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Objectives Australian guidelines recommend people aged 50–70 years old consider taking low-dose aspirin to reduce their risk of colorectal cancer. The aim was to design sex-specific decision aids (DAs) with clinician and consumer input, including expected frequency trees (EFTs) to communicate the risks and benefits of taking aspirin. Methods Semi-structured interviews were conducted with clinicians. Focus groups were conducted with consumers. The interview schedules covered ease of comprehension, design, potential effects on decision-making, and approaches to implementation of the DAs. Thematic analysis was employed; independent coding by 2 researchers was inductive. Themes were developed through consensus between authors. Results Sixty-four clinicians were interviewed over 6 months in 2019. Twelve consumers aged 50–70 years participated in two focus groups in February and March 2020. The clinicians agreed that the EFTs would be helpful to facilitate a discussion with patients but suggested including an additional estimate of the effects of aspirin on all-cause mortality. The consumers felt favourable about the DAs and suggested changes to the design and wording to ease comprehension. Conclusion DAs were designed to communicate the risks and benefits of low-dose aspirin for disease prevention. The DAs are currently being trialled in general practice to determine their impact on informed decision-making and aspirin uptake.

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INTRODUCTION: Halitosis is common and can have a significant impact on quality of life. It is attributed to both intraoral and extraoral causes. Although halitosis treatment depends on the aetiology, little is known about consumers' perception of halitosis causes and the types of assistance sought. The Say Ahhh Study aimed to explore the interprofessional care for halitosis and improve understanding by the general public. Phase 1 explored the perceptions of health care providers. This article reports the findings of Phase 2, which explored the general public's knowledge of halitosis, its management, and help-seeking behaviour. METHODS: Patients and clients at 2 medical clinics, 3 dental clinics, and 2 pharmacies in Melbourne and rural Victoria were approached and invited to participate in a short semistructured interview. Qualitative data was thematically analysed. RESULTS: A total of 122 participants (54 males, 66 females, 2 missing) were interviewed. Participants' past experience with halitosis influences their understanding of the cause. Halitosis was attributed mostly to poor oral hygiene and diet and less commonly to systemic disease. Their perception of the condition's severity influenced whether they seek professional help. Their perceived roles of health professionals and ease of access influenced their choice of health professionals to seek help from. CONCLUSION: The Victorian general public is aware of the causes of halitosis and the available treatment options. Choice of treatment and help-seeking behaviour are influenced by experience, perceived severity of the condition, and perceived role of health professionals and their accessibility.

Background Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in Indonesia. Focused HDP management pathways for Indonesian primary care practice have been developed from a consensus development process. However, the acceptability and feasibility of the pathways in practice have not been explored. This study reports on the implementation process of the pathways to determine their acceptability and feasibility in Indonesian practice. Methods The pathways were implemented in three public primary care clinics (Puskesmas) in Yogyakarta province for a month, guided by implementation science frameworks of Medical Research Council (MRC) and the Practical Robust Implementation and Sustainability Model (PRISM). The participating providers (general practitioners (GPs), midwives, and nurses) were asked to use recommendations in the pathways for a month. The pathway implementation evaluations were then conducted using clinical audits and a triangulation of observations, focus groups (FGs), and interviews with all of the participants. Clinical audit data were analysed descriptively, and qualitative data were analysed using a mix of the inductive-deductive approach of thematic analysis. Results A total of 50 primary care providers, four obstetricians, a maternal division officer in the local health office and 61 patients agreed to participate, and 48 of the recruited participants participated in evaluation FGs or interviews. All of the providers in the Puskesmas attempted to apply recommendations from the pathways to various degrees, mainly adopting preeclampsia risk factor screenings and HDP monitoring. The participants expressed that the recommendations empowered their practice when it came to HDP management. However, their practices were challenged by professional boundaries and hierarchical barriers among health care professionals, limited clinical resources, and regulations from the local health office. Suggestions for future scale-up studies were also mentioned, such as involving champion obstetricians and providing more patient education toolkits. Conclusion The HDP management pathways are acceptable and feasible in Indonesian primary care. A further scale-up study is desired and can be initiated with investigations to minimise the implementation challenges and enhance the pathways’ value in primary care practice.

