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BACKGROUND: Experiencing loneliness can be distressing and increasing evidence indicates that being lonely is associated with poor physical and mental health outcomes. Cross-sectional studies have demonstrated that people with disability have increased risk of experiencing loneliness compared to people without disability. However, we do not know if these inequalities have changed over time. This study investigated the prevalence of loneliness for people with disability in Australia annually from 2003 to 2020 to examine whether disability-related inequalities in loneliness have changed over time, and disaggregated results for subgroups of people with disability by age group, sex, and disability group. METHODS: We used annual data (2003-2020) from the Household, Income and Labour Dynamics in Australia Survey. Loneliness was measured by a single question assessing the subjective experience of loneliness. For each wave, we calculated population-weighted age-standardised estimates of the proportion of people experiencing loneliness for people with and without disability. We then calculated the absolute and relative inequalities in loneliness between people with and without disability for each wave. Analyses were stratified by 10-year age groups, sex, and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). RESULTS: From 2003 to 2020, the prevalence of loneliness was greater for people with disability, such that people with disability were 1.5 to 1.9 times more likely to experience loneliness than people without disability. While the prevalence of loneliness decreased for people without disability between 2003 and 2020, the prevalence of loneliness did not decrease for people with disability during this period. Inequalities in loneliness were more substantial for people with intellectual or learning disabilities, psychological disability, and brain injury or stroke. CONCLUSION: This study confirms that peo

BACKGROUND: Loneliness can have a detrimental impact on health, yet little is known about the association between disability and loneliness. METHODS: Secondary analysis of three waves of data collected between 2017 and 2020 by the UK's annual household panel study, Understanding Society. Direct age-standardisation was used to compare the prevalence of loneliness at each wave and the persistence of loneliness across all three waves for participants with/without disabilities aged 16-65 years. Transitional probabilities for the stability of loneliness, the stability of non-loneliness, the onset of loneliness and the offset of loneliness between consecutive waves were also estimated. RESULTS: At each wave, the prevalence of loneliness was significantly higher among respondents with disabilities than respondents without disabilities; these inequalities persisted with no evidence of change over time. The prevalence of persistent loneliness was 46% for respondents with disabilities compared with 22% for respondents without disabilities. Risk factors for the likelihood of persistent loneliness included disability, financial stress, not living as a couple, living in rented accommodation, being female and not being employed. The probability of the onset and stability of loneliness between successive waves were markedly higher for people with disabilities compared with people without disabilities. CONCLUSION: Adults with disabilities were more likely to experience loneliness, become lonely and remain lonely over time than their peers. Policies and interventions aimed at reducing loneliness should ensure that they are accessible and effective for people with disabilities. Further research is needed to explore the health outcomes of persistent loneliness among people with/without disabilities.

BACKGROUND: Loneliness is a significant public health concern due to its detrimental impact on health and wellbeing. Despite people with disability reporting higher levels of loneliness than the general population, there has been little research into how this is affecting their health and wellbeing. In light of this, the aim of our study was to scope both the existing evidence about the health and wellbeing outcomes associated with loneliness for people with disability, as well as the conceptual frameworks and measures utilised in this field of research. METHODS: To conduct this scoping review, we followed the methodology outlined by JBI and searched MEDLINE, Scopus, Informit, Embase, and Web of Science for peer-reviewed, English-language articles published between 1 January 2000 and 8 February 2023. Two independent reviewers completed screening, full-text review and data extraction, with consensus sought at each stage. Data were analysed using content analysis and presented both numerically and narratively. RESULTS: Out of the initial 1602 publications identified in the scoping review, only nine were included after duplicate removal, title and abstract screening, and full-text review. This limited number of studies, with the earliest study one published in 2015, represents a key finding. Eight of the nine studies were quantitative, and all were conducted in high income countries. Most of these studies utilised a version of the University of Los Angles Loneliness Scale to measure loneliness and addressed specific impairment groups. Notably, most of the studies identified associations between loneliness and health and wellbeing outcomes for people with disability. CONCLUSIONS: This scoping review highlights the current scarcity of studies examining the effect that loneliness has on the health and wellbeing outcomes of people with disability. As most of the reviewed studies relied on loneliness measures designed for individuals without disability, they potentially ove

