [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]

The high prevalence and health effect of tobacco smoking and secondhand smoke exposure among Aboriginal and Torres Strait Islander people is well known. Due to its significance, the responsibility of tackling smoking among Aboriginal and Torres Strait Islander people should not remain solely with health service providers. The creation of supportive environments and collaboration beyond the health sector are critical elements of comprehensive primary health care practised by Aboriginal Community Controlled Health Services. This paper discusses how Apunipima Cape York Health Council worked with three Aboriginal Shire Councils to create more smoke-free places, using local working groups, information sessions and community-based health promotion. The flexibility and the time allocated to the engagement process with councils, community leaders, organisations and community members were important. All three communities acknowledged the benefits of role modelling and working together to improve health, with addressing tobacco smoking seen as 'everyone's business' and 'not just service providers'. Aboriginal Shire Councils can play a critical role, in partnership with Aboriginal Community Controlled Health Services, in creating healthy places that enable healthy choices. [ABSTRACT FROM AUTHOR]

People living with Parkinson's disease (PWPD) in rural areas have limited access to local condition-specific care. This paper examines the healthcare preferences of PWPD living in rural areas and how a community-driven initiative to employ a movement disorder nurse (MDN) functioned to address barriers to health services access. A qualitative design facilitated an understanding of how interactions with the health system shaped PWPD and their carer's experiences of living in a regional community. A total of 42 semi-structured interviews were conducted 6–9 months apart; 19 interviews with PWPD and 23 dyadic interviews. The findings support the contention that specialist care can be effectively delivered through allied health professionals in some settings. In particular, having access to a specialist MDN can cushion the effects of living with Parkinson's disease in regional and rural areas where continuity of care and access to timely support is often difficult for people to find. The quality of social support provided by the MDN may increase people's ability to cope in the face of an unpredictable disease course. This is consistent with prior research, which identified that a specialist nurse or allied health services for people living with chronic conditions is enhances quality of life. [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]

The global burden of chronic disease has forced health systems to focus on improved care. This has led to improved health outcomes for some populations, but not for all people or for all conditions. The rising prevalence of chronic disease has also significantly increased demands on healthcare systems, with unsustainable costs to funders. To improve health and social outcomes for all people with chronic disease, it is critical to embrace allied health professionals as key members of primary healthcare teams. The recognised efficacy and cost-effectiveness of many allied health interventions suggest that implementation into usual care would result in enhanced outcomes for people accessing healthcare, their families and communities, and for health systems. Our aim is to highlight the current unacceptable lack of allied health integration into primary healthcare teams, and illustrate the potential value of improved and equitable access to allied health professionals for managing chronic conditions and multimorbidity. Recent policy initiatives in Australia have increased the involvement of allied health in the management of people with chronic conditions in primary care. Although this is positive, there is an opportunity for allied health to make a greater contribution. This paper highlights the gaps in the integration of allied health into primary healthcare teams, and provides some discussion as to how this could be improved to reduce the burden of chronic conditions on the healthcare system. [ABSTRACT FROM AUTHOR]

Refugees can experience problems accessing and utilising Australian primary health care services, resulting in suboptimal health outcomes. Little is known about the impact of their pre-migration health care experiences. This paper demonstrates how the Afghan pre-migration experiences of primary health care can affect engagement with Australian primary care services. It considers the implications for Australian primary health care policy, planning and delivery. This paper is based on the international experiences, insights and expert opinions of the authors, and is underpinned by literature on Afghan health-seeking behaviour. Importantly, Afghanistan and Australia have different primary health care strategies. In Afghanistan, health care is predominantly provided through a community-based outreach approach, namely through community health workers residing in the local community. In contrast, the Australian health care system requires client attendance at formal health service facilities. This difference contributes to service access and utilisation problems. Community engagement is essential to bridge the gap between the Afghan community and Australian primary health care services. This can be achieved through the health sector working to strengthen partnerships between Afghan individuals, communities and health services. Enhanced community engagement has the potential to improve the delivery of primary health care to the Afghan community in Australia. [ABSTRACT FROM AUTHOR]

