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Abbott P, Frede C, Hu WCY, Lujic S, Trankle S, Campbell L, Gunasekera H, Walsh R, Leach AJ, Morris P, Kong K, Reath J. Acute otitis media symptoms and symptom scales in research with Aboriginal and Torres Strait Islander children. PLoS One 2023; 18:e0280926. [PMID: 36821636 PMCID: PMC9949645 DOI: 10.1371/journal.pone.0280926] [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: 06/25/2022] [Accepted: 12/29/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander children experience a high burden of otitis media. We collected data on symptoms associated with acute otitis media (AOM) in a clinical trial involving children receiving primary care at urban Aboriginal Medical Services. Two scales were employed to monitor symptoms over time: the AOM-Severity of Symptoms scale (AOM-SOS) and the AOM-Faces Scale (AOM-FS). This study took place at a mid-point of the un-blinded trial. METHODS We examined symptoms at enrolment and day 7, and compared the scales for trends, and bivariate correlation (Spearman's rho) over 14 days. Responsiveness of the scales to clinical change was determined by Friedman's test of trend in two subgroups stratified by day 7 AOM status. We interviewed parents/carers and research officers regarding their experience of the scales and analysed data thematically. RESULTS Data derived from 224 children (18 months to 16 years; median 3.6 years). Common symptoms associated with AOM at baseline were runny nose (40%), cough (38%) and irritability (36%). More than one third had no or minimal symptoms at baseline according to AOM-SOS (1-2/10) and AOM-FS scores (1-2/7). The scales performed similarly, and were moderately correlated, at all study points. Although scores decreased from day 0 to 14, trends and mean scores were the same whether AOM was persistent or resolved at day 7. Users preferred the simplicity of the AOM-FS but encountered challenges when interpreting it. CONCLUSION We found minimally symptomatic AOM was common among Aboriginal and Torres Strait Islander children in urban settings. The AOM-SOS and AOM-FS functioned similarly. However, it is likely the scales measured concurrent symptoms related to upper respiratory tract infections, given they did not differentiate children with persistent or resolved AOM based on stringent diagnostic criteria. This appears to limit the research and clinical value of the scales in monitoring AOM treatment among Aboriginal and Torres Strait Islander children.
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Affiliation(s)
- Penelope Abbott
- Department of General Practice, Western Sydney University, Campbelltown, New South Wales, Australia
- * E-mail:
| | - Caitlin Frede
- Department of General Practice, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Wendy C. Y. Hu
- Medical Education Unit, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Sanja Lujic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Steven Trankle
- Department of General Practice, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Letitia Campbell
- Kalwun Development Corporation, Gold Coast, Queensland, Australia
| | - Hasantha Gunasekera
- Children’s Hospital Westmead Clinical School, Sydney University, Sydney, New South Wales, Australia
| | - Robyn Walsh
- Department of General Practice, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Amanda J. Leach
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Peter Morris
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jennifer Reath
- Department of General Practice, Western Sydney University, Campbelltown, New South Wales, Australia
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Kerr M, Evangelidis N, Abbott P, Craig JC, Dickson M, Scholes-Robertson N, Sinka V, Vastani RT, Widders K, Stephens J, Tong A. Indigenous peoples' perspectives of living with chronic kidney disease: systematic review of qualitative studies. Kidney Int 2022; 102:720-727. [PMID: 35788358 DOI: 10.1016/j.kint.2022.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Marianne Kerr
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
| | - Nicole Evangelidis
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Penrith, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Victoria Sinka
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Rahim T Vastani
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katherine Widders
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Jacqueline Stephens
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Lau P, Ryan S, Abbott P, Tannous K, Trankle S, Peters K, Page A, Cochrane N, Usherwood T, Reath J. Protocol for a Delphi consensus study to select indicators of high-quality general practice to achieve Quality Equity and Systems Transformation in Primary Health Care (QUEST-PHC) in Australia. PLoS One 2022; 17:e0268096. [PMID: 35609025 PMCID: PMC9128979 DOI: 10.1371/journal.pone.0268096] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background High-quality general practice has been demonstrated to provide cost-effective, equitable health care and improve health outcomes. Yet there is currently not a set of agreed comprehensive indicators in Australia. We have developed 79 evidence-based indicators and their corresponding 129 measures of high-quality general practice. This study aims to achieve consensus on relevant and feasible indicators and measures for the Australian context. Methods This Delphi consensus study, approved by WSU Human Research Ethics Committee, consists of three rounds of online survey with general practice experts including general practitioners, practice nurses and primary health network staff. The identified indicators and measures are grouped under an attribute framework aligned with the Quadruple Aim, and further grouped under structures, processes and outcomes according to the Donabedian framework. Participants will rate each indicator and measure for relevance and feasibility, and provide comments and recommendations of additional indicators or measures. In the last round, participants will also be asked their views on the implementation of a quality indicator tool. Each indicator and measure will require ≥70% agreement in both relevance and feasibility to achieve consensus. Aggregated ratings will be statistically analysed for response rates, level of agreement, medians, interquartile ranges and group rankings. Qualitative responses will be analysed thematically using a mixed inductive and deductive approach. Discussion This protocol will add to the current knowledge of the translation of performance guidelines into quality practice across complex clinical settings and in a variety of different contexts in Australian general practice. The Delphi technique is appropriate to develop consensus between the diverse experts because of its ability to offer anonymity to other participants and minimise bias. Findings will contribute to the design of an assessment tool of high-quality general practice that would enable future primary health care reforms in Australia.
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Affiliation(s)
- Phyllis Lau
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- * E-mail:
| | - Samantha Ryan
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Kathy Tannous
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- School of Business, Western Sydney University, Sydney, NSW, Australia
| | - Steven Trankle
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Kath Peters
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Natalie Cochrane
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Tim Usherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- George Institute for Global Health, Sydney, NSW, Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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Metusela C, Cochrane N, van Werven H, Usherwood T, Ferdousi S, Messom R, O'Halloran D, Fasher M, Page A, Trankle S, Abbott P, Tannous WK, Peters K, Meisinger K, Reath J. Developing indicators and measures of high-quality for Australian general practice. Aust J Prim Health 2022; 28:215-223. [PMID: 35450569 DOI: 10.1071/py21164] [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: 07/12/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rising health costs and health inequity are major challenges in Australia, as internationally. Strong primary health care is well evidenced to address these challenges. Primary Health Networks (PHNs) work with general practices to collect data and support quality improvement; however, there is no consensus regarding what defines high quality. This paper describes the development of an evidence-based suite of indicators and measures of high-quality general practice for the Australian context. METHODS We reviewed the literature to develop a suitable framework and revise quality assurance measures currently in use, then reviewed these in three workshops with general practitioners, practice managers, nurses, consumers and PHN staff in western Sydney. We used a descriptive qualitative research approach to analyse the data. RESULTS A total of 125 evidence-based indicators were agreed to be relevant, and 80 were deemed both relevant and feasible. These were arranged across a framework based on the Quadruple Aim, and include structure, process and outcome measures. CONCLUSIONS The agreed suite of indicators and measures will be further validated in collaboration with PHNs across Australia. This work has the potential to inform health systems innovation both nationally and internationally.
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Affiliation(s)
- Christine Metusela
- Department of General Practice, School of Medicine, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia; and Present address: School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
| | - Natalie Cochrane
- Department of General Practice, School of Medicine, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia
| | - Hannah van Werven
- Department of General Practice, School of Medicine, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia; and Present address: Locum GP at Huisartsenpraktijk De Es, H. Leefsmastraat 4, 7556 JG Hengelo, The Netherlands; and Present address: Huisartsenpraktijk Voss, Jacob Roggeveenstraat 51, 7534 CD Enschede, The Netherlands
| | - Tim Usherwood
- Sydney Medical School, The University of Sydney, Anderson Stuart Building, Camperdown, NSW 2050, Australia
| | - Shahana Ferdousi
- Western Sydney Primary Health Network, Blacktown, 85 Flushcombe Road, Blacktown, NSW 2148, Australia
| | - Ray Messom
- Western Sydney Primary Health Network, Blacktown, 85 Flushcombe Road, Blacktown, NSW 2148, Australia
| | - Diana O'Halloran
- Department of General Practice, School of Medicine, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia; and Western Sydney Primary Health Network, Blacktown, 85 Flushcombe Road, Blacktown, NSW 2148, Australia
| | - Michael Fasher
- Department of General Practice, School of Medicine, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia; and Western Sydney Primary Health Network, Blacktown, 85 Flushcombe Road, Blacktown, NSW 2148, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia
| | - Steven Trankle
- Department of General Practice, School of Medicine, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia
| | - Penelope Abbott
- Department of General Practice, School of Medicine, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia
| | - W Kathy Tannous
- Translational Health Research Institute, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia
| | - Kath Peters
- Translational Health Research Institute, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia; and School of Nursing and Midwifery, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia
| | - Kirsten Meisinger
- Cambridge Health Alliance, Harvard Center for Primary Care, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Jennifer Reath
- Department of General Practice, School of Medicine, Western Sydney University, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560, Australia
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Walsh R, Reath J, Gunasekera H, Leach A, Kong K, Askew D, Girosi F, Hu W, Usherwood T, Lujic S, Spurling G, Morris P, Watego C, Harkus S, Woodall C, Tyson C, Campbell L, Hussey S, Abbott P. INFLATE: a protocol for a randomised controlled trial comparing nasal balloon autoinflation to no nasal balloon autoinflation for otitis media with effusion in Aboriginal and Torres Strait Islander children. Trials 2022; 23:309. [PMID: 35421984 PMCID: PMC9009496 DOI: 10.1186/s13063-022-06145-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 03/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Otitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children. METHODS/DESIGN This multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3-16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken. DISCUSSION INFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12617001652369 . Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration.
