BackgroundPopulation health planning within a health district requires current information on health profiles of the target population. Information obtained during primary care interactions may provide a valuable surveillance system for chronic disease burden. The Sentinel Practices Data Sourcing project aimed to establish a sentinel site surveillance system to obtain a region-specific estimate of the prevalence of chronic diseases and mental health disorders within the Illawarra-Shoalhaven region of New South Wales, Australia.MethodsIn September 2013, de-identified information for all patient interactions within the preceding 24 months was extracted and collated using a computerised chronic disease management program that has been designed for desktop application (Pen Computer Systems Clinical Audit Tool: ™ (PCS CAT)). Collated patient data included information on all diagnosed pathologies and mental health indicators, clinical variables such as anthropometric measures, and patient demographic variables such as age, sex, geographical location of residence and indigenous status. Age-standardised prevalence of selected health conditions was calculated.ResultsOf the 52 general practices within the 6 major Statistical Local Areas (SLAs) of the health district that met the inclusion criteria, 17 consented to participate in the study, yielding data on n = 152,767 patients, and representing 39.7% of the regional population. Higher than national average estimates were found for the age-adjusted prevalence of chronic diseases such as obesity/overweight (65.9% vs 63.4%), hypertension (11.9% vs 10.4%) and anxiety disorders (5.0% vs 3.8%), but a lower than national average age-adjusted prevalence of asthma (8.0% vs 10.2%) was also identified.ConclusionsThis proof-of-concept study has demonstrated that the scope of data collected during patient visits to their general practitioners (GPs), facilitated through the Medicare-funded primary health care system in Australia, provides an opportunity for monitoring of chronic disease prevalence and its associated risk factors at the local level. Selection of sentinel sites that are representative of the population being served will facilitate an accurate and region-specific system for the purpose of population health planning at the primary care level.

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BackgroundTechnological advances in clinical data capturing and storage systems have led to recent attempts at disease surveillance and region specific population health planning through regularly collected primary care administrative clinical data. However the accuracy and comprehensiveness of primary care health records remain questionable.MethodsWe aimed to explore the perceptions and experiences of general practice staff in maintaining accurate patient health data within clinical software used in primary care settings of regional NSW. Focus groups were conducted with general practitioners, practice nurses and practice administrative staff from 17 practices in the Illawarra-Shoalhaven region of the state of New South Wales (NSW) in Australia that had participated in the Sentinel Practices Data Sourcing (SPDS) project - a general practice based chronic disease surveillance and data quality improvement study. A total of 25 respondents that included 12 general practitioners (GPs) and 13 practice staff participated in the 6 focus groups. Focus groups were audio-recorded and transcribed verbatim. Thematic analysis of the data was undertaken.ResultsFive key themes emerged from the data. Firstly, the theme of resourcing data management raised issues of time constraints, the lack of a dedicated data management role and the importance of multidisciplinary involvement, including a data champion. The need for incentives was identified as being important to motivate ongoing commitment to maintaining data quality. However, quality of software packages, including coding issues and software limitations and information technology skills were seen as key barriers. The final theme provided insight into the lessons learnt from the project and the increased awareness of the importance of data quality amongst practice staff.ConclusionThe move towards electronic methods of maintaining general practice patient records offers significant potential benefits in terms of both patient care and monitoring of health status and health needs within the community. However, this study has reinforced the importance of human factors in the maintenance of such datasets. To achieve optimal benefits of electronic health and medical records for patient care and for population health planning purposes, it is extremely essential to address the barriers that clinicians and other staff face in maintaining complete and correct primary care patient electronic health and medical information.

ObjectivesTo identify smaller geographic and region-specific evidence to inform population health planning for overweight and obesity.DesignCross-sectional secondary analysis of data.SettingPrimary healthcare—17 general practices located in the Illawarra-Shoalhaven region of New South Wales (NSW).ParticipantsA subset (n=36 674) of the Sentinel Practices Data Sourcing project adult persons data set (n=118 794) that included information on disease status of all adult patients who had height and weight measurements recorded in their electronic health records and had visited the included general practices within the Illawarra-Shoalhaven region of NSW between September 2011 and September 2013.Main outcome measuresAge-adjusted odds ratio (aOR) of overweight and obesity was determined for high and low levels of socioeconomic disadvantage based on Socio-Economic Indexes for Areas (SEIFA)—Index of Relative Socio-Economic Disadvantage (IRSD) scores of patients' residential statistical local area.ResultsIn men, overweight was lowest in areas of highest socioeconomic disadvantage (aOR=0.910; 95% CI 0.830 to 0.998; p<0.001); but no statistically significant association with socioeconomic score was found for women. Overall obesity was associated with high socioeconomic disadvantage (aOR=1.292; 95% CI 1.210 to 1.379; p<0.001).ConclusionsThis type of data analysis reveals multiple layers of evidence that should be assessed for population health approaches to curb the epidemic of obesity and overweight. It strongly highlights the need for preventive health initiatives to be specific to gender and socioeconomic attributes of the target population.