Objectives Australian guidelines recommend people aged 50 to 70-years-old, consider taking low-dose aspirin to reduce their risk of colorectal cancer. The aim was to design sex-specific decision aids (DAs) with clinician and consumer input including expected frequency trees (EFTs) to communicate risks and benefits of taking aspirin. Methods Semi-structured interviews were conducted with clinicians. Focus groups were conducted with consumers. The interview schedules covered ease of comprehension, design, potential effects on decision making, and approaches to implementation of the DAs. Thematic analysis was employed; independent coding by two researchers was inductive. Themes were developed through consensus between authors. Results Sixty-four clinician were interviewed over six-months in 2019. Twelve consumers, aged 50 to 70 years, participated in two focus groups in February and March 2020.

Objectives Australian guidelines recommend people aged 50 to 70-years-old, consider taking low-dose aspirin to reduce their risk of colorectal cancer. The aim was to design sex-specific decision aids (DAs) with clinician and consumer input including expected frequency trees (EFTs) to communicate risks and benefits of taking aspirin. Methods Semi-structured interviews were conducted with clinicians. Focus groups were conducted with consumers. The interview schedules covered ease of comprehension, design, potential effects on decision making, and approaches to implementation of the DAs. Thematic analysis was employed; independent coding by two researchers was inductive. Themes were developed through consensus between authors. Results Sixty-four clinician were interviewed over six-months in 2019. Twelve consumers, aged 50 to 70 years, participated in two focus groups in February and March 2020.

Background Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. Methods Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically. Results A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.

Almost all of global maternal mortality caused by HDP occurs in low to middle-income countries (LMIC). However, limited guidance is available to local primary care practitioners who are usually the main health care providers. This review examined existing international practice guidelines to identify potential practices to improve HDP management in Indonesian primary care settings. We performed structured literature search strategies and snowballing searches in six databases (MEDLINE, Web of Science, EMBASE, CINAHL, Cochrane reviews and Google Scholar) for guidelines that were published between 2007 and 2018 using relevant keywords and phrases of 'guidelines', 'hypertensive disorders of pregnancy' or 'preeclampsia' and 'primary care'. The AGREE II instrument was used to assess quality and reporting of the eligible guidelines. Thematic analysis was performed on all of the guidelines and the results were discussed among the project investigators. Sixteen international practice guidelines or similar management recommendations were reviewed. Almost all of them were partially applicable, with some managements potentially able to be adopted to Indonesian primary care settings. Three main themes for improving HDP management were identified, namely clinical management, care planning, and professional communication. These potential improvements in managing women with HDP in Indonesia may also be relevant in other LMIC. Further contextualisation is required to facilitate their adoption in practice settings.

The COVID-19 (coronavirus disease 2019) pandemic has the potential to worsen existing health inequalities faced by Aboriginal and Torres Strait Islander peoples in Australia. We aimed to assess the impact of the pandemic on First Nations people health assessments using an interrupted time series model utilizing data extracted from the Australian Medicare Benefits Schedule database. Additive triple exponential smoothing was used to model health assessments undertaken between January 2017 and December 2019. The model was used to predict health assessments between January 2020 and June 2020 with 95% confidence ( P < .05). There was no significant difference between observed and predicted First Nations people health assessments in January, February, and June 2020. However, we found a statistically significant decrease in health assessments in March (16.5%), April (23.1%), and May (17.2%) 2020. The proportion of total health assessments delivered via telehealth was 0.5%, 23.6%, 17.6%, and 10.0% for March, April, May, and June 2020, respectively. The decrease in total First Nations people health assessments compounds the risk of poorer health outcomes in this population already vulnerable due to a high burden of chronic disease and considerable social, economic, and health inequalities. Strategies to improve the delivery of telehealth for First Nations people must be considered.

Touch for health (TFH) based kinesiology is a complementary therapy with foundations in a natural health training developed utilising techniques from chiropractic, osteopathy and acupressure therapies. Although popular, the impact of the therapy is poorly understood. The aim of this study was to understand outcomes of TFH-based kinesiology interventions that clients perceive as important in their lives.A qualitative phenomenological approach was chosen to capture rich descriptive data. Thirteen individuals were recruited from TFH-based kinesiology practices. Focus groups included semi-structured questions, photo-elicitation and a wellness word activity to prompt discussion on impacts of interventions. Audio-recordings were transcribed, coded and grouped to develop themes. Comparisons were made and linked with the wellness model, theory of planned behaviour and mindfulness-based interventions.Three interrelated themes emerged: impact on awareness, experience of effects and impact on action. TFH-based kinesiology was perceived to enhance self-awareness and feelings of wellbeing, promote self-care and support new actions to manage stress and complement conventional healthcare. The use of a mind-body approach with feedback from muscle testing and less need for dialogue were valued. Photo-elicitation generated rich narratives recounting experiences after interventions. Impacts aligned with the wellness model and resembled outcomes of mindfulness-based interventions.This study provides an insight into experiences and impacts of TFH-based kinesiology. Interventions were seen to facilitate self-awareness, experiences of wellbeing and promote self-care. Findings contribute towards a knowledge-base to foster dialogue and inform TFH-based kinesiologists, health professionals, consumers and research of TFH-based kinesiology and comparative therapies.