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Affiliation(s)
- Robyn Walsh
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Amanda Leach
- Menzies School of Health Research, Darwin, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Deborah Askew
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Federico Girosi
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Timothy Usherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sanja Lujic
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, Australia
| | - Geoffrey Spurling
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service) Queensland Health, Brisbane, Australia
| | - Peter Morris
- Menzies School of Health Research, Darwin, Australia
| | - Chelsea Watego
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | | | - Claudette Tyson
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Sylvia Hussey
- Townsville Aboriginal and Islander Health Service, Townsville, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Sydney, Australia.
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Abbott P, Watt K, Magin P, Davison J, Hu WCY. Welcomeness for people with substance use disorders to general practice: a qualitative study. Fam Pract 2022; 39:257-263. [PMID: 34791184 DOI: 10.1093/fampra/cmab151] [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: 11/13/2022] Open
Abstract
BACKGROUND Good primary care for people with substance use disorders (SUDs) is crucial given the high prevalence of SUDs and overdose deaths. OBJECTIVE To explore general practice care for people with a history of SUDs from the perspectives of women involved with the criminal justice system. METHODS Qualitative interview study with pre- and postrelease interviews, undertaken in Australian prisons and community settings. We utilized thematic analysis informed by constructivist grounded theory. RESULTS We undertook 65 interviews with 39 women. Access to and experience of general practitioner (GP) care was affected by perceived welcomeness, decisions around disclosure, and consultation experiences related to medication prescription. Participants reported that they were not as welcome as other patients, welcome could be conditional on not disclosing SUDs or only requesting unrelated healthcare, and GPs did not always differentiate between past and current drug use. Participants perceived difficulty finding general practices where the potential benefit of disclosing SUDs outweighed the risks of stigmatized reactions and lack of GP skills and interest. Participants did not always recognize that care beyond physical health could occur in general practice. The pejorative implications of labelling patients as "doctor shoppers" were challenged by participants, as they considered it could be necessary to attend multiple GPs to find a welcoming practice. CONCLUSIONS People with histories of SUDs do not uniformly experience welcomeness in general practice, perpetuating poor engagement in healthcare and poor outcomes related to SUDs. Programmes targeting prescription drug misuse through general practice should also promote welcomeness for people with SUDs.
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Affiliation(s)
- Penelope Abbott
- Department of General Practice, School of Medicine, Western Sydney University, Sydney, Australia
| | - Kelly Watt
- Aboriginal and Torres Strait Islander Community Health Service, Brisbane, Australia
| | - Parker Magin
- Discipline of General Practice, University of Newcastle, Newcastle, Australia
| | | | - Wendy C Y Hu
- Medical Education Unit, School of Medicine, Western Sydney University, Sydney, Australia
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Campbell L, Reath J, Hu W, Gunasekera H, Askew D, Watego C, Kong K, Walsh R, Doyle K, Leach A, Tyson C, Abbott P. The socioemotional challenges and consequences for caregivers of Aboriginal and Torres Strait Islander children with otitis media: A qualitative study. Health Expect 2022; 25:1374-1383. [PMID: 35297133 PMCID: PMC9327870 DOI: 10.1111/hex.13476] [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: 11/01/2021] [Revised: 02/14/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Living with ear disease can have extensive impacts on physical, emotional and social well-being. This study explored otitis media (OM) and its management from the perspective of caregivers of Aboriginal and Torres Strait Islander children. METHODS Semi-structured interviews were conducted from 2015 to 2020 with caregivers of Aboriginal and Torres Strait Islander children with OM. Thematic analysis of transcripts was undertaken using a constructivist grounded theory approach through the leadership and the cultural lens of an Aboriginal community-based researcher. RESULTS Caregivers described OM as having profound impacts on their child's physical, developmental, and emotional well-being, with long waits for specialist treatment contributing to extra strain on families. Children's well-being suffered when OM was mistaken for poor behaviour and children were punished, with caregivers subsequently experiencing strong feelings of guilt. Concerns were conveyed about the social implications of having a sick child. The variable nature of OM symptoms meant that caregivers had to monitor closely for sequelae and advocate for appropriate treatment. Success in navigating the diagnosis and treatment of OM can be strongly impacted by the relationship between caregivers and health professionals and the perceived access to respectful, collaborative and informative healthcare. CONCLUSION OM may have substantial social and emotional consequences for children and their caregivers. A holistic understanding of the way in which OM impacts multiple facets of health and well-being, as well as recognition of challenges in accessing proper care and treatment, will aid families managing OM and its sequelae. PATIENT OR PUBLIC CONTRIBUTION Governing boards, managers, staff and community members from five Australian Aboriginal Medical Services were involved in the approval, management and conduct of this study and the wider clinical trials. The caregivers of Aboriginal and Torres Strait Islander patients at these services informed the interview study and guided its purpose.
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Affiliation(s)
- Letitia Campbell
- Kalwun Development Corporation, Gold Coast, Australia.,Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Jennifer Reath
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Wendy Hu
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Hasantha Gunasekera
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Deborah Askew
- Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Chelsea Watego
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kelvin Kong
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Robyn Walsh
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Kerrie Doyle
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
| | - Amanda Leach
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
| | - Claudette Tyson
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Metro South Health, Brisbane, Australia
| | - Penelope Abbott
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, Australia
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Reath J, Lau P, Lo W, Trankle S, Brooks M, Shahab Y, Abbott P. Strengthening learning and research in health equity – opportunities for university departments of primary health care and general practice. Aust J Prim Health 2022; 29:131-136. [PMID: 36343335 DOI: 10.1071/py22146] [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: 07/13/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
This paper explores the roles of university departments of primary health care (PHC) and general practice in promoting health equity. The coronavirus disease 2019 (COVID-19) pandemic has exposed long-standing health and workforce inequities in Australia, as elsewhere. Addressing these inequities will require wide-ranging responses particularly focussed on PHC and the PHC workforce. Well-resourced university departments of PHC and general practice have potential to lead research informing PHC transformation and strategies to reduce health inequity, as well as to train and inspire a future PHC workforce. Examples from such academic departments in Australia and internationally are briefly described, and the experience of a recently established department of general practice is considered, in order to recommend enablers including institutional support, curriculum design, and partnerships with communities and between institutions. Support for community-based clinical schools, practice-based research networks and strengthening PHC research capacity will enable the PHC and general practice academy to engage more effectively in addressing health inequity.
