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The Australian National Diabetes Audit (ANDA) is an annual benchmarking activity which collects, collates and compares data from diabetes centres across Australia (audit). Participating centres receive summarised results, benchmarked against other centres (feedback). Feedback can assist practitioners in identifying areas to improve care and help improve diabetes outcomes for their patients. This thesis examined factors related to contemporary diabetes care in Australia, including use of ANDA feedback in practice. Redesigned feedback and cointerventions to assist in use of ANDA feedback for clinical quality improvement were implemented and evaluated in a cluster randomised trial, offering valuable lessons for future diabetes registries.

Fundamental care combines the needs of the person being cared for with the caregiver’s actions. The approach is not just about addressing an individual’s physical needs but about understanding and addressing the psychosocial and relational needs of the person receiving care while providing support, generating trust, and associated appropriate actions and behaviours. It is a relationship process that takes place within the framework of an organisation with solid policies and systems that place the person at the centre of attention while enabling workers' job satisfaction. These fundamental needs are only met through a positive and trusting relationship with the care recipient, including their family and everyone involved. Abstracto. Los cuidados fundamentales combinan las necesidades de la persona atendida con las acciones de quien la cuida. No se trata solo de las necesidades físicas, sino que también comprenden las necesidades psicosociales y relacionales de la persona, respaldadas por la confianza y acciones adecuadas de los que la cuidan. El proceso se desarrolla en el marco de una organización que cuenta con políticas y sistemas sólidos que sitúan a la persona en el centro de la atención, mientras habilitan la satisfacción laboral de los trabajadores. Estas necesidades fundamentales sólo se satisfacen a través de una relación positiva y de confianza con la persona que recibe los cuidados, incluyendo a su familia y a todos los involucrados en el proceso. Pinero de Plaza & Kitson, 2023 - Spanish adaptation of the Fundamentals of Care Framework: White paper in Spanish and English. Flinders University. DOI: 10.25451/flinders.23280881 Prepared for the first research symposium on care and humanisation and revised by Ana María Porcel Gálvez (PhD, BSc, RN) & Regina Allande Cusso (PhD, RN). Conference Organised by INVESCARE Granada, Spain. (12 of June 2023). The English version is accessible from pages 12 -21.

The authors report upon the failure of implementation of national guidance relating to the provision of vascular services. The report is based upon an analysis of trends and disparities in the provision of vascular services, carried out as part of an NIHR programme of research by the Vascular Services Research Group at the School of Health and Related Research, University of Sheffield.

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Shared Decision Making (SDM) is an interactive process through which patients and clinicians come to a decision regarding the patient’s treatment. SDM is said to improve health outcomes and healthcare utilisation. Given the benefits of SDM health services are required to implement SDM. This PhD explored the barriers and facilitators to SDM from the perspective of multiple stakeholders from policy to practice and co-designed theory-informed interventions to address these using behavioural science. Findings provide a framework through which health services can meet their policy requirements while upholding the right of patients to be included in decisions about their care.

Although community pharmacists have further reduced medication errors and improved care with access to patient data through unidirectional health information exchange (HIE), access to routine patient data has not been sustained. Several barriers to sustaining use and access of HIE in community pharmacies have been noted, such as lack of implementation supports and technological restrictions. Further, pharmacists and pharmacy technicians have not been involved in the development of HIE systems for their use previously. My research aims to optimize HIE access for community pharmacists through our co-developed HIE interface prototype specifically for use by community pharmacy teams in collaboration with PioneerRx, a pharmacy dispensing software system and our state HIE, the Indiana Health Information Exchange (IHIE), and provide supports for the sustainability of community pharmacist access to HIE. Therefore, the objectives of my research are to 1) conduct a formative usability evaluation of the HIE interface prototype with community pharmacists and pharmacy technicians to inform strategies to improve the HIE interface design for future implementation in community pharmacies (“Study One”) and 2) identify the potential barriers, facilitators, and recommendations for HIE implementation in community pharmacies through semi-structured interviews to create a curated list of resources to address identified implementation needs to assist with the future implementation of HIE (“Study Two”). The findings from Study One demonstrate the HIE interface prototype was viewed favorably by pharmacists and pharmacy technicians, with the average System Usability Scale (SUS) score 69 (scale 0 – 100, where 100 is the best). Pharmacists reported higher satisfaction than technicians on average (74 vs. 65, respectively). Key problems identified included accessibility of HIE links and placement in the existing workflow and application label name clarifications. The same eight pharmacists and eight pharmacy technicians, with the addition of seven patients, completed interviews in Study Two. Five barriers, four facilitators, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE, guidance on workflow and team roles, and provider and patient facing resources for discussing HIE. Curated draft implementation resource items that are responsive to all four key implementation needs are in development. The combination of findings from Study One and Study Two create the blueprint for pharmacy-team informed implementation of HIE in community pharmacies.