Objective: To explore health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic. Setting: Australia. Participants: Allied health, nursing and medical students with a planned rural or remote placement between February and October 2020. Design: Semi-structured interviews (n = 29) with data thematically analysed. Results: Five main themes emerged from student experiences: (1) ‘Do we go? Don't we go? Like how much risk is involved?’ related to student concerns regarding acquiring and transmitting COVID-19 on placement; (2) ‘We are sort of just standing at the door trying to watch’ encompassed student perceptions of missed clinical learning opportunities in response to health and safety measures related to COVID-19; (3) ‘I, as a student, sort of fell under the radar’ related to student perceptions of suboptimal supervision; (4) ‘It was a bit more difficult to engage with that wider community’ recognised student feelings of social disconnection and their lack of opportunity for community immersion; and (5) ‘We felt like we got something that is more than we expected’ emerged from student reflections on training during the pandemic and alternative placements (virtual, simulated and non-clinical) that exceeded expectations for learning. Conclusions: Although most students were willing and able to undertake their rural or remote placement in some form during the early stages of the pandemic and identified unanticipated learning benefits, students recognised lost opportunities to build clinical skills, become culturally aware and connect with rural communities. It remains unknown how these rural and remote placement experiences will impact rural intention and in turn, rural workforce development.

OBJECTIVES: To explore and synthesise the evidence relating to features of quality in rural health student placements. DESIGN: Scoping review. DATA SOURCES: MEDLINE, CINAHL, Embase, ProQuest, Informit, Scopus, ERIC and several grey literature data sources (1 January 2005 to 13 October 2020). STUDY SELECTION: The review included peer-reviewed and grey literature from Organisation for Economic Co-operation and Development listed countries that focused on quality of health student placements in regional, rural and remote areas. DATA EXTRACTION: Data were extracted regarding the methodological and design characteristics of each data source, and the features suggested to contribute to student placement quality under five categories based on a work-integrated learning framework. RESULTS: Of 2866 resulting papers, 101 were included for data charting and content analysis. The literature was dominated by medicine and nursing student placement research. No literature explicitly defined quality in rural health student placements, although proxy indicators for quality such as satisfaction, positive experiences, overall effectiveness and perceived value were identified. Content analysis resulted in four overarching domains pertaining to features of rural health student placement quality: (1) learning and teaching in a rural context, (2) rural student placement characteristics, (3) key relationships and (4) required infrastructure. CONCLUSION: The findings suggest that quality in rural health student placements hinges on contextually specific features. Further research is required to explore these findings and ways in which these features can be measured during rural health student placements.

BACKGROUND: People with intellectual disability experience inadequate access to general practice and poorer health outcomes than the general population. While some access barriers have been identified for this population, these studies have often used narrow definitions of access, which may not encompass the multiple dimensions that influence access to general practice. To address this gap, we conducted a scoping review to identify factors impacting access to general practice for people with intellectual disability in Australia, using a holistic framework of access conceptualised by Levesque and colleagues. METHODS: This scoping review followed Joanna Briggs Institute methodology and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Medline (Ovid), Scopus, CINAHL, Informit and PsycINFO databases were searched. Screening, full-text review and data extraction were completed by two independent reviewers, with consensus reached at each stage of the study. Data were extracted, coded and synthesised through deductive qualitative analysis - using the five corresponding conceptual dimensions within Levesque and colleagues' theoretical framework of access, which incorporate both supply-side features of health systems and services, and demand-side characteristics of consumers and populations. RESULTS: The search identified 1364 publications. After duplicate removal, title and abstract screening and full-text review, 44 publications were included. Supply-side factors were more commonly reported than demand-side factors, with the following issues frequently identified as impacting access to general practice: limited general practitioner education about, and/or experience of, people with intellectual disability; communication difficulties; and inadequate continuity of care. Less frequently included were factors such as the health literacy levels, promotion of general practice services and availability of complete