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Affiliation(s)
- Jennifer Reath
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Phyllis Lau
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia; and Department of General Practice, The University of Melbourne, Carlton, Vic. 3050, Australia
| | - Winston Lo
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Steven Trankle
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Miriam Brooks
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Yasin Shahab
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Penelope Abbott
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia
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Abbott P, Askew D, Watego C, Hu WC, Campbell L, Tyson C, Walsh R, Hussey S, Doyle K, Gunasekera H, Leach AJ, Usherwood T, Armstrong-Kearns J, Reath J. Randomised clinical trial research within Aboriginal and Torres Strait Islander primary health services: a qualitative study. BMJ Open 2021; 11:e050839. [PMID: 34952874 PMCID: PMC8710871 DOI: 10.1136/bmjopen-2021-050839] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To better understand how to undertake valuable, ethical and sustainable randomised controlled clinical trial (RCT) research within Aboriginal and Torres Strait Islander primary health services. DESIGN In a qualitative approach, we utilised data collected between 2013 and 2020 during the planning and implementation of two RCTs. The data comprised agreed records of research meetings, and semistructured interviews with clinical trial stakeholders. The stakeholders were parents/carers of child participants, and site-based research officers, healthcare providers and community advisory groups. Our thematic analysis was informed by constructivist grounded theory. SETTING The RCTs investigated the management of otitis media in Aboriginal and Torres Strait Islander children, with the first RCT commencing recruitment in 2014 and the second in 2017. They took place in Aboriginal Medical Services (AMSs), large primary health services for Aboriginal and Torres Strait Islander people, based in urban and regional communities across two Australian states and one territory. RESULTS We analysed data from 56 meetings and 67 interviews, generating themes on making research valuable and undertaking ethical and sustainable RCTs. Aboriginal and Torres Strait Islander leadership, and support of AMSs in their service delivery function were critical. The broad benefits of the trials were considered important to sustainability, including workforce development, enhanced ear healthcare and multidirectional research capacity building. Participants emphasised the long-term responsibility of research teams to deliver benefits to AMSs and communities regardless of RCT outcomes, and to focus on relationships, reciprocity and creating positive experiences of research. CONCLUSION We identify principles and strategies to assist in undertaking ethical and sustainable RCTs within Aboriginal and Torres Strait Islander primary health services. Maintaining relationships with AMSs and focusing on mutual workforce development and capacity building creates opportunities for long-term benefits so that health research and RCTs work for Aboriginal and Torres Strait Islander peoples, services, communities and researchers. TRIAL REGISTRATION NUMBER ACTRN12613001068752 (Pre-results); ACTRN12617001652369 (Pre-results).
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Affiliation(s)
- Penelope Abbott
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Deborah Askew
- Primary Care Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Chelsea Watego
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Wendy Cy Hu
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Letitia Campbell
- Kalwun Development Corporation, Gold Coast, Queensland, Australia
| | - Claudette Tyson
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Brisbane, Queensland, Australia
| | - Robyn Walsh
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Sylvia Hussey
- Townsville Aboriginal and Islander Health Service, Townsville, Queensland, Australia
| | - Kerrie Doyle
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | - Amanda Jane Leach
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Tim Usherwood
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Jennifer Reath
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
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Ndwiga DW, McBride KA, Simmons D, Thompson R, Reath J, Abbott P, Alofivae-Doorbinia O, Patu P, Vaovasa AT, MacMillan F. Using Community Based Research Frameworks to Develop and Implement a Church-Based Program to Prevent Diabetes and Its Complications for Samoan Communities in South Western Sydney. Int J Environ Res Public Health 2021; 18:ijerph18179385. [PMID: 34501974 PMCID: PMC8430533 DOI: 10.3390/ijerph18179385] [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] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
Pasifika communities bear a disproportionate burden of diabetes compared to the general Australian population. Community-based participatory research (CBPR), which involves working in partnership with researchers and communities to address local health needs, has gained prominence as a model of working with underserved communities. This paper describes how Le Taeao Afua (LTA) Samoan diabetes prevention program was underpinned by two CBPR frameworks to develop a culturally tailored church-based lifestyle intervention to prevent diabetes and its complications in the Australian Samoan community. The name LTA, which means ‘a new dawn,’ was chosen by the community to signify a new dawn without diabetes in the Australian Samoan community. Strategies for engaging with the Australian Samoan community in South Western Sydney are discussed mapped to the key principles from the CBPR frameworks. In particular, this paper highlights the steps involved in building relationships with Samoan community leaders and the vital role of community activators and peer support facilitators in the success of delivering the program. Lessons learnt, such as the importance of church and maintaining a Samoan way of life in daily activities, and processes to build effective partnerships and maintain long-term relationships with the Australian Samoan community, are also discussed. Our paper, through providing a case example of how to apply CBPR frameworks, will help guide future community-based health promotion programs for underserved communities.
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Affiliation(s)
- Dorothy W. Ndwiga
- School of Health Sciences, Western Sydney University, Penrith 2751, Australia;
- Institute of Health and Management, Parramatta 2150, Australia
- Correspondence: (D.W.N.); (F.M.); Tel.: +61-2-4620-3464 (F.M.)
| | - Kate A. McBride
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Ronda Thompson
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Penrith 2751, Australia; (K.A.M.); (D.S.); (R.T.); (J.R.); (P.A.)
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | | | - Paniani Patu
- The Practice Blacktown NSW, Blacktown 2148, Australia;
| | - Annalise T. Vaovasa
- School of Health Sciences, Western Sydney University, Penrith 2751, Australia;
| | - Freya MacMillan
- School of Health Sciences, Western Sydney University, Penrith 2751, Australia;
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Penrith 2751, Australia
- Translational Health Research Institute, Western Sydney University, Penrith 2751, Australia
- Correspondence: (D.W.N.); (F.M.); Tel.: +61-2-4620-3464 (F.M.)
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Green A, Abbott P, Luckett T, Davidson PM, Delaney J, Delaney P, Gunasekera H, DiGiacomo M. 'It's quite a complex trail for families now' - Provider understanding of access to services for Aboriginal children with a disability. J Child Health Care 2021; 25:194-211. [PMID: 32301329 DOI: 10.1177/1367493520919305] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aboriginal and Torres Strait Islander children experience a higher prevalence of disability and socio-economic disadvantage than other Australian children. Early intervention from across the health, education and social service sectors is vital for improving outcomes, but families face a number of barriers to service access which impede intervention. This study aimed to inform ways to improve access to services for families of urban-dwelling Aboriginal children with a range of disabilities. A qualitative approach was taken to explore providers' perceptions of factors that either impeded or enabled families' access to services. In this research, the term 'provider' refers to individuals who are employed in a range of sectors to deliver a service involving assessment or management of an individual with a disability. Semi-structured in-depth interviews with 24 providers were conducted. Data analysis was informed by the general inductive approach and then applied deductively to the candidacy framework to generate additional insights. Candidacy focuses on how potential users access the services they need and acknowledges the joint negotiation between families and providers regarding such access. Our research identified that candidacy was influenced by the historical legacy of colonisation and its ongoing socio-cultural impact on Aboriginal people, as well as funding and current policy directives. Enacting culturally sensitive and meaningful engagement to better understand families' needs and preferences for support, as well as support for providers to develop their understanding of family contexts, will contribute to facilitating service access for Aboriginal children with a disability.
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Affiliation(s)
- Anna Green
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Patricia Mary Davidson
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia.,School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - John Delaney
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Patricia Delaney
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Hasantha Gunasekera
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
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12
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Rupasinghe M, Reath J, Cvetkovski B, Smith S, Bosnic-Anticevich S, Kritikos V, Abbott P. Have we got the right focus in asthma care in general practice? A qualitative study. Aust J Gen Pract 2021; 50:410-415. [PMID: 34059847 DOI: 10.31128/ajgp-03-20-5290] [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 AND OBJECTIVES Asthma presentations are common in general practice, but opportunities to control asthma are often missed. The aim of this study was to explore how general practitioners (GPs) and practice nurses (PNs) deliver asthma care, with particular attention to perceived roles and challenges, and ways to improve management. METHOD Using a qualitative approach, semi-structured interviews were conducted with GPs and PNs working in an area of cultural diversity and socioeconomic disadvantage in western Sydney. Inductive thematic analysis was undertaken. RESULTS Nineteen interviews were conducted, with nine GPs and 10 PNs. The main focus of asthma care was on acute presentations, with less emphasis on follow-up and preventive care and underuse of general practice chronic disease models of care. PN roles were generally limited to acute asthma assessment and triage. GPs did not commonly use spirometry or access non-GP specialist input. DISCUSSION Asthma care in general practice may be improved by a greater focus on prevention and control, including through follow-up after acute presentations, enhanced collaboration between GPs and PNs, and supportive practice models.