HDCT’s 4th Clinical Trial Intensive Workshop for 2022 covering Data, Analysis & Research Output. The Workshop is Hosted by Dr Erin Morton – Lead of Flinders University’s Health Data & Clinical Trials (HDCT). Internal and external guest speakers with expertise in the topic. – Dr. Maria Alejandra Pinero de Plaza – Joey Gerlach – Rhys Williams – Dr. Alline Beleigoli – Dr. Kelly Loffler 19 OCT HDCT Clinical Trial Intensive Workshop10:00 am - 1:00 pm Flinders medical Centre | Level 5 5E305 Collaborative Teaching Space Audience: General Public, Industry partners, Recent graduates, Researchers, Staff, Students.

This PhD project investigated gaps in screening, diagnosis, treatment and control of hypertension and diabetes in resource limited settings in south Asia. There are three major findings. First, there is a substantial burden of these conditions, with significant gaps in diagnosis leading to poor control. Second, while health facilities do not have the resources to manage hypertension, lifestyle counselling and monitoring by community health workers is effective in reducing blood pressure. Third, these improvements may not continue when patients are left to initiate their longer-term health care, so clinicians may be required to provide ongoing monitoring and support.

This thesis presents research on an innovative care model for hepatitis C testing and treatment – the CT2 Study – in Myanmar, and on the patient experience of accessing the national program. The CT2 Study showcased the successful implementation of a decentralised and simplified care model, featuring point-of-care testing and non-specialist prescribers; it achieved high retention in care and cure rates, and was feasible to implement in a resource-constrained setting. Findings from the patient experience study highlighted how gratitude for the opportunity to access treatment at no cost meant that patients were willing to endure inconveniences and unmet expectations of care.

Background COVID-19 pandemic has reminded how older adults with frailty are particularly exposed to adverse outcomes. In the acute care setting, consideration of evidence-based practice related to frailty screening and management is needed to improve the care provided to aging populations. It is important to assess for frailty in acute care so as to establish treatment priorities and goals for the individual. Our study explored understanding on frailty and practice of frailty screening among different acute care professionals in Singapore, and identify barriers and facilitators concerning frailty screening and its implementation. Methods A qualitative study using focus group discussion among nurses and individual interviews among physicians from four departments (Accident & Emergency, Anesthesia, General Surgery, Orthopedics) in three acute hospitals from the three public health clusters in Singapore. Participants were recruited through purposive sampling of specific clinicians seeing a high proportion of older patients at the hospitals. Thematic analysis of the data was performed using NVIVO 12.0. Results Frailty was mainly but inadequately understood as a physical and age-related concept. Screening for frailty in acute care was considered important to identify high risk patients, to implement targeted treatment and care, and to support decision making and prognosis estimation. Specific issues related to screening, management and implementation were identified: cooperation from patient/caregivers, acceptance from healthcare workers/hospital managers, need for dedicated resources, guidelines for follow-up management and consensus on the scope of measurement for different specialties. Conclusion Our findings indicated the need for 1) frailty-related education program for patients/care givers and stakeholders 2) inter-professional collaboration to develop integrated approach for screening and management of hospital patients with frailty and 3) hospital-wide consensus to adopt a common frailty screening tool.

