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Namsrai T, Phillips C, Parkinson A, Gregory D, Kelly E, Cook M, Desborough J. Diagnostic delay of sarcoidosis: an integrated systematic review. Orphanet J Rare Dis 2024; 19:156. [PMID: 38605384 PMCID: PMC11010435 DOI: 10.1186/s13023-024-03152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Sarcoidosis is a chronic inflammatory granulomatous disease of unknown cause. Delays in diagnosis can result in disease progression and poorer outcomes for patients. Our aim was to review the current literature to determine the overall diagnostic delay of sarcoidosis, factors associated with diagnostic delay, and the experiences of people with sarcoidosis of diagnostic delay. METHODS Three databases (PubMed/Medline, Scopus, and ProQuest) and grey literature sources were searched. Random effects inverse variance meta-analysis was used to pool mean diagnostic delay in all types of sarcoidosis subgroup analysis. Diagnostic delay was defined as the time from reported onset of symptoms to diagnosis of sarcoidosis. RESULTS We identified 374 titles, of which 29 studies were included in the review, with an overall sample of 1531 (694 females, 837 males). The overall mean diagnostic delay in all types of sarcoidosis was 7.93 months (95% CI 1.21 to 14.64 months). Meta-aggregation of factors related to diagnostic delay in the included studies identified three categories: (1) the complex and rare features of sarcoidosis, (2) healthcare factors and (3) patient-centred factors. Meta-aggregation of outcomes reported in case studies revealed that the three most frequent outcomes associated with diagnostic delay were: (1) incorrect diagnosis, (2) incorrect treatment and (3) development of complications/disease progression. There was no significant difference in diagnostic delay between countries with gatekeeper health systems (where consumers are referred from a primary care clinician to specialist care) and countries with non-gatekeeper systems. No qualitative studies examining people's experiences of diagnostic delay were identified. CONCLUSION The mean diagnostic delay for sarcoidosis is almost 8 months, which has objective consequences for patient management. On the other hand, there is a paucity of evidence about the experience of diagnostic delay in sarcoidosis and factors related to this. Gaining an understanding of people's experiences while seeking a diagnosis of sarcoidosis is vital to gain insight into factors that may contribute to delays, and subsequently inform strategies, tools and training activities aimed at increasing clinician and public awareness about this rare condition. TRIAL REGISTRATION PROSPERO Registration number: CRD42022307236.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
| | - Christine Phillips
- School of Medicine and Psychology, The Australian National University, Canberra, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
| | - Dianne Gregory
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
- Sarcoidosis Lyme Australia, Camden, Australia
| | - Elaine Kelly
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
- Sarcoidosis Lyme Australia, Camden, Australia
| | - Matthew Cook
- John Curtin School of Medical Research, The Australian National University, Canberra, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia.
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Bourke S, Munira SL, Parkinson A, Lancsar E, Desborough J. Exploring the barriers and enablers of diabetes care in a remote Australian context: A qualitative study. PLoS One 2023; 18:e0286517. [PMID: 37498850 PMCID: PMC10373998 DOI: 10.1371/journal.pone.0286517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/17/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE This qualitative study explored the current barriers and enablers of diabetes care in the Indian Ocean Territories (IOT). METHODS A constructivist grounded theory approach that incorporated semi-structured telephone interviews was employed. Initial analysis of the interview transcripts used a line-by-line approach, to identify recurring themes, connections, and patterns, before they were re-labelled and categorised. This was followed by axial coding, categorisation refinement, and mapping of diabetes triggers in the IOT. PARTICIPANTS AND SETTING The IOT, consisting of Christmas Island and the Cocos (Keeling) Islands, are some of the most remote areas in Australia. When compared with mainland Australia, the prevalence of type 2 diabetes in the IOT is disproportionately higher. There were no known cases of type 1 diabetes at the time of the study. Like other remote communities, these communities experience difficulties in accessing health services to prevent and manage diabetes. Twenty health care professionals and health service administrators in the IOT took part in semi-structured telephone interviews held during April-June 2020. Participants included GPs, nurses, dietitians, social and community services workers, school principals, and administrators. The interview questions focused on their perceptions of the current diabetes care in place in the IOT and their views on the challenges of providing diabetes care in the IOT. RESULTS We identified four main barriers and two main enabling factors to the provision of effective diabetes care in the IOT. The barriers were: (i) societal influences; (ii) family; (iii) changing availability of food; (v) sustainability and communication. The two main enablers were: (i) tailoring interventions to meet local and cultural needs and values; and (ii) proactive compliance with the medical model of care. CONCLUSION Due to the cultural and linguistic diversity within the IOT, many of the identified barriers and enablers are unique to this community and need to be considered and incorporated into routine diabetes care to ensure successful and effective delivery of services in a remote context.
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Affiliation(s)
- Siobhan Bourke
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Syarifah Liza Munira
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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Eysenbach G, Lin YK, Chhabra M, Henschke A, Brown E, Pedley L, Pedley E, Hannan K, Brown K, Wright K, Phillips C, Tricoli A, Nolan CJ, Suominen H, Desborough J. Toward Diabetes Device Development That Is Mindful to the Needs of Young People Living With Type 1 Diabetes: A Data- and Theory-Driven Qualitative Study. JMIR Diabetes 2023; 8:e43377. [PMID: 36696176 PMCID: PMC9947809 DOI: 10.2196/43377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND An important strategy to understand young people's needs regarding technologies for type 1 diabetes mellitus (T1DM) management is to examine their day-to-day experiences with these technologies. OBJECTIVE This study aimed to examine young people's and their caregivers' experiences with diabetes technologies in an exploratory way and relate the findings to the existing technology acceptance and technology design theories. On the basis of this procedure, we aimed to develop device characteristics that meet young people's needs. METHODS Overall, 16 in-person and web-based face-to-face interviews were conducted with 7 female and 9 male young people with T1DM (aged between 12 and 17 years) and their parents between December 2019 and July 2020. The participants were recruited through a pediatric diabetes clinic based at Canberra Hospital. Data-driven thematic analysis was performed before theory-driven analysis to incorporate empirical data results into the unified theory of acceptance and use of technology (UTAUT) and value-sensitive design (VSD). We used the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist for reporting our research procedure and findings. In this paper, we summarize the key device characteristics that meet young people's needs. RESULTS Summarized interview themes from the data-driven analysis included aspects of self-management, device use, technological characteristics, and feelings associated with device types. In the subsequent theory-driven analysis, the interview themes aligned with all UTAUT and VSD factors except for one (privacy). Privacy concerns or related aspects were not reported throughout the interviews, and none of the participants made any mention of data privacy. Discussions around ideal device characteristics focused on reliability, flexibility, and automated closed loop systems that enable young people with T1DM to lead an independent life and alleviate parental anxiety. However, in line with a previous systematic review by Brew-Sam et al, the analysis showed that reality deviated from these expectations, with inaccuracy problems reported in continuous glucose monitoring devices and technical failures occurring in both continuous glucose monitoring devices and insulin pumps. CONCLUSIONS Our research highlights the benefits of the transdisciplinary use of exploratory and theory-informed methods for designing improved technologies. Technologies for diabetes self-management require continual advancement to meet the needs and expectations of young people with T1DM and their caregivers. The UTAUT and VSD approaches were found useful as a combined foundation for structuring the findings of our study.
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Affiliation(s)
| | | | - Madhur Chhabra
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Adam Henschke
- Philosophy Section, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands
| | - Ellen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Lachlan Pedley
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Elizabeth Pedley
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.,The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australia
| | - Kristal Hannan
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Karen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.,The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australia
| | - Kristine Wright
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.,The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australia
| | - Christine Phillips
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Antonio Tricoli
- Nanotechnology Research Laboratory, Faculty of Engineering, The University of Sydney, Sydney, Australia.,Nanotechnology Research Laboratory, Research School of Chemistry, College of Science, The Australian National University, Canberra, Australia
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia.,The John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, Australia.,Department of Endocrinology and Diabetes, Canberra Health Services, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering, Computing and Cybernetics, The Australian National University, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
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Namsrai T, Phillips C, Desborough J, Gregory D, Kelly E, Cook M, Parkinson A. Diagnostic delay of sarcoidosis: Protocol for an integrated systematic review. PLoS One 2023; 18:e0269762. [PMID: 36812191 PMCID: PMC9946231 DOI: 10.1371/journal.pone.0269762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/01/2022] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Sarcoidosis is a rare systemic inflammatory granulomatous disease of unknown cause. It can manifest in any organ. The incidence of sarcoidosis varies across countries, and by ethnicity and gender. Delays in the diagnosis of sarcoidosis can lead to extension of the disease and organ impairment. Diagnosis delay is attributed in part to the lack of a single diagnostic test or unified commonly used diagnostic criteria, and to the diversity of disease manifestations and symptom load. There is a paucity of evidence examining the determinants of diagnostic delay in sarcoidosis and the experiences of people with sarcoidosis related to delayed diagnosis. We aim to systematically review available evidence about diagnostic delay in sarcoidosis to elucidate the factors associated with diagnostic delay for this disease in different contexts and settings, and the consequences for people with sarcoidosis. METHODS AND ANALYSIS A systematic search of the literature will be conducted using PubMed/Medline, Scopus, and ProQuest databases, and sources of grey literature, up to 25th of May 2022, with no limitations on publication date. We will include all study types (qualitative, quantitative, and mixed methods) except review articles, examining diagnostic delay, incorrect diagnosis, missed diagnosis or slow diagnosis of all types of sarcoidosis across all age groups. We will also examine evidence of patients' experiences associated with diagnostic delay. Only studies in English, German and Indonesian will be included. The outcomes we examine will be diagnostic delay time, patients' experiences, and factors associated with diagnostic delay in sarcoidosis. Two people will independently screen the titles and abstracts of search results, and then the remaining full-text documents against the inclusion criteria. Disagreements will be resolved with a third reviewer until consensus is reached. Selected studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). A meta-analysis and subgroup analyses of quantitative data will be conducted. Meta-aggregation methods will be used to analyse qualitative data. If there is insufficient data for these analyses, a narrative synthesis will be conducted. DISCUSSION This review will provide systematic and integrated evidence on the diagnostic delay, associated factors, and experiences of diagnosis delay among people with all types of sarcoidosis. This knowledge may shed light on ways to improve diagnosis delays in diagnosis across different subpopulations, and with different disease presentations. ETHICS AND DISSEMINATION Ethical approval will not be required as no human recruitment or participation will be involved. Findings of the study will be disseminated through publications in peer-reviewed journals, conferences, and symposia. TRIAL REGISTRATION PROSPERO Registration number: CRD42022307236. URL of the PROSPERO registration: https://www.crd.york.ac.uk/PROSPEROFILES/307236_PROTOCOL_20220127.pdf.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Christine Phillips
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- * E-mail:
| | - Dianne Gregory
- Sarcoidosis Australia, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Elaine Kelly
- Sarcoidosis Australia, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Matthew Cook
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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Wang STL, Parkinson A, Butler D, Law HD, Fanning V, Desborough J. Real price of health-experiences of out-of-pocket costs in Australia: protocol for a systematic review. BMJ Open 2022; 12:e065932. [PMID: 36600422 PMCID: PMC9772657 DOI: 10.1136/bmjopen-2022-065932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Australians have substantial out-of-pocket (OOP) health costs compared with other developed nations, even with universal health insurance coverage. This can significantly affect access to care and subsequent well-being, especially for priority populations including those on lower incomes or with multimorbidity and chronic illness. While it is known that high OOP healthcare costs may contribute to poorer health outcomes, it is not clear exactly how these expenses are experienced by people with chronic illnesses. Understanding this may provide critical insights into the burden of OOP costs among this population group and may highlight policy gaps. METHOD AND ANALYSIS A systematic review of qualitative studies will be conducted using Pubmed, CINAHL Complete (EBSCO), Cochrane Library, PsycINFO (Ovid) and EconLit from date of inception to June 2022. Primary outcomes will include people's experiences of OOP costs such as their preferences, priorities, trade-offs and other decision-making considerations. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and methodological appraisal of included studies will be assessed using the Critical Appraisal Skills Programme. A narrative synthesis will be conducted for all included studies. ETHICS AND DISSEMINATION Ethics approval was not required given this is a systematic review that does not include human recruitment or participation. The study's findings will be disseminated through conferences and symposia and shared with consumers, policymakers and service providers, and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022337538.