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Affiliation(s)
- Maithri Rupasinghe
- MBBS, MRCGP (INT), MD (Family Medicine), FCGP, Visiting Fellow, Department of General Practice, Western Sydney University, NSW
| | - Jennifer Reath
- MBBS, DipRANZCOG, FRACGP, MMed, GAICD, Chair, Department of General Practice, Western Sydney University, NSW
| | - Biljana Cvetkovski
- BPharm (Hons), MPharm (Research), PhD, Postdoctoral Research Fellow, Quality Use of Respiratory Medicines Use Group, Woolcock Institute, University of Sydney, NSW
| | - Sheree Smith
- BNursing, MSocPlanningDevelopment, PhD (Public Health), PostGradCertHealthEcon, Professor, School of Nursing and Midwifery, Western Sydney University, NSW
| | - Sinthia Bosnic-Anticevich
- BPharm (Hons), PhD, Professor and Team Leader, Quality Use of Respiratory Medicines Use Group, Woolcock Institute, University of Sydney, Sydney Local Health District, NSW
| | - Vicky Kritikos
- BPharm, MPharm (Clinical), PhD, GradCertEdStudies (Higher Education), Clinical Lead, Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, NSW; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, NSW
| | - Penelope Abbott
- MBBS (Hons), MPH, PhD, Churchill Fellow, GAICD, FRACGP, Associate Professor, Department of General Practice, School of Medicine, Western Sydney University, NSW
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13
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Nagendrababu V, Abbott P, Duncan HF, Fouad AF, Kruse C, Patel S, Pigg M, Rechenberg DK, Dummer PMH. Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) guidelines: a development protocol. Int Endod J 2021; 54:1051-1055. [PMID: 33583062 DOI: 10.1111/iej.13497] [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: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
Diagnostic accuracy studies play an important role in informing clinical practice and patient management, by evaluating the ability of diagnostic testing and imaging to identify the presence or absence of a disease or condition. These studies compare the relative diagnostic strength of the test or device with a reference standard, therefore, guiding clinical decisions on the reliability of the test, the need for further tests, and whether to monitor or treat a particular condition. Inadequate and incomplete reporting of diagnostic accuracy studies can disguise methodological deficiencies and ultimately result in study bias and the inability to translate research findings into daily clinical practice. The Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) guidelines are being developed in order to improve the accuracy, transparency, completeness and reproducibility of diagnostic accuracy studies in the speciality of Endodontology. The aim of this paper is to report the process used to develop the PRIDASE guidelines based on a well-established consensus process. The project leaders (PD, VN) formed a steering committee of nine members (PD, VN, PA, AF, DR, SP, CK, MP, HD) to oversee and manage the project. The PRIDASE steering committee will develop the initial draft of the PRIDASE guidelines by adapting and modifying the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guidelines, adding new items related specifically to the nature of Endodontics and incorporate the Clinical and Laboratory Images in Publication (CLIP) principles. The initial guidelines will consist of a series of domains and individual items and will be validated by the members of a PRIDASE Delphi Group (PDG) consisting of a minimum of 30 individuals who will evaluate independently the individual items based on two parameters: 'clarity' using a dichotomous scoring (yes/no) and 'suitability' for inclusion using a 9-point Likert Scale. The scores awarded by each member and any suggestions for improvement will be shared with the PDG to inform an iterative process that will result in a series of items that are clear and suitable for inclusion in the new PRIDASE guidelines. Once the PDG has completed its work, the steering committee will create a PRIDASE Meeting Group (PMG) of 20 individuals from around the world. Members of the PDG will be eligible to be the part of PMG. The draft guidelines and flowchart approved by the PDG will then be presented for further validation and agreement by the PMG. As a result of these discussions, the PRIDASE guidelines will be finalized and then disseminated to relevant stakeholders through publications and via the Preferred Reporting Items for study Designs in Endodontology (PRIDE) website (http://pride-endodonticguidelines.org). Periodic updates to the PRIDASE guidelines will be made based on feedback from stakeholders and end-users.
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Affiliation(s)
- V Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - P Abbott
- UWA Dental School, University of Western Australia, Nedlands, Australia
| | - H F Duncan
- Division of Restorative Dentistry, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - A F Fouad
- School of Dentistry, UAB, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - C Kruse
- Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - S Patel
- The Faculty of Dentistry, Oral and Craniofacial Sciences, Kings' College London, London, UK
| | - M Pigg
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - D K Rechenberg
- Department of Conservative and Preventive Dentistry, University of Zürich, Zürich, Switzerland
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Fung T, Abbott P, Arora A, George A, Villarosa A, Reath J. Oral health care in urban general practice: what are the support and training needs? Aust J Prim Health 2021; 27:265-270. [PMID: 33653503 DOI: 10.1071/py20239] [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: 10/12/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022]
Abstract
Patients with oral health problems often attend GPs instead of dentists, particularly in rural areas. There has been little research exploring challenges in providing oral health care in urban general practice. A cross-sectional survey of GPs in Greater Western Sydney explored their experiences, knowledge, confidence, and their oral health educational needs. Descriptive statistics and content analysis was undertaken. Forty-nine GPs reported experience of a wide range of oral health presentations. Approximately 60% were confident to undertake oral health examinations and determine the cause of acute toothache. Although 87% were confident providing preventative oral health advice, most did not include this in routine health assessments. Only 41% were confident explaining eligibility for public dental services. Barriers to providing oral health care were time constraints, lack of equipment and limited oral health training. Our research highlights oral health support and training needs in urban Australian general practice, as well as the need for systems-wide change to oral health training in outer urban settings to tackle health inequity, similar to those advocated in rural Australia.
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Affiliation(s)
- Thomas Fung
- Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Penelope Abbott
- Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Amit Arora
- Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; and The University of Sydney, NSW 2006, Australia; and Sydney Local Health District and Sydney Dental Hospital, PO Box M30, Missenden Road, Camperdown, NSW 2050, Australia
| | - Ajesh George
- Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; and The University of Sydney, NSW 2006, Australia; and South Western Sydney Local Health District, Locked Bag 7279, Liverpool BC, NSW 1871, Australia; and Ingham Institute Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Amy Villarosa
- Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; and South Western Sydney Local Health District, Locked Bag 7279, Liverpool BC, NSW 1871, Australia; and Ingham Institute Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Jennifer Reath
- Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; and Corresponding author.
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15
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Brooks M, Reath J, McDonnell L, Abbott P. Increasing general practitioner use of evidence-based medicine in teaching and clinical practice through evidence-based journal clubs. Aust J Prim Health 2021; 27:271-275. [PMID: 34233147 DOI: 10.1071/py20267] [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: 11/10/2020] [Accepted: 04/16/2021] [Indexed: 11/23/2022]
Abstract
Learning evidence-based medicine (EBM) skills is now integral to university medical education. GPs who trained before the introduction of EBM in the late 1990s have identified a lack of training in this area. Evidence-based journal clubs (EBJCs) aim to promote the application of research evidence to clinical decision making. GPs meet regularly to develop EBM skills and apply these to questions arising in their clinical practice. Over 4 years, 47 GP clinical supervisors of medical students participated in a series of EBJCs offered by a university medical school. This article presents a qualitative exploration of their views and experiences. GPs noted that participating in EBJCs improved their use of EBM in clinical practice by making them more independent learners, facilitating consistent management approaches in group practices and aligning their skills in EBM with those of current students. Barriers such as time constraints and limited access to EBM resources were also noted, and GPs discussed strategies for managing these. Opportunities for GPs who act as clinical supervisors to increase their skills in EBM are important, particularly for those GPs transitioning from a traditional medical education model to an EBM model, as they role model highest-quality patient care to students, including the need for ongoing learning.
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Affiliation(s)
- Miriam Brooks
- Department of General Practice, School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia; and Corresponding author.
| | - Jennifer Reath
- Department of General Practice, School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Louise McDonnell
- Hazelbrook General Practice, 9 Rosedale Avenue, Hazelbrook, NSW 2779, Australia
| | - Penelope Abbott
- Department of General Practice, School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia
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Cosgriff D, Reath J, Abbott P. Why do people with long-term health needs see more than one GP?: a qualitative study. Aust J Prim Health 2020; 26:514-519. [PMID: 33292926 DOI: 10.1071/py20179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022]
Abstract
This study aimed to understand what barriers exist or choices are made by patients who access regular care for long-term health issues from multiple GPs. This was a qualitative interview study in Western Sydney community settings consisting of semi-structured interviews and inductive thematic analysis. Twenty participants who accessed GP care were interviewed. Sixteen had seen multiple GPs over the previous twelve months and all had seen multiple GPs over preceding years. Participants valued interpersonal continuity of care. Nevertheless, they made decisions to meet their needs by seeing multiple GPs. They considered waiting times, preference for an individual GP based on their consultation style or perception of their particular area of expertise, experiences with reception staff and the practice model of care. Participants were aware that interpersonal continuity of care was considered important by GPs and were reticent to be seen as 'doctor shoppers'. Therefore, they did not usually disclose that they saw multiple doctors and were unlikely to discuss continuity of care with a GP. Participants made considered choices about health care. Despite general practice promoting interpersonal continuity of care, it is not always achievable or desired by patients. GPs can promote care continuity through supportive practice models and dialogue about when continuity is desirable.