Evaluation of programs and determining its challenges to improve and implement reforms is essential in a healthcare system. A primary healthcare program was conducted since 1984 in Iran and faces various challenges after several decades of its life. The aim of this study is to evaluate Iran's primary healthcare program and determine its challenges and weaknesses. In the present systematic review study, the published articles related to Iran's primary healthcare were searched and collected from Iranian databases (SID, Magiran, Noormags and Irandoc) and international databases (Pubmed, Scopus, Web of Knowledge and Google Scholar). The Iranian grey literature was also explored. In total, from 336 papers identified, 25 papers were deemed relevant after the step-by-step review of articles and removal of non-related articles. The results of this study show that primary healthcare in Iran has different challenges and weaknesses. Most of these challenges and weaknesses relate to the structure and process of primary healthcare. The Iranian primary healthcare system has achieved many successes in community health promotion, but today, because of social, economic, political and environmental changes, it does not meet the needs of the people; therefore, this system requires structural reforms. [ABSTRACT FROM AUTHOR]

People with a lived experience of mental illness are at a higher risk for developing oral diseases and having poorer oral health than the broader population. This paper explores the role of Australian community mental health services in supporting the prevention and management of poor oral health among people living with mental illness. Through focus groups and semi-structured interviews, participants identified the value of receiving oral health support within a community mental health setting, in particular the delivery of basic education, preventive strategies, assistance with making or attending appointments and obtaining priority access to oral health services. Engagement with Community Health Services and referrals generated through the priority access system were identified as key enablers to addressing oral health issues. This study provides new insight into the importance of undertaking an integrated approach to reducing the oral health disparities experienced by those living with mental illness. [ABSTRACT FROM AUTHOR]

Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas. [ABSTRACT FROM AUTHOR]

Children and adolescents in rural Australia experience poorer health and educational outcomes than those in urban areas. This paper presents findings from a qualitative study exploring the role of primary health care registered nurses (RNs) working in the School-Based Primary Health Care Service in Broken Hill, far west New South Wales. The Service integrates health district-employed RNs with school learning and support teams to increase service access and improve health and education outcomes for students. The findings show that RNs used care navigation to reduce barriers to care by addressing healthcare candidacy with students and families. The RNs also linked schools, families and health and social care services, and facilitated intersectoral collaboration to improve the support provided to students experiencing health and developmental issues. Integrating health district-employed RNs with existing student support services is a promising approach to improving the health and education of disadvantaged students. This study provides individual- and system-level explanations of the role of the school-based primary health care RN and can inform the development of similar services elsewhere. Rural children experience poorer health and educational outcomes than urban children. This study describes the role of health district-employed primary health care registered nurses working with school learning support teams in a rural community. The nurses linked schools, families and health and social care services to improve the support provided to students with health and developmental issues. Integrating primary health care nurses with existing student support services is a promising intersectoral approach to reduce inequities experienced by disadvantaged students. [ABSTRACT FROM AUTHOR]

Health and social service agencies need to be responsive to the healthcare requirements of culturally and linguistically diverse (CALD) groups in the community. This is a challenging proposition, particularly due to shifting demographics in developed Western countries such as Australia. Organisations that strive for cultural competence can potentially reduce the barriers associated with inequitable access to services by CALD groups. Community health services play a vital role in the provision of culturally competent health services to people from CALD groups. Additional research related to cultural competence in the community health context is needed. Thus, the aim of this paper is to explore the positioning of cultural competence within community health from multiple perspectives using a qualitative case study of a community health service located in Victoria, Australia. The findings suggest that if the essential needs of clients are met, regardless of cultural background (e.g. able to communicate with staff, trust and a respectful and caring environment), then issues related to cultural background may be of less significance for some clients. [ABSTRACT FROM AUTHOR]

Manufactured home villages (MHVs) are an increasingly popular housing option for older Australians. This paper reports a cross-sectional survey that sought to describe the health status and health service access of MHV residents. The survey tool comprised demographic and health status items, primary healthcare access perceptions and the World Health Organization Quality of Life tool (WHOQOL-BREF). One-hundred-eighty-six MHV residents from regional NSW completed the survey. Hypertension (54.8%) and arthritis (46.5%) were the most prevalent chronic diseases reported. Overall, respondents expressed a high level of satisfaction with the sense of safety and security (82.8%), neighbours (69.4%) and the overall location of the villages (66.7%). There was good to excellent internal consistency of all four WHOQOL-BREF domain scores, with a comparatively lower sample mean score for the 'Physical' and 'Psychological' domains. MHV residents are a significant cohort of older people with high rates of chronic disease and reasonably poor access to transport services, which affects their capacity to access health services. They also have comparatively low levels of quality of physical and psychological life along with low levels of satisfaction with their health. [ABSTRACT FROM AUTHOR]