Objective: To assess sperm retrieval rates of Onco-Testicular Sperm Extraction (oncoTESE) in men with testicular tumors and coexisting severe spermatogenic impairment. Method(s): Multi-centre Australian wide retrospective review of oncoTESE procedures performed within the last 10 years. Patients were postpubertal adults having a testicular tumor requiring orchidectomy, with severe oligozoospermia or nonobstructive azoospermia. Ipsilateral testicular sperm extraction was performed following radical inguinal orchidectomy. A contralateral micro-testicular sperm extraction was performed if no sperm or insufficient amounts were initially achieved. Surgical sperm retrieval rates, live birth rates and post operative serum testosterone were recorded. Result(s): Four surgeons compiled a total 13 patients. The mean age was 34.9 years. Seven of 13 were germ cell tumor (GCT), 4 of 13 had non-GCT and 2 of 13 contained benign lesions. Twelve of 13 patients were azoospermic and 1 was severely oligozoospermic. Sperm was found in 6 of 7 GCT patients; 3 of 7 were found in the ipsilateral testis whilst the remaining 4 underwent contralateral micro-testicular sperm extraction; sperm was retrieved in 3 of 4. The respective mean pre and post orchidectomy testosterone was 12.0 vs 14.1nmol/L (GCT cohort). Cryopreserved sperm has been used in assisted reproduction in 2 of 13 patients, with median follow up of 38.7 months. Including use of both cryopreserved and fresh sperm, 6 pregnancies were achieved, including 5 healthy live births and 1 miscarriage. Conclusion(s): OncoTESE appears feasible, with acceptable sperm retrieval and subsequent live birth rates, following assisted reproduction. Despite significant underutilisation in the Australian population, oncoTESE should be considered in the management for TC patients with severe oligozoospermia, or nonobstructive azoospermia.Copyright © 2021 Elsevier Inc.

Effective efforts to strengthen health systems need diverse, multi-stakeholder networks working together on complex or 'wicked' problems such as prevention and control of chronic diseases, solutions to which go beyond the role and capability of one organisation. The contextual complexities inherent in 'wicked' problems mean that solutions warrant a systems approach that encompasses innovation and new ways of thinking about, facilitating and implementing collective decision-making processes and change practices. Innovation platforms are a mechanism for facilitating communication and collaboration among diverse stakeholders, promoting joint action and stimulating innovation. Developmental evaluation is an approach that is increasingly being used to evaluate innovative and emergent programmes and projects, as it enables evaluators to provide real-time feedback so that evaluation findings can be used to guide development and adaptations. Developmental evaluation emphasises learning and adaptation, and aligns well with the implementation of innovation platforms that have continuous reflection, learning and adaptation as a specific design principle. Here, we outline our rationale for applying a developmental evaluation to enhance the formation, functioning and outcomes of an innovation platform aimed at accelerating and strengthening large-scale quality improvement efforts in Australian Aboriginal and Torres Strait Islander primary healthcare. We provide examples to explain how the developmental evaluation findings were used for adaptation of the innovation platform and assess to what extent our application of developmental evaluation was consistent with, and reflective of, its essential principles. Our evaluation aligned strongly with the principles of developmental evaluation, and the approach we took was well suited to situations with a developmental purpose, innovation niche and complexity such as innovation platforms. As a result, along with the increasing interest i

The launch of the third edition of the National guide to preventive health assessment for Aboriginal and Torres Strait Islander people in March 2018 heralds a renewed commitment to improving the delivery of preventive care, and should reinvigorate discussions on the effectiveness of Indigenous-specific health assessments and how best to implement them. A substantial body of evidence on adherence to guideline-recommended care has been generated through a research-based continuous quality improvement (CQI) initiative conducted between 2010 and 2014. The research, which involved clinical audits of more than 17 000 client records and 119 systems assessments relating to preventive care in 137 Indigenous primary healthcare centres across Australia, shows that a structured CQI program can improve the delivery of preventive health assessments and use of evidence-based guidelines. However, program implementation has also seen the emergence of new challenges. This paper reflects on four major lessons from this collaborative program of applied research that will lead to more effective delivery of preventive care.