Introduction: Halitosis is common and can have significant impact on quality of life. Current literature recommends multidisciplinary approaches. This paper explored the practice, knowledge and views of Australian general dental practitioners (GDPs), general medical practitioners (GMPs) and community pharmacists (CPs) on halitosis and interprofessional collaboration to manage halitosis. Methods: A mixed methods approach was used. Recruited GMPs, GDPs and CPs completed an online survey. A small number then participated in semi-structured follow-up interviews. Results: Sixty-six GDPs, 27 GMPs and 114 CPs completed the survey. Five from each group were interviewed. Sixty-eight percent of GMPs and 46% of CPs considered halitosis management part of their role despite the majority feeling that they had insufficient oral health training. Sixty-eight percent of GMPs, 86% of GDPs and 79% of CPs thought interprofessional halitosis care would benefit patients. Most participants admitted to feeling uneasy when starting conversations with their patients about halitosis. Most GDPs did not monitor their patients’ progress, and GMPs seemed comfortable in managing halitosis only when it had a systemic cause. Critically, the role of CPs in halitosis management was poorly understood. Conclusion: Most GDPs, GMPs and CPs find it challenging to manage patients with halitosis and are interested in working together. Improving health professionals’ knowledge and training will contribute to comprehensive interprofessional halitosis management.

Objective To examine whether the Ways of Thinking and Ways of Doing (WoTWoD) cultural respect framework improves clinically appropriate anticipatory care in general practice and the cultural respect levels of medical practice staff. Design Mixed methods, cluster randomised controlled trial with a participatory action research approach. Setting, participants Fifty-six general practices in Sydney and Melbourne, 2014-2017. Intervention WoTWoD encompasses a toolkit (ten scenarios illustrating cross-cultural behaviour in clinical practice), one half-day workshop, cultural mentor support for practices, and a local care partnership between participating Medicare locals/primary health networks and local Aboriginal Community Controlled Health Services for guiding the program and facilitating community engagement. The intervention lasted 12 months at each practice. Major outcomes Rates of claims for MBS item 715 (health assessment for Aboriginal and Torres Strait Islander People) and recording of chronic disease risk factors; changes in cultural quotient (CQ) scores of practice staff. Results Complete results were available for 28 intervention (135 GPs, 807 Indigenous patients) and 25 control practices (210 GPs, 1554 Indigenous patients). 12-Month rates of MBS item 715 claims and recording of risk factors for the two groups were not statistically significantly different, nor were mean changes in CQ scores, regardless of staff category and practice attributes. Conclusion The WoTWoD program did not increase the rate of Indigenous health checks or improve cultural respect scores in general practice. Conceptual, methodologic, and contextual factors that influence cultural mentorship, culturally respectful clinical practice, and Indigenous health care require further investigation. Trial registration Australia New Zealand Clinical Trials Registry ACTRN12614000797673.

Background National and international guidelines for the management of hypertensive disorders of pregnancy (HDP) are available in developing countries. However, more detailed clinical pathways for primary care settings are limited. This study focuses on Indonesia, where 72% of women who died from HDP and its complications had received less appropriate treatment according to international guidelines. There is an urgent need to develop primary care focused pathways that enable general practitioners (GPs), midwives and other relevant providers to manage HDP better. Objectives This paper describes a study protocol for the development of HDP management pathways for Indonesian primary care settings. Methods This study design is informed by Implementation Science theories and consists of three phases. The exploratory phase will involve conducting semi-structured interviews with key Indonesian primary care stakeholders to explore their experiences and views on HDP management. The development phase will apply evidence from the literature review and results of the exploratory phase to develop HDP management pathways contextualised to Indonesian primary care settings. Consensus will be sought from approximately 50 experts, consist of general practitioners (GPs), midwives, obstetricians, nurses and policy makers using Delphi technique survey. The evaluation phase will involve a pilot study to evaluate the pathways’ acceptability and feasibility in a sample of Indonesian primary care practices using mixed methods. Discussion The implementation science frameworks inform and guide the phases in this study. Qualitative interviews in the exploratory phase are conducive to eliciting opinions from key stakeholders. Using Delphi technique at the development phase is suitable to seek participants’ consensus on HDP management in primary care. Observations, focus group discussions, interviews as well as analysis of patients’ medical records at the evaluation phase are expected to provide a comprehensive investigation of the implementation of the pathways in practice settings.