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Affiliation(s)
- David Cosgriff
- Osana Cremorne, 320 Military Road, Cremorne, NSW 2090, Australia; and Department of General Practice, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; and Corresponding author.
| | - Jenny Reath
- Department of General Practice, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Penelope Abbott
- Department of General Practice, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Trankle SA, Usherwood T, Abbott P, Roberts M, Crampton M, Girgis CM, Riskallah J, Chang Y, Saini J, Reath J. Key stakeholder experiences of an integrated healthcare pilot in Australia: a thematic analysis. BMC Health Serv Res 2020; 20:925. [PMID: 33028299 PMCID: PMC7542969 DOI: 10.1186/s12913-020-05794-2] [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] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally. METHODS We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n = 42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts. RESULTS Key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting. CONCLUSIONS Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.
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Affiliation(s)
- Steven A Trankle
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Tim Usherwood
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
- George Institute for Global Health, Sydney, Australia
| | - Penelope Abbott
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Mary Roberts
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
| | | | - Christian M Girgis
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - John Riskallah
- Western Sydney Local Health District (Blacktown Hospital), Sydney, Australia
| | - Yashu Chang
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
- Western Sydney Local Health District (Blacktown Hospital), Sydney, Australia
| | - Jaspreet Saini
- Western Sydney Primary Health Network, Sydney, Australia
| | - Jennifer Reath
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Ndwiga DW, MacMillan F, McBride KA, Thompson R, Reath J, Alofivae-Doorbinia O, Abbott P, McCafferty C, Aghajani M, Rush E, Simmons D. Outcomes of a church-based lifestyle intervention among Australian Samoans in Sydney - Le Taeao Afua diabetes prevention program. Diabetes Res Clin Pract 2020; 160:108000. [PMID: 31904445 DOI: 10.1016/j.diabres.2020.108000] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/20/2019] [Accepted: 12/31/2019] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate the effectiveness of a culturally adapted, church-based lifestyle intervention among Australian Samoans living in Sydney. METHODS This was a prospective, pre-post study of a church-wide education and support programme delivered by Community Coach Facilitators and Peer Support Facilitators to prevent, and promote self-management of, Type 2 diabetes. Participants completed questionnaires, anthropometric and HbA1c measurements before and 3-8 months after the intervention. The primary outcome was HbA1c. RESULTS Overall, 68/107(63.5%) participants completed both before and after intervention data collection (mean age 48.9 ± 14.2 years; 57.2% female). HbA1c dropped significantly between baseline and follow-up among participants with known diabetes (8.1 ± 2.4% (65 mmol/mol) vs 7.4 ± 1.8% (57 mmol/mol); p = 0.040) and non-significantly among participants with newly diagnosed diabetes (8.0 ± 2.1% (64 mmol/mol) vs 7.1 ± 2.3 (54 mmol/mol); p = 0.131). Participants with no diabetes increased their weekly moderate and vigorous physical activity (316.1 ± 291.6mins vs 562.4 ± 486.6mins; p = 0.007) and their diabetes knowledge also improved post-intervention (42.0 ± 13.5% to 61.3 ± 20.2%; p < 0.001). There were no significant reductions in blood pressure, BMI or waist circumference at follow-up. CONCLUSIONS A structured, church-based, culturally tailored lifestyle intervention showed a number of improvements in diabetes risk among Samoans in Sydney. The intervention however, requires a more rigorous testing in a larger randomised controlled trial over a longer time period.
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Affiliation(s)
- Dorothy W Ndwiga
- School of Science and Health, Western Sydney University, Australia
| | - Freya MacMillan
- School of Science and Health, Western Sydney University, Australia; Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Australia; Translational Health Research Institute, Western Sydney University, Australia
| | - Kate A McBride
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Australia; Translational Health Research Institute, Western Sydney University, Australia; School of Medicine, Western Sydney University, Australia
| | - Ronda Thompson
- School of Medicine, Western Sydney University, Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Australia
| | | | | | | | - Marra Aghajani
- School of Medicine, Western Sydney University, Australia
| | - Elaine Rush
- Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand
| | - David Simmons
- Diabetes Obesity Metabolism Translational Research Unit, Western Sydney University, Australia; Translational Health Research Institute, Western Sydney University, Australia; School of Medicine, Western Sydney University, Australia.
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Green A, Abbott P, Luckett T, Davidson PM, Delaney J, Delaney P, Gunasekera H, DiGiacomo M. Collaborating across sectors to provide early intervention for Aboriginal and Torres Strait Islander children with disability and their families: a qualitative study of provider perspectives. J Interprof Care 2019; 34:388-399. [PMID: 31821054 DOI: 10.1080/13561820.2019.1692798] [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] [Indexed: 10/25/2022]
Abstract
Aboriginal and Torres Strait Islander children experience a higher prevalence of disability than other Australian children. Early intervention from across the health, education, and social service sectors is vital for improving outcomes, but families face lack of coordination between services. This study aimed to inform improvements in service access for families of urban-dwelling Aboriginal children with disability through exploring providers' perceptions of factors that influenced working together across sectors. Semi-structured interviews were conducted. Data analysis was informed by the general inductive approach and the Collaborative Practice to Enhance Patient Care Outcomes framework. Twenty-four providers participated. Interprofessional collaborative practice was influenced by interdependent interactional and organizational factors. Interactional factors fit within one of two dimensions: the ability of providers to share common goals and vision within a complex cross-sector service landscape, and influence of interpersonal relationships on their sense of belonging working in a cross-cultural space. Organizational factors also fit within one of two dimensions: the influence of governance in relation to its role in coordination and unlocking the strength of schools as service settings, and the need to formalize processes for effective interprofessional communication. Interprofessional collaborative practice was managed within the context of systemic factors relating to policy and funding. These findings demonstrate the complex interplay of factors related to the cross-sector involvement of providers in early intervention service provision. Consideration of these factors is required to facilitate collaborative cross-sector responses to improve service access for Aboriginal families.Abbreviations: WHO: world health organization; ACCHS: aboriginal community controlled health service; GP: general practitioner; NDIS: national disability insurance scheme.
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Affiliation(s)
- Anna Green
- Faculty of Health, IMPACCT, University of Technology Sydney, Sydney, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Richmond, Australia
| | - Tim Luckett
- Faculty of Health, IMPACCT, University of Technology Sydney, Sydney, Australia
| | - Patricia Mary Davidson
- Faculty of Health, IMPACCT, University of Technology Sydney, Sydney, Australia.,School of Nursing, Johns Hopkins University, Baltimore, USA
| | - John Delaney
- Faculty of Health, IMPACCT, University of Technology Sydney, Sydney, Australia
| | - Patricia Delaney
- Faculty of Health, IMPACCT, University of Technology Sydney, Sydney, Australia
| | | | - Michelle DiGiacomo
- Faculty of Health, IMPACCT, University of Technology Sydney, Sydney, Australia
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Shahab Y, Alofivae-Doorbinnia O, Reath J, MacMillan F, Simmons D, McBride K, Abbott P. Samoan migrants' perspectives on diabetes: A qualitative study. Health Promot J Austr 2019; 30:317-323. [PMID: 30869806 DOI: 10.1002/hpja.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/29/2018] [Accepted: 03/12/2019] [Indexed: 01/20/2023] Open
Abstract
ISSUE ADDRESSED The Samoan community in Australia has one of the highest rates of diabetes in Australia. We explored the experiences and perceptions of Samoan patients living with diabetes and their family members. METHODS Semi-structured interviews were conducted with adults from a Samoan background living in Australia who had diabetes and their family members. Participants were recruited from a single general practice with a high proportion of Pacific Islander patients, through self-response to waiting room flyers. Inductive thematic analysis was conducted using a constructivist-grounded theory approach. This qualitative project was part of the developmental phase of a larger project aiming to promote healthy lifestyles and decrease diabetes in the Samoan community in Sydney, Australia. RESULTS Twenty participants, aged 36-67 years, were interviewed. The majority was men (n = 13) and all were migrants to Australia. Participants reported a range of barriers to early detection and self-management of diabetes, including dietary practices common within their culture and the role of church and religion. They identified that pride in their heritage and role within families could be a barrier to care but also provided an opportunity for health promotion. CONCLUSIONS The cultural factors which influence the risk and management of diabetes in the Samoan community in Australia can be the barriers to health change but also provide opportunities for culturally targeted diabetes education and health promotion. SO WHAT?: These findings will inform the development of approaches for the prevention and management of diabetes within the Samoan-Australian community. These include health-promotion initiatives which take into account the role of cultural dietary practices, diabetes stigma, cultural pride and working with churches.
