Search

Background: Trans, gender diverse and non-binary people face substantial societal stigma, and have some of the highest unmet health needs across the Australian population. These include extremely prevalent mental health issues (with 48% of youths attempting suicide, and 56% of adults being diagnosed with depression over their lifetime), coupled with significant barriers accessing the gender-affirming healthcare that is often essential for alleviating distress. In response to these needs, gender services have expanded in recent years, shifting from the traditional secondary model towards the more accessible 'informed consent' primary care model. However, there is poor coordination between models, with usage patterns and relative effectiveness in meeting needs remaining unknown. Aim/Objectives: To compare clients in the informed consent primary care model with those in the secondary model of care. We hypothesise that clients in the informed consent model would display less complex backgrounds and health needs than those in the traditional model, since complex cases would likely get referred. Method(s): Retrospective cross-sectional audit of clients who attended Equinox Gender Diverse Health Centre (primary care) and those who attended Monash Health Gender Clinic (secondary care) during 2017-2018. We will compare routinely collected clinical data on socioeconomic disadvantage, mental health comorbidities, health needs, and rapidity of assessment. Finding(s): Interim results will be presented. Implications: As gender services continue to expand, this study will highlight whether the new informed consent model is handling simpler cases whilst appropriately referring complex cases to specialised services, offering insights to policymakers for system reform and future clinical guidelines.

Background: Alcohol brief interventions (BIs) involve assessing a person's alcohol use and offering individualised advice to reduce health risks. Yet, despite their proven effectiveness, clinicians do not routinely offer brief interventions for alcohol use in daily practice. Aim/Objectives: To identify factors that influence whether alcohol BIs are used in consultations from the perspective of clinicians and patients. Method(s): Qualitative study using semi-structured interviews and focus groups (face-to-face and virtual) of primary care clinicians working in the greater Melbourne metropolitan region and patients from across Australia. Field notes were made from audio-recordings and themes were identified using a matrix based on the question structure. Finding(s): Thirty-nine GPs, 9 practice nurses and 16 patients participated. Barriers were identified at multiple levels of the healthcare system and across the general community including Australian drinking norms; inconsistent public health messaging around alcohol harm; patients not identifying general practice as a place to go for help; community stigma; general practice culture around preventive health; limitations of clinical software and current patient resources. Identified facilitators for embedding BIs in daily practice included: (1) raising community awareness of the health harms of alcohol; (2) building a practice culture around prevention; and (3) supportive resources to facilitate discussion about alcohol use and strategies to reduce intake. Implications: We have identified factors at multiple levels of the healthcare system that influence the successful implementation of alcohol BIs in general practice. We will now develop an intervention for increasing clinician uptake of BIs in daily general practice.

Context: There is a growing number of people seeking admission to hospitals with multiple and complex health care needs. Many of these people can be successfully treated in primary and community care, without needing admission to hospital. Collaboration with experts in big data analytics, research and healthcare including administration are needed to produce timely evidence on where to focus to reduce possible avoidable hospitalisations. This data-driven project resulted from a data-driven partnership between Monash University, Monash Health, and an industry partner in real-time data engineering and data science, Klarrio. Objective(s): To determine rates and patterns of hospital admissions in a large metropolitan health service, and identify potentially preventable hospitalisations. Design(s): Retrospective analysis of non-identifiable routine data from emergency department and inpatient admissions between January 2013 and December 2017. Application of machine learning techniques to identify spatial, socio-demographic and temporal patterns. Setting(s): Monash Health, Victoria's largest public health service services approximately 2,000,000 people living in the south east of Melbourne and Victoria. Participant(s): Routine care data from 381,920 patients with >1M inpatient admissions, and 496,502 patients with >1M emergency department visits. Finding(s): Preliminary data examination is underway by Klarrio to develop a proof-of-concept dashboard for visualising complex relationships in health service utilisation. Implication(s) for practice: Research traditionally takes place in disciplinary silos; however, partnerships such as this one with academics, informatics specialists, clinicians and a public health service has enabled an innovative and data-driven resource to be developed. Lessons from working within this multidisciplinary partnership will be shared.

Context: Person-centred care is a core element of high-quality health care. Integrated care programs, which aim to improve a person's capacity to manage their chronic conditions and thus reduce their use of acute health services, are based on principles of person-centred care. While many programs improve single disease-specific outcomes and health service use, clients' experiences of person-centred care are unknown. Objective(s): To explore the extent to which person-centred care is incorporated into an integrated care program in a large health service. Design(s): Qualitative design comprising interviews with clients and staff; with data analysed thematically. Setting(s): Monash Health's Complex Care Program in south-east Melbourne, with population groups disadvantaged in accessing services due to cultural, linguistic, or socio-economic factors. Participant(s): We interviewed 18 staff, 23 clients with multiple chronic conditions and complex needs, and/or their carers (7). Finding(s): We will present findings from interviews, exploring themes based on principles of person-centred care, including (1) involving clients in planning, (2) using information to make decisions, and (3) having their needs identified and met. Results will also provide insight into barriers and enablers to providing person-centred care. We will present the characteristics of care that matter most to clients. Implication(s) for practice: Findings will describe person-centred elements of care delivered to and experienced by people with multiple chronic conditions. Similar programs aiming to improve disease management to achieve better health outcomes and reduce health service use can adopt these elements.

BACKGROUND: Plantar heel pain is a common source of pain and disability. Evidence-based treatment decisions for people with plantar heel pain should be guided by the best available evidence, expert clinical reasoning, and consider the needs of the patient. Education is a key component of care for any patient and needs to be tailored to the patient and their condition. However, no previous work has identified, far less evaluated, the approaches and content required for optimal education for people with plantar heel pain. The aim of this study was to gather the patients' perspective regarding their lived experience, attitudes and educational needs in order to inform the content and provision of meaningful education delivery approaches. METHODS: Using a qualitative descriptive design, semi-structured interviews were conducted with participants with a clinical diagnosis of plantar heel pain. A topic guide was utilised that focused on the experience of living with plantar heel pain and attitudes regarding treatment and educational needs. Interviews were audio recorded, transcribed verbatim and analysed using the Framework approach. Each transcription, and the initial findings, were reported back to participants to invite respondent validation. RESULTS: Eighteen people with plantar heel pain were interviewed. Descriptive analysis revealed eight themes including perceptions of plantar heel pain, impact on self, dealing with plantar heel pain, source of information, patient needs, patient unmet needs, advice to others and interest in online education. Participants revealed doubt about the cause, treatment and prognosis of plantar heel pain. They also expressed a desire to have their pain eliminated and education individually tailored to their condition and needs. Respondent validation revealed that the transcripts were accurate, and participants were able to recognise their own experiences in the synthesised themes. CONCLUSION: Plantar heel pain has a negative impact on hea