Background: Diabetes and periodontitis have a bi-directional relationship. And yet, collaborations between primary healthcare practitioners in diabetes and oral health care are minimal. This study explored the views of general practice and oral health professionals on the link between diabetes and periodontitis, and interprofessional diabetes and oral health management. Methods: A sequential mixed-methods exploratory research design was used. General practice and oral health professionals were recruited from four community health centres in Melbourne. Quantitative surveys explored participants’ experiences, attitudes and knowledge of diabetes and oral health management and interprofessional collaboration; qualitative follow-up interviews explored survey responses with selected participants. Results: 58 participants completed the online surveys; 22 then participated in semi-structured interviews. Participants generally had strong intentions to collaborate interprofessionally in diabetes and oral health management. Most general practice and oral health professional participants were willing to perform simple screening for periodontitis or diabetes respectively. Themes from the interviews were grouped under three domains: ‘attitude towards diabetes and oral health management’, ‘subjective norms’ and ‘perceived behavioural control’; and an overarching domain to describe participants’ ‘current practice’. Existing siloed primary healthcare practices and lack of formal referral pathways contribute to poor interprofessional collaboration. Most participants were unsure of each other’s responsibilities and roles. Their lack of training in the relationship between general and oral health, compounded by systemic barriers including time constraint, high dental costs, long public dental waiting list and unintegrated health information systems, also impeded interprofessional care. Conclusions: The diabetes and oral health link is not properly recognised or managed collaboratively by relevant primary healthcare professionals in Australia. There is, nonetheless, strong intentions to engage in interprofessional diabetes and oral health care to contribute to improved patient outcomes. Primary healthcare professionals need dedicated and accredited interprofessional training and competencies, formal referral systems and sustainable health policies to facilitate collaboration.

ObjectivesAustralian guidelines recommend all adults aged 50–70 years old without existing contraindications consider taking low-dose aspirin (100–300 mg per day) for at least 2.5 years to reduce their risk of developing colorectal cancer. We aimed to explore clinicians’ practices, knowledge, opinions, and barriers and facilitators to the implementation of these new guidelines.MethodsSemistructured interviews were conducted with clinicians to whom the new guidelines may be applicable (Familial Cancer Clinic staff (geneticists, oncologists and genetic counsellors), gastroenterologists, pharmacists and general practitioners (GPs)). The Consolidated Framework for Implementation Research (CFIR) underpinned the development of the interview guide. Coding was inductive and themes were developed through consensus between the authors. Emerging themes were mapped onto the CFIR domains: characteristics of the intervention, outer setting, inner setting, individual characteristics and process.ResultsSixty-four interviews were completed between March and October 2019. Aspirin was viewed as a safe and cheap option for cancer prevention. GPs were considered by all clinicians as the most important health professionals for implementation of the guidelines. Cancer Council Australia, as a trusted organisation, was an important facilitator to guideline adoption. Uncertainty about aspirin dosage and perceived strength of the evidence, precise wording of the recommendation, previous changes to guidelines about aspirin and conflicting findings from trials in older populations were barriers to implementation.ConclusionWidespread adoption of these new guidelines could be an important strategy to reduce the incidence of bowel cancer, but this will require more active implementation strategies focused on primary care and the wider community.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12620001003965).

Medications form a significant portion of spending in primary health care. Angiotensin-converting enzyme inhibitors (ACE-Is) are among the most prescribed blood pressure medications in general practice. Medications within this class are considered therapeutically equivalent, but the cost of each ACE-I varies. Our aim was to explore cost and other factors that influence general practitioners (GPs) to prescribe a specific ACE-I and understand their views on therapeutic interchange within this drug class. We conducted a qualitative study of Australian GPs using thematic analysis. We found that GPs were aware of therapeutic equivalency within the ACE-I class, but unaware of the cost differences. Although GPs tended to adopt a prescribing preference, they were open to fewer prescribing options if there was a decreased cost to patients and the PBS, or potential to minimise prescribing error. Our findings have immediate relevance for national prescribing policies and the Pharmaceutical Benefits Scheme (PBS). The wide selection of ACE-Is that are available results in diverse prescribing patterns and may not be cost-effective for patients or the PBS. Restricting the number of drug options within the ACE-I class in primary care appears to be an acceptable drug cost-containment strategy according to our sample of GPs.