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Affiliation(s)
- Shelley Ting-Li Wang
- School of Medicine and Psychology, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Danielle Butler
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Hsei Di Law
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Vanessa Fanning
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
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Hall Dykgraaf S, Desborough J, Parkinson A, Sturgiss EA, Kelly P, Kidd M. Implementing mandatory COVID-19 vaccination for Australian aged care workers. Med J Aust 2022; 217:570-574. [PMID: 36403195 PMCID: PMC10099713 DOI: 10.5694/mja2.51770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Sally Hall Dykgraaf
- Rural Clinical School, Australian National University, Canberra, ACT.,Academic Unit of General Practice, Australian National University, Canberra, ACT
| | - Jane Desborough
- College of Medicine, Biology and the Environment, Australian National University, Canberra, ACT
| | - Anne Parkinson
- Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | | | - Paul Kelly
- Australian Government Department of Health and Aged Care, Canberra, ACT
| | - Michael Kidd
- Australian Government Department of Health and Aged Care, Canberra, ACT
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Pramono A, Smith J, Bourke S, Desborough J. How midwives and nurses experience implementing ten steps to successful breastfeeding: a qualitative case study in an Indonesian maternity care facility. Int Breastfeed J 2022; 17:84. [PMID: 36461020 PMCID: PMC9719222 DOI: 10.1186/s13006-022-00524-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/19/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The in-hospital stay following childbirth is a critical time for education and support of new mothers to establish breastfeeding. The WHO/UNICEF 'Ten Steps to Successful Breastfeeding (Ten Steps)' was launched globally in 1989 to encourage maternity services to educate and support mothers to breastfeed. The strategy is effective, however its uptake within health systems and facilities has been disappointing. We aimed to understand midwives' and nurses' experiences of implementing the Ten Steps in an Indonesian hospital. METHODS This qualitative study was conducted in an Indonesian hospital which has been implementing the Ten Steps since the hospital's establishment in 2012. Fourteen midwives and nurses participated in a focus group in January 2020. Data were analyzed using thematic analysis. RESULTS We identified five themes that represented midwives' and nurses' experiences of implementing the Ten Steps in this Indonesian maternity unit: 1) Human rights of child and mother, 2) Dependency on precarious leadership, 3) Lack of budget prioritization, 4) Fragmented and inconsistent implementation of the Ten Steps across the health system, and 5) Negotiating with family, community and culture. The results highlighted a dependency on local hospital champions and a lack of budget prioritization as barriers to implementation, as well as health system gaps which prevented the enablement of mothers and families to establish and maintain breastfeeding successfully in Indonesian maternity services. CONCLUSIONS As Indonesia has one of the largest populations in South East Asia, it is an important market for infant milk formula, and health services are commonly targeted for marketing these products. This makes it especially important that the government invest strongly in Ten Steps implementation. Continuity of care within and across the health system and leadership continuity are key factors in reinforcing its implementation. The study findings from this Indonesian maternity care facility re-emphasize WHO recommendations to integrate the Ten Steps into national health systems and increase pre-service education on breastfeeding for health care professionals.
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Affiliation(s)
- Andini Pramono
- grid.1001.00000 0001 2180 7477Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Julie Smith
- grid.1001.00000 0001 2180 7477Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Siobhan Bourke
- grid.1001.00000 0001 2180 7477Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Jane Desborough
- grid.1001.00000 0001 2180 7477Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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Namsrai T, Parkinson A, Chalmers A, Lowe C, Cook M, Phillips C, Desborough J. Diagnostic delay of myositis: an integrated systematic review. Orphanet J Rare Dis 2022; 17:420. [PMID: 36411487 PMCID: PMC9677896 DOI: 10.1186/s13023-022-02570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/30/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Idiopathic inflammatory myopathies (IIM) are a heterogenous group of rare muscular autoimmune diseases characterised by skeletal muscle inflammation with possible diagnostic delay. Our aim was to review the existing evidence to identify overall diagnostic delay for IIM, factors associated with diagnostic delay, and people's experiences of diagnostic delay. METHODS Three databases and grey literature sources were searched. Diagnostic delay was defined as the period between the onset of symptoms and the year of first diagnosis of IIM. We pooled the mean delay using random effects inverse variance meta-analysis and performed subgroup analyses. RESULTS 328 titles were identified from which 27 studies were included. Overall mean diagnostic delay was 27.91 months (95% CI 15.03-40.79, I2 = 99%). Subgroup analyses revealed a difference in diagnostic delay between non-inclusion body myositis (IBM) and IBM types. There was no difference in diagnostic delay between studies in which myositis specific autoantibodies (MSA) were tested or not tested. In countries with gatekeeper health systems, where primary care clinicians authorize access to specialty care, people experienced longer periods of diagnostic delay than people with IIM in countries with non-gatekeeper systems. While studies discussed factors that may influence diagnostic delay, significant associations were not identified. No qualitative studies examining people's experiences of diagnostic delay were identified. CONCLUSION Diagnostic delay of IIM has extensive impacts on the quality of life of people living with this disease. Understanding the experiences of people with IIM, from symptom onset to diagnosis, and factors that influence diagnostic delay is critical to inform clinical practice and training activities aimed at increasing awareness of this rare disease and expediting diagnosis. TRIAL REGISTRATION PROSPERO Registration number: CRD42022307236 URL of the PROSPERO registration: https://www.crd.york.ac.uk/PROSPEROFILES/307236_PROTOCOL_20220127.pdf.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Anita Chalmers
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- The Myositis Association- Australia Inc, Berry, NSW, Australia
| | - Christine Lowe
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- The Myositis Association- Australia Inc, Berry, NSW, Australia
| | - Matthew Cook
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Christine Phillips
- School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia.
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Pramono A, Smith J, Bourke S, Desborough J. "We All Believe in Breastfeeding": Australian Midwives' Experience of Implementing the Baby Friendly Hospital Initiative. J Hum Lact 2022; 38:780-791. [PMID: 35792378 DOI: 10.1177/08903344221106473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The education and support of new mothers during the in-hospital stay for childbirth is a critical time to establish breastfeeding. The Baby-Friendly Hospital Initiative was launched in 1991 to encourage maternity services to support and educate mothers to breastfeed by implementing Ten Steps to Successful Breastfeeding. RESEARCH AIM To explore midwives' experiences of implementing the Baby-Friendly Hospital Initiative in a Baby-Friendly accredited public hospital in Australia. METHODS In this prospective, cross-sectional qualitative study we used focus groups to explore midwives' experiences. Midwives (N = 26) participated in two focus groups conducted between October and November 2019. Data were analyzed using thematic analysis. RESULTS Time as a critical resource, and continuity of care, were crosscutting themes that framed midwives' experiences in supporting mothers to breastfeed their babies. Time constraints were experienced both through the health system structure and the BFHI accreditation process. Despite the challenges, the overarching theme-that we all believe in breastfeeding-fueled midwives' motivation. CONCLUSION Health services policy and practice need to consider ways to enable continuity of midwifery care and adequate time for midwives to support women to breastfeed their babies.
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Affiliation(s)
- Andini Pramono
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Julie Smith
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Siobhan Bourke
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
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Halcomb E, Fernandez R, Mursa R, Stephen C, Calma K, Ashley C, McInnes S, Desborough J, James S, Williams A. Evaluation of the Brief COPE scale and exploration of coping among primary healthcare nurses' during COVID-19. J Nurs Manag 2022; 30:2597-2608. [PMID: 36181251 PMCID: PMC9538445 DOI: 10.1111/jonm.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/29/2022] [Accepted: 09/25/2022] [Indexed: 11/27/2022]
Abstract
Aim To explore primary health care nurses’ coping strategies and evaluate the psychometric properties of the Brief COPE scale. Background Primary health care nurses are experiencing significant COVID‐19‐related psychological impacts. Beyond understanding the impacts, there is a need to explore coping strategies. Methods This online cross‐sectional survey was completed by 359 Australian primary health care nurses between October and December 2020. Results Factor analysis revealed seven factors (support, disengagement and venting, humour, positive reframing, acceptance, substance use, and spiritual/religious beliefs)(Cronbach’s alpha >0.69). There was an association between age, years of nursing and years of primary health care nursing and the factors of ‘support’, ‘disengagement and venting’ and ‘positive reframing’. Years of experience were also associated with the factor ‘humour’. Urban respondents had higher scores for the ‘support’ factor. Conclusions The Brief COPE scale is a valid and reliable tool for assessing primary health care nurses' coping. As demographic characteristics impact the coping strategies that nurses use, supports need to be tailored to optimise their impact. Implications for nursing management Nurse managers need to consider the workforce demographics when designing and implementing support strategies. The Brief COPE can identify current coping strategies and inform interventions to build coping capacity.
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Affiliation(s)
- Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave Wollongong NSW.,Illawarra Health and Medical Institute, Northfields Ave Wollongong NSW
| | - Ritin Fernandez
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave Wollongong NSW.,Centre for Research in Nursing and Health, Level 1 Research and Education Building, St George Hospital, South Street, Kogarah NSW
| | - Ruth Mursa
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave Wollongong NSW.,Illawarra Health and Medical Institute, Northfields Ave Wollongong NSW
| | - Catherine Stephen
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave Wollongong NSW.,Illawarra Health and Medical Institute, Northfields Ave Wollongong NSW
| | - Kaara Calma
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave Wollongong NSW.,Illawarra Health and Medical Institute, Northfields Ave Wollongong NSW.,School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC
| | - Christine Ashley
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave Wollongong NSW
| | - Susan McInnes
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Ave Wollongong NSW
| | - Jane Desborough
- Research School of Population Health, College of Health and Medicine Australian National University, Canberra ACT
| | - Sharon James
- Department of General Practice, School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC
| | - Anna Williams
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW
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11
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Hossain MZ, Daskalaki E, Brüstle A, Desborough J, Lueck CJ, Suominen H. The role of machine learning in developing non-magnetic resonance imaging based biomarkers for multiple sclerosis: a systematic review. BMC Med Inform Decis Mak 2022; 22:242. [PMID: 36109726 PMCID: PMC9476596 DOI: 10.1186/s12911-022-01985-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is a neurological condition whose symptoms, severity, and progression over time vary enormously among individuals. Ideally, each person living with MS should be provided with an accurate prognosis at the time of diagnosis, precision in initial and subsequent treatment decisions, and improved timeliness in detecting the need to reassess treatment regimens. To manage these three components, discovering an accurate, objective measure of overall disease severity is essential. Machine learning (ML) algorithms can contribute to finding such a clinically useful biomarker of MS through their ability to search and analyze datasets about potential biomarkers at scale. Our aim was to conduct a systematic review to determine how, and in what way, ML has been applied to the study of MS biomarkers on data from sources other than magnetic resonance imaging.