Introduction and Objectives: The Australia and New Zealand Audit of Surgical Mortality (ANZASM) reviews all deaths either following an operation or under the care of a surgeon. The operating surgeon completes a surgical case form (SCF) once the death has been reported and an independent first line assessor (FLA) from the same specialty reviews this to assess any potential adverse events, areas of concern or areas of consideration (ACON). If more information is required a second line assessment (SLA) by a different surgeon is conducted using the hospital notes. We have assessed the ANZASM data to see how urology compares with the national data set. Method(s): The ANZASM Bi-National Audit System (BAS) database was interrogated for all deaths under the care of a urologist. The highest level of assessment was recorded and any ACON documented. It was also recorded whether the assessor felt that the ACON was responsible for the patient's death and was preventable. The results were compared with the national dataset to assess whether urology was an outlier. Result(s): 1026 completely assessed urology deaths were recorded in BAS between 2009 and 2017. 144 (14.04%) deaths were referred for a SLA. Using the highest assessment available 751 (73.2%) deaths were found to have no issues. Table 1 details the ACON. As an area of consideration is a debatable point, causation and preventability have not been included. Conclusion(s): The vast majority of deaths occurring under the care of urological surgeons in Australia and New Zealand are unavoidable and do not raise any concerns when independently reviewed. Compared to the national data, urology is not an outlier. Just over 10% of deaths are associated with adverse events or areas of concern that may have contributed to the patient's death and are potentially preventable. These cases need to be reviewed in greater detail to assess for lessons to help prevent future deaths. (Table presented).

Introduction & Objective: There are no published randomised studies comparing extracorporeal shock wave lithotripsy (SWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL) as treatments for 10-20mm renal stones. We have conducted a pilot study to assess the practicality of a sufficiently powered randomised controlled trial. Method(s): All adult patients with a maximum stone diameter of 10-20mm on CT scan were eligible for enrolment. Patients were randomised to SWL, URS or PCNL. Treatments were carried out using standard protocols-all SWL conducted without anaesthesia, URS with Holmium: YAG laser dusting and PCNL in the modified supine position. Repeat or alternative treatments were performed as clinically appropriate until the patients were considered stone free. All patients had a post-treatment CT scan to assess stone free rate (SFR). Images were reviewed by a radiologist blinded to treatment. Data collected included pre-treatment stone size and Hounsfield units, pre-/post-treatment global health scores, number/duration of treatments, complications and SFR. Ethical approval was obtained. Data were analysed using Kruskal-Wallis and Chi-square tests. Result(s): Thirty one patients were randomised; 11 treated with URS and 10 each for SWL and PCNL. There were no significant differences in age, sex and stone size/position between the groups. SFR were 60%, 55% and 80% for SWL, URS and PCNL respectively (p = 0.33). PCNL patients received significantly fewer procedures (median 1, range 1-3) than both SWL (median 2, range 1-5) and URS (median 2, range 1-3) (p = 0.015) with an overall similar stay in hospital. Overall complications were more common with SWL (50%), compared to 20% for PCNL and 9% URS (p = 0.019) and the only complications greater than Clavien Grade 1 were following SWL (steinstrasse in 30%). Conclusion(s): PCNL achieves the highest SFR with the lowest number of procedures, with a comparable overall length of hospital stay to URS and SWL. URS of