Diabetes and oral disease are becoming increasingly prevalent in Australia and share a bidirectional relationship. Despite this relationship, collaboration between the medical and dental professions is limited. This study assessed the available evidence of interprofessional educational programs on diabetes and oral health management and their effects on knowledge and confidence of health professionals involved. This review included randomized and non-randomized-controlled trials and before-and-after comparison studies in English with no limits on the year of publication. Electronic databases Medline, EMBASE, Emcare, and CINAHL were systematically searched and studies were critically appraised. Nineteen articles were identified from 411 for full-text screening. Four studies of a quasi-experimental design with a pre- and posttest evaluation were included in the review. Of these, three studies reported positive changes in the participants' knowledge of the roles of other healthcare professionals with improved attitudes toward interprofessional collaboration and communication, and one reported increased confidence of medical and dental professionals when working in an interprofessional team. Interprofessional education should improve health professionals' attitudes and knowledge of the roles of other health professionals in managing diabetes and oral health and their confidence in working together. However, given the limited availability of interprofessional education on diabetes and oral health management, continuous research in this area would improve the evidence base.

ObjectivesIn Australia, therapeutic interchange of angiotensin-converting enzyme (ACE) inhibitors could generate savings for patients and the Pharmaceutical Benefits Scheme (PBS). The PBS subsidises nine drugs in the ACE inhibitor class. These drugs are therapeutically equivalent, but the price varies between each drug. Patients are key players in successful therapeutic interchange programmes, but little is known about their views. This study aims to explore patient views of therapeutic interchange of ACE inhibitors in Australian primary care.DesignQualitative exploratory research study using semi-structured interviews, asking participants about therapeutic interchange and their attitude towards hypothetically switching ACE inhibitors. Data were analysed thematically.SettingAustralian primary care.ParticipantsFourteen adults in Australia currently taking an ACE inhibitor, recruited via general practices and pharmacies, social media and professional networks.FindingsFive key themes were identified: participants’ limited understanding of medication; the expectation that a new drug would be ‘the same’; the view that choice, convenience and fear of change outweigh the cost; altruism; and trust in health professionals, particularly participants’ own general practitioner (GP).ConclusionsPatients’ limited understanding of medication changes poses a barrier to therapeutic interchange. Clinicians should explore patients’ understanding and expectations of therapeutic interchange. Counselling from trusted health professionals, particularly GPs, could ameliorate concerns. Policymakers implementing therapeutic interchange programmes should ensure a trusted GP directs medication changes.

ObjectiveThis study aimed to explore how general practitioners (GPs) access and use both guidelines and electronic medical records (EMRs) to assist in clinical decision-making when prescribing antibiotics in Australia.DesignThis is an exploratory qualitative study with thematic analysis interpreted using the Theory of Planned Behaviour (TPB) framework.SettingThis study was conducted in general practice in Victoria, Australia.ParticipantsTwenty-six GPs from five general practices were recruited to participate in five focus groups between February and April 2018.ResultsGPs expressed that current EMR systems do not provide clinical decision support to assist with antibiotic prescribing. Access and use of guidelines were variable. GPs who had more clinical experience were less likely to access guidelines than younger and less experienced GPs. Guideline use and guideline-concordant prescribing was facilitated if there was a practice culture encouraging evidence-based practice. However, a lack of access to guidelines and perceived patients’ expectation and demand for antibiotics were barriers to guideline-concordant prescribing. Furthermore, guidelines that were easy to access and navigate, free, embedded within EMRs and fit into the clinical workflow were seen as likely to enhance guideline use.ConclusionsCurrent barriers to the use of antibiotic guidelines include GPs’ experience, patient factors, practice culture, and ease of access and cost of guidelines. To reduce inappropriate antibiotic prescribing and to promote more rational use of antibiotic in the community, guidelines should be made available, accessible and easy to use, with minimal cost to practicing GPs. Integration of evidence-based antibiotic guidelines within the EMR in the form of a clinical decision support tool could optimise guideline use and increase guideline-concordant prescribing.