Methods
Systematic searches through eight databases were conducted for literature published in 2014–2020 on MS and specified ML algorithms.
Results
Of the 1, 052 returned papers, 66 met the inclusion criteria. All included papers addressed developing classifiers for MS identification or measuring its progression, typically, using hold-out evaluation on subsets of fewer than 200 participants with MS. These classifiers focused on biomarkers of MS, ranging from those derived from omics and phenotypical data (34.5% clinical, 33.3% biological, 23.0% physiological, and 9.2% drug response). Algorithmic choices were dependent on both the amount of data available for supervised ML (91.5%; 49.2% classification and 42.3% regression) and the requirement to be able to justify the resulting decision-making principles in healthcare settings. Therefore, algorithms based on decision trees and support vector machines were commonly used, and the maximum average performance of 89.9% AUC was found in random forests comparing with other ML algorithms.
Conclusions
ML is applicable to determining how candidate biomarkers perform in the assessment of disease severity. However, applying ML research to develop decision aids to help clinicians optimize treatment strategies and analyze treatment responses in individual patients calls for creating appropriate data resources and shared experimental protocols. They should target proceeding from segregated classification of signals or natural language to both holistic analyses across data modalities and clinically-meaningful differentiation of disease.
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12
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Brew-Sam N, Parkinson A, Lueck C, Brown E, Brown K, Bruestle A, Chisholm K, Collins S, Cook M, Daskalaki E, Drew J, Ebbeck H, Elisha M, Fanning V, Henschke A, Herron J, Matthews E, Murugappan K, Neshev D, Nolan CJ, Pedley L, Phillips C, Suominen H, Tricoli A, Wright K, Desborough J. The current understanding of precision medicine and personalised medicine in selected research disciplines: study protocol of a systematic concept analysis. BMJ Open 2022; 12:e060326. [PMID: 36691172 PMCID: PMC9454080 DOI: 10.1136/bmjopen-2021-060326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/08/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The terms 'precision medicine' and 'personalised medicine' have become key terms in health-related research and in science-related public communication. However, the application of these two concepts and their interpretation in various disciplines are heterogeneous, which also affects research translation and public awareness. This leads to confusion regarding the use and distinction of the two concepts. Our aim is to provide a snapshot of the current understanding of these concepts. METHODS AND ANALYSIS Our study will use Rodgers' evolutionary concept analysis to systematically examine the current understanding of the concepts 'precision medicine' and 'personalised medicine' in clinical medicine, biomedicine (incorporating genomics and bioinformatics), health services research, physics, chemistry, engineering, machine learning and artificial intelligence, and to identify their respective attributes (clusters of characteristics) and surrogate and related terms. A systematic search of the literature will be conducted for 2016-2022 using databases relevant to each of these disciplines: ACM Digital Library, CINAHL, Cochrane Library, F1000Research, IEEE Xplore, PubMed/Medline, Science Direct, Scopus and Web of Science. These are among the most representative databases for the included disciplines. We will examine similarities and differences in definitions of 'precision medicine' and 'personalised medicine' in the respective disciplines and across (sub)disciplines, including attributes of each term. This will enable us to determine how these two concepts are distinguished. ETHICS AND DISSEMINATION Following ethical and research standards, we will comprehensively report the methodology for a systematic analysis following Rodgers' concept analysis method. Our systematic concept analysis will contribute to the clarification of the two concepts and distinction in their application in given settings and circumstances. Such a broad concept analysis will contribute to non-systematic syntheses of the concepts, or occasional systematic reviews on one of the concepts that have been published in specific disciplines, in order to facilitate interdisciplinary communication, translational medical research and implementation science.
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Affiliation(s)
- Nicola Brew-Sam
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christian Lueck
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Neurology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Ellen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Anne Bruestle
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Katrina Chisholm
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Simone Collins
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Matthew Cook
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Eleni Daskalaki
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Janet Drew
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Harry Ebbeck
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mark Elisha
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Vanessa Fanning
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Adam Henschke
- Department of Philosophy, University of Twente, Enschede, Overijssel, The Netherlands
| | - Jessica Herron
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Emma Matthews
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Krishnan Murugappan
- Nanotechnology Research Lab, Research School of Chemistry, College of Science, Australian National University, Canberra, Australian Capital Territory, Australia
- CSIRO, Mineral Resources, Clayton South, Victoria, Australia
| | - Dragomir Neshev
- Department of Electronic Materials Engineering, Research School of Physics, College of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Endocrinology and Diabetes, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Lachlan Pedley
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Computing, University of Turku, Turku, Finland
| | - Antonio Tricoli
- Nanotechnology Research Lab, Research School of Chemistry, College of Science, Australian National University, Canberra, Australian Capital Territory, Australia
- Nanotechnology Research Laboratory, Faculty of Engineering, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristine Wright
- The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Dykgraaf SH, Desborough J, Sturgiss E, Parkinson A, Dut GM, Kidd M. Older people, the digital divide and use of telehealth during the COVID-19 pandemic. Aust J Gen Pract 2022; 51:721-724. [DOI: 10.31128/ajgp-03-22-6358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Desborough J, Wright M, Parkinson A, Dykgraaf SH, Ball L, Dut GM, Sturgiss E, de Toca L, Kidd M. What strategies have been effective in optimising COVID-19 vaccine uptake in Australia and internationally? Aust J Gen Pract 2022; 51:725-730. [DOI: 10.31128/ajgp-05-22-6427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Di Law H, Marasinghe D, Biddle N, Butler D, Lancsar E, Desborough J, Korda R. Progressivity of out-of-pocket costs for Medicare-subsidised services and medicines in Australia. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesIn line with affordability and equity principles, Medicare—Australia’s universal public health insurance system—has measures to limit out-of-pocket costs (OOPC), especially among lower income households. We examined the distribution of OOPC for Medicare-subsidised out-of-hospital services and prescription medicines, for Census households, according to their ability to pay.
MethodsWe used 2016 Australian Census data linked to Medicare claims to obtain OOPC for out-of-hospital services and medicines in each household in 2017-18. We derived household disposable income by combining income information from the Census linked to income tax and social security data. All data were available from the Multi-Agency Data Integration Project, enabled through a partnership of various government agencies. We quantified OOPC as a proportion of equivalised household disposable income and calculated Kakwani indices (K) to measure progressivity. We also used linked National Health Survey data to analyse costs separately by chronic conditions.
ResultsWe analysed 85% (n=6,830,365) of all Census private households. Overall, OOPC as a percentage of equivalised household disposable income decreased from 1.16% (out-of-hospital services) and 1.35% (prescription medicines) in the poorest decile to 0.63% and 0.34% in the richest decile, respectively. The regressive trend was less pronounced for out-of-hospital services (K = -0.06), with percentage OOPC relatively stable between the 2nd and 9th income deciles; while percentage OOPC decreased steeply with increasing income for medicines (K = -0.24). (Chronic conditions results will be presented—embargoed at time of submission)
ConclusionOOPC for out-of-hospital Medicare services were mildly regressive while those for prescription medicines were distinctly regressive. Actions to reduce inequity in OOPC for medicines, such as reducing the co-payments for low income households should be considered.
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Matenge S, Sturgiss E, Desborough J, Hall Dykgraaf S, Dut G, Kidd M. Ensuring the continuation of routine primary care during the COVID-19 pandemic: a review of the international literature. Fam Pract 2022; 39:747-761. [PMID: 34611708 PMCID: PMC8515263 DOI: 10.1093/fampra/cmab115] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in the diversion of health resources away from routine primary care delivery. This disruption of health services has necessitated new approaches to providing care to ensure continuity. OBJECTIVES To summarize changes to the provision of routine primary care services during the pandemic. METHODS Rapid literature review using PubMed/MEDLINE, SCOPUS, and Cochrane. Eligible studies were based in primary care and described practice-level changes in the provision of routine care in response to COVID-19. Relevant data addressing changes to routine primary care delivery, impact on primary care functions and challenges experienced in adjusting to new approaches to providing care, were obtained from included studies. A narrative summary was guided by Burns et al.'s framework for primary care provision in disasters. RESULTS Seventeen of 1,699 identified papers were included. Studies reported on telehealth use and public health measures to maintain safe access to routine primary care, including providing COVID-19 screening, and establishing dedicated care pathways for non-COVID and COVID-related issues. Acute and urgent care were prioritized, causing disruptions to chronic disease management and preventive care. Challenges included telehealth use including disparities in access and practical difficulties in assessing patients, personal protective equipment shortages, and financial solvency of medical practices. CONCLUSIONS Substantial disruptions to routine primary care occurred due to the COVID-19 pandemic. Primary care practices' rapid adaptation, often with limited resources and support, demonstrates agility and innovative capacity. Findings underscore the need for timely guidance and support from authorities to optimize the provision of comprehensive routine care during pandemics.