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Affiliation(s)
- Yasin Shahab
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | | | - Jennifer Reath
- School of Medicine and Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Freya MacMillan
- School of Science and Health, and Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - David Simmons
- School of Medicine and Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate McBride
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Penelope Abbott
- School of Medicine and Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Reath J, Abbott P, Kurti L, Morgan R, Martin M, Parry A, Gordon E, Thomas J, Drysdale M. Correction to: Supporting Aboriginal and Torres Strait islander cultural educators and cultural mentors in Australian general practice education. BMC Med Educ 2018; 18:276. [PMID: 30466411 PMCID: PMC6251186 DOI: 10.1186/s12909-018-1359-z] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Following publication of the original article [1], the author reported that Fig. 1 was missing.
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Affiliation(s)
- Jennifer Reath
- Department of General Practice, Western Sydney University, Campbelltown, Australia.
| | - Penelope Abbott
- Department of General Practice, Western Sydney University, Sydney, Australia
| | | | - Ruth Morgan
- Western Sydney University, Sydney, Australia
| | - Mary Martin
- Queensland Aboriginal and Islander Health Council, South Brisbane, Australia
| | - Ada Parry
- Menzies School of Health Research, Darwin, Australia
| | - Elaine Gordon
- Department of General Practice, Western Sydney University, Sydney, Australia
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Abbott P, Brooker R, Reath J. Managing the hope and worry of housing renewal-supporting well-being in the emerging community. Health Promot J Austr 2018; 30:344-349. [PMID: 30220094 DOI: 10.1002/hpja.205] [Citation(s) in RCA: 2] [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] [Received: 12/12/2017] [Accepted: 09/12/2018] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Housing renewal is a common urban housing and development strategy internationally. An intended result is increased social inclusion and well-being of residents through public housing de-concentration. In this study, we examined challenges encountered during the process of housing renewal from the perspectives of community-based staff and volunteers. METHODS We conducted semi-structured qualitative interviews with housing and community workers, service managers and community volunteers who were working with residents experiencing housing renewal in an outer metropolitan estate in New South Wales. We analysed the data thematically. RESULTS Seventeen participants were interviewed in a mix of individual and group interviews. Housing workers uncovered substantial resident health and social support needs during housing assessments. Promoting access to services and supporting the mental health and social connectedness of residents into the future were seen as key goals and challenges. However, lack of clarity on which services and community resources would exist in the new neighbourhood at the completion of the renewal project made this more difficult, particularly when supporting the social housing residents who were remaining in the changing community. CONCLUSIONS Supporting the mental health and well-being of residents experiencing housing renewal is an important role of community-based workers, volunteers and service providers. This includes facilitating access to health care and other services and promoting social connectedness in the emerging community. Increased clarity on what community resources and services will be available subsequent to redevelopment will assist in these aims. SO WHAT?: Early knowledge of what community resources and services will be in place long term in communities undergoing housing renewal will allow staff and volunteers to better support the health and well-being of residents.
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Affiliation(s)
- Penelope Abbott
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Ron Brooker
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Jennifer Reath
- Department of General Practice, School of Medicine, Western Sydney University, Penrith, NSW, Australia
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Reath J, Abbott P, Kurti L, Morgan R, Martin M, Parry A, Gordon E, Thomas J, Drysdale M. Supporting aboriginal and Torres Strait islander cultural educators and cultural mentors in Australian general practice education. BMC Med Educ 2018; 18:236. [PMID: 30309368 PMCID: PMC6182837 DOI: 10.1186/s12909-018-1340-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Promoting cultural competence of health professionals working with Aboriginal and Torres Strait Islander communities is key to improving health outcomes. Cultural Educators and Cultural Mentors (CE/ CMs) have critical roles in Australian general practice training, yet these are not well understood. METHODS Guided by a CE/CM Network, our research team including experienced CE/CMs, used surveys and semi-structured interviews to explore these roles and investigate best practice in employment and support. Participants sampled from stakeholders involved in general practice education across Australia included CE/CMs, Medical Educators, General Practice Supervisors and Registrars, and representatives of Regional Training Organisations, Indigenous Health Training Posts and other key organisations. We undertook thematic analysis using a framework approach, refined further in team discussions that privileged views of CE/ CM members. RESULTS Participants comprised 95 interviewees and 55 survey respondents. We organised our findings under three overarching themes: understandings about cultural education and mentoring; employment and support of CE/CMs; and delivery and evaluation of cultural education and mentoring. Our findings supported a central role for Aboriginal and Torres Strait Islander CE/CMs in face-to-face Registrar education about culture and history and related impacts on health and healthcare. Cultural education was reported to provide base-line learning as preparation for clinical practice whilst cultural mentoring was seen as longitudinal, relationship-based learning. Mentoring was particularly valued by Registrars working in Aboriginal and Torres Strait Islander communities. Challenges described with employment and support included difficulties in finding people with skills and authority to undertake this demanding work. Remuneration was problematic, particularly for CMs whose work-time is difficult to quantify, and who are often employed in other roles and sometimes not paid. Other improved support recommended included appropriate employment terms and conditions, flexibility in role definitions, and professional development. Recommendations concerning implementation and evaluation included valuing of cultural education, greater provision of mentoring, partnerships with Medical Educators, and engagement of CE/CMs in rigorous evaluation and assessment processes. CONCLUSIONS Our research highlights the importance of the unique CE/CM roles and describes challenges in sustaining them. Professional and organisational support is needed to ensure delivery of respectful and effective cultural education within general practitioner training.
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Affiliation(s)
- Jennifer Reath
- Department of General Practice, Western Sydney University, Campbelltown, Australia
| | - Penelope Abbott
- Department of General Practice, Western Sydney University, Sydney, Australia
| | | | - Ruth Morgan
- Western Sydney University, Sydney, Australia
| | - Mary Martin
- Queensland Aboriginal and Islander Health Council, South Brisbane, Australia
| | - Ada Parry
- Menzies School of Health Research, Darwin, Australia
| | - Elaine Gordon
- Department of General Practice, Western Sydney University, Sydney, Australia
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Green A, Abbott P, Davidson PM, Delaney P, Delaney J, Patradoon-Ho P, DiGiacomo M. Interacting With Providers: An Intersectional Exploration of the Experiences of Carers of Aboriginal Children With a Disability. Qual Health Res 2018; 28:1923-1932. [PMID: 30101663 DOI: 10.1177/1049732318793416] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intersectionality has potential to create new ways to describe disparities and craft meaningful solutions. This study aimed to explore Aboriginal carers' experiences of interactions with health, social, and education providers in accessing services and support for their child. Carers of Aboriginal children with a disability were recruited from an Australian metropolitan Aboriginal community-controlled health service. In-depth, semistructured interviews were conducted with 19 female carers. Intersectionality was applied as an analytical framework due to the inherent power differentials for Aboriginal Australians and carers for people with a disability. Marginalization and a lack of empowerment were evident in the experiences of interactions with providers due to cultural stereotypes and racism, lack of cultural awareness and sensitivity, and poverty and homelessness. Community-led models of care can help overcome the intersectional effects of these identities and forms of oppression in carers' interactions with providers and enhance access to care.
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Affiliation(s)
- Anna Green
- 1 University of Technology Sydney, Sydney, New South Wales, Australia
| | - Penelope Abbott
- 2 Western Sydney University, Penrith, New South Wales, Australia
| | - Patricia Mary Davidson
- 1 University of Technology Sydney, Sydney, New South Wales, Australia
- 3 Johns Hopkins University, Baltimore, Maryland, USA
| | - Patricia Delaney
- 1 University of Technology Sydney, Sydney, New South Wales, Australia
| | - John Delaney
- 1 University of Technology Sydney, Sydney, New South Wales, Australia
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Brooker R, Hu W, Reath J, Abbott P. Medical student experiences in prison health services and social cognitive career choice: a qualitative study. BMC Med Educ 2018; 18:3. [PMID: 29291725 PMCID: PMC5748951 DOI: 10.1186/s12909-017-1109-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students. METHODS Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings. RESULTS Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system. CONCLUSION Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expanding interest into a field they had not previously considered. An important aspect of such learning is the opportunity to overcome negative preconceptions of consultations with prisoners.
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Affiliation(s)
- Ron Brooker
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Green A, Luckett T, Abbott P, DiGiacomo M, Delaney J, Delaney P, Davidson PM. A framework for an asset-informed approach to service mapping. Nurse Res 2017; 25:19-25. [PMID: 29251444 DOI: 10.7748/nr.2017.e1479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Asset-informed approaches are increasingly emphasised in public health, but transferring this approach to planning health services requires prospective systematic methods. Asset-informed approaches to service-mapping have started to develop, but there are no standardised guidelines. These methods are becoming of particular interest, as nurses engage in population health activities. AIM To identify methods of asset-informed mapping for addressing health problems and develop a framework to support the methodological rigour of service-mapping. DISCUSSION The authors undertook an integrative literature review using a systematic approach and narrative synthesis. Ten articles met the inclusion criteria. Reported methods included the formation of a core team to drive the process, as well as varying detail about methods of collecting data and forming maps. Challenges and solutions included the effectiveness of the core team depending on having a designated leader, frequent meetings and previous partnerships, using community 'cultural brokers', and determining aims and scope. CONCLUSION Results of the review can be used to modify existing generic resources for asset-informed mapping to their application in health services. Four main stages seem especially applicable and important: defining the parameters of the service-mapping process; identifying services; mapping services; and consultation and implementation. IMPLICATIONS FOR PRACTICE The shift towards asset-informed approaches in community and public health is an important step in realising the potential of existing assets in communities to influence health outcomes. The framework offered in this paper is intended to assist in developing an evidence base, by promoting the systematic and rigorous reporting of methods used in asset-informed approaches to service-mapping.