Indigenous Australians are disproportionally affected by hepatitis B compared with non-Indigenous Australians. The higher prevalence of hepatitis B among Indigenous Australians has been linked to an increased incidence of liver cancer in this population. There is evidence that comprehensive programs of hepatitis B virus management, which include liver cancer surveillance and appropriate antiviral therapy, offer a cost-effective approach to reduce the incidence of liver cancer in Australia. This paper reports on data from the first study investigating understandings of hepatitis B and attitudes to treatment among Torres Strait Islanders living with chronic hepatitis B. Forty-two participants completed an interview questionnaire. Participants typically had an unclear understanding of hepatitisBand reported significant gaps in monitoring and follow up. A majority of participants indicated a willingness to use treatment if required. The findings of this study suggest the need for a new service delivery model that is appropriate to remote communities such as the Torres Strait Islands, to improve hepatitis B follow up, disease monitoring and management, and where appropriate, the uptake of treatment. [ABSTRACT FROM AUTHOR]

The article discusses papers published within the issue including one on health reforms, one on the process of organizational change in a non-government organization (NGO), and another on a local initiative aimed to improve health care access for disadvantaged culturally and linguistically diverse communities.

This paper discusses the current situation of Chinese village doctors and highlights the importance of increasing the number of village doctors for better health service and a stronger health system. This study reviewed relevant health policies and data from the Chinese Statistic Year Book 2016 to assess the current status of Chinese village doctors and clinics. The Chinese government has launched a set of healthcare reforms to strengthen primary health care (PHC), especially in rural areas. However, the recruitment and retention of village doctors has not been successful. The analysis of available data suggests that fewer doctors or graduated medical students want to work in village clinics and provide services for rural residents. It is widely recognised in China and other countries that a good PHC system protects the population's health at low cost. To achieve a better health system, the Chinese government should strengthen PHC, expanding the village clinics' coverage to improve access to PHC and basic public health, and introduce more sustainable policies to attract more PHC practitioners to Chinese villages.

The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P<0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation. [ABSTRACT FROM AUTHOR]

In this paper, program logic will be used to 'map out' the planning, development and evaluation of the general practice Pap nurse program in the Australian general practice arena. The incorporation of program logic into the evaluative process supports a greater appreciation of the theoretical assumptions and external influences that underpin general practice Pap nurse activity. The creation of a program logic model is a conscious strategy that results an explicit understanding of the challenges ahead, the resources available and time frames for outcomes. Program logic also enables a recognition that all players in the general practice arena need to be acknowledged by policy makers, bureaucrats and program designers when addressing through policy, issues relating to equity and accessibility of health initiatives. Logic modelling allows decision makers to consider the complexities of causal associations when developing health care proposals and programs. It enables the Pap nurse in general practice program to be represented diagrammatically by linking outcomes (short, medium and long term) with both the program activities and program assumptions. The research methodology used in the evaluation of the Pap nurse in general practice program includes a descriptive study design and the incorporation of program logic, with a retrospective analysis of Australian data from 2001 to 2009. For the purposes of gaining both empirical and contextual data for this paper, a data set analysis and literature review was performed. The application of program logic as an evaluative tool for analysis of the Pap PN incentive program facilitates a greater understanding of complex general practice activity triggers, and also allows this greater understanding to be incorporated into policy to facilitate Pap PN activity, increase general practice cervical smear and ultimately decrease burden of disease. [ABSTRACT FROM AUTHOR]

With the aging population, the tide of chronic disease is rising with attendant increases in health service need. Integrated care and patient-centred approaches, which established partnerships between a regional Hospital and health service (HHS), the local primary health network and local general practitioners (GPs), were identified as exemplars of an approach needed to support growing community health needs. This paper summarises the findings from a process evaluation of four GP–specialist care integration programs with the aim of identifying recommendations for embedding integrated GP–specialist care into routine practice within the HHS. The process evaluation of the integration programs drew on input from a multidisciplinary expert advisory group and data collected through face-to-face semi-structured interviews with key stakeholders, as well as surveys of participating GPs and patients. Overarching findings were identified and grouped under six themes: interdisciplinary teamwork; communication and information exchange; the use of shared care guidelines or pathways; training and education; access and accessibility; and funding. Within each theme, key challenges and enablers emerged. The findings of this study highlight benefits and challenges associated with the establishment of integrated care between primary and secondary care providers, leading to the development of key recommendations for routine integration. [ABSTRACT FROM AUTHOR]

