Search

Background Multimorbidity is prevalent in general practice and general practitioners internationally report challenges in its management. Understanding the perspectives of general practitioners at the frontline of care is important for system sustainability and accessibility as populations age. Objective To explore Australian general practitioner perspectives on managing multimorbidity, the factors supporting their work, and those impeding their ability to meet their own standards of care provision. Method A qualitative study conducted with Australian general practitioners using semistructured, in-depth interviews and inductive thematic data analysis. Results Twelve interviews with general practitioners were conducted. Three main themes were constructed from the data: Multimorbidity as an encounter with complexity and contingency; Evidence constraints in multimorbidity care; and Concerns for patient safety. System structure and the Australian general practice model restrict general practitioners' ability to provide care to their level of satisfaction by linking short consultation times to practice remuneration. Attitudes toward the applicability of guideline evidence were mixed despite most general practitioners questioning its generalizability. Patient safety concerns pervaded most interviews and largely centered on system fragmentation and insufficient intersectoral communication. General practitioners rely on multiple sources of information to provide patient-centered care but chiefly the accumulated knowledge of their patients. Conclusions Australian general practitioners share many multimorbidity concerns with international colleagues. While multimorbidity-specific evidence may be unrealistic to expect in the immediate term, system investment and adaptation is needed to support general practice sustainability and clinician ability to provide adequate multimorbidity care, suitably remunerated, into the future. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences with health care systems that treat each of their health conditions separately, resulting in fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address this epidemiologic transition. This systematic review seeks to understand if and how multimorbidity impacts on the work of GPs, the strategies they employ to manage challenges, and what they believe still needs addressing to ensure quality patient care. Methods: Systematic review and thematic synthesis of qualitative studies reporting GP experiences of managing patients with multimorbidity. The search included nine major databases, grey literature sources, Google and Google Scholar, a hand search of Journal of Comorbidity, and the reference lists of included studies. Results: Thirty-three studies from fourteen countries were included. Three major challenges were identified: practising without supportive evidence; working within a fragmented health care system whose policies and structures remain organised around single condition care and specialisation; and the clinical uncertainty associated with multimorbidity complexity and general practitioner perceptions of decisional risk. GPs revealed three approaches to mitigating these challenges: prioritising patient-centredness and relational continuity; relying on knowledge of patient preferences and unique circumstances to individualise care; and structuring the consultation to create a sense of time and minimise patient risk. Conclusions: GPs described an ongoing tension between applying single condition guidelines to patients with multimorbidity as security against uncertainty or penalty, and potentially causing patients harm. Above all, they chose to prioritise their long-term relationships for the numerous gains this brought such as mutual trust, deeper insight into a patient's unique circumstances, and useable knowledge of each individual's capacity for the work of illness and goals for life. GPs described a need for better multimorbidity management guidance. Perhaps more than this, they require policies and models of practice that provide remunerated time and space for nurturing trustful therapeutic partnerships. [ABSTRACT FROM AUTHOR]

Background: Integrated care is an increasingly important principle for organising healthcare. Integrated care models show promise in reducing resource wastage and service fragmentation whilst improving the accessibility, patient-centredness and quality of care for patients. Those needing reliable access to the growing research evidence base for integrated care can be frustrated by search challenges reflective of the topic's complexity. The aim of this study is to report the empirical development and validation of two search filters for rapid and effective retrieval of integrated care evidence in PubMed. One filter is optimised for recall and the other for precision.Methods: An Expert Advisory Group comprising international integrated care experts guided the study. A gold standard test set of citations was formed from screening Handbook Integrated Care chapter references for relevance. This set was divided into a Term Identification Set (20%) for determining candidate terms using frequency analysis; a Filter Development Set (40%) for testing performance of term combinations; and a Filter Validation Set (40%) reserved for confirming final filter performance. In developing the high recall filter, recall was steadily increased while maintaining precision at ≥50%. Similarly, the high precision filter sought to maximise precision while keeping recall ≥50%. For each term combination tested, an approximation of precision was obtained by reviewing the first 100 citations retrieved in Medline for relevance.Results: The gold standard set comprised 534 citations. The search filter optimised for recall ('Broad Integrated Care Search') achieved 86.0-88.3% recall with corresponding low precision (47-53%). The search filter optimised for precise searching ('Narrow Integrated Care Search') demonstrated precision of 73-95% with recall reduced to between 55.9 and 59.8%. These filters are now available as one-click URL hyperlinks in the website of International Foundation for Integrated Care.Conclusions: The Broad and Narrow Integrated Care Search filters provide potential users, such as policy makers and researchers, seamless, reliable and ongoing access to integrated care evidence for decision making. These filters were developed according to a rigorous and transparent methodology designed to circumvent the challenges of information retrieval posed by this complex, multifaceted topic. [ABSTRACT FROM AUTHOR]