BACKGROUND AND OBJECTIVES General practitioners (GPs) are known to encounter challenges when working with patients from refugee backgrounds. In this study we explore GPs’ perceptions of a trial version of the Australian Refugee Health Practice Guide website, an online resource designed to support GPs working in refugee health. METHOD We conducted semi-structured interviews in two phases with 10 GPs from Melbourne, Victoria. Data analysis involved a mixed inductive and deductive framework analysis approach. RESULTS The website was viewed as a central repository of refugee health–specific information with useful links. It helped fill knowledge gaps for participants and affirm existing practice. The volume of text on each page was a potential barrier to use in clinical practice. DISCUSSION Supporting GPs to become familiar with the website, further adapting it to make key information rapidly accessible and keeping it up to date will be critical to its future uptake.

Background and objectives Preventive care in general practice is fundamental to managing the Australian diabetes epidemic. Recommended preventive care is nonetheless underperformed. The aim of this pilot study was to demonstrate proof of concept that pre-consultation patient-directed reminders could improve preventive care in general practice. Method Over two weeks, four general practices used a special software tool to generate reminder sheets listing recommended checks for a subset of patients with type 2 diabetes mellitus (T2DM). The sheets were given to patients before their consultations. The number of checks performed was compared for patients who did and did not receive reminders. General practitioners (GPs) were interviewed about the reminders and chronic disease management. Results Patients who received reminders had more recommended checks performed than those who did not receive reminders. GPs found the reminders useful but suggested that broader system changes are required. Discussion Pre-consultation patient-directed reminders could potentially be an effective tool to increase preventive care for patients with T2DM in general practice.

Introduction: Interdisciplinary care is critical in diabetes management. There is evidence of a two-way relationship between diabetes and periodontal (gum) disease. Yet, medical and dental professionals continue to work in silos. This project aimed to develop and pilot an integrated diabetes oral health care model involving general practitioners (GPs), primary healthcare nurses (PHCNs) and oral health professionals (OHPs) in community health settings. Methods: Mixed methods exploratory study was conducted. GPs, PHCNs and OHPs from four Australian community health centres with co-located medical and dental services participated in online surveys and some were selected for follow-up semi structured interviews to explore their perspectives on diabetes and periodontal care. An integrated care model comprising risk screening, assessment and referral processes was then developed based on the findings and advice from an advisory committee. Information and training on the model were provided before practitioners at one community health centre piloted the model for 2 weeks. Following the pilot, practitioners involved participated in focus groups and interviews to explore feasibility and acceptability of the model. All quantitative data was analysed descriptively, and qualitative data was analysed thematically. Results: Fifty-eight practitioners completed the online surveys. Just over half were confident to identify risk factors or manage comorbid diabetes and periodontal conditions. Fewer than 2 in 10 always or often referred their patients with diabetes or periodontal conditions to each other. All except one agree that better interprofessional collaboration would benefit patients with diabetes. Twenty-two practitioners participated in follow-up interview. Themes elicited were grouped under 4 domains: current practice, attitudes towards diabetes oral health management, subjective norms that influence attitudes, perceived behavioural controls that impact on integrated care. During the pilot, 7 OHPs conducted 28 diabetes risk assessments, 7 GP/PHCNs conducted 59 periodontal risk assessments, resulting in 7 medical and 23 dental referrals. Eleven practitioners then participated in focus groups and interviews. Most found the model acceptable and feasible although there were concerns about patients’ receptiveness, time constraint, unintegrated information system, long dental appointment waiting list and lack of education in comorbid diabetes and periodontal disease. Discussions: Interprofessional collaboration and education would improve diabetes and periodontal disease management. An integrated care model that addresses the beliefs and barriers that impact on health care professionals’ collaboration is needed. Findings from this study have informed the development of a multidisciplinary educational program for diabetes management and the refining of the integrated diabetes oral health care model. Conclusion: The developed integrated diabetes oral health care model was acceptable and feasible in the Australian community health setting. Lessons learned: Different funding models and priorities between clinical services, time constraint, costs and paperwork all influence the uptake of new knowledge and practices. Healthcare professionals need to understand each other’s roles and have opportunities to share information effectively. Limitations: Small sample sizes; study conducted only in community health setting; pilot conducted only in one community health service. Suggestions for future research: Future development of a cost-effective integrated care model would provide best practice care for patients with comorbid diabetes and periodontal conditions.