Introduction and Objectives: The Australian and New Zealand Audit of Surgical Mortality (ANZASM) reviews all deaths either following an operation or under the care of a surgeon. The operating surgeon completes a surgical case form (SCF) once the death is reported and this is reviewed by independent assessors, with a case note review utilized when additional information is required. We have analyzed the ANZASM for data to provide the largest ever review of urological deaths. Method(s): The ANZASM Bi-National Audit System (BAS) database was interrogated for all deaths under the care of a urologist. Information on patient age, sex, hospital admission site, admission type, number of operations and operations conducted was obtained from the database. This demographic data was compared to the published all specialty ANZASM data. Result(s): The complete data for 1034 assessed urology deaths were recorded in BAS between 2009 and 2017. 764 (73.9%) males and 270 (26.1%) females were included. The mean age at the time of death was 77.6 years (range 21-101). 1091 operations were recorded in total (primary and re-operations) and there were 208 non-operative presentations (Table 1). 148 patients underwent 2 or more operations during their admission including some operations under different specialties. The most common primary operations are detailed in Table 2. Conclusion(s): Urology deaths appear to have the same proportion of operations as the general data set but are more commonly associated with elective surgery and private hospital admission than the overall ANZASM data. The most common emergency procedures were associated with sepsis and bleeding. We will be further investigating the reasons associated with the elective surgical deaths. (Table presented).

Introduction Traditional practice following percutaneous nephrolithotomy (PCNL) is to leave a nephrostomy drain in situ. 'Tubeless' PCNL involves placement of a ureteric stent in lieu of nephrostomy drain. In 'totally-tubeless' PCNL, no drainage is left. The purpose of this study was to demonstrate that standard and miniaturised PCNL can be performed tubeless or totally tubeless with excellent safety and clinical outcomes. Patients and methods Fifty-two tubeless or totally-tubeless PCNLs were performed between 2013 and 2018 (the majority between 2016 and 2018 following introduction of miniaturised PCNL equipment). PCNLs were performed in the Galdakao-modified supine Valdivia position. Data on outcomes and complications were collected prospectively. Decision to omit nephrostomy drain or ureteric catheter/ stent was made at time of surgery in cases that were deemed suitable (e.g. no solitary kidney, minimal bleeding and fluoroscopic/visual complete stone clearance at operation completion). Stone clearance rates, length of hospital stay and complications were determined. Results 13 tubeless and 39 totally tubeless PCNLs were performed. Miniaturised equipment was utilised in 11 of the totally tubeless group. Overall stone-free rate was 86%. Median length of stay was 1 day. The rate of complications (Clavien-Dindo grade 3 and above) was 8%. Conclusions Omitting a nephrostomy drain or ureteric stent is a safe option in suitable patients. We have demonstrated excellent stone free rates with minimal complications and length of hospital stay. We plan to conduct a pilot trial assessing the clinical outcomes, feasibility and acceptability of tubeless miniaturised vs tubeless conventional PCNL using validated pain scores and PROMs.

Background and objectives The gold standard for the tissue diagnosis of prostate cancer has moved toward transperineal prostate biopsy (TPB). We recently changed from transrectal ultrasound guided prostate biopsy and established a TPB theatre list due to the supposed decrease in risk of infection. In this study, we have audited our data after 500 biopsies to ascertain whether the new service has adhered to worldwide standards for the safety of TPB. Materials and methods This was a retrospective chart analysis of 3 years of data (1 Sep 2015 to 31 Dec 2018). The hospital database was mined for all documented billings for TPB using CMBS code 37219. This list was compared with a search of operation reports using the code 37219 and keywords: transperineal biopsy, transperineal prostate biopsy, TP biopsy and TPB. Two authors reviewed the medical record to resolve any conflict in results. Where consensus was not reached, it was resolved by the primary author. An analysis of the medical record was used to identify rates of post-operative urinary tract infection (UTI), bleeding, sepsis, acute urinary retention (AUR) and readmission. Bleeding that did not meet Dindo-Clavien Surgical Complication Classification Grade I or above was excluded. Results 517 men (mean age 64 years) underwent TPB over this period. Indications in men not on active surveillance included: rising prostate specific antigen (70.0%), abnormal digital rectal examination (7.5%) and other reasons (2.1%). Repeat TPB was triggered during active surveillance in 20.3% of men. The rate of benign diagnosis was 42.3% while malignant histology was divided into 57.0% adenocarcinoma, 0.3% squamous cell carcinoma and 0.2% other invasive tumour. The rate of post-operative UTI was 0.6%, bleeding 3.7%, sepsis 0.2%, AUR 1.7% and re-admission 0.4%. Conclusion Loeb et al. (2011) reported the rate of infectious and non-infectious complication requiring readmission at 6.9% and 0.3% respectively after analysis of the Surveillanc

