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Background: Health system reform is directed towards better management of diabetes. However, change can be difficult, and patients’ perspectives are a key aspect of implementing change. Objective: This study investigated patients’ perceptions and experiences of type 2 diabetes (T2DM), self‐care and engagement with GP‐led integrated diabetes care. Design: Qualitative interviews were conducted with purposively selected patients with T2DM following their initial medical appointment in the new model of care. Normalization process theory was used to orientate the thematic analysis, to explain the work of implementing change. Setting: Two specialist GP‐based complex diabetes services in primary care in Brisbane, Australia. Participants: Intervention group patients (n = 30) in a randomized controlled trial to evaluate a model of GP‐led integrated care for complex T2DM. Main outcome measures: Participants’ experiences and perceptions of diabetes management and a GP‐led model of care. Results: Three themes were identified: sensibility of change, ‘diabetic life’ and diabetes care alliance. The imperative of change made sense, but some participants experienced dissonance between this rational view and their lived reality. Diabetes invaded life, revealing incongruities between participants’ values and living with diabetes. They appreciated a flexible and personalized approach to care. Discussion: Participants responded to advice in ways that seemed rational within the complexities of their life context. Their diabetes partnerships with health professionals coupled providers’ biomedical expertise with patients’ contextual expertise. Conclusions: Learning to manage relationships with various health professionals adds to patients’ diabetes‐related work. Providers need to adopt a flexible, interactive approach and foster trust, to enable better diabetes care. [ABSTRACT FROM AUTHOR]

The article presents a pilot study which investigates the content validity and usability of the Primary Care Practice Improvement Tool (PC-PIT). The study used mixed-methods research design and formative assessment framework during the analysis of the tool's performance. The study found that PC-PIT offers innovative solution to resolve organisational improvement complexities in primary health care and general practice.

The article focuses on the systematic review of articles regarding the major challenges in implementing the patient-centred medical home (PCMH) in Australian primary care reforms. Among the common barriers in the adoption of PCMH include the lack of resources and infrastructure, appropriate payment systems, and inadequate measures on work performance. Also mentioned is the difficulties in using an electronic health record, patient management, and transformation process.

The article discusses the study which determines consideration on high-quality practice performance in primary care and identifies component which were integral to high-quality practice. The study conducts a narrative systematic review of grey and published articles from 2002-2013 using electronic databases such as PubMed and Cochrane Library. The study found that only 31 articles out of 241 were included for data extraction that involves 10 organizational assessment methods or tools.

Background: The diagnosis of primary ciliary dyskinesia (PCD) requires the analysis of ciliary function and ultrastructure. Diagnosis can be complicated by secondary effects on cilia such as damage during sampling, local inflammation or recent infection. To differentiate primary from secondary abnormalities, re-analysis of cilia following culture and re-differentiation of epithelial cells at an air-liquid interface (ALI) aids the diagnosis of PCD. However changes in ciliary beat pattern of cilia following epithelial cell culture has previously been described, which has brought the robustness of this method into question. This is the first systematic study to evaluate ALI culture as an aid to diagnosis of PCD in the light of these concerns. Methods: We retrospectively studied changes associated with ALI-culture in 158 subjects referred for diagnostic testing at two PCD centres. Ciliated nasal epithelium (PCD n = 54; non-PCD n = 111) was analysed by high-speed digital video microscopy and transmission electron microscopy before and after culture. Results: Ciliary function was abnormal before and after culture in all subjects with PCD; 21 PCD subjects had a combination of static and uncoordinated twitching cilia, which became completely static following culture, a further 9 demonstrated a decreased ciliary beat frequency after culture. In subjects without PCD, secondary ciliary dyskinesia was reduced. Conclusions: The change to ciliary phenotype in PCD samples following cell culture does not affect the diagnosis, and in certain cases can assist the ability to identify PCD cilia. [ABSTRACT FROM AUTHOR]

Background A new model of complex diabetes care is provided by a multidisciplinary team which incorporates general practitioner (GP) Clinical Fellows supported by an Endocrinologist and diabetes educator within a community-based general practice setting. This study evaluates the health and clinical benefits of the new model of care, assesses the acceptability of the model to patients, GPs and other health professionals, and examines the cost-effectiveness of the model. Methods and design The study is an open, non-inferiority randomised controlled trial with data collected at baseline, 6 and 12 months. Participants are identified from new patients on hospital-based diabetes outpatient clinic waiting lists and new GP referrals. Eligible consenting patients are randomised to either a community practice site (intervention) or a hospital site (usual care). In the intervention model, medical care is led by a GP Clinical Fellow in partnership with an Endocrinologist. Quantitative measures include clinical indicators with HbA1c as the primary outcome; patient-reported outcomes include health-related quality of life, mental health and satisfaction with care. Qualitative methods will be used to explore the perspectives and experiences of patients and providers regarding the new model of care. An economic evaluation will also be undertaken. Discussion This model of care seeks to improve the quality and safety of healthcare at the interface between the hospital and primary care sectors for patients with complex diabetes. The study will provide empirical evidence about the impact of the model of care on health outcomes, patient and clinician satisfaction, as well as any economic impacts. Trial registration Clinical Trials Registry Number: ACTRN12612000380897 [ABSTRACT FROM AUTHOR]

The article discusses the General Practice (GP) Super Clinics Program of the Australian government that uses an independent and competitive process of offering an integrated multidisciplinary patient-centered health care. It describes the program as a controversial initiative that has garnered varying degrees of support from consumers and health care communities. It presents the GP Super Clinic initiative launched by the University of Queensland and discusses how it proposes to improve the primary care capacity of regionally-located GP super clinics.