Medically and non-medically trained researchers make critical contributions to rigorous primary health care research. Non-medically qualified staff face unique challenges compared with medically qualified counterparts when entering academic primary care. They often encounter challenges in professional identity, building a career within a discipline that is medically focused and, accessing continuing academic appointments or fellowship funding which is often restricted to those with medical qualifications. Navigating opportunities for career advancement can be difficult with few easily identifiable and accessible ‘Champions’ for Primary Health Care Scientists. In the UK, the Society for Academic Primary Care (SAPC) recognised this gap and addressed it by creating PHoCuS – a group within SAPC for Primary Health Care Scientists. The PHoCuS group was established to better understand and address the career development needs of SAPC members from non-medical backgrounds. Establishing a similar group in Australia and New Zealand that understands and can address the needs of nonmedical academics and researchers working in academic primary care is a conversation we need to have. Sitting within an overarching representative body like AAAPC, a Primary Health Care Scientists group will give voice and champion the work of non-medical academics and researchers, and facilitate career support and development for this group. How it is relevant to primary care? Non-medical researchers make up as much as 70% of the primary health care research workforce in Australia (Barton et al. 2015, Oliver-Baxter et al. 2016). They play critical roles leading, informing, supporting and enabling primary care research. They enhance the quality of primary care research through using rigorous methodologies and contribute to building a stronger evidence-base for general practice and primary care. And yet, this diverse group, made up of individuals from a broad range of disciplinary backgrounds (Barton et al. 2015, Yen et al. 2010) lacks a clearly defined professional identity and has little professional representation that can advocate for their unique roles and career development needs. Continuing this situation poses an inevitable threat to the development and maintenance of primary care research capacity in Australia and New Zealand. AAAPC has over the years evolved from its original focus on representation and advocacy for Australian academic GPs to today embracing a broad vision of academic primary care that recognises and celebrates the multidisciplinary make-up of the academic primary care workforce in Australia and New Zealand. Establishing a Primary Health Care Scientists group in AAAPC will further demonstrate commitment to this vision. The impact it would make to patients and communities: A Primary Health Care Scientists group will promote a more stable and engaged research workforce. Retention of researchers and academics with specific disciplinary methodological expertise will improve the quantity and quality of primary health care research evidence in Australia and New Zealand.

Closing the gap in health and welfare for Aboriginal and Torres Strait Islander peoples is an ongoing challenge.The objectives of this article are to conceptualise and operationalise models of cultural mentorship within a multifaceted practice-based program to facilitate culturally and clinically appropriate care.Participatory action research and workshops were conducted with Aboriginal Elders, Aboriginal health workers (AHWs), Indigenous health project officers (IHPOs) and staff from participating Medicare Locals (MLs).Roles and responsibilities in a cultural mentorship relationship were defined, along with potential benefits and harm. Mentors and mentees should be comfortable with their own identity and/or ethnicity before engaging in a mentorship relationship. Mutual trust is implicit and participants must be prepared, flexible and mutually respectful to achieve mutual goals. The cultural mentorship model includes Aboriginal Elders and local care partnerships of Aboriginal community-controlled and primary care organisations, and practice mentorship teams of a local AHW/IHPO, research project officer and, where available, ML practice support officer.A successful cultural mentorship model is multi-level and safe, and requires mutual trust and respect, time and resources. Potential benefits include equitable access to, and use of, safe quality care for Aboriginal and Torres Strait Islander patients in general practice.

Background Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity – defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire – of the streamed simulations. Design and Methods In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted. Results Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P

Rocky, an Aboriginal man in his 40s, who has spent half his life in jail as he has seriously misused alcohol since his teens, has not re-offended and intends to work with Indigenous prisoners in similar circumstances after a healing programme staff, with mental health colleagues, implemented an intensive spiritual healing and rehabilitation programme, tailored for Rocky. The article started with Rocky's story reviews the social and economic issues related to Aboriginal people, particularly the issue of the over presentation in Australian prison system. It explores the pilot healing programme, adopts a fully holistic approach that focuses on Indigenous rights to self-determination and the individual's path to physical, psychological and spiritual healing as one of the community-initiated projects.

This paper aims to explore the barriers and facilitators for Aboriginal and Torres Strait Islander Australians with chronic disease to access urban, mainstream general practice and primary health care. Six focus groups and five interviews were conducted with 40 participants that included Aboriginal people with diabetes, health service providers and policy makers. Using diabetes as the exemplar, participants were asked to relate their own experiences of diabetes management. Data was thematically analysed. Two overarching themes and seven other factors were identified as influencing Aboriginal people's access to health services. Cultural competence can be achieved within a health service when all nine factors are addressed in the context of the local community. Closing the health gap between Aboriginal and non-Aboriginal Australians requires a particular sensitivity and understanding of the facilitators and barriers for urban Aboriginal people accessing mainstream health services.