In Australia, older adults aged 75+ years are encouraged to avail themselves of the comprehensive 75+ health assessment (75+ HA) to identify medical conditions and highlight potential risk factors for poor health. However, uptake of this item has been reported to be low. This study aimed to identify the uptake of the 75+ HA within regional areas of New South Wales and compare this against state and national trends over an 11-year period. Data on uptake of the 75+ HA for item numbers 700 and 702, from 1999 until 2010, were obtained from the Medicare Australia portal and Department of Health and Ageing databases. Trends over time were collated and compared at the regional, state and national level. The study found that an increasing number of the 75+ HAs were performed from 1999 to 2009. Overall, the uptake of the 75+ HA is generally low across Australia, at ~20% of the eligible population, but varied across states and even regions within states. The study also revealed that despite low uptake encouraging trends were evident over a decade of 75+ HA implementation. It is argued that strategies in improving the uptake should be targeted for early identification of health risk and overall improved quality of health in older adults. KeywordsGeneral practice, older adults, primary health care, primary prevention . Overall, the uptake of the 75+ HA was generally low across Australia, at ~20% of the eligible population, but varied across states and even regions within states. The study also revealed that despite low uptake encouraging trends were evident over a decade of 75+ HA implementation. It is argued that strategies in improving the uptake should be targeted for early identification of health risk and overall improved quality of health in older adults.

Background & aims Older malnourished patients experience increased length of hospital stay and greater morbidity compared to their well nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 12 months follow-up. Methods Secondary data analysis of 2602 consecutive patient admissions to an acute tertiary hospital in New South Wales, Australia on or before 1st June 2009. Twelve-month data was analysed in a sub-sample of 774 patients. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records included hospital readmission rate, total length of stay (LOS), change in level of care at discharge, and in-hospital mortality. Results A third (34%) of patients were malnourished and 55% at risk of malnutrition. Using a Cox proportional hazards regression model, controlling for underlying illness and age, patients at risk of malnutrition were 2.46 (95% CI: 1.36, 4.45; p = 0.003) times more likely to have a poor clinical outcome (mortality/discharge to higher level of care), while malnourished patients had a 3.57 (95% CI: 1.94, 6.59; p = 0.000) times higher risk. Conclusions A poor nutritional status carries a substantially greater risk of death and/or loss of dependency in older adults. Interventions to improve the nutritional status of patients during their hospital stay, and following discharge back to the community, are needed to lower the risk of adverse outcomes.

BackgroundChronic disease risk on a population level can be quantified through health surveys, either continuous or periodic. To date, information gathered from primary care interactions, using sentinel sites, has not been investigated as a potentially valuable surveillance system in Australia.MethodsA pilot study was conducted in a single General Practice in a regional area of New South Wales, Australia to assess the feasibility of accessing data obtained through a computerised chronic disease management program that has been designed for desktop application (Pen Computer Systems (PCS) Clinical Audit Tool: ™ PCS CAT). Collated patient data included information on chronic disease management and prevention, prevalence of overweight and obesity, mental health indicators, medication profiling and home medicine reviews, as well as uptake of preventive health services (immunisation and cervical cancer screening).ResultsHigher than national average estimates were found for the age-adjusted prevalence of chronic diseases such as hypertension (14.3% for sample vs 10.4%, nationally), anxiety disorders (4.4% vs 3.8%) and obesity/overweight (67.1 vs 63.4%). Preventive health assessment items were undersubscribed, ranging from 6–20% in eligible patients.ConclusionsThis pilot study has demonstrated that the scope of data collected by patient visits to their General Practitioners, facilitated through the Medicare-funded primary health care system in Australia, offers a feasible opportunity for monitoring of chronic disease prevalence and its associated risk factors. The inclusion of a larger number of sentinel sites that are generalizable to the population being served would provide an accurate and region-specific system for the purposes of population health planning at the primary care level in order to improve the overall health of the community.

BackgroundNutrition screening in older adults is not routinely performed in Australian primary care settings. Low awareness of the extent of malnutrition in this patient group, lack of training and time constraints are major barriers that practice staff face. This study aimed to demonstrate the feasibility of including a validated nutrition screening tool and accompanying nutrition resource kit for use with older patients attending general practice. Secondary aims were to assess nutrition-related knowledge of staff and to identify the extent of malnutrition in this patient group.MethodsNine general practitioners, two general practice registrars and 11 practice nurses from three participating general practices in a rural, regional and metropolitan area within a local health district of New South Wales, Australia were recruited by convenience sampling.Individual in-depth interviews, open-ended questionnaires and an 11-item knowledge questionnaire were completed three months following in-practice group workshops on the Mini Nutritional Assessment Short Form (MNA-SF). Staff were encouraged to complete the MNA-SF within the Medicare-funded 75+ Health Assessment within this time period. Staff interviews were digitally recorded, transcribed verbatim and analysed thematically using qualitative analysis software QSR NVivo 10.ResultsFour key themes were determined regarding the feasibility of performing MNA –SF: ease of use; incorporation into existing practice; benefit to patients’ health; and patients’ perception of MNA-SF. Two key themes related to the nutrition resource kit: applicability and improvement. These findings were supported by open ended questionnaire responses. Knowledge scores of staff significantly improved from baseline (52% to 66%; P < 0.05). Of the 143 patients that had been screened, 4.2% (n = 6) were classified as malnourished, 26.6% (n = 38) ‘at risk’ of malnutrition and 69.2% (n = 99) as well-nourished.ConclusionIt is feasible to include the MNA-SF and a nutrition resource kit within routine general practice, but further refinement of patients’ electronic clinical records in general practice software would streamline this process.