The new Australian Primary Health Networks: how will they integrate public health and primary care?

Booth, Mark; Hill, Graham; Moore, Michael J.; Dalla, Danielle; Moore, Michael G.; Messenger, Anne

doi:10.17061/phrp2611603

Cited by 90 publications

(62 citation statements)

References 7 publications

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“…Our study highlights the need not only for improved and culturally appropriate primary care provision for indigenous patients, but also improved communication and follow up after strokes. Future utilisation of a stroke nurse and Aboriginal medical services to ensure engagement with primary community care, as well as developing systems to ensure inpatient investigations are completed prior to discharge, may be used to improve follow up on discharge . The importance of engagement with primary community care is reinforced as some patients had no GP identified on their electronic medical record with whom the discharge summary was to be sent for completion of requested investigations.…”

Section: Discussionmentioning

confidence: 99%

“…The implementation of acute stroke units has improved patient morbidity and mortality . Guidelines emphasise the benefits of early and ongoing rehabilitation involving allied health staff and the role of the general practitioner (GP) in the prevention of future strokes and optimisation of stroke risk factors . The transition of care between hospitals and primary healthcare physicians has been identified as high risk for compromising the care of patients, with 15% of all adverse events reported by Australian GPs are due to poor communication on discharge .…”

Section: Introductionmentioning

confidence: 99%

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Management of stroke in the Australian Indigenous population: from hospitals to communities

Tiedeman

Suthers

Julien

et al. 2019

Internal Medicine Journal

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Background Ischaemic strokes lead to significant morbidity and mortality within the Australian Indigenous population, with known variances in the management of strokes between indigenous and non‐indigenous populations. Aims To compare investigations and management of indigenous and non‐indigenous patients presenting to a New South Wales rural referral hospital with an ischaemic stroke to the national stroke standards across inpatient and outpatient settings. Methods Historical cohort study of 43 indigenous and 167 non‐indigenous patients admitted to Tamworth Rural Referral Hospital with an ischaemic cerebrovascular accident. Results Indigenous patients were significantly less likely to have investigations completed, including carotid imaging (93.8% vs 100%, P = 0.012) and echocardiography (73.3% vs 97.7%, P = 0.004). Discharge follow up was significantly lower for the indigenous population (74.4% vs 87.4%, P = 0.034). Indigenous stroke patients were 15.8 years younger than non‐indigenous subjects (56.8 vs 72.6 years old; P < 0.001). Indigenous patients were more likely to have stroke risk factors, including smoking (51.2% vs 15.0%; P < 0.001), diabetes mellitus (37.2% vs 16.8%, P = 0.003) and past history of cerebrovascular accident or transient ischaemic attack (50.2% vs 31.1%, P = 0.032). Conclusions The investigation and post‐discharge care of indigenous ischaemic stroke patients is inferior to non‐indigenous patients. Indigenous patients within rural NSW have a higher prevalence of preventable disease, including those that confer a higher stroke risk. Further research is needed to investigate the cause of these discrepancies and to improving indigenous stroke care between hospitals and primary care providers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of stroke in the Australian Indigenous population: from hospitals to communities

Tiedeman

Suthers

Julien

et al. 2019

Internal Medicine Journal

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“…In Australia the newly formed Primary Health Care Networks are in a strong position to provide the necessary infrastructure to better support the role of general practice and coordinate the activities of health professionals, Local Health Districts and nongovernment organisations. These independent organisations are aligned with Local Hospital Networks and with their mandate to improve the effectiveness of medical services, especially for priority populations, they can better coordinate abortion care across the primary and public health systems [31]. …”

Section: Discussionmentioning

confidence: 99%

Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study

et al. 2017

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BackgroundAustralian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs.MethodsWe undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically.ResultsThree main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted.ConclusionsExploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition, formalised referral pathways to the public sector are required to ensure timely care in the case of complications or the provision of surgical options. Leadership and coordination across the health sector is needed to facilitate integrated abortion care particularly for rural and low income women.

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“…In 2015, Primary Health Networks were introduced in the most significant transformation of the Australian health-care system since Medicare and will assume the lead role in planning across mental health, substance misuse, and suicide prevention initiatives at the regional and local levels. The need for evidence-based approaches was reiterated for the priority Indigenous populations (Booth et al, 2016). School-based programs were identified as offering particular opportunities for Indigenous adolescents (Commonwealth of Australia, 2013).…”

Section: Discussionmentioning

confidence: 99%

The Development of a Survey Instrument to Assess Aboriginal and Torres Strait Islander Students’ Resilience and Risk for Self-Harm

et al. 2017

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Background: Australian policies for Aboriginal and Torres Strait Islander well-being outline the importance of local community-based interventions; for adolescents, schoolbased programs have been identified as beneficial. However, there is a lack of localized data to determine levels of resilience and risk and thus whether programs are effective. This paper describes the challenges and opportunities in collaboratively designing and piloting a localized survey instrument to measure Indigenous students' resilience and upstream risk factors for self-harm and the resultant instrument.Methods: A participatory action research approach was used to engage education staff, health-care providers, students, and researchers to design and pilot the survey instrument. A six-phased process facilitated survey development: (1) defining the logic and exploring the evidence; (2) understanding and tailoring for context; (3) testing for feasibility and relevance; (4) testing for appropriateness and comprehension; (5) facilitating survey administration; and (6) refining the instrument. Processes in each phase were recorded and transcribed with thematic analysis used to identify key challenges and opportunities arising during development.results: Four key challenges and opportunities were identified: (1) the relevance of international survey instruments for Indigenous Australian students; (2) accounting for distinct environments; (3) the balance between assessing risk and protective factors; and (4) tailoring for literacy levels and school engagement. The final Student Survey instrument comprised 4 demographic and 56 resilience, risk, service use, and satisfaction questions. The T4S will be administered routinely on annual student intake. Discussion and conclusion: The six-phased participatory processes resulted in a tailored instrument that could identify the critical resilience and upstream risk factors facing a cohort of Indigenous students who attend boarding schools for secondary education. Challenges were resolved collaboratively and the pilot results were directly translated to education practice and its integration with health services. Our results suggest that both the phased process of developing the T4S and the instrument itself can be adapted for other Indigenous adolescent well-being and/or self-harm prevention programs.

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The new Australian Primary Health Networks: how will they integrate public health and primary care?

Cited by 90 publications

References 7 publications

Management of stroke in the Australian Indigenous population: from hospitals to communities

Management of stroke in the Australian Indigenous population: from hospitals to communities

Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study

The Development of a Survey Instrument to Assess Aboriginal and Torres Strait Islander Students’ Resilience and Risk for Self-Harm

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