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Affiliation(s)
- Sethunya Matenge
- Department of Health Services Research and Policy, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Garang Dut
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Michael Kidd
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,Australian Government Department of Health, Canberra, ACT, Australia.,Department of Family and Community Medicine, The University of Toronto, Toronto, Canada.,Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia.,Southgate Institute for Equity, Health and Society, Flinders University, Adelaide, SA, Australia
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17
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Namsrai T, Desborough J, Chalmers A, Lowe C, Cook M, Phillips C, Parkinson A. Diagnostic delay of myositis: protocol for an integrated systematic review. BMJ Open 2022; 12:e060312. [PMID: 35697457 PMCID: PMC9196154 DOI: 10.1136/bmjopen-2021-060312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Idiopathic inflammatory myopathies (IIM). described as 'inflammatory myositis', are a heterogeneous group of rare muscular autoimmune diseases characterised by skeletal muscle inflammation. Its complex characteristics with lack of accurate diagnostic tests, unified classification system and comprehensive widely used diagnostic criteria could lead to diagnostic delay. This study will review diagnostic delay in myositis and provide an overview and clearer insight of patients' experiences, causes and consequences of diagnostic delay in myositis. METHODS AND ANALYSIS The literature source will be a systematic search of PubMed/MEDLINE, Scopus, ProQuest and sources of grey literature, conducted from database inception to December 2021 without restrictions on publication date. All study types (qualitative and quantitative) except review articles, examining diagnostic delay, incorrect diagnosis, missed diagnosis or slow diagnosis of all types of myositis in all ages will be included. Evidence of patients' experiences associated with diagnostic delay will also be examined. Studies in languages other than English, German and Indonesian will be excluded. Outcomes will be diagnostic delay time, patients' experiences, and causes and consequences associated with diagnostic delay in myositis. Two review authors will independently screen the titles and abstracts of search results against the inclusion criteria. The Mixed Methods Appraisal Tool (MMAT) will be used to appraise selected studies. Two independent authors will extract data using a prepiloted data extraction tool. If sufficient quantitative data is available, a meta-analysis will be conducted along with subgroup analysis including pooled diagnostic delay in each type of myositis. Qualitative data will be analysed in line with meta-aggregation methods. If data is insufficient, a narrative synthesis will be conducted. ETHICS AND DISSEMINATION As this work is a systematic review, ethical approval was not required. Findings of the study will be disseminated through publications in peer-reviewed journals, conferences and symposia. PROSPERO REGISTRATION NUMBER CRD42022289830.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anita Chalmers
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Myositis Australia Inc, Canberra, Australian Capital Territory, Australia
| | - Christine Lowe
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Myositis Australia Inc, Canberra, Australian Capital Territory, Australia
| | - Matthew Cook
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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18
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Yeung S, Perriman D, Chhabra M, Phillips C, Parkinson A, Glasgow N, Douglas KA, Cox D, Smith P, Desborough J. ACT Transition from Hospital to Home Orthopaedic Survey: a cross-sectional survey of unplanned 30-day readmissions for patients having total hip arthroplasty. BMJ Open 2022; 12:e055576. [PMID: 35636791 PMCID: PMC9152933 DOI: 10.1136/bmjopen-2021-055576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify patient, hospital and transitional factors associated with unplanned 30-day readmissions in patients who had a total hip arthroplasty (THA). DESIGN A cross-sectional survey was performed. All patients attending a 6-week follow-up after a THA in the Australian Capital Territory (ACT) at four public and private clinics in the ACT from 1 February 2018 to 31 January 2019, were invited to complete an ACT Transition from Hospital to Home Orthopaedic Survey. PARTICIPANTS Within the ACT, 431 patients over the age of 16 attending their 6-week post-surgery consultation following a THA entered and completed the survey (response rate 77%). PRIMARY OUTCOME MEASURE The primary outcome measure was self-reported readmissions for any reason within 30 days of discharge after a THA. Multiple logistic regression was used to estimate ORs of factors associated with unplanned 30-day readmissions. RESULTS Of the 431 participants (representing 40% of all THAs conducted in the ACT during the study period), 27 (6%) were readmitted within 30 days of discharge. After controlling for age and sex, patients who did not feel rested on discharge were more likely to be readmitted within 30 days than those who felt rested on discharge (OR=5.75, 95% CI: (2.13 to 15.55), p=0.001). There was no association between post-hospital syndrome (ie, in-hospital experiences of pain, sleep and diet) overall and readmission. Patients who suffered peripheral vascular disease (PVD) were significantly more likely to have an unplanned 30-day readmission (OR=16.9, 95% CI: (3.06 to 93.53), p=0.001). There was no significant difference between private and public patient readmissions CONCLUSIONS: Hospitals should develop strategies that maximise rest and sleep during patients' hospital stay. Diagnosis and optimum treatment of pre-existing PVD prior to THA should also be a priority to minimise the odds of subsequent unplanned readmissions.
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Affiliation(s)
- Sybil Yeung
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Diana Perriman
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
- ACT Health, Canberra City, Australian Capital Territory, Australia
| | - Madhur Chhabra
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- Australian Primary Health Care Research Institute, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas Glasgow
- Australian National University Research School of Population Health, Canberra, Australian Capital Territory, Australia
| | - Kirsty A Douglas
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Darlene Cox
- Health Care Consumer Association, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
- The Trauma and Orthopaedic Resarch Unit, ACT Health, Canberra City, Australian Capital Territory, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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19
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Desborough J, Blashki G, Hall Dykgraaf S, Vine R, Roddam M, Munindradasa A, Kidd M. Rapid deployment of support for a mental health crisis: 10 priorities framing Australia's COVID-19 pandemic response. Aust J Prim Health 2022; 28:271-282. [PMID: 35605985 DOI: 10.1071/py22006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic has challenged the mental health of communities worldwide, with the triple pressures of financial insecurity, lockdowns, and worry about the infection. Australia rapidly deployed resources to protect the mental wellbeing of the community through supplementing existing services, supporting at-risk groups, investing in social supports, embracing technology, and supporting the health workforce. This paper describes the Australian Government's investment in mental health during the COVID-19 pandemic in relation to the 10 priority areas identified in Australia's National Mental Health Pandemic Response Plan.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, ACT 2601, Australia
| | - Grant Blashki
- Nossal Institute for Global Health and Melbourne Sustainable Society Institute, The University of Melbourne, Grattan Street, Parkville, Vic. 3010, Australia; and Beyond Blue, 1/360 Burwood Road, Hawthorn, Vic. 3122, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, 54 Mills Road, Acton, ACT 2601, Australia
| | - Ruth Vine
- Health Systems Policy and Primary Care Group, Australian Government Department of Health, 23 Furzer Street, Woden, ACT 2615, Australia
| | - Mark Roddam
- Health Systems Policy and Primary Care Group, Australian Government Department of Health, 23 Furzer Street, Woden, ACT 2615, Australia
| | - Ashvini Munindradasa
- College of Health and Medicine, Australian National University, 54 Mills Road, Acton, ACT 2601, Australia
| | - Michael Kidd
- College of Health and Medicine, Australian National University, 54 Mills Road, Acton, ACT 2601, Australia; and Australian Government Department of Health, 23 Furzer Street, Woden, ACT 2615, Australia; and Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; and World Health Organization Collaborating Centre on Family Medicine and Primary Care; and Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Vic., Australia; and Southgate Institute for Health, Society and Equity, Flinders University, SA 5042, Australia
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Parkinson A, Brunoro C, Leayr J, Fanning V, Chisholm K, Drew J, Desborough J, Phillips C. Front Cover: Volume 25 Issue 3. Health Expect 2022. [DOI: 10.1111/hex.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anne Parkinson
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Crystal Brunoro
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Jack Leayr
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Vanessa Fanning
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Katrina Chisholm
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Janet Drew
- Department of Health Services Research and Policy Australian National University Acton Australia
| | - Jane Desborough
- Department of Health Services Research and Policy Australian National University Acton Australia
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21
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Parkinson A, Matenge S, Desborough J, Hall Dykgraaf S, Ball L, Wright M, Sturgiss EA, Kidd M. The impact of
COVID
‐19 on chronic disease management in primary care: lessons for Australia from the international experience. Med J Aust 2022; 216:445-448. [PMID: 35403236 PMCID: PMC9114997 DOI: 10.5694/mja2.51497] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Anne Parkinson
- National Centre for Epidemiology and Population Health Australian National University Canberra ACT
| | - Sethunya Matenge
- National Centre for Epidemiology and Population Health Australian National University Canberra ACT
| | - Jane Desborough
- National Centre for Epidemiology and Population Health Australian National University Canberra ACT
| | | | - Lauren Ball
- Centre for Health Practice Innovation Griffith University Brisbane QLD
| | - Michael Wright
- Centre for Health Economics Research and Evaluation University of Technology Sydney Sydney NSW
| | | | - Michael Kidd
- Australian National University Canberra ACT
- COVID‐19 Primary Care Response Group Australian Government Department of Health Canberra ACT
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22
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Davis S, Roberts L, Desborough J, Dykgraaf SH, Burns P, Kidd M, Maddox R, de Toca L, Lokuge K. Integrating General Practice Into the Australian COVID-19 Response: A Description of the General Practitioner Respiratory Clinic Program in Australia. Ann Fam Med 2022; 20:273-276. [PMID: 35606123 PMCID: PMC9199048 DOI: 10.1370/afm.2808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/09/2022] Open
Abstract
Integrating primary care with the health response is key to managing pandemics and other health emergencies. In recognition of this, the Australian Government established a network of respiratory clinics led by general practitioners in response to the coronavirus disease 2019 (COVID-19) pandemic as part of broader measures aimed at supporting primary care. General practitioner (GP) respiratory clinics provide holistic face-to-face assessment and treatment to those with respiratory symptoms in an environment with strict protocols for infection prevention and control. This ensures that these patients are able to access high quality primary care while protecting the general practice workforce and other patients. The GP respiratory clinic model was developed and operationalized 10 days after the policy was announced, with the first 2 respiratory clinics opening on March 21, 2020. Subsequently a total of 150 respiratory clinics were opened and served over 800,000 patients within more than 99% of Australia's postcodes. These clinics used a standardized data collection tool that has provided the largest and most complete primary care surveillance database of respiratory illness in Australia. The success of the GP respiratory clinic model was made possible due to strong partnerships with Primary Health Networks and individual general practices that rapidly shifted operations to embrace this new approach. This article describes the development and early implementation of this model.
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Affiliation(s)
- Stephanie Davis
- Australian National University, Canberra, Acton, Australia .,Australian Government Department of Health, Canberra, Acton, Australia
| | - Leslee Roberts
- Australian Government Department of Health, Canberra, Acton, Australia
| | | | | | - Penelope Burns
- Australian National University, Canberra, Acton, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra, Acton, Australia
| | - Raglan Maddox
- Australian National University, Canberra, Acton, Australia
| | - Lucas de Toca
- Australian Government Department of Health, Canberra, Acton, Australia
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Chhabra M, Perriman D, Phillips C, Parkinson A, Glasgow N, Douglas K, Cox D, Smith P, Desborough J. Understanding factors affecting 30-day unplanned readmissions for patients undergoing total knee arthroplasty (TKA): the ACT Transition from Hospital to Home Orthopaedics Survey. BMJ Open 2022; 12:e053831. [PMID: 35410923 PMCID: PMC9003601 DOI: 10.1136/bmjopen-2021-053831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate factors associated with unplanned 30-day readmissions following a total knee arthroplasty (TKA), including association with post-hospital syndrome, patient enablement and transition from hospital to home. DESIGN, SETTING AND PARTICIPANTS A cross-sectional written survey of public and private patients attending a 6-week follow-up appointment after TKA at one of four clinical services in the Australian Capital Territory (ACT) between 1 February 2018 and 31 January 2019. Multiple logistic regression analyses were used to measure associations between patient, hospital and transitional care factors with unplanned 30-day readmissions, while controlling for known confounders. RESULTS Of the 380 participants who completed the survey (n=380, 54% of TKAs undertaken over the study period), 3.4% (n=13; 95% CI: 1.8 to 5.8) were subsequently readmitted within 30 days of discharge after a primary hospitalisation. Public patients were significantly more likely to be readmitted within 30 days compared with private patients (adjusted OR=6.31, 95% CI: 1.59 to 25.14, p=0.009), and patients who attended rehabilitation were significantly less likely to be readmitted within 30 days of discharge than those who did not (adjusted OR=0.16, 95% CI: 0.04 to 0.57, p=0.005). There were no associations between post-hospital syndrome or patient enablement and 30-day readmissions in this study. CONCLUSION Reasons underlying the difference in unplanned readmission rates for public versus private patients need to be explored, including differences in surgical waiting times and the consequences for impairment and disease complexity. Strategies to foster increased participation post-surgical rehabilitation programmes need to be developed as an avenue to mitigate the burden of unplanned 30-day readmissions on individuals and health systems.
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Affiliation(s)
- Madhur Chhabra
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Diana Perriman
- Trauma and Orthopaedic Research Unit, ACT Health, Canberra City, Australian Capital Territory, Australia
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas Glasgow
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Kirsty Douglas
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Darlene Cox
- Health Care Consumers Association, ACT, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- Trauma and Orthopaedic Research Unit, ACT Health, Canberra City, Australian Capital Territory, Australia
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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Sturgiss E, Dut GM, Matenge S, Desborough J, Hall Dykgraaf S, Mazza D, Kidd M. COVID-19 and access to sexual and reproductive healthcare for young people: An overview of the international literature and policy. Aust J Gen Pract 2022; 51:271-277. [PMID: 35362014 DOI: 10.31128/ajgp-10-21-6206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic has reduced the ability of young people to access appropriate and timely sexual and reproductive healthcare (SRH). The aim of this study was to summarise international innovations aimed at ensuring ongoing access. METHOD This study was an overview of peer‑reviewed literature and policy statements from international and national organisations related to SRH for young people during COVID-19. RESULTS Innovations have focused on improving access to appropriate and timely SRH for young people, mostly through telehealth; increasing community and healthcare worker awareness of the heightened risk of gender-based violence and its consequences; and removing restrictions on contraception and abortion access. Despite this, a substantial decline in sexual wellbeing and SRH access has been reported from many parts of the world, although Australian data are lacking. DISCUSSION Support for young people to access timely and appropriate SRH during the COVID-19 pandemic should be a priority for policymakers around the world.