Clinical commissioning was introduced in South Australia in 2012 to support implementation of the South Australian Health Care Plan and to achieve the desired transformation and efficiency gains required for a sustainable health system. This paper describes how the South Australian Commissioning Model was established and the process of developing the necessary culture, governance arrangements and performance management structures. Commissioning has played a key role in improving appropriateness and quality of clinical practice, resulting in reduced hospital inpatient growth and average length of stay. Despite early successes, there remain many challenges that need to be faced before value can be demonstrated consistently across the whole system. [ABSTRACT FROM AUTHOR]

Background: Primary care practitioners worldwide are urged to promote dementia risk reduction as part of preventive care. To facilitate this in Australian primary care, we developed the Umbrella intervention, comprising a waiting room survey and patient information cards for use in consultations. Educational and relational strategies were employed to mitigate implementation barriers. Methods: In this cross-sectional, non-randomised implementation study within the South East Melbourne Primary Health Network, we employed mixed-methods outcome evaluation. Antecedent outcomes (acceptability, appropriateness, and feasibility) and actual outcomes (adoption, penetration, and fidelity) were assessed from the perspective of primary care practitioners and patients. Results: Five practices piloted the intervention and implementation strategies, including 16 primary care practitioners engaging with 159 patients. The Umbrella intervention was deemed acceptable, appropriate, and feasible, but penetration was limited. Approximately half of eligible primary care practitioners used the intervention, with moderate fidelity. Engagement with implementation strategies was similarly limited. While most strategies were well-received, improvements in online peer discussions and staff readiness were desired. Conclusions: The Umbrella intervention is a viable approach to promoting dementia risk reduction in Australian general practice, supported by educational and relational strategies. Stakeholder-informed refinements to enhance uptake are recommended before advancing to a definitive trial. Primary care practitioners should be promoting dementia risk reduction as part of preventive care. Using a rigorous, theory-driven, evidence-based, stakeholder-informed approach, we developed an intervention for promoting dementia risk reduction that was acceptable, appropriate, feasible, and complemented by acceptable and appropriate implementation strategies. However, preventive interventions will not be taken up widely in general practice until they are prioritised above competing demands on resources. [ABSTRACT FROM AUTHOR]

Background: The factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children are unclear. This study's objective aimed to describe decision-makers' perspectives on factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children. Methods: We conducted semi-structured interviews with 13 participants experienced in making funding decisions at organisational, state, territory and national levels. Decision-makers were from New South Wales, Northern Territory, Queensland, Victoria and Western Australia. Transcripts were analysed thematically following the principles of grounded theory. Results: We identified five themes, each with subthemes. First, prioritising engagement for authentic partnerships (opportunities to build relationships and mutual understanding, co-design and co-evaluation for implementation). Second, valuing participant experiences to secure receptiveness (cultivating culturally safe environments to facilitate acceptability, empowering for self-determination and sustainability, strengthening connectedness and collaboration for holistic care, restoring confidence and generational trust through long-term commitments). Third, comprehensive approaches to promote health and wellbeing (linking impacts to developmental milestones, maintaining access to health care, broadening conceptualisations of child health). Fourth, threats to optimal service delivery (fractured and outdated technology systems amplify data access difficulties, failure to 'truly listen' fuelling redundant policy, rigid funding models undermining innovation). Fifth, navigating political and ideological hurdles to advance community priorities (negotiating politicians' willingness to support community-driven objectives, pressure to satisfy economic and policy considerations, countering entrenched hesitancy to community-controlled governance). Conclusion: Decision-makers viewed participation, engagement, trust, empowerment and community acceptance as important indicators of service performance. This study highlights factors that influence decisions to fund health services for Aboriginal and Torres Strait Islander children. Making decisions to fund health services requires evidence that decision-makers consider relevant. This study identifies and defines factors of health services for Aboriginal and Torres Strait Islander children that influence funding decisions from the perspectives of decision-makers. Knowing the factors that decision-makers find useful when making decisions to fund health services can inform the types of measures that health services include in reports used to support applications for funding. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify the potential roles for Community Health Navigators (CHNs) in addressing problems faced by patients on discharge from hospital to the community, and attitudes and factors which may influence their adoption. Methods: Twenty-six qualitative interviews and an online codesign workshop were conducted with patients, nurses, general practice staff, health service managers, community health workers, general practitioners, medical specialists, and pharmacists in the Sydney Local Health District. Qualitative themes from the interviews and workshop transcripts were analysed inductively and subsequently grouped according to a socio-ecological model. Results: CHNs could assist patients to navigate non-clinical problems experienced by patients on discharge through assessing needs, establishing trust, providing social and emotional support that is culturally and linguistically appropriate, engaging family and carers, supporting medication adherence, and helping to arrange and attend follow up health and other appointments. Important factors for the success of the CHNs in the performance and sustainability of their roles were the need to establish effective communication and trust with other healthcare team members, be accepted by patients, have access to information about referral and support services, receive formal recognition of their training and experience, and be supported by appropriate supervision. Conclusions: This study was unique in exploring the potential role of CHNs in addressing problems faced by patients on discharge from Australian hospitals and the factors influencing their adoption. It informed training and supervision needs and further research to evaluate CHNs' effectiveness and the acceptance of their role within the healthcare team. Community health workers have been demonstrated in overseas research to play a key role in supporting patients to prevent hospital readmission. This role is now emerging in Australia especially for vulnerable and disadvantaged groups. This study identifies the key potential roles in the Australian context and the training and supervision required. [ABSTRACT FROM AUTHOR]