Background In England, many services that are paid for using taxpayers’ money are decided on and funded by local commissioners such as Local Authorities (LAs) and Clinical Commissioning Groups (CCGs); although, CCGs are set to be replaced by Integrated Care Systems (ICSs) within 2022. LAs are responsible for publicly funded social care (e.g. home-based services) and some public health services (e.g. sexual health services). CCGs are responsible for funding most healthcare services in local areas. All local decision makers aim to fund services for public benefit; for example, promoting and protecting health and preventing ill-health, while ensuring ‘value for money’ for taxpayers. Such services and local decision makers often collect data to inform their processes. This data is used to support the services provided for individuals, but also for administrative reasons. This data could be used more often to help inform improvements to current services and funding of new services, but also to support research by universities. However, as this data could include potentially personal and sensitive information, it is important that it is protected and only shared in circumstances when there is a clear and legal reason that would benefit the public. What did we aim to achieve? We set out to understand: (1) what data is available to local decision makers; (2) how they currently use it; (3) how data can be used and potentially shared with parties who want to use it for public benefit. Furthermore, we aimed to explain how to best use and share data legally with clear reasons for its use. An example would be helping local decision makers calculate which services are considered ‘value for money’ or not, to allow local decision makers to best use money available to them. How did we do it? We first identified examples of when data has been used and legally shared to inform local decision making. We then produced a detailed list of what data these local decision makers have available. These examples and data were discussed with people who work within two LAs and a CCG, within three universities, and members of the public. This allowed us to further explore what is important to consider when using such data to inform local decision making or research purposes, and how the use of such information could be made more transparent and understandable for the public. Patient and the public involvement in the project A lay co-applicant (KS) helped with every aspect of the research project. We additionally set up a public advisory group to advise on the public workshops, interpretation of the findings, and co-design study outputs. What did we discover? Local commissioners are using and sharing data in various ways to benefit the public, such as identifying if certain people may be at-risk of a bad event; for example, older people at-risk of falling who would then require hospital and perhaps social care. However, local commissioners are not always clear in how they report the use of such data, who has control or is using such data, and if any public benefit was ever achieved from recording this data. We attempted to develop an understanding of what data was available for adult social care services. However, we were unable to achieve this aim because of issues to do with the amount of time, effort, and types of staff available within the relevant local commissioners to understand the data available. By discussing the need and use of data with LA and CCG staff, and members of the public, we identified a variety of areas to improve the responsible use of data. One thing discussed was the need for trust and understanding between everyone involved about how and when data is being used, what data is used (for example, if it reflects an individual or group), but also the public benefit of using such data. When analysing data, researchers and local commissioners need to communicate better and come to a joint understanding of how such data can be accessed and used for public benefit. This includes information about what services are considered value for money and who may be paying for what aspects associated with the services across CCGs and LAs, and if there is any chance spending may not remain within budget. Overall, there are ways to responsibly use data which protects the public and could provide public benefit such as treating or avoiding ill-health; however, clearer communication and building trust is needed. How will this research change health and social care? We believe our research could start to change and improve how researchers and local decision makers use locally available data to decide which services to fund to benefit communities. This includes suggested information to be made clearer to the public.

Therapeutic virtual reality (VR) has emerged as a highly promising tool to assess and treat a range of mental illnesses. However, the predicted widespread adoption of VR in mental healthcare has yet to eventuate. The research conducted in the current thesis aimed to systematically investigate potential barriers and enablers to the clinical implementation of therapeutic VR from the perspective of clinical stakeholders. It is anticipated that this new knowledge will help inform practical recommendations for strategies to promote broad uptake of therapeutic VR and a climate receptive to its promise for true innovation in mental healthcare.

Presentation on the DATA Management Plan for PROLIFERATE concerning RAPIDx AI. HDCT’s 4th Clinical Trial Intensive Workshop for 2022 covering Data, Analysis & Research Output. The Workshop was Hosted by Dr Erin Morton – Lead of Flinders University’s Health Data & Clinical Trials (HDCT). Internal and external guest speakers with expertise in the topic. – Dr Maria Alejandra Pinero de Plaza – Joey Gerlach – Rhys Williams – Dr Alline Beleigoli – Dr Kelly Loffler 19 OCT HDCT Clinical Trial Intensive Workshop10:00 am - 1:00 pm Flinders medical Centre | Level 5 5E305 Collaborative Teaching Space Audience: General Public, Industry partners, Recent graduates, Researchers, Staff, Students.