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Affiliation(s)
- Elizabeth Sturgiss
- FRACGP, PhD, BMed, MPH, MForensMed, FHEA, Senior Research Fellow, School of Primary and Allied Health Care, Monash University, Melbourne, Vic
| | - Garang M Dut
- MD, MPH, MBA, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, Canberra, ACT; Fellow in Health Systems, College of Health @ Medicine, Australian National University, Canberra, ACT
| | - Sethunya Matenge
- MPH, Research Fellow, College of Health and Medicine, Australian National University, Canberra, ACT
| | - Jane Desborough
- RN, RM, MPH, PhD, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Senior Research Fellow, Research School of Population Health, Australian National University, ACT
| | - Sally Hall Dykgraaf
- RN, Grad Cert Clin Man, PhD Scholar, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Research Manager, Rural Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, ACT
| | - Danielle Mazza
- MD, MBBS, FRACGP, Grad Dip Women@s Health, Head, Department of General Practice, Monash University, Vic; Director, SPHERE (NHMRC Centre of Excellence in Sexual and Reproductive Health for Women in Primary Care), Department of General Practice, Monash University, Vic
| | - Michael Kidd
- AM, MD, FAHMS, Deputy Chief Medical Officer and Principal Medical Advisor, Primary Care Division, Australian Government Department of Health, Canberra, ACT; Professor of Primary Care Reform, College of Health and Medicine, Australian National University, Canberra, ACT
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25
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Sturgiss E, Desborough J, Hall Dykgraaf S, Matenge S, Dut G, Davis S, de Toca L, Kelly P, Kidd M. Digital health to support primary care provision during a global pandemic. AUST HEALTH REV 2022; 46:269-272. [PMID: 35301983 DOI: 10.1071/ah21263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/09/2021] [Indexed: 11/23/2022]
Abstract
The urgency of the COVID-19 pandemic in Australia has seen the implementation of digital health technologies to support continuity of high-quality primary care provision. Digital health innovation has been used to operationalise the nation's pandemic preparedness principles by reducing risk of infection to both healthcare workers and at-risk patients, sustaining care for chronic and acute health conditions, and supporting the mental health of the population. In this perspective piece, we document the Australian Federal government's digital health response to ensure the ongoing delivery of high-quality primary care. This includes the implementation of telehealth, point-of-care testing, electronic records and e-prescriptions, national primary care data collection and analysis, and digital communication. Digital health has been a critical element of the pandemic response and paves the way for future primary care provision during disasters and emergencies. Further research is needed to capture the effectiveness, feasibility and acceptability of these innovations for both patients and primary care practitioners.
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Affiliation(s)
- Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, Vic., Australia; and Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Sally Hall Dykgraaf
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Sethunya Matenge
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Garang Dut
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Stephanie Davis
- Australian Government Department of Health, Canberra, ACT, Australia
| | - Lucas de Toca
- Australian Government Department of Health, Canberra, ACT, Australia
| | - Paul Kelly
- Australian Government Department of Health, Canberra, ACT, Australia
| | - Michael Kidd
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia; and Department of General Practice, University of Melbourne, Vic., Australia; and Murdoch Children's Research Institute, Melbourne, Vic., Australia; and Department of Family and Community Medicine, University of Toronto, ON, Canada; and Southgate Institute for Health Equity and Society, Flinders University, Adelaide, SA, Australia
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Desborough J, Hall Dykgraaf S, Sturgiss E, Parkinson A, Dut G, Kidd M. What has the COVID-19 pandemic taught us about the use of virtual consultations in primary care? Aust J Gen Pract 2022; 51:179-183. [PMID: 35224583 DOI: 10.31128/ajgp-09-21-6184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Telehealth has been a very useful resource in primary care consultations during the COVID-19 pandemic. OBJECTIVE The aim of this article is to examine primary care providers' (PCPs') and patients' experiences of using video and telephone modalities and their perceptions of the quality of telehealth. DISCUSSION Video consultations offer the advantage of enabling visualisation of a patient's visual affect and physical appearance, and they are helpful in building therapeutic relationships. However, many PCPs and patients find telephone consultations of equal value, and this has been the preferred telehealth modality internationally. This may be due to challenges experienced by PCPs and patients with the set-up and use of video consultation technologies, and the quality of these experiences. Some members of a number of at-risk groups have experienced greater challenges with this. The future of telehealth in primary care requires its coherent integration into clinical infrastructure and substantial bolstering of community access and capacity to use both video and telephone modalities.
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Affiliation(s)
- Jane Desborough
- RN, RM, MPH, PhD, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Senior Research Fellow, Research School of Population Health, Australian National University, ACT
| | - Sally Hall Dykgraaf
- RN, Grad Cert Clin Man, PhD Scholar, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Research Manager, Rural Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, ACT
| | - Elizabeth Sturgiss
- PhD, FRACGP, BMed, MPH, MForensMed, Senior Lecturer, Department of General Practice, Monash University, Vic; Visiting Fellow, Australian National University, ACT.
| | - Anne Parkinson
- BA, PhD, AFHEA, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, Canberra, ACT; Postdoctoral Fellow, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT
| | - Garang Dut
- MD, MPH, MBA, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, Canberra, ACT; Fellow in Health Systems, College of Health @ Medicine, Australian National University, Canberra, ACT
| | - Michael Kidd
- AM MBBS (Hons), MD, DCCH, DipRACOG, MCFP, FAHMS, Principal Medical Advisor and Deputy Chief Medical Officer, Australian Government Department of Health, ACT; Professor of Primary Care Reform, Australian National University, ACT; Adjunct Professor, Department of Family and Community Medicine, University of Toronto, Canada; Emeritus Director, World Health Organization Collaborating Centre on Family Medicine and Primary Care, GVA; Professorial Fellow, Murdoch Children@s Research Institute, The Royal Children@s Hospital Melbourne, Vic; Honorary Professor of Global Primary Care, Southgate Institute for Health, Society and Equity, Flinders University, SA
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27
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Hettiarachchi C, Daskalaki E, Desborough J, Nolan CJ, O'Neal D, Suominen H. Integrating Multiple Inputs Into an Artificial Pancreas System: Narrative Literature Review. JMIR Diabetes 2022; 7:e28861. [PMID: 35200143 PMCID: PMC8914747 DOI: 10.2196/28861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/07/2021] [Accepted: 01/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Type 1 diabetes (T1D) is a chronic autoimmune disease in which a deficiency in insulin production impairs the glucose homeostasis of the body. Continuous subcutaneous infusion of insulin is a commonly used treatment method. Artificial pancreas systems (APS) use continuous glucose level monitoring and continuous subcutaneous infusion of insulin in a closed-loop mode incorporating a controller (or control algorithm). However, the operation of APS is challenging because of complexities arising during meals, exercise, stress, sleep, illnesses, glucose sensing and insulin action delays, and the cognitive burden. To overcome these challenges, options to augment APS through integration of additional inputs, creating multi-input APS (MAPS), are being investigated. Objective The aim of this survey is to identify and analyze input data, control architectures, and validation methods of MAPS to better understand the complexities and current state of such systems. This is expected to be valuable in developing improved systems to enhance the quality of life of people with T1D. Methods A literature survey was conducted using the Scopus, PubMed, and IEEE Xplore databases for the period January 1, 2005, to February 10, 2020. On the basis of the search criteria, 1092 articles were initially shortlisted, of which 11 (1.01%) were selected for an in-depth narrative analysis. In addition, 6 clinical studies associated with the selected studies were also analyzed. Results Signals such as heart rate, accelerometer readings, energy expenditure, and galvanic skin response captured by wearable devices were the most frequently used additional inputs. The use of invasive (blood or other body fluid analytes) inputs such as lactate and adrenaline were also simulated. These inputs were incorporated to switch the mode of the controller through activity detection, directly incorporated for decision-making and for the development of intermediate modules for the controller. The validation of the MAPS was carried out through the use of simulators based on different physiological models and clinical trials. Conclusions The integration of additional physiological signals with continuous glucose level monitoring has the potential to optimize glucose control in people with T1D through addressing the identified limitations of APS. Most of the identified additional inputs are related to wearable devices. The rapid growth in wearable technologies can be seen as a key motivator regarding MAPS. However, it is important to further evaluate the practical complexities and psychosocial aspects associated with such systems in real life.
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Affiliation(s)
- Chirath Hettiarachchi
- School of Computing, College of Engineering and Computer Science, The Australian National University, Canberra, Australia
| | - Elena Daskalaki
- School of Computing, College of Engineering and Computer Science, The Australian National University, Canberra, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Christopher J Nolan
- Australian National University Medical School, College of Health and Medicine, The Australian National University, Canberra, Australia.,John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - David O'Neal
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, The Australian National University, Canberra, Australia.,Data61, Commonwealth Industrial and Scientific Research Organisation, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland
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Desborough J, Parkinson A, Lewis F, Ebbeck H, Banfield M, Phillips C. Outside Front Cover: Volume 25 Issue 1. Health Expect 2022. [DOI: 10.1111/hex.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jane Desborough
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Anne Parkinson
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Fiona Lewis
- Australian National University Medical School, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Harry Ebbeck
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
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Parkinson A, Brunoro C, Leayr J, Fanning V, Chisholm K, Drew J, Desborough J, Phillips C. Intertwined like a double helix: A meta-synthesis of the qualitative literature examining the experiences of living with someone with multiple sclerosis. Health Expect 2022; 25:803-822. [PMID: 35118764 PMCID: PMC9122458 DOI: 10.1111/hex.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/16/2021] [Accepted: 12/31/2021] [Indexed: 12/01/2022] Open
Abstract
Background Multiple sclerosis (MS) is a chronic serious condition of uncertain course and outcome. There is relatively little literature on the experiences of people who live with a person with MS. They inhabit a locus of care that spans caring for (a relational act) and caring about (a moral stance, addressing fairness, compassion and justice) the person with MS. Methods Using the theoretical lens of personhood, we undertook a scoping review and meta‐synthesis of the qualitative literature on the experiences of people who live with a person with MS, focusing on the nature of, and constraints upon, caring. Results Of 330 articles, 49 were included in the review. We identified five themes. One of these—seeking information and support—reflects the political economy of care. Two are concerned with the moral domain of care: caring as labour and living with uncertainty. The final two themes—changing identities and adapting to life with a person with MS—point to the negotiation and reconstitution of personhood for both the person with MS and the people they live with. Conclusion People with MS are embedded in relational social networks of partners, family and friends, which are fundamental in the support of their personhood; the people who live with them are ‘co‐constituents of the patient's identity’ assisting them to make sense of their world and self in times of disruption due to illness. Support services and health care professionals caring for people with MS are currently very much patient‐centred; young people in particular report that their roles are elided in the health system's interaction with a parent with MS. There is a need to look beyond the person with MS and recognize the relational network of people who surround them and broaden their focus to encompass this network. Patient and Public Involvement Our research team includes four members with MS and two members with lived experience of living or working with people with MS. A third person (not a team member) who lives with a partner with MS provided feedback on the paper.