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Affiliation(s)
- Anna Green
- Centre for Cardiovascular & Chronic Care, University of Technology Sydney, Australia
| | - Tim Luckett
- Centre for Cardiovascular & Chronic Care, University of Technology Sydney, Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Michelle DiGiacomo
- Centre for Cardiovascular & Chronic Care, University of Technology Sydney, Australia
| | - John Delaney
- Centre for Cardiovascular & Chronic Care, University of Technology, Sydney, Australia
| | - Patricia Delaney
- Centre for Cardiovascular & Chronic Care, University of Technology Sydney, Australia
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Abbott P, Magin P, Lujic S, Hu W. Supporting continuity of care between prison and the community for women in prison: a medical record review. AUST HEALTH REV 2017; 41:268-276. [PMID: 27467100 DOI: 10.1071/ah16007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022]
Abstract
Objectives The aim of the present study was to examine health information transfer and continuity of care arrangements between prison and community health care providers (HCPs) for women in prison. Methods Medical records of women released from New South Wales prisons in 2013-14 were reviewed. Variables included health status, health care in prison and documented continuity of care arrangements, including information transfer between prison and community. Associations were measured by adjusted odds ratios (AORs) using a logistic regression model. Text from the records was collected as qualitative data and analysed to provide explanatory detail. Results In all, 212 medical records were systematically sampled and reviewed. On prison entry, information was requested from community HCPs in 53% of cases, mainly from general practitioners (GPs, 39%), and was more likely to have occurred for those on medication (AOR 7.08; 95% confidence interval (CI) 3.71, 13.50) or with schizophrenia or other psychotic disorders (AOR 4.20; 95% CI 1.46, 12.11). At release, continuity of care arrangements and health information transfer to GPs were usually linked to formal pre-release healthcare linkage programs. Outside these programs, only 20% of records had evidence of such continuity of care at release, with the odds higher for those on medication (AOR 8.28; 95% CI 1.85, 37.04) and lower for women with problematic substance misuse (AOR 0.32; 95% CI 0.14, 0.72). Few requests for information were received after individuals had been released from custody (5/212; two from GPs). Conclusion Increased health information transfer to community HCPs is needed to improve continuity of care between prison and community. What is known about the topic? Many women in prison have high health needs. Health and well being are at further risk at the time of transition between prison and community. What does this paper add? This study provides evidence that outside formal programs, which are currently available only for a minority of women, continuity of care arrangements and transfer of health information do not usually occur when women leave prison. Pragmatic choices about continuity of care at the interface between prison and community may have been made, particularly focusing on medication continuity. Barriers to continuity of care and ways forward are suggested. What are the implications for practitioners? Siloing of health care delivered within prison health services through lack of continuity of care at release is wasteful, both in terms of healthcare costs and lost opportunities to achieve health outcomes in a vulnerable population with high health needs. There is need for an increased focus on continuity of care between prison and community health services, HCP support and training and expansion of pre-release planning and healthcare linkage programs to assist larger numbers of women in prison.
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Affiliation(s)
- Penelope Abbott
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia. Email
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, Newbolds Building, University Drive, Newcastle, NSW 2308, Australia. Email
| | - Sanja Lujic
- Centre for Big Data Research in Health, UNSW Australia, Sydney, NSW 2052, Australia. Email
| | - Wendy Hu
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia. Email
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DiGiacomo M, Green A, Delaney P, Delaney J, Patradoon-Ho P, Davidson PM, Abbott P. Experiences and needs of carers of Aboriginal children with a disability: a qualitative study. BMC Fam Pract 2017; 18:96. [PMID: 29187141 PMCID: PMC5707922 DOI: 10.1186/s12875-017-0668-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/16/2017] [Indexed: 11/15/2022]
Abstract
Background Australian parents/carers of a person with a disability experience higher rates of depression, more financial stress, and are twice as likely to be in poor physical health than the general population. Aboriginal and Torres Strait Islander peoples experience worse health, social and economic outcomes than other Australians, and those with a disability face ‘double disadvantage’. This study aimed to better understand the experiences and needs of parents/carers/families of Aboriginal children with a disability. Methods Semi-structured in-depth interviews were conducted with parents or primary carers of Aboriginal children aged zero-eight with disability. Interviews were analysed using thematic analysis. Results Nineteen women (sixteen mothers and three grandmothers) were interviewed. More than half were lone carers (without a partner or spouse). Participants described their experiences, including challenges and facilitators, to providing and accessing care, impacts on their health and wellbeing, and associated economic and non-economic costs of caregiving. Financial strain and social isolation was particularly prominent for lone carers. Conclusions Tailoring services to the needs of carers of Aboriginal children with a disability means supporting kinship caregiving, facilitating engagement with other Aboriginal families, and streamlining services and systems to mitigate costs. The experiences described by our participants depict an intersection of race, socio-economic status, gender, disability, and caregiving. Services and funding initiatives should incorporate such intersecting determinants in planning and delivery of holistic care.
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Affiliation(s)
- Michelle DiGiacomo
- University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Anna Green
- University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Patricia Delaney
- University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - John Delaney
- University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Patrick Patradoon-Ho
- Blacktown and Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown Road, Blacktown, NSW, 2148, Australia.,Western Sydney University, Locked Bag 1797, Penrith, NSW, 1797, Australia
| | - Patricia Mary Davidson
- University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.,Johns Hopkins University, School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Penelope Abbott
- Western Sydney University, Locked Bag 1797, Penrith, NSW, 1797, Australia.
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Abbott P, Lloyd JE, Joshi C, Malera-Bandjalan K, Baldry E, McEntyre E, Sherwood J, Reath J, Indig D, Harris MF. Do programs for Aboriginal and Torres Strait Islander people leaving prison meet their health and social support needs? Aust J Rural Health 2017; 26:6-13. [DOI: 10.1111/ajr.12396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Penelope Abbott
- School of Medicine; Western Sydney University; Penrith South New South Wales Australia
| | - Jane E. Lloyd
- Centre for Primary Health Care and Equity; University of New South Wales; Sydney New South Wales Australia
| | - Chandni Joshi
- Centre for Primary Health Care and Equity; University of New South Wales; Sydney New South Wales Australia
| | - Kathy Malera-Bandjalan
- Aboriginal and Torres Strait Islander Health Worker Journal; Sydney New South Wales Australia
| | - Eileen Baldry
- School of Social Sciences; University of New South Wales; Sydney New South Wales Australia
| | - Elizabeth McEntyre
- School of Social Sciences; University of New South Wales; Sydney New South Wales Australia
| | - Juanita Sherwood
- National Centre for Cultural Competence; University of Sydney; Sydney New South Wales Australia
| | - Jennifer Reath
- School of Medicine; Western Sydney University; Penrith South New South Wales Australia
| | - Devon Indig
- School of Public Health and Community Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity; University of New South Wales; Sydney New South Wales Australia
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Affiliation(s)
- P Abbott
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
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Barton C, Tam CWM, Abbott P, Hall S, Liaw ST. Can research that is not intended or unlikely to be published be considered ethical? Aust Fam Physician 2017; 46:442-444. [PMID: 28609603] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND For research to be ethically acceptable, the potential benefits must justify any risks involved for participants. Dissemination of research findings through publication is one way of creating benefit, but not all researchers intend to publish their research. Other factors, such as lack of size or representativeness, generalisability or innovativeness, or negative findings mean the research is unlikely to be published in a peer-reviewed medical journal. OBJECTIVE This paper discusses ethical considerations in research where peer-reviewed publication is not intended or unlikely. DISCUSSION Proposing research that is not intended or unlikely to be published in a peer-reviewed journal does not preclude it from being considered ethical. Additional benefits of such projects may include professional development of investigators, pilot data collection leading to more definitive studies, or developing collaborations with research users that increase relevance and improve utility of findings.