Background: While the need for digital health capability and technological innovation in palliative care services is growing rapidly, relatively little is known about the current uptake and views of individual palliative care practitioners. This study aims to explore palliative care practitioners' current use of and perspectives on digital health innovation in palliative care. Methods: A descriptive cross-sectional survey with a web-based questionnaire was used. Participants were multidisciplinary palliative care practitioners in Australia. Results: Surveys were returned by 170 medical, nursing, and allied health practitioners working in palliative care. Most respondents reported using a variety of digital health technology associated with clinical information systems, mobile devices, SMS text messaging, teleconferencing, and Wi-Fi. These technologies were used for the purpose of communicating with other health professionals, accessing web-based or mobile health palliative care resources, collecting or managing patient data, and providing information or education. However, few reported electronic access to patients' advance care planning documentation or could update these data. Respondents were moderately confident in their ability to use digital health, held positive beliefs that palliative care could be enhanced through digital health, and were generally supportive of ongoing innovation through digitally-enable models of care. Palliative care providers would most like to see digital health innovations in the areas of client health records, telehealth, and personal health tracking. Conclusion: This is the first national study of digital health in Australian palliative care providers. It contributes new knowledge in this important area of palliative care practice to guide policy and education, whilst informing future directions for research. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care IC is a multifaceted concept, with a vast range of overlapping terminologies. Bibliometric analyses have demonstrated the evidence base for IC is diffuse. Peer-reviewed research is published in a range of journals which are indexed in bibliographic databases with subject coverage extending beyond health. A significant amount of relevant IC literature is found outside conventional publishing channels in the grey literature. Thus, practitioners and researchers face significant challenges to finding relevant IC literature. To address the issues associated with retrieving integrated care literature, an IC search filter, badged as Integrated Care Search ICS, was developed. A search filter is an evidence-based search strategy with a known level of retrieval effectiveness. Various "value adding" products were also developed to enhance the effectiveness and usability of the search filter. Methods: Following a well-established experimental methodology [1], and informed by bibliometric analyses and consultation with an established Expert Advisory Group EAG, ICS was developed and validated for use in PubMed. Additionally, a research librarian translated the validated search filter for use in other databases, and developed a guide for searching the grey literature for content relevant to IC. Finally, input from the EAG was solicited via survey to guide the development of relevant topic searches to be combined with the search filter to further refine results. Results: Given the challenges associated with IC literature retrieval, two versions of the validated search filter were developed. ICS Narrow enables more precise searching, whereas ICS Broad enables more sensitive searching. Supplementary topic searches covering care settings, populations, geographic regions and facets of IC are provided, to enable more focused searching by end-users. Both search filters were translated for use in other databases including: Medline Ovid, Embase Ovid, PsycINFO Ovid, CINAHL EBSCOhost, Cochrane Library Wiley, Scopus, Web of Science, and ProQuest. Finally, step-by-step instructions for searching for relevant IC grey literature were developed. These products are available on an interim site https://www.caresearch.com.au/caresearch/tabid/4757/Default.aspx, and it is planned that they will be moved to the IFIC website in time for launch at ICIC18. Discussion: ICS and its associated value-adding products provide end users with the ability to locate difficult-to-retrieve published and unpublished IC literature. Conclusions: A flexible approach to database searching using a combination of keyword and subject headings is required for optimal retrieval of the published IC literature across a range of databases. Lessons learned: The polymophous nature of IC necessitated the development of not one but two validated search filters, and an additional suite of products, including guidance for IC grey literature retrieval. Limitations: The envisioned functionality of the search filters has not been fully achieved, as they are currently hosted on an interim site. Suggestions for future research: Further research studies could include an evaluation of the impact of Integrated Care Search on end-user satisfaction with retrievals and search confidence. [ABSTRACT FROM AUTHOR]

Introduction: Evidence from quality research is vital for demonstrating the effectiveness of integrated care in reducing health care fragmentation. Locating that evidence should be a crucial precursor to its use in informed policy making and organisational reform. Finding integrated care research may, however, present challenges due to a multiplicity of definitions and frameworks, and relevance across a range of sectors, organisations, and professional groups. Understanding difficulties in finding integrated care evidence could aid in the development of practical measures to make it more visible. This might include customised repositories, search tools, or strategies for improving dissemination. Bibliometric analysis is one method for examining published literature relevant to a field of research or practice. It is particularly useful for mapping complex, fluid and diffuse fields such as integrated care. This study builds on and extends a previous bibliometric analysis by Sun[1] by investigating: the growth of the integrated care literature; the core journals in which it is published; the combination of bibliographic databases required to find the majority of the literature; and the value of the PubMed standardized term Medical Subject Heading for retrieving it. Methods: The broad term 'Integrated care' was searched across the title, abstract, and subject heading fields within PubMed, CINAHL, EMBASE Ovid, PsycINFO Ovid, EconLit Ovid and Cochrane Central Register of Controlled Trials. The citations retrieved were analysed for frequency by year and country of publication, author, journal name, natural language terms, and subject headings. In addition, the performance of the Medical Subject Heading MeSH term 'Delivery of Health Care, Integrated' was tested by asking an advisory group of integrated care experts n=8 to each screen a set of 100 citations retrieved by this heading and indicating relevance of each. Results: A wide range of terms and journal titles contribute to the integrated care body of evidence and multiple databases provide access to a significant number of unique citations beyond PubMed. Furthermore, Interrater agreement was low on the relevance of citations retrieved by PubMed's main integrated care MeSH term. Discussion: This study confirms the diffuse nature of the integrated care research literature and highlights factors that may make it inherently difficult to find via search mechanisms. This includes a lack of consensus between experts as to the relevance of literature retrieved by its main indexing term in PubMed. Conclusions: Our findings suggest a need for search solutions to enhance the identification and, by extension, utilisation, of the integrated care literature. Limitations: The use of the single broad term 'integrated care' to find citations across databases was a pragmatic approach to finding a core set of literature for analysis. We acknowledge that integrated care is described by a variety of terms and this approach would not find a substantial subset of relevant citations. Suggestions for future research: Following this study, an integrated care search filter was developed for finding the literature in PubMed. Other practical tools for finding integrated care literature are advocated. [ABSTRACT FROM AUTHOR]