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Affiliation(s)
- Anne Parkinson
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Crystal Brunoro
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Jack Leayr
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Vanessa Fanning
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Katrina Chisholm
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Janet Drew
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Acton, Australia
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Suominen H, Manocha M, Desborough J, Parkinson A, Apthorp D. Finger Tapping Measures for Parkinson's Disease: Preliminary Evaluation of an Android Application for Data Collection in Australia. Stud Health Technol Inform 2021; 284:475-480. [PMID: 34920574 DOI: 10.3233/shti210775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parkinson's Disease (PD) is a progressive chronic disorder with a high misdiagnosis rate. Because finger-tapping tasks correlate with its fine-motor symptoms, they could be used to help diagnose and assess PD. We first designed and developed an Android application to perform finger-tapping tasks without trained supervision, which is not always feasible for patients. Then, we conducted a preliminary user evaluation in Australia with six patients clinically diagnosed with PD and sixteen controls without PD. The application could be used in research and healthcare for regular symptom and progression assessment and feedback.
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Affiliation(s)
- Hanna Suominen
- The Australian National University (ANU), Australia.,Data61/Commonwealth Scientific and Industrial Research Organisation, Australia.,University of Turku, Finland
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Desborough J, Parkinson A, Lewis F, Ebbeck H, Banfield M, Phillips C. A framework for involving coproduction partners in research about young people with type 1 diabetes. Health Expect 2021; 25:430-442. [PMID: 34890473 PMCID: PMC8849360 DOI: 10.1111/hex.13403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/24/2021] [Accepted: 11/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background Involvement of end‐users in research can enhance its quality, relevance, credibility and legitimacy; however, the processes through which these changes occur are unclear. Our aim was to explore a coproduction research team's experiences of their involvement in research about young people with type 1 diabetes mellitus (T1DM). Methods Semi‐structured interviews conducted with two young people with T1DM, two parents, one diabetes educator, one endocrinologist‐scientist and one research‐engineer explored experiences of coproduction research and its impact on both the research and the participants. Drawing on grounded theory, we undertook inductive analysis and storyline mapping to develop a theorized framework of mechanisms supporting the process of coproduction in T1DM research with young people. Findings The framework involving coproduction partners in research about young people with type 1 diabetes centres on the unique expertize that different team members bring to the research and describes conditions that enable expert contributions through the enactment of a variety of expert roles. The framework also describes outcomes—the impact of the expert contributions on both the research and the team members involved. Conclusion The findings of this small exploratory study provide a sound foundation to develop further understanding about structures and processes that are integral for the success of coproduction research teams. The framework may provide a guide for researchers planning to incorporate coproduction, on elements that are important for this model of research to succeed. It may also inform coproduction impact assessment research and be used for hypothesis testing and expansion in future studies.
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Affiliation(s)
- Jane Desborough
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Fiona Lewis
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Harry Ebbeck
- Department of Health Services, Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Halcomb E, Fernandez R, Mursa R, Stephen C, Calma K, Ashley C, McInnes S, Desborough J, James S, Williams A. Mental health, safety and support during COVID-19: A cross-sectional study of primary health care nurses. J Nurs Manag 2021; 30:393-402. [PMID: 34890472 DOI: 10.1111/jonm.13534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 12/05/2021] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study is to explore primary health care nurses' mental health, concerns and perceived safety and supports during COVID-19. BACKGROUND Respiratory pandemics have negative impacts on nurses' wellbeing. While literature is replete with hospital nurses' experiences, there is less exploration of COVID-19 impacts on primary health care nurses. Given the importance of primary health care nurses in the health system, understanding their experiences is vital. METHODS Three hundred and fifty nine primary health care nurses responded to an online cross-sectional survey. The Depression Anxiety Stress Scales (DASS-21) was used to measure emotional state. Data were analysed using descriptive and inferential statistics. RESULTS DASS-21 scores indicated that 39.6% of participants were experiencing symptoms of depression, anxiety or stress. Of those, 41.8% were experiencing symptoms on one scale, 26.9% were experiencing symptoms on two scales and 31.2% were experiencing symptoms across all three scales. Most participants identified that their feelings were related to COVID-19. CONCLUSIONS COVID-19 is having a significant impact on primary health care nurses' mental health. Nurse managers need to develop strategies to effectively address nurses' concerns and effectively support them to sustain the workforce during and after the pandemic. IMPLICATIONS FOR NURSING MANAGEMENT Findings from this study can inform the design of effective nurse support programmes to reduce mental health impacts and promote staff wellbeing during the pandemic.
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Affiliation(s)
- Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Institute, Wollongong, New South Wales, Australia
| | - Ritin Fernandez
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Centre for Research in Nursing and Health, St George Hospital, Kogarah, New South Wales, Australia
| | - Ruth Mursa
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Institute, Wollongong, New South Wales, Australia
| | - Catherine Stephen
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Institute, Wollongong, New South Wales, Australia
| | - Kaara Calma
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Institute, Wollongong, New South Wales, Australia
| | - Christine Ashley
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Susan McInnes
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jane Desborough
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharon James
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Department of General Practice, School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Anna Williams
- School of Nursing and Midwifery, Health Sciences and Physiotherapy, University of Notre Dame Australia, Sydney, New South Wales, Australia
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Butler DC, Jorm LR, Larkins S, Humphreys J, Desborough J, Korda KJ. Examining area-level variation in service organisation and delivery across the breadth of primary healthcare. Usefulness of measures constructed from routine data. PLoS One 2021; 16:e0260615. [PMID: 34852021 PMCID: PMC8635352 DOI: 10.1371/journal.pone.0260615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effective PHC systems. Using a suite of measures constructed at the area-level, this study explored their application in assessing area-level variation in PHC organisation and delivery. Methods Routinely collected data from New South Wales, Australia were used to construct 13 small area-level measures of PHC service organisation and delivery that best approximated access (availability, affordability, accommodation) comprehensiveness and coordination. Regression analyses and pairwise Pearson’s correlations were used to examine variation by area, and by remoteness and area disadvantage. Results PHC service delivery varied geographically at the small-area level–within cities and more remote locations. Areas in major cities were more accessible (all measures), while in remote areas, services were more comprehensive and coordinated. In disadvantaged areas of major cities, there were fewer GPs (most disadvantaged quintile 0.9[SD 0.1] vs least 1.0[SD 0.2]), services were more affordable (97.4%[1.6] bulk-billed vs 75.7[11.3]), a greater proportion were after-hours (10.3%[3.0] vs 6.2[2.9]) and for chronic disease care (28%[3.4] vs 17.6[8.0]) but fewer for preventive care (50.7%[3.8] had cervical screening vs 62.5[4.9]). Patterns were similar in regional locations, other than disadvantaged areas had less after-hours care (1.3%[0.7] vs 6.1%[3.9]). Measures were positively correlated, except GP supply and affordability in major cities (-0.41, p < .01). Implications Application of constructed measures revealed inequity in PHC service delivery amenable to policy intervention. Initiatives should consider the maldistribution of GPs not only by remoteness but also by area disadvantage. Avenues for improvement in disadvantaged areas include preventative care across all regions and after-hours care in regional locations.
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Affiliation(s)
- D. C. Butler
- Research School of Population Health, Australian National University, Canberra, Australia
- * E-mail:
| | - L. R. Jorm
- Centre for Big Data Research in Health, University of New South Wales, Kensington, Australia
| | - S. Larkins
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
| | - J. Humphreys
- School of Rural Health, Monash University, Melbourne, Australia
| | - J. Desborough
- Research School of Population Health, Australian National University, Canberra, Australia
| | - K. J. Korda
- Research School of Population Health, Australian National University, Canberra, Australia
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Desborough J, Dykgraaf SH, Phillips C, Wright M, Maddox R, Davis S, Kidd M. Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics. Fam Pract 2021; 38:811-825. [PMID: 33586769 PMCID: PMC7928916 DOI: 10.1093/fampra/cmaa142] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND COVID-19 is the fifth and most significant infectious disease epidemic this century. Primary health care providers, which include those working in primary care and public health roles, have critical responsibilities in the management of health emergencies. OBJECTIVE To synthesize accounts of primary care lessons learnt from past epidemics and their relevance to COVID-19. METHODS We conducted a review of lessons learnt from previous infectious disease epidemics for primary care, and their relevance to COVID-19. We searched PubMed/MEDLINE, PROQUEST and Google Scholar, hand-searched reference lists of included studies, and included research identified through professional contacts. RESULTS Of 173 publications identified, 31 publications describing experiences of four epidemics in 11 countries were included. Synthesis of findings identified six key lessons: (i) improve collaboration, communication and integration between public health and primary care; (ii) strengthen the primary health care system; (iii) provide consistent, coordinated and reliable information emanating from a trusted source; (iv) define the role of primary care during pandemics; (v) protect the primary care workforce and the community and (vi) evaluate the effectiveness of interventions. CONCLUSIONS Evidence highlights distinct challenges to integrating and supporting primary care in response to infectious disease epidemics that have persisted over time, emerging again during COVID-19. These insights provide an opportunity for strengthening, and improved preparedness, that cannot be ignored in a world where the frequency, virility and global reach of infectious disease outbreaks are increasing. It is not too soon to plan for the next pandemic, which may already be on the horizon.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Sally Hall Dykgraaf
- Australian National University Rural Clinical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine Australian National University, Canberra, Australia
| | - Michael Wright
- Centre for Health Economics Research and Evaluation (CHERE), University Technology Sydney, Sydney, Australia
| | - Raglan Maddox
- COVID-19 Primary Care Response Group, Australian Department of Health, Canberra, Australia
- National Centre for Epidemiology and Public Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Stephanie Davis
- COVID-19 Primary Care Response Group, Australian Department of Health, Canberra, Australia
- National Centre for Epidemiology and Public Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- World Health Organization Collaborating Centre on Family Medicine and Primary Care, Geneva, Switzerland
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
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Parkinson A, Brew-Sam N, Hall Dykgraaf S, Nolan C, Lafferty A, Schmidli R, Brown E, Brown K, Pedley L, Ebbeck H, Pedley E, Wright K, Phillips C, Desborough J. Managing type 1 diabetes during the COVID-19 pandemic is a team effort: a qualitative study of the experiences of young people and their parents. Integr Healthc J 2021; 3:e000082. [PMID: 38607941 PMCID: PMC8593267 DOI: 10.1136/ihj-2021-000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/26/2021] [Indexed: 11/03/2022] Open
Abstract
Objective To explore the experiences of young people with type 1 diabetes mellitus (T1DM) and their parents in accessing integrated family-centred care in the Australian Capital Territory during the COVID-19 pandemic. Methods and analysis This is a pragmatic, qualitative descriptive study for which we conducted semistructured interviews with 11 young people with T1DM aged 12-16 years and 10 of their parents who attended an outpatient diabetes service in Canberra, Australia. Thematic analysis was conducted in accordance with the methods outlined by Braun and Clarke. Results Three themes were identified: feeling vulnerable, new ways of accessing care and trust in the interdisciplinary diabetes healthcare team. Participants believed having T1DM made them more vulnerable to poor outcomes if they contracted COVID-19, resulting in avoidance of face-to-face care. Telephone consultations offered a convenient and contact-free way to undertake 3-monthly reviews. The greatest difference between telephone and face-to-face consultations was not having access to the whole interdisciplinary diabetes support team at one appointment, physical examination and haemoglobin A1c testing during telehealth consultations. Participants trusted that clinicians would arrange face-to-face meetings if required. Some felt a video option might be better than telephone, reflecting in part the need for more training in communication skills for remote consultations. Conclusion Young people with T1DM and their parents require collaborative care and contact with multiple healthcare professionals to facilitate self-management and glycaemic control. While telephone consultations offered convenient, safe, contact-free access to healthcare professionals during the COVID-19 pandemic, the added value of video consultations and facilitating access to the whole interdisciplinary diabetes support team need to be considered in future clinical implementation of telehealth.