Background: General practice training in outer metropolitan (OM) areas contributes to patients' access to care. Differences in clinical practice and training in rural versus urban areas have been established, but less is known about OM versus inner metropolitan (IM) differences – whether they offer a trainee learning experience of populations with distinct demographics and healthcare characteristics. This study sought to identify the characteristics and associations of general practice training in New South Wales and Australian Capital Territory OM areas, compared to IM and rural areas. Methods: Cross-sectional analyses of data (2016–2020) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours, were performed. Multinomial logistic regression assessed associations of rural/OM/IM practice location with registrar and practice factors, patient factors, consultation content factors and consultation action factors. Results: Overall, 1308 registrars provided data from 177,026 consultations. For several variables, there was a pattern in the differences of associations across rural/OM/IM areas. Experience of care of older patients and Aboriginal and/or Torres Strait Islander health were more likely in OM than IM areas. Care of patients from non-English speaking background was more likely in OM than in rural areas. Possible markers of healthcare access (specialist referrals, and pathology and imaging requests) were less likely in OM than in both IM and rural areas. Conclusions: OM areas are distinct (and educationally rich) clinical learning environments, with distinct demographic characteristics and seeming healthcare access limitations. This finding has implications for workforce support and health resource allocation. General practice in outer metropolitan regions is unique. In GP registrars' practice in these regions, fewer specialist, pathology and imaging referrals were generated, and care of older patients and Aboriginal and Torres Strait Islander patients was more likely than in inner metropolitan areas. Care of patients from non-English speaking backgrounds was more likely than in rural areas. A gradient (from inner metropolitan to outer metropolitan to rural regions) existed for many characteristics of registrars, practices, patients and clinical care. [ABSTRACT FROM AUTHOR]

Adult women in Australia are more likely than men to have no teeth, more missing teeth or have a dental hospital admission. Experiences of war, family and domestic violence, mental health or alcohol and other drug use problems may also negatively affect women's oral health. Yet, oral health is often excluded from primary healthcare. Little is known about what helps or inhibits primary healthcare service workers to promote oral health to women in need. Identifying the perceptions and experiences of such workers is a step towards a strategy to develop resources to support them in raising oral health issues with disadvantaged clients. This paper presents findings from a qualitative study conducted at a community-based women's health service, which used focus groups to investigate workers' perceptions of promoting oral health and accessing services for their clients. Findings indicated how structural issues informed oral healthcare, where workers generally did not consider oral health their responsibility, were reluctant to raise the issue with clients and had limited oral health knowledge and resources. To overcome these barriers, workers identified the need for oral health resources and better linkages to the dental system to help support their clients.

In this paper, whānau Māori highlight how a Kaupapa Māori-centred intervention (the Harti Hauora Tamariki tool, hereafter Harti tool) has improved interactions with health services. The Harti tool is undergoing a randomised control trial (RCT) at Waikato Hospital in New Zealand. As part of the RCT, the authors engaged in a series of qualitative interviews with whānau members of tamariki Māori (children aged 0–5 years) admitted to Waikato Hospital's paediatric ward. Whānau who met at least one criteria for New Zealand's domains of deprivation were included. Using a Kaupapa Māori approach to the study, participants shared their views on barriers and facilitators to accessing health resources and primary care services. The interviews conducted highlight how the Harti tool, when administered in a culturally appropriate and respectful manner that prioritised relationship-building, enabled better connection to healthcare services. Prevalent in our analysis were connections to wider determinants of health and ways to reduce existing health inequities. To conclude the paper, how the Harti tool has enhanced feelings of being in control of health, with the potential to reduce the likelihood of a hospital readmission, is highlighted. [ABSTRACT FROM AUTHOR]