Introduction and Objectives: The Australia and New Zealand Audit of Surgical (Table presented) Mortality (ANZASM) reviews of all deaths either following an operation or under the care of a surgeon. It has gradually been introduced to all states and territories since 2010 and has been a mandated part of a surgeons continuing professional development since 2012. A unique aspect of the review is the completing surgeon's ability to reflect on the surgical death and to state with hindsight whether anything should have been done differently. We have reviewed these reflections for the ANZASM urology deaths. Method(s): The ANZASM Bi-National Audit System (BAS) database was interrogated for all deaths under the care of a urologist. The highest level of independent assessment was reviewed to establish whether there were any adverse events, areas of concern or areas of consideration with the cases (ACON). The surgeon completed surgical case form (SCF) was then reviewed to assess concordance with the assessment and whether the surgeon would have done anything differently. Result(s): 1026 completely assessed urology deaths were recorded in BAS between 2009 and 2017. Of these 275 (26.8%) were assessed to have at least one ACON. In 137 (49.8%) cases the SCF agreed that there was an AOC. Concordance with the assessment and SCF for the most serious level (adverse event) was 17 of 45 (37.8%). On reflection surgeons would have changed management in 91 (33.1%) of the AOC cases. The concordance for all AOC was 46 of 89 (51.7%) cases between 2009/ 11, 37 of 90 (41.1%) cases between 2012/ 14 and 54 of 96 (56.3%) cases between 2015/17. Conclusion(s): The ANZASM review process is an educational tool so that surgeons can learn from patient deaths and modify practice. A surgical death is potentially devastating for both surgical staff and patient families. The vast majority of urology deaths are unavoidable and do not raise any concerns, but we have reviewed those cases were independent conce

Introduction Supine approaches to percutaneous nephrolithotomy (PCNL) are becoming more widely adopted and have a number of advantages compared to the traditional prone approach. The purpose of this study was to report our experience and clinical outcomes with a modified supine PCNL technique. We describe the modifications we have made to the technique over time and offer suggestions to deal with more challenging cases. Patients and methods 331 supine PCNLs were performed at a high volume Australian endourology centre between 2011 and 2019. All PCNLs were performed in the Galdakao-modified supine Valdivia position. Conventional PCNL was performed via a 24Fr Amplatz sheath and a 22Fr nephroscope. Miniaturised equipment has been available at our centre since 2016. Data on outcomes and complications were collected prospectively. Data including stone clearance rates, length of hospital stay and complications were analysed. Increased familiarity with the technique and the introduction of miniaturised equipment has led to a more recent trend towards tubeless and totally tubeless approaches. Results 331 supine PCNLs were performed between 2011 and 2019. Mean body mass index was 30. Overall stone-free rate in the series was 80%. Median length of stay was 1.5 days. The rate of serious complications (Clavien-Dindo grade 3 and above) in the series was low. Conclusions Supine PCNL has a number of advantages compared to the traditional prone approach. We have demonstrated excellent stone free rates in our cohort with minimal complications and length of stay. Operative time has reduced with increased experience. Endoscopic combined intra-renal surgery is a particular advantage of the supine approach and has helped us achieve good stone clearance in patients with complex stone burdens.