Introduction: This workshop is an interactive demonstration of a validated search filter which has been developed to assist clinicians and managers in locating published research on integrated care. The presenters will give a brief overview of the project and the methodology used. They will demonstrate the beta version of the search filter and invite comment and feedback from the audience. Attendees are encouraged to share their experiences in locating the peer-reviewed literature on IC, including specific questions on aspects of IC for which evidence is sought. Integrated care (IC) is a prime driver of healthcare policy and practice reform internationally as governments and healthcare organisations endeavour to enhance efficiencies and patientcentred care. It is, however, a multifaceted concept, with a vast range of overlapping terminologies, and arguably lacks a unifying definition [1]. Search filters represent one innovative solution to this problem, by enabling brokered access to the underlying evidence base for rapid utilisation. Methods: The International Foundation for Integrated Care (IFIC), Central Coast Local Health District (NSW), The University of Newcastle (NSW), and Flinders Filters, Flinders University (SA)[2] collaborated to create an IC search filter (or "search strategy") with known retrieval effectiveness in the PubMed Database, using a well-established experimental methodology[3]. Results: An IC search filter with a known level of sensitivity has been developed and validated for PubMed. This filter will be combined with a range of topics of interest to the IC community for more focused retrieval. These topics will include patient-centred care; health and social care integration; and chronic disease management. The search filter, badged as Integrated Care Search, will be made available on the IFIC website at https://integratedcarefoundation.org/. Discussions: IC is a polymorphous topic with contextually different meanings. Despite inherent complexities, under the guidance of international experts, it was possible to develop and validate a search filter which is capable of retrieving PubMed indexed IC literature at multiple levels of granularity through simple, one-click links. In tegrated Care Search will improve the ease, speed, and accuracy by which IC evidence is found. End-users can rely on the fact that it comprises a range of core IC concept terms, comprehensively identified and tested in a set of literature deemed of importance by IC experts. [ABSTRACT FROM AUTHOR]

Background: Obesity and musculoskeletal pain are strongly related, but there is emerging evidence that body fat, not body weight, may be a better indicator of risk. There is, therefore, a need to determine if body fat is associated with musculoskeletal pain as it may improve management strategies. The aim of this systematic review was to investigate the association between body fat and musculoskeletal pain.Methods: Seven electronic databases were searched from inception to 8th January 2018. Cross-sectional and longitudinal studies investigating the association between measures of body fat and musculoskeletal pain were included. All included articles were assessed for methodological rigour using the Epidemiology Appraisal Instrument. Standardised mean differences (SMDs) and effect estimates were pooled for meta-analysis.Results: A total of 10,221 citations were identified through the database searching, which after abstract and full-text review, yielded 28 unique articles. Fourteen studies were included in the meta-analyses, which found significant cross-sectional associations between total body fat mass and widespread pain (SMD 0.49, 95% CI 0.37-0.61, p < 0.001). Individuals with low-back pain and knee pain had a higher body fat percentage than asymptomatic controls (SMD 0.34, 95% CI 0.17-0.52, p < 0.001 and SMD 0.18, 95% CI 0.05-0.32, p = 0.009, respectively). Fat mass index was significantly, albeit weakly, associated with foot pain (SMD 0.05, 95% CI 0.03-0.06, p < 0.001). Longitudinal studies (n = 8) were unsuitable for meta-analysis, but were largely indicative of elevated body fat increasing the risk of incident and worsening joint pain. There was conflicting evidence for an association between body fat percentage and incident low-back pain (3 studies, follow-up 4-20 years). Increasing knee pain (1 study) and incident foot pain (2 studies) were positively associated with body fat percentage and fat mass index. The percentage of items in the EAI graded as 'yes' for each study ranged from 23 to 85%, indicating variable methodological quality of the included studies.Conclusions: This systematic review and meta-analysis identified positive cross-sectional associations between increased body fat and widespread and single-site joint pain in the low-back, knee and foot. Longitudinal studies suggest elevated body fat may infer increased risk of incident and worsening joint pain, although further high-quality studies are required. [ABSTRACT FROM AUTHOR]