A central strategy in addressing health disparities experienced by Indigenous people has been based on a concern with workforce improvement. In this paper, the Indigenous Australian healthcare workforce literature since 1977 is reviewed and its scope of concern, as being often limited to questions of 'supply', is critiqued. The pipeline metaphor, whether used explicitly or implied, regularly focuses attention on closing the gap on Indigenous representation within the health workforce. The exception though is the discourse concerning Indigenous Health Workers (IHWs), where questions concerning the legitimacy of the role continue to abound within a workforce hierarchy where community knowledge, though shown to be crucial to culturally safe health service provision, is trumped by the other health professions whose knowledges and legitimacy are not in question. This contrast exemplifies the need to examine the working of power not just 'supply'. The pipeline metaphor is disrupted with concerns about a range of other 'gaps' – gaps in the recognition of Indigenous knowledges, in organisational structures, in governance and in self-awareness by the health professions of their whiteness. As the health system continues to measure workforce development in terms of pipeline capacity, our study questions what happens beyond the pipeline. [ABSTRACT FROM AUTHOR]

Efforts to address Indigenous health disadvantage require a refocus on urban settings, where a rapidly increasing majority (79%) of Indigenous Australians live. Proximity to mainstream primary care has not translated into health equity, with the majority of the Indigenous burden of disease (73%) remaining in urban areas and urban Indigenous people continuing to face significant barriers in accessing comprehensive and culturally appropriate care. This paper presents a case study of how the Institute for Urban Indigenous Health (IUIH) has strategically responded to these challenges in South East Queensland – home to Australia's largest and equal fastest growing Indigenous population. The IUIH has developed a new regional and systematised model – a regional health 'ecosystem' – for how primary care is delivered and intersects with the broader health system. Through intentional action, which strengthens the self-efficacy of community, the IUIH System of Care has delivered real gains for the Indigenous population of the region and has the capacity to deliver similar improvements in health access and outcomes in other regions. [ABSTRACT FROM AUTHOR]

Critically reflecting on researcher–community partnerships is a key component in implementing chronic condition interventions in Indigenous communities. This paper draws on the results and learnings from a process evaluation that measures how well two research–community partnerships have followed the He Pikinga Waiora (HPW) Implementation Framework while co-designing chronic condition interventions in primary care. The HPW framework is centred on Indigenous self-determination and knowledge surrounded by community engagement, cultural centredness, systems thinking and integrated knowledge translation. The evaluation included in-depth interviews and online surveys with 10 team members. The findings demonstrate that the HPW framework was followed well, with strengths particularly in community engagement and relationship building. Areas for improvement included systems thinking and integrated knowledge translation to support sustainability of the interventions. The need for partnerships to use process evaluation results to support critical reflection is asserted, which helps build strong trust and synergy, power sharing and effective and sustainable implementation practices. It is concluded that the HPW framework is well suited to evaluating implementation of health interventions in primary care as it assists in the facilitation of better collaboration between researchers and Indigenous communities, and encourages the implementation team to reflect on power and privilege. [ABSTRACT FROM AUTHOR]

The oral health of older people living in residential aged care facilities has been widely recognised as inadequate. The aim of this paper is to identify barriers to effective engagement of health-care providers in oral care in residential aged care facilities. A literature review was conducted using MEDline, CINAHL, Web of Science, Academic Search Complete and PsychInfo between 2000 and 2013, with a grey literature search of government and non-government organisation policy papers, conference proceedings and theses. Keywords included: dental/oral care, residential aged care, health-care providers, barriers, constraints, and limitations. A thematic framework was used to synthesise the literature according to a series of oral health-care provision barriers, health-care provider barriers, and cross-sector collaborative barriers. A range of system, service and practitioner level barriers were identified that could impede effective communication/collaboration between different health-care providers, residents and carers regarding oral care, and these were further impeded by internal barriers at each level. Findings indicated several areas for investigation and consideration regarding policy and practice improvements. While further research is required, some key areas should be addressed if oral health care in residential aged care services is to be improved. [ABSTRACT FROM AUTHOR]