Lumos: a state wide linkage programme in Australia integrating general practice data to guide system design. Reforming our health care system: time to rip off the band-aid? Keywords: Health systems; Benchmarking; Health policy EN Health systems Benchmarking Health policy 301 301 1 10/05/21 20211001 NES 211001 The health reform imperative is clear; it now requires national courage and leadership to implement it While Australia has traditionally delivered some of the best health care outcomes in the world,1 there are increasing signs that our strained health care system is pushing the stress performance curve into the red. [Extracted from the article]

The article focuses on a systematic review of articles regarding the effectiveness and sustainability of integrated health governance model in primary and secondary health care. Topics discussed include the information and communication technologies, professional development, and consumer and patient participation.

An introduction is presented in which the editor discusses various reports within the issue on topics including implementation research, its positive impact on practitioner participation, policy intelligence, and product use, its importance in primary care, and health care reform.

The article offers a look at issues related to General Practice Education and Training (GPET) in Australia as of June 2011. GPET was established by the Australian government in 2001 to develop the Australian General Practice Training (AGPT) program. The health system reform undergone by the country promised to improve the delivery of primary medical care.

The article focuses on the significance of the value co-creation approach in the primary health care reform in Australia. Topics discussed include an overview of the value co-creation method, the primary care reform in the country, the application of the approach's strategies and its success, and its importance in the country's primary care.

Objective: To nationally trial the Primary Care Practice Improvement Tool (PC-PIT), an organisational performance improvement tool previously co-created with Australian primary care practices to increase their focus on relevant quality improvement (QI) activities.Design: The study was conducted from March to December 2015 with volunteer general practices from a range of Australian primary care settings. We used a mixed-methods approach in two parts. Part 1 involved staff in Australian primary care practices assessing how they perceived their practice met (or did not meet) each of the 13 PC-PIT elements of high-performing practices, using a 1-5 Likert scale. In Part 2, two external raters conducted an independent practice visit to independently and objectively assess the subjective practice assessment from Part 1 against objective indicators for the 13 elements, using the same 1-5 Likert scale. Concordance between the raters was determined by comparing their ratings. In-depth interviews conducted during the independent practice visits explored practice managers' experiences and perceived support and resource needs to undertake organisational improvement in practice.Results: Data were available for 34 general practices participating in Part 1. For Part 2, independent practice visits and the inter-rater comparison were conducted for a purposeful sample of 19 of the 34 practices. Overall concordance between the two raters for each of the assessed elements was excellent. Three practice types across a continuum of higher- to lower-scoring practices were identified, with each using the PC-PIT in a unique way. During the in-depth interviews, practice managers identified benefits of having additional QI tools that relate to the PC-PIT elements.Conclusions: The PC-PIT is an organisational performance tool that is acceptable, valid and relevant to our range of partners and the end users (general practices). Work is continuing with our partners and end users to embed the PC-PIT in existing organisational improvement programs. [ABSTRACT FROM AUTHOR]

Value co-creation redresses a key criticism of researcher-driven approaches to research - that researchers may lack insight into the end users' needs and values across the research journey. Value co-creation creates, in a step-wise way, value with, and for, multiple stakeholders through regular, ongoing interactions leading to innovation, increased productivity and co-created outcomes of value to all parties - thus creating a "win more-win more" environment. The Centre of Research Excellence (CRE) in Building Primary Care Quality, Performance and Sustainability has co-created outcomes of value that have included robust and enduring partnerships, research findings that have value to end users (such as the Primary Care Practice Improvement Tool and the best-practice governance framework), an International Implementation Research Network in Primary Care and the International Primary Health Reform Conference. Key lessons learned in applying the strategies of value co-creation have included the recognition that partnership development requires an investment of time and effort to ensure meaningful interactions and enriched end user experiences, that research management systems including governance, leadership and communication also need to be "co-creative", and that openness and understanding is needed to work across different sectors and cultures with flexibility, fairness and transparency being essential to the value co-creation process. [ABSTRACT FROM AUTHOR]

The article focuses on the value co-creation approach, a methodology that aims to enhance primary health care reform in Australia. Topics discussed include an overview of the value co-creation method, the significance of the approach for the closer integration between health care business and researchers, and its demonstration within different industries.

Abstract: Diabetic retinopathy is the leading cause of preventable blindness in Australians younger than 60years, mainly from the development of diabetic macular oedema and the sequelae of advanced proliferative diabetic retinopathy. However, early detection and subsequent treatment of diabetic retinopathy, as recommended in Australian national guidelines, can prevent nearly all cases of severe vision loss and blindness, but few people achieve this goal. This paper describes the design and methods of an open controlled trial that aims to assess the feasibility, acceptability, and relative costs and benefits of identification and management of early stages of diabetic retinopathy in primary care, with tele-ophthalmic support and education. A mix of urban, regional and rural general practices across Queensland, Australia are participating in this study, with control practices matched to intervention practices by geographic location, size, patient profile, and shared hospital referral pathways. Outcome measures include the quality of the retinal photographs, the general practitioners'' diagnostic accuracy, the acceptability of this intervention to patients, general practice staff and ophthalmologists, screening rates, appropriate monitoring of early stage disease, and the cost-effectiveness of this model, compared to usual care. If proven to be effective, this model of diabetic retinopathy screening and early disease stage monitoring has the potential to improve access to appropriate care. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN 00336192). [Copyright &y& Elsevier]