© 2019 Laycock, Bailie, Percival, Matthews, Cunningham, Harvey, Copley, Patel and Bailie. Introduction: Increasing the use of evidence in healthcare policy and practice requires greater understanding of how stakeholders use evidence to inform policy, refine systems and change practice. Drawing on implementation theory, we have used system-focused participatory research to engage diverse stakeholders in using aggregated continuous quality improvement (CQI) data from Australian Indigenous primary health care settings to identify priority evidence-practice gaps, barriers/enablers and strategies for improvement. This article reports stakeholders' use or intended use of evidence at various levels of the system, and factors mediating use. Material and Methods: Interviews were undertaken with a purposeful sample of 30 healthcare stakeholders in different roles, organization types and settings in one Australian jurisdiction and with national participants, as part of the project's developmental evaluation. Qualitative data were analyzed to identify themes and categories relating to use of evidence. Results: Context-specific aggregated CQI data that were relatable to the diverse professional roles and practices provided an effective starting point for sharing perspectives, generating practice-based evidence and mobilizing evidence-use. Interviewees perceived the co-produced findings as applicable at different levels and useful for planning, policy development, supporting best practice and reflection, capacity strengthening and developing new research. Factors mediating use were commitment to best practice; the credibility of the evidence and its perceived relevance to work roles, contexts and decision needs; report format and language; facilitation and communication; competing work pressures and the organizational environment for change. Conclusions: This study found that primary health care stakeholders used evidence on quality of care for a variety of purposes. This could b

© 2018 The Author(s). Background: Participatory research approaches improve the use of evidence in policy, programmes and practice. Few studies have addressed ways to scale up participatory research for wider system improvement or the intensity of effort required. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to analyse implementation of an interactive dissemination process engaging stakeholders with continuous quality improvement (CQI) data from Australian Indigenous primary healthcare centres. This paper reports lessons learnt about scaling knowledge translation research, facilitating engagement at a system level and applying the i-PARIHS framework to a system-level intervention. Methods: Drawing on a developmental evaluation of our dissemination process, we conducted a post-hoc analysis of data from project records and interviews with 30 stakeholders working in Indigenous health in different roles, organisation types and settings in one Australian jurisdiction and with national participants. Content-analysed data were mapped onto the i-PARIHS framework constructs to examine factors contributing to the success (or otherwise) of the process. Results: The dissemination process achieved wide reach, with stakeholders using aggregated CQI data to identify system-wide priority evidence-practice gaps, barriers and strategies for improvement across the scope of care. Innovation characteristics influencing success were credible data, online dissemination and recruitment through established networks, research goals aligned with stakeholders' interest in knowledge-sharing and motivation to improve care, and iterative phases of reporting and feedback. The policy environment and infrastructure for CQI, as well as manager support, influenced participation. Stakeholders who actively facilitated organisational- and local-level engagement were important for connecting others with the data and with the externally located

Background: Chlamydia, gonorrhoea and syphilis are readily treatable sexually transmitted infections (STIs) which continue to occur at high rates in Australia, particularly among Aboriginal Australians. This study aimed to: explore the extent of variation in delivery of recommended STI screening investigations and counselling within Aboriginal primary health care (PHC) centres; identify the factors associated with variation in screening practices; and determine if provision of STI testing and counselling increased with participation in continuous quality improvement (CQI). Methods: Preventive health audits (n = 16,086) were conducted at 137 Aboriginal PHC centres participating in the Audit and Best Practice for Chronic Disease Program, 2005-2014. STI testing and counselling data were analysed to determine levels of variation in chlamydia, syphilis and gonorrhoea testing and sexual health discussions. Multilevel logistic regression was used to determine factors associated with higher levels of STI-related service delivery and to quantify variation attributable to health centre and client characteristics. Results: Significant variation in STI testing and counselling exists among Aboriginal PHC centres with health centre factors accounting for 43% of variation between health centres and jurisdictions. Health centre factors independently associated with higher levels of STI testing and counselling included provision of an adult health check (odds ratio (OR) 3.40; 95% Confidence Interval (CI) 3.07-3.77) and having conducted 1-2 cycles of CQI (OR 1.34; 95% CI 1.16-1.55). Client factors associated with higher levels of STI testing and counselling were being female (OR 1.45; 95% CI 1.33-1.57), Aboriginal (OR 1.46; 95% CI 1.15-1.84) and aged 20-24 years (OR 3.84; 95% CI 3.07-4.80). For females, having a Pap smear test was also associated with STI testing and counselling (OR 4.39; 95% CI 3.84-5.03). There was no clear association between CQI experience beyond two CQI cycles a

