Search

The article examines a cross sectional study on the management of cardiovascular disease (CVD) risk in people with comorbid mental illness. Topics discussed include the association between psychological distress and CVD, group with high prevalence of CVD risk factors and CVD-related premature death, and limitations of the study.

Background: Relational continuity, 'a therapeutic relationship between a patient and provider/s that spans health care events', has been associated with improved patient outcomes.Objectives: To evaluate whether an intervention incorporating patient enrolment and a funding model for higher-risk patients influenced patient-reported experience measures, particularly relational continuity.Methods: Cluster-randomized controlled trial over 12 months (1 August 2018-31 July 2019). Participating patients within intervention practices were offered enrolment with a preferred general practitioner, a minimum of 3 longer appointments, and review within 7 days of hospital admission or emergency department attendance. Intervention practices received incentives for longer consultations (dependent on reducing unnecessary prescriptions and tests), early post-hospital follow-up, and hospitalization reductions. The primary outcome was patient-reported relational continuity, measured by the Primary Care Assessment Tool Short Form.Results: A total of 774 patients, aged 18-65 years with a chronic illness or aged over 65 years, from 34 general practices in metropolitan, regional, and rural Australia across 3 states participated. Response rates for questionnaires were >90%. From a maximum of 4.0, mean baseline scores for relational continuity were 3.38 (SE 0.05) and 3.42 (SE 0.05) in control and intervention arms, respectively, with no significant between-group differences in changes pre-post trial. There were no significant changes in other patient-focussed measures.Conclusion: Patient-reported relational continuity was high at baseline and not influenced by the intervention, signalling the need for caution with policies incorporating patient enrolment and financial incentives. Further research is required targeting at-risk patient groups with low baseline engagement with primary care. [ABSTRACT FROM AUTHOR]

Objective: In 2002, New South Wales (NSW) Health introduced an updated policy for occupational screening and vaccination against infectious diseases. This study describes healthcare worker (HCW) immunity to hepatitis B, measles, mumps, rubella (MMR) and varicella based on serological screening, following introduction of this policy. Methods: HCW screening serology performed at two healthcare facilities in south western Sydney (Bankstown and Fairfield) was extracted for the period September 2003 to September 2005. Immunity to hepatitis B, MMR and varicella was quantitated and cross-tabulated against age, sex and staff risk category. Results: A total of 1,320 HCWs were screened. Almost two thirds were immune to hepatitis B while immunity to MMR and varicella ranged from 88% to 94%. Age stratification showed lower levels of measles immunity in those born after 1965. Conclusions: Despite availability of vaccination for over two decades, a significant proportion of HCWs at these two facilities were non-immune to hepatitis B. This is of concern for those non-immune staff involved in direct clinical care, who are at risk of blood and body fluid exposures. The small group of HCWs non-immune to MMR and varicelia pose a risk to themselves and others in the event of an outbreak. Implications: There is a need for improved implementation of the occupational screening and vaccination policy, including better education of HCWs about the risks of non-immunity to vaccine preventable diseases. The revised 2007 NSW Health policy may assist this process and will need evaluation to determine whether HCW immunity improves in the coming years. Keywords: Health personnel, immunity, vaccination, hepatitis B, measles, varicella doi: 10.1111/j.1753-6405.2008.00257.x

Objectives: To explore the views of general practitioners and practice nurses about barriers to influenza vaccination among under 65 high-risk patients and strategies to overcome those barriers. Methods: Focus group discussions with general practitioners and practice nurses. Results: Barriers identified included: lack of awareness among patients about influenza vaccination; GP workload; poor GP motivation; lack of practice nurses; lack of patient recall systems; cost of vaccine; and lack of media campaign. Strategies proposed included: public education campaigns; free supply of vaccine; dissemination of evidence to motivate GPs; incentives to establish recall systems; and greater involvement of practice nurses in the process. Conclusion: Influenza vaccination has not been well accepted by people aged less than 65 years. Implementation of proposed strategies has the potential to improve the vaccination coverage. Implications: An improvement in influenza vaccination coverage among people less than 65 years who are in high-risk groups has the potential to reduce hospitalisation and health care costs. Key words: Influenza vaccination; adult and middle aged; health knowledge, attitude and practice. doi:10.1111/j.1753-6405.2007.00143.x