This article describes the way a multidisciplinary research team set about 'Aboriginalising' their research processes in the initial phase of a project that aimed to develop a culturally appropriate model of care for urban Aboriginal people with diabetes. Although academic conventions and protocols tended to dominate, the project incorporated the innovative approach that the Aboriginal researchers brought to the process of recruiting and facilitating focus groups, which they likened to 'hunting and gathering'. In developing and strengthening partnerships between research institutions and Aboriginal communities, it is important that Aboriginal and non-Aboriginal researchers challenge the conventional academic models of research in ways that are culturally appropriate and informed by Aboriginal scholarship. This article illustrates the difficulties and challenges on both sides of the partnership. It concludes by outlining the key principles learnt during the first phase of the project.

Australian guidelines recommend annual screening and monitoring of chronic kidney disease (CKD) in people with type 2 diabetes (T2D). A cross-sectional study utilising data from NPS Medicine Wise Medicine Insight program from June 2015 to May 2016 was undertaken to explore: (1) the proportion of patients with T2D attending general practice who have had screening for, or ongoing monitoring of, CKD; (2) the proportion of patients without a documented diagnosis of CKD who have pathology consistent with CKD diagnosis; and (3) the patient factors associated with screening and the recording of a diagnosis of CKD. Of 90 550 patients with T2D, 44 394 (49.0%) were appropriately screened or monitored. There were 8030 (8.9%) patients with a recorded diagnosis of CKD, whereas 6597 (7.3%) patients had no recorded diagnosis of CKD despite pathology consistent with a diagnosis. Older age and diagnosis of hypertension or hyperlipidaemia were associated with increased odds of CKD diagnosis being recorded. Older patients, males, those with recorded diagnoses of hypertension or hyperlipidaemia and those who had their medical record opened more frequently were more likely to be screened appropriately. Screening and monitoring of CKD appears suboptimal. Research to explore barriers to screening, recording and monitoring of CKD, and strategies to address these, is required. Refereed/Peer-reviewed

Aim To assess the impact of a community pharmacy diabetes service model on patient outcomes in Type 2 diabetes. Methods The study utilized a multisite, control vs. intervention, repeated-measures design within four states in Australia. Fifty-six community pharmacies, 28 intervention and 28 control, were randomly selected from a representative sample of urban and rural areas. Intervention pharmacies delivered a diabetes service to patients with Type 2 diabetes, which comprised an ongoing cycle of assessment, management and review, provided at regular intervals over 6 months in the pharmacy. These services included support for self monitoring of blood glucose, education, adherence support, and reminders of checks for diabetes complications. Control pharmacists assessed patients at 0 and 6 months and delivered no intervention. Results A total of 289 subjects (149 intervention and 140 control) completed the study. For the intervention subjects, the mean blood glucose level decreased over the 6-month study from 9.4 to 8.5 mmol/l (P < 0.01). Furthermore, significantly greater improvements in glycaemic control were seen in the intervention group compared with the control: the mean reduction in HbA1c in the intervention group was −0.97% (95% CI: −0.8, −1.14) compared with −0.27% (95% CI: −0.15, −0.39) in the control group. Improvements were also seen in blood pressure control and quality of life in the intervention group. Conclusion A pharmacy diabetes service model resulted in significant improvements in clinical and humanistic outcomes. Thus, community pharmacists can contribute significantly to improving care and health outcomes for patients with Type 2 diabetes. Future research should focus on clarifying the most effective elements of the service model.

Objective To compare the efficacy and cost-effectiveness of two methods of screening for undiagnosed type 2 diabetes in Australian community pharmacy. Methods A random sample of 30 pharmacies were allocated into two groups: (i) tick test only (TTO); or (ii) sequential screening (SS) method. Both methods used the same initial risk assessment for type 2 diabetes. Subjects with one or more risk factors in the TTO group were offered a referral to their general practitioner (GP). Under the SS method, patients with risk factors were offered a capillary blood glucose test and those identified as being at risk referred to a GP. The effectiveness and cost-effectiveness of these approaches was assessed. Results A total of 1286 people were screened over a period of 3 months. The rate of diagnosis of diabetes was significantly higher for SS compared with the TTO method (1.7% versus 0.2%; p =0.008). The SS method resulted in fewer referrals to the GP and a higher uptake of referrals than the TTO method and so was the more cost-effective screening method. Conclusions SS is the superior method from a cost and efficacy perspective. It should be considered as the preferred option for screening by community based pharmacists in Australia.