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Affiliation(s)
- Anne Parkinson
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicola Brew-Sam
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sally Hall Dykgraaf
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher Nolan
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Antony Lafferty
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Robert Schmidli
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Ellen Brown
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Brown
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lachlan Pedley
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Harry Ebbeck
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Elizabeth Pedley
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kristine Wright
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christine Phillips
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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Dykgraaf SH, Matenge S, Desborough J, Sturgiss E, Dut G, Roberts L, McMillan A, Kidd M. Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence. J Am Med Dir Assoc 2021; 22:1969-1988. [PMID: 34428466 PMCID: PMC8328566 DOI: 10.1016/j.jamda.2021.07.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. DESIGN Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. SETTING AND PARTICIPANTS Residents and staff in care settings such as nursing homes and long-term care facilities. METHODS PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. RESULTS Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. CONCLUSIONS AND IMPLICATIONS High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.
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Affiliation(s)
- Sally Hall Dykgraaf
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia.
| | - Sethunya Matenge
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Jane Desborough
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Elizabeth Sturgiss
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Garang Dut
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Leslee Roberts
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Canberra ACT, Australia
| | - Alison McMillan
- Australian Government Department of Health, Canberra ACT, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra ACT, Australia
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James S, Ashley C, Williams A, Desborough J, Mcinnes S, Calma K, Mursa R, Stephen C, Halcomb EJ. Experiences of Australian primary healthcare nurses in using telehealth during COVID-19: a qualitative study. BMJ Open 2021; 11:e049095. [PMID: 34362804 PMCID: PMC8350972 DOI: 10.1136/bmjopen-2021-049095] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study sought to explore the experiences of Australian primary healthcare (PHC) nurses in the use of telehealth during COVID-19. Telehealth was defined as the use of any telecommunications mode (eg, telephone and videoconferencing) to deliver healthcare. DESIGN AND SETTING Thematic analysis of qualitative interviews undertaken in Australian PHC. PARTICIPANTS Twenty-five PHC nurses who had participated in a national survey about their experiences during COVID-19 were recruited using purposive sampling. METHODS Semistructured telephone interviews were conducted from June to August 2020. Interviews lasted a mean of 38.5 min. They were audio-recorded and transcribed before thematic analysis was undertaken. The consolidated criteria for reporting qualitative research were followed. RESULTS Four overarching themes were identified: preparedness, accessibility of telehealth, care experience and impacts on the PHC nurses' role. Some nurses were experienced in the use of telehealth, while others indicated a lack of preparation and limited appropriate technology to support its use. Telehealth enabled patients to access care but did not support complex clinical assessment. Participants indicated that patient engagement in telehealth was dependent on access and confidence using technology, perceived safety when physically attending the practice and the value they placed on care via telehealth. Many participants expressed frustration about telehealth funding and its impact on facilitating nurses to practise to their full scope. CONCLUSION Telehealth has provided a means to continue PHC service delivery during COVID-19. While there are advantages to adopting this technology, considerations of the challenges and lessons from this experience are important to inform the future implementation of telehealth initiatives.
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Affiliation(s)
- Sharon James
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Christine Ashley
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anna Williams
- School of Nursing and Midwifery, Health Sciences and Physiotherapy, University of Notre Dame, Sydney, New South Wales, Australia
| | - Jane Desborough
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Susan Mcinnes
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kaara Calma
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ruth Mursa
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Catherine Stephen
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth J Halcomb
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Munindradasa A, Blashki G, Hall Dykgraaf S, Desborough J, Kidd M. General practitioner management of mental health during the COVID-19 pandemic. Aust J Gen Pract 2021; 50:472-477. [PMID: 34189550 DOI: 10.31128/ajgp-11-20-5745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychological issues are common presentations in general practice. The COVID-19 pandemic has created a 'perfect storm' for the deterioration of mental health. General practitioners (GPs) are ideally placed to provide supports for people with mental health issues. OBJECTIVE The objective of this article is to provide an overview of management approaches for mental health issues, paying attention to fostering resilience and lifestyle factors, particularly during the COVID-19 pandemic period. DISCUSSION While feelings of fear and anxiety are expected in these uncertain times, some people may experience an exacerbation of a mental illness or develop a mental health issue for the first time during the COVID-19 pandemic. A list of resources available to GPs is provided, and case studies are used to demonstrate how these resources can be used to support assessment and management during the COVID-19 pandemic.
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Affiliation(s)
- Ashvini Munindradasa
- MChD, MPH, Academic General Practice Registrar, Rural Clinical School, Australian National University, ACT
| | - Grant Blashki
- MBBS, MD, FRACGP, Lead Clinical Advisor, Beyond Blue, Vic; Associate Professor, Nossal Institute for Global Health and Melbourne Sustainable Society Institute, The University of Melbourne, Vic
| | - Sally Hall Dykgraaf
- RN, Grad Cert Clin Man, PhD Scholar, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Research Manager, Rural Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, ACT
| | - Jane Desborough
- RN, RM, MPH, PhD, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Senior Research Fellow, Research School of Population Health, Australian National University, ACT
| | - Michael Kidd
- AM MBBS (Hons), MD, DCCH, DipRACOG, MCFP, FAHMS, Principal Medical Advisor and Deputy Chief Medical Officer, Australian Government Department of Health, ACT; Professor of Primary Care Reform, Australian National University, ACT; Adjunct Professor, Department of Family and Community Medicine, University of Toronto, Canada; Emeritus Director, World Health Organization Collaborating Centre on Family Medicine and Primary Care, GVA; Professorial Fellow, Murdoch Children@s Research Institute, The Royal Children@s Hospital Melbourne, Vic; Honorary Professor of Global Primary Care, Southgate Institute for Health, Society and Equity, Flinders University, SA
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Parkinson A, Drew J, Hall Dykgraaf S, Fanning V, Chisholm K, Elisha M, Lueck C, Phillips C, Desborough J. 'They're getting a taste of our world': A qualitative study of people with multiple sclerosis' experiences of accessing health care during the COVID-19 pandemic in the Australian Capital Territory. Health Expect 2021; 24:1607-1617. [PMID: 34227728 PMCID: PMC8483188 DOI: 10.1111/hex.13284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background People with multiple sclerosis (MS), who are often immunocompromised, require complex care and engage with a variety of health‐care providers to manage their health. Objective To elucidate people with MS' experiences of accessing health care during the COVID‐19 pandemic in Australia. Design A qualitative study involving semi‐structured interviews and thematic analysis. Settings and participants Eight adults with a clinical diagnosis of MS participated in telephone or video call interviews between June and July 2020. Results Participants were aware that having MS made them more vulnerable to contracting COVID‐19. In some cases, usual care was postponed or not sought. Some circumstances warranted the risk of a face‐to‐face consultation. Benefits of telehealth consultations included improved access, convenience and being contact‐free. In comparison with video consultations, those via telephone were considered less personal and limited capacity to read body language, and for physical examination. Most participants hoped to incorporate telehealth into their future health‐care routines. Discussion and conclusion Personal risk assessment and trust in health‐care professionals are determinants of the mode through which people with MS accessed health care during the COVID‐19 pandemic. Telehealth has been a valuable tool to mitigate COVID‐19 transmission through enabling contact‐free consultations. People with MS may find specific value in video consultations, which enable visualization of physical function. There is a need for training and support for all clinicians to conduct remote consultations. Patient or public contribution This study was conducted by a team comprised of four people with MS, a neurologist and four health services researchers.
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Affiliation(s)
- Anne Parkinson
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Janet Drew
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | | | - Vanessa Fanning
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Katrina Chisholm
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Mark Elisha
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Christian Lueck
- Medical School, Australian National University, Canberra, ACT, Australia.,Department of Neurology, Canberra Hospital, Canberra, ACT, Australia
| | - Christine Phillips
- Medical School, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
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Hall Dykgraaf S, Desborough J, de Toca L, Davis S, Roberts L, Munindradasa A, McMillan A, Kelly P, Kidd M. "A decade's worth of work in a matter of days": The journey to telehealth for the whole population in Australia. Int J Med Inform 2021; 151:104483. [PMID: 33984625 PMCID: PMC8103781 DOI: 10.1016/j.ijmedinf.2021.104483] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/16/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
Introduction Internationally the COVID-19 pandemic has triggered a dramatic and unprecedented shift in telehealth uptake as a means of protecting healthcare consumers and providers through remote consultation modes. Early in the pandemic, Australia implemented a comprehensive and responsive set of policy measures to support telehealth. Initially targeted at protecting vulnerable individuals, including health professionals, this rapidly expanded to a “whole population” approach as the pandemic evolved. This policy response supported health system capacity and community confidence by protecting patients and healthcare providers; creating opportunities for controlled triage, remote assessment and treatment of mild COVID-19 cases; redeploying quarantined or isolated health care workers (HCWs); and maintaining routine and non-COVID healthcare. Purpose This paper provides a review of the literature regarding telephone and video consulting, outlines the pre-COVID background to telehealth implementation in Australia, and describes the national telehealth policy measures instituted in response to COVID-19. Aligned with the existing payment system for out of hospital care, and funded by the national health insurance scheme, a suite of approximately 300 temporary telehealth Medicare-subsidised services were introduced. Response to these initiatives was swift and strong, with 30.01 million services, at a cost of AUD $1.54 billion, claimed in the first six months. Findings This initiative has been a major policy success, ensuring the safety of healthcare consumers and healthcare workers during a time of great uncertainty, and addressing known financial risks and barriers for health service providers. The risks posed by COVID-19 have radically altered the value proposition of telehealth for patients and clinicians, overcoming many previously encountered barriers to implementation, including willingness of clinicians to adopt telehealth, consumer awareness and demand, and the necessity of learning new ways of conducting safe consultations. However, ensuring the quality of telehealth services is a key ongoing concern. Conclusions Despite a preference by policymakers for video consultation, the majority of telehealth consults in Australia were conducted by telephone. The pronounced dominance of telephone item numbers in early utilisation data suggests there are still barriers to video-consultations, and a number of challenges remain before the well-described benefits of telehealth can be fully realised from this policy and investment. Ongoing exposure to a range of clinical, legislative, insurance, educational, regulatory, and interoperability concerns and solutions, driven by necessity, may drive changes in expectations about what is desirable and feasible – among both patients and clinicians.
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Affiliation(s)
- Sally Hall Dykgraaf
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Australia.
| | - Jane Desborough
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Australia
| | - Lucas de Toca
- Acting FAS COVID-19 Primary Care Response, Primary Care Division, Australian Government Department of Health, Australia
| | - Stephanie Davis
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Australia
| | - Leslee Roberts
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Australia
| | | | | | - Paul Kelly
- Australian Government Department of Health, Australia
| | - Michael Kidd
- Australian Government Department of Health, Australia
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Desborough J, Hall Dykgraaf S, Davis S, Kidd M. Reflecting on Australia's five principles for pandemic response in primary care through the lens of early international experiences of COVID-19. Aust J Gen Pract 2021; 50. [PMID: 33543152 DOI: 10.31128/ajgp-covid-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In scoping the emerging literature on COVID-19 during 2020 and considering its policy relevance, we identified six emerging challenges that highlight the importance of the five principles.
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Affiliation(s)
- Jane Desborough
- RN, RM, MPH, PhD, Action Researcher, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Senior Research Fellow, Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University; Program Leader, Health Experience Team, Our Health in Our Hands (OHIOH), Australian National University, ACT
| | - Sally Hall Dykgraaf
- RN, Grad Cert Clin Man, PhD Scholar, Action Research, COVID-19 Primary Care Response Group (seconded), Primary Care Division, Australian Government Department of Health, ACT; Research Manager, Rural Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, ACT
| | - Stephanie Davis
- MBBS, MAppEpi, Medical Advisor, COVID-19 Primary Care Response Group, Australian Government Department of Health, ACT; Medical Advisor, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Michael Kidd
- AM MBBS (Hons), MD, DCCH, DipRACOG, MCFP, FAHMS, Principal Medical Advisor and Deputy Chief Medical Officer, Australian Government Department of Health, ACT; Professor of Primary Care Reform, Australian National University, ACT; Adjunct Professor, Department of Family and Community Medicine, University of Toronto, Canada; Emeritus Director, World Health Organization Collaborating Centre on Family Medicine and Primary Care, GVA; Professorial Fellow, Murdoch Children@s Research Institute, The Royal Children@s Hospital Melbourne, Vic; Honorary Professor of Global Primary Care, Southgate Institute for Health, Society and Equity, Flinders University, SA
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Brew-Sam N, Chhabra M, Parkinson A, Hannan K, Brown E, Pedley L, Brown K, Wright K, Pedley E, Nolan CJ, Phillips C, Suominen H, Tricoli A, Desborough J. Experiences of Young People and Their Caregivers of Using Technology to Manage Type 1 Diabetes Mellitus: Systematic Literature Review and Narrative Synthesis. JMIR Diabetes 2021; 6:e20973. [PMID: 33528374 PMCID: PMC7886614 DOI: 10.2196/20973] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/23/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the last decade, diabetes management has begun to transition to technology-based care, with young people being the focus of many technological advances. Yet, detailed insights into the experiences of young people and their caregivers of using technology to manage type 1 diabetes mellitus are lacking. OBJECTIVE The objective of our study was to describe the breadth of experiences and perspectives on diabetes technology use among children and adolescents with type 1 diabetes mellitus and their caregivers. METHODS This systematic literature review used integrated thematic analysis to guide a narrative synthesis of the included studies. We analyzed the perspectives and experiences of young people with type 1 diabetes mellitus and their caregivers reported in qualitative studies, quantitative descriptive studies, and studies with a mixed methods design. RESULTS Seventeen articles met the inclusion criteria, and they included studies on insulin pump, glucose sensors, and remote monitoring systems. The following eight themes were derived from the analysis: (1) expectations of the technology prior to use, (2) perceived impact on sleep and overnight experiences, (3) experiences with alarms, (4) impact on independence and relationships, (5) perceived usage impact on blood glucose control, (6) device design and features, (7) financial cost, and (8) user satisfaction. While many advantages of using diabetes technology were reported, several challenges for its use were also reported, such as cost, the size and visibility of devices, and the intrusiveness of alarms, which drew attention to the fact that the user had type 1 diabetes mellitus. Continued use of diabetes technology was underpinned by its benefits outweighing its challenges, especially among younger people. CONCLUSIONS Diabetes technologies have improved the quality of life of many young people with type 1 diabetes mellitus and their caregivers. Future design needs to consider the impact of these technologies on relationships between young people and their caregivers, and the impact of device features and characteristics such as size, ease of use, and cost.
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Affiliation(s)
- Nicola Brew-Sam
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Madhur Chhabra
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kristal Hannan
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ellen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Lachlan Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Karen Brown
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Kristine Wright
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Elizabeth Pedley
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Canberra Health Services, Canberra, Australia
| | - Christopher J Nolan
- Canberra Health Services, Canberra, Australia.,ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia.,The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, Australian National University, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland.,Data61, Commonwealth Scientific and Industrial Research Organisation, Canberra, Australia
| | - Antonio Tricoli
- The John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, Australia.,Nanotechnology Research Lab, Research School of Chemistry, College of Science, Australian National University, Canberra, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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Pramono A, Smith J, Desborough J, Bourke S. Social value of maintaining baby-friendly hospital initiative accreditation in Australia: case study. Int J Equity Health 2021; 20:22. [PMID: 33413439 PMCID: PMC7792205 DOI: 10.1186/s12939-020-01365-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. METHOD The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital's Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. RESULTS The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16-112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. CONCLUSIONS Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity.
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Affiliation(s)
- Andini Pramono
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, Canberra, Australian Capital Territory 0200 Australia
| | - Julie Smith
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, Canberra, Australian Capital Territory 0200 Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, Canberra, Australian Capital Territory 0200 Australia
| | - Siobhan Bourke
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, Canberra, Australian Capital Territory 0200 Australia
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James S, Halcomb E, Desborough J, McInnes S. Barriers and facilitators to lifestyle risk communication by Australian general practice nurses. Aust J Prim Health 2021; 27:30-35. [PMID: 33222756 DOI: 10.1071/py20139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
Lifestyle risk factors are antecedents to many chronic conditions and are largely modifiable. Health professional support is often sought to reduce lifestyle risk. The ongoing relationship general practice nurses typically have with patients situates them ideally to provide this support. This paper explores the barriers and facilitators to lifestyle risk communication by registered nurses (RNs) in Australian general practice. Fifteen general practice RNs from south-eastern Australia participated in semistructured interviews. Verbatim transcriptions of the audio-recorded interviews were analysed using thematic analysis. Six themes emerged in terms of perceived barriers and facilitators: educational preparation and confidence; organisational and funding arrangements; lifestyle risk prioritisation; organisational support; autonomous roles; and supporting patients' needs. Although communication about lifestyle risk factors is within the general practice nurses' scope of practice, concerted efforts fostering interdisciplinary collaboration, the prioritisation of time, funding and educational opportunities would better support this role, at the same time optimising chronic disease management and patient outcomes.
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Affiliation(s)
- Sharon James
- School of Nursing, University of Wollongong, Auckland Street, Bega, NSW 2550, Australia; and Corresponding author.
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Medicine, Biology and the Environment, Australian National University, 63 Eggleston Road, Acton, ACT 2601, Australia
| | - Susan McInnes
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
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James S, Mcinnes S, Halcomb E, Desborough J. General practice nurses’ communication strategies for lifestyle risk reduction: A content analysis. J Adv Nurs 2020; 76:3082-3091. [DOI: 10.1111/jan.14518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Sharon James
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong Bega Australia
| | - Susan Mcinnes
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong & Illawarra Health & Medical Research Institute Wollongong Australia
| | - Elizabeth Halcomb
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong & Illawarra Health & Medical Research Institute Wollongong Australia
| | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population HealthCollege of Medicine, Biology and the EnvironmentAustralian National University Acton Australia
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46
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Affiliation(s)
- Jane Desborough
- College of Health and Medicine, Australian National University, Canberra, ACT
| | - Sally Hall Dykgraaf
- College of Health and Medicine, Australian National University, Canberra, ACT
| | - Lucas de Toca
- COVID-19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT
| | - Stephanie Davis
- COVID-19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Leslee Roberts
- COVID-19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT
| | - Catherine Kelaher
- Chief Medical Officer Group, Australian Government Department of Health, Canberra, ACT
| | - Michael Kidd
- College of Health and Medicine, Australian National University, Canberra, ACT.,COVID-19 Primary Care Response Group, Australian Government Department of Health, Canberra, ACT
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47
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Desborough J, Brunoro C, Parkinson A, Chisholm K, Elisha M, Drew J, Fanning V, Lueck C, Bruestle A, Cook M, Suominen H, Tricoli A, Henschke A, Phillips C. 'It struck at the heart of who I thought I was': A meta-synthesis of the qualitative literature examining the experiences of people with multiple sclerosis. Health Expect 2020; 23:1007-1027. [PMID: 32578287 PMCID: PMC7696124 DOI: 10.1111/hex.13093] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 02/03/2023] Open
Abstract
Background People with multiple sclerosis (MS) have varied experiences and approaches to self‐management. This review aimed to explore the experiences of people with MS, and consider the implications of these experiences for clinical practice and research. Methods A meta‐synthesis of the qualitative literature examining experiences of people with MS was conducted using systematic searches of ProQuest, PubMed, CINAHL and PsycINFO. We incorporated feedback from team members with MS as expert patient knowledge‐users to capture the complex subjectivities of persons with lived experience responding to research on lived experience of the same disease. Results Of 1680 unique articles, 77 met the inclusion criteria. We identified five experiential themes: (a) the quest for knowledge, expertise and understanding, (b) uncertain trajectories (c) loss of valued roles and activities, and the threat of a changing identity, (d) managing fatigue and its impacts on life and relationships, and (f) adapting to life with MS. These themes were distributed across three domains related to disease (symptoms; diagnosis; progression and relapse) and two contexts (the health‐care sector; and work, social and family life). Conclusion The majority of people in the studies included in this review expressed a determination to adapt to MS, indicating a strong motivation for people with MS and clinicians to collaborate in the quest for knowledge. Clinicians caring for people with MS need to consider the experiential and social outcomes of this disease such as fatigue and the preservation of valued social roles, and incorporate this into case management and clinical planning.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Crystal Brunoro
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Katrina Chisholm
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Mark Elisha
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Janet Drew
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Vanessa Fanning
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Christian Lueck
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Bruestle
- John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Matthew Cook
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Hanna Suominen
- School of Computer Science, College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia
| | - Antonio Tricoli
- Research School of Electrical Energy & Materials Engineering, College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia
| | - Adam Henschke
- National Security College, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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Hall Dykgraaf S, Desborough J, Kelaher C, Kidd M. COVID-19 highlights risks of healthcare and social care workers attending work while ill. Aust J Gen Pract 2020; 49. [PMID: 32539245 DOI: 10.31128/ajgp-covid-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As COVID-19 affects healthcare and social care systems around the world, reports of infection among healthcare and social care workers continue to accumulate.
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49
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Desborough J, Hall Dykgraaf S, Rankin D, Kidd M. The importance of consistent advice during a pandemic: An analysis of Australian advice regarding personal protective equipment in healthcare settings during COVID-19. Aust J Gen Pract 2020; 49:369-372. [DOI: 10.31128/ajgp-04-20-5374] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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James S, Desborough J, McInnes S, Halcomb EJ. Nonverbal communication between registered nurses and patients during chronic disease management consultations: Observations from general practice. J Clin Nurs 2020; 29:2378-2387. [DOI: 10.1111/jocn.15249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/06/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Sharon James
- School of Nursing University of Wollongong BEGA NSW Australia
| | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population Health College of Medicine, Biology and the Environment Australian National University ACTON ACT Australia
| | - Susan McInnes
- School of Nursing University of Wollongong WOLLONGONG NSW Australia
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