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Affiliation(s)
- Christopher Barton
- PhD, MMedSci, BSc, is Research Fellow, Department of General Practice, University of Adelaide, South Australia
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Lloyd JE, McEntyre E, Baldry E, Trofimovos J, Indig D, Abbott P, Reath J, Malera-Bandjalan K, Harris MF. Aboriginal and non-aboriginal Australian former prisoners' patterns of morbidity and risk of hospitalisation. Int J Equity Health 2017; 16:3. [PMID: 28056999 PMCID: PMC5216534 DOI: 10.1186/s12939-016-0497-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/18/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022] Open
Abstract
Background People who have been in custody are more likely to experience multiple, long standing health issues. They are at high risk of illness and injury post release and experience poor access to health services both of which contribute to high rates of recidivism. The study was conducted to examine Aboriginal and non-Aboriginal former prisoners’ risk of hospitalisation and rehospitalisation in the five years post release from custody and identified the common reasons for hospitalisations. Methods Common reasons for hospital admission were identified by conducting descriptive analysis of linked data, related to former prisoners, from NSW Ministry of Health and Corrective Services NSW. This relied upon admitted patient data for 1899 patients. Of this cohort, 1075 people had been admitted to hospital at least once and remained out of custody over a five year period. The independent variables we studied included age, sex, and whether or not the person was Aboriginal. We conducted univariate and multivariate analysis on the following dependent variables: number of admissions over five years after release; more than one admission; days between custody and first hospitalisation; and days between first and second hospitalisation. Results Mental and behavioural disorders, injuries and poisoning, and infectious or parasitic diseases were the three most common reasons for admission. Aboriginal and non-Aboriginal former prisoners had a broadly similar pattern of reasons for admission. Yet Aboriginal former prisoners were more likely than non-Aboriginal former prisoners to have a shorter mean interval between hospital admission and readmission (187 days compared to 259 days, t = 2.90, p-0.004). Conclusions Despite poorer health among Aboriginal people, there were broadly similar patterns of reasons for admission to hospital among Aboriginal and non-Aboriginal former prisoners. There may be a number of explanations for this. The cohort was not a representative sample of the NSW prison population. There was an overrepresentation of individuals with cognitive disability (intellectual disability, acquired brain injury, dementia, fetal alcohol spectrum disorder) in the study population, which may have impacted on this group accessing hospital health care. Alternatively perhaps there were fewer presentations to hospital by Aboriginal former prisoners despite a greater need. The shorter interval between hospital admission and readmission for Aboriginal former prisoners may suggest the need for better follow up care in the community after discharge from hospital. This presents an opportunity for primary health care services to work more closely with hospitals to identify and manage Aboriginal former prisoners discharged from hospital so as to prevent readmission.
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Affiliation(s)
- Jane E Lloyd
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Elizabeth McEntyre
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Eileen Baldry
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Julian Trofimovos
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Devon Indig
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Penelope Abbott
- Department of General Practice, Faculty of Medicine, Western Sydney University, Sydney, Australia
| | - Jennifer Reath
- Department of General Practice, Faculty of Medicine, Western Sydney University, Sydney, Australia
| | | | - Mark F Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Green A, Abbott P, Delaney P, Patradoon-Ho P, Delaney J, Davidson PM, DiGiacomo M. Navigating the journey of Aboriginal childhood disability: a qualitative study of carers' interface with services. BMC Health Serv Res 2016; 16:680. [PMID: 27905923 PMCID: PMC5134075 DOI: 10.1186/s12913-016-1926-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 06/02/2016] [Accepted: 11/25/2016] [Indexed: 12/31/2022] Open
Abstract
Background The disadvantage experienced by Aboriginal and Torres Strait Islander children with a disability is well recognized. The long term consequences of failing to address disability on health, education and employment underlies the importance of early intervention. Caregivers experience a disproportionate burden and have challenges accessing services. The aim of this study was to describe the carer journey of accessing support and services. Methods We conducted in-depth semi-structured interviews with nineteen parents and carers of Aboriginal children aged 0–8 years. The children were patients at a child developmental clinic at a metropolitan area Aboriginal health service in Eastern Australia. Interpretive phenomenological analysis was applied to transcribed verbatim accounts. Results Four themes were developed using the ‘journey’ metaphor to describe the carer pathway of accessing support and services at the community, service and policy levels. Themes included 1) the need for increased signage within communities via community education, information and awareness, 2) wrong way signs, roundabouts and roadblocks encountered when accessing services, 3) alternate routes can facilitate the journey, and 4) incompatibility of inflexible bureaucratic road rules and lived realities. Conclusions The challenges of caring for a child with a disability are indisputable and these can be compounded for people experiencing socio-economic disadvantage and marginalisation. Overcoming challenges to service access faced by carers of Aboriginal children with a disability will require investment in community, services and policy to tailor culturally appropriate models of care. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1926-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Green
- University of Technology Sydney, Center for Cardiovascular and Chronic Care, Faculty of Health, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Penelope Abbott
- Western Sydney University, Locked Bag 1797, Penrith, NSW, 1797, Australia.
| | - Patricia Delaney
- University of Technology Sydney, Center for Cardiovascular and Chronic Care, Faculty of Health, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Patrick Patradoon-Ho
- Western Sydney University, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, Blacktown Road, Blacktown, NSW, 2148, Australia
| | - John Delaney
- University of Technology Sydney, Center for Cardiovascular and Chronic Care, Faculty of Health, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Patricia Mary Davidson
- University of Technology Sydney, Center for Cardiovascular and Chronic Care, Faculty of Health, Johns Hopkins University, School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Michelle DiGiacomo
- University of Technology Sydney, Center for Cardiovascular and Chronic Care, Faculty of Health, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
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Gogia SB, Maeder A, Mars M, Hartvigsen G, Basu A, Abbott P. Unintended Consequences of Tele Health and their Possible Solutions. Contribution of the IMIA Working Group on Telehealth. Yearb Med Inform 2016:41-46. [PMID: 27830229 DOI: 10.15265/iy-2016-012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Assess unforeseen consequences of Telehealth and suggest solutions Methods: An outline was created collecting all possible ill effects classified into Clinical considerations, Administrative concerns including interpersonal relations, Technical issues, Legal / Ethical concerns and Miscellaneous. Each topic was assigned to a particular WG member to lead, gather opinion and review existing literature. RESULTS AND CONCLUSION A wide array of problems have been described. Except for technical issues, literature on this topic is scant, so this article is based more on personal experience and data collected from surveys. Much can be done to prevent such problems, such as a need for standardization with related clinical studies for devices as well as processes used for telehealth is underlined, besides evaluation of outcomes of projects undertaken.
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Affiliation(s)
- S B Gogia
- WG Chairperson Shashi Bhushan Gogia, E-Mail:
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Abbott P, Davison J, Magin PJ, Hu W. 'If they're your doctor, they should care about you': Women on release from prison and general practitioners. Aust Fam Physician 2016; 45:728-732. [PMID: 27695723] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Nearly half of the people leaving prison see a general practitioner (GP) within a month of release, which provides an opportunity to promote health for this vulnerable group. OBJECTIVE The objective of this article is to examine the expectations and experiences of GP care of women leaving prison. METHODS Semi-structured interviews pre-release and post-release from prison were analysed using inductive thematic analysis. RESULTS Sixty-nine interviews were conducted with 40 women while they were still in prison and 29 of these women after they were released. Women perceived GPs as lacking interest in their social support needs and believed GPs needed more skills in substance misuse management. Given the fear of stigma, women may not disclose recent incarceration, affecting the continuity of healthcare initiated in prison. DISCUSSION GPs' acknowledgement of, and assistance with, the broad issues that have an impact on the health and wellbeing of women after release is valued. Whole-person care also requires GP accessibility, management of substance misuse, continuity of care and understanding of the stigma associated with incarceration.
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Affiliation(s)
- Penelope Abbott
- MBBS, MPH, FRACGP is Senior Lecturer, Department of General Practice, School of Medicine, University of Western Sydney, NSW
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Abbott P, Gunasekera H, Leach AJ, Askew D, Walsh R, Kong K, Girosi F, Bond C, Morris P, Lujic S, Hu W, Usherwood T, Tyson S, Spurling G, Douglas M, Schubert K, Chapman S, Siddiqui N, Murray R, Rabbitt K, Porykali B, Woodall C, Newman T, Reath J. A multi-centre open-label randomised non-inferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial. Trials 2016; 17:119. [PMID: 26941013 PMCID: PMC4778283 DOI: 10.1186/s13063-016-1247-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/20/2016] [Indexed: 12/02/2022] Open
Abstract
Background Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. Methods/Design This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 − 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. Discussion The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications. Trial registration The trial is registered