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Background The majority of allied health services are delivered by small, private practices in the primary care setting with limited government funding. During the coronavirus disease 2019 (COVID-19) lockdowns these practices were subject to the same health orders as any other private business with only 'essential services' permitted to remain open. Research aim We set out to understand the impact of the COVID-19 pandemic, and associated public health measures, on the financial viability of private allied health practices. Methods Thirteen semi-structured interviews were conducted with primary care allied health practice owners and managers in Sydney. Data were analysed thematically. Findings All of the interviewees reported experiencing the stress of balancing precarious finances caused by reduced and/or fluctuating patient demand. Patients' reluctance to seek care was compounded by ambiguity around whether allied health services were 'essential'. Manual therapies were particularly vulnerable to financial stress because their capacity to transition to telehealth and access to government funding were limited. Conversely, psychologists reported demand for their services exceeded what they could provide. Study implications The findings are indicative of primary care allied health's peripheral status in Australia's primary care landscape. Greater priority to the funding and integration of primary care allied health is needed in primary care policy.

Objective To explain how the Primary Health Network commissioning model works, and factors likely to affect its success. Methods The study focuses on the delivery of primary healthcare services by one Primary Health Network (PHN) in Australia. The qualitative case study is informed by a desk top review, interviews (n = 49) and observations with key stakeholders involved in commissioning and delivering primary healthcare services in the region. Results The study provides several insights about the PHN model. First, conceptually, the PHN commissioning model is well suited to identifying and meeting local primary healthcare priorities, bringing together a range of stakeholders involved in healthcare provision. Second, although primary healthcare services are difficult to specify and measure, PHN staff use their content knowledge and experience, and relationships with providers and the community, to design services that meet the needs of consumers. Third, the success of this model may be undermined by short funding cycles and short lead-times, a focus on national rather than local priorities, and continual reductions in operational funding. This may result in more procedural forms of contract management, which may mean that changes in service need, provision and quality go unnoticed. Conclusions This study shows that although clever in design, the PHN model may not meet its full potential. Given continual changes to the model, including funding, further independent research should be undertaken to understand how PHNs adjust and whether services continue to meet the needs of the local community.

Objective The aim of this research was to explore the experiences of general practice in delivering Australia's coronavirus disease 2019 (COVID-19) vaccine, and the impact on practice finances and workforce. Methods Eighteen semi-structured interviews with owners and practice managers of general practices in Greater Sydney between June and August 2021 were conducted. Results Practices reported early enthusiasm for the vaccine rollout and engaged in large-scale staffing and infrastructure adaptations to manage increased vaccination workload. Although some practices reported increased income related to vaccination, nearly all reported increased costs. Lack of timely and transparent communication between primary care and policymakers was a major concern for practices. Conclusions The success of Australia's COVID-19 vaccine rollout relied on the goodwill of general practices. Participation in the COVID-19 vaccine rollout resulted in increased stress, increased administration workload, and reduced financial viability for many practices.

Objective Medication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian patients with chronic conditions. Methods Data from 267086 participants in the Sax Institute's 45 and Up Study linked to data from the Pharmaceutical Benefits Scheme (PBS) provided by the Department of Human Services were used. Patients using angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, glitazones and bisphosphonates were identified and classified according to concessional status and whether they had access to the PBS 'safety net'. Data were analysed using mainly descriptive methods to investigate the association of adherence with cost and other selected covariates. Results Across medications, the group facing the highest copayment was least adherent. Speaking a language other than English at home and facing high levels of psychological distress were also associated with lower levels of adherence. Conclusions As for statins, the main financial determinant of adherence is cost in the form of prescribed copayments, suggesting that this may apply across many medications. What is known about the topic? Previous studies have shown patients' concern about the costs of pharmaceuticals, and more detailed studies of statins show that the lowest adherence relates to patients facing the highest copayments. What does this paper add? This paper provides support for the contention that the results found for statins broadly apply across more medications used by people with chronic conditions. What are the implications for practitioners? Although practitioners cannot affect legislated copayments, they can consider the costs of options for medications for patients with chronic conditions, especially those gener

Many Caladenia species have been reduced to extremely small and/or fragmented populations, and reintroduction/translocation into natural or rehabilitated habitats, by using ex situ propagated plants or via direct seeding, represents an important adjunct in conservation planning. However, Caladenia species are some of the most difficult terrestrial orchid taxa to propagate, in part because of the specificity of the mycorrhizal associations and the need to provide growing conditions that suit both the mycorrhizal fungi and Caladenia plants. The present paper reviews recent advances in Caladenia propagation and reintroduction methods, including in vitro seed germination, transferral from in vitro to nursery environments, ex vitro symbiotic germination (germination in inoculated nursery media), nursery cultivation, the use of nurse plants and reintroduction of Caladenia into natural habitats by using seed, dormant tubers or growing plants. Techniques discussed in the present paper increase the options for future Caladenia conservation programs, especially for those species currently on the brink of extinction. © CSIRO 2009.