BACKGROUND: To close health disparities between Indigenous and non-Indigenous Australians, the Australian government in 2010 reduced medication copayments for Indigenous Australians living with, or at risk of, a chronic disease. Patients were registered for this incentive by their general practitioner. OBJECTIVE: To assess rates of hospitalizations for chronic conditions among Indigenous Australians before and after copayment reductions. DESIGN: Observational time-trend study of hospitalizations for chronic conditions sensitive to medication adherence.. PARTICIPANTS: Indigenous persons age 15 years and older in 16 urban, regional, and remote locations. The population ranged from 40,953 in 2009 to 42,651 in 2011. MAIN OUTCOMES: Hospitalizations for diabetes, asthma, chronic obstructive pulmonary disease, hypertension, heart failure, and cardiovascular events. KEY RESULTS: Approximately 22 % of Indigenous persons registered for the medication copayment incentive in the first 18 months of implementation. In areas with rates of incentive uptake exceeding 22 %, the age-standardized rate of hospitalizations for chronic conditions among Indigenous Australians declined from 103.4/1000 (95 % CI 88.8/1000 to 118.0/1000) in 2009 to 60.0/1000 (95 % CI 49.3/1000 to 70.7/1000) in 2011. In areas with below-average uptake of the incentive, we observed non-significant reductions in age-standardized hospitalization rates (from 63.3/1000 [95 % CI 52.9/1000 to 73.7/1000] in 2009 to 58.0/1000 [95 % CI 48.5/1000 to 67.5/1000] in 2011). Among Indigenous Australians, the rate of admission for acute conditions (pneumonia, influenza, urinary tract infection, pyelonephritis, and dehydration) was 38.4/1000 (95 % CI 32.4/1000 to 44.3/1000) in 2009 and 36.2/1000 (95 % CI 30.4/1000 to 41.8/1000) in 2011. Among the non-Indigenous population, we found substantially lower rates of hospitalizations and modest declines from 2009 to 2011. CONCLUSIONS: Though we cannot make causal inferences from the re

BACKGROUND: Potentially preventable chronic diseases are the greatest contributor to the health gap between Aboriginal and Torres Strait Islander peoples and non--Indigenous Australians. Preventive care is important for earlier detection and control of chronic disease, and a number of recent policy initiatives have aimed to enhance delivery of preventive care. We examined documented delivery of recommended preventive services for Indigenous peoples across Australia and investigated the influence of health center and client level factors on adherence to best practice guidelines. METHODS: Clinical audit data from 2012 to 2014 for 3,623 well adult clients (aged 15-54) of 101 health centers from four Australian states and territories were analyzed to determine adherence to delivery of 26 recommended preventive services classified into five different modes of care on the basis of the way in which they are delivered (e.g., basic measurement; laboratory tests and imaging; assessment and brief interventions, eye, ear, and oral checks; follow-up of abnormal findings). Summary statistics were used to describe the delivery of each service item across jurisdictions. Multilevel regression models were used to quantify the variation in service delivery attributable to health center and client level factors and to identify factors associated with higher quality care. RESULTS: Delivery of recommended preventive care varied widely between service items, with good delivery of most basic measurements but poor follow-up of abnormal findings. Health center characteristics were associated with most variation. Higher quality care was associated with Northern Territory location, urban services, and smaller service population size. Client factors associated with higher quality care included age between 25 and 34 years, female sex, and more regular attendance. CONCLUSION: Wide variation in documented preventive care delivery, poor follow-up of abnormal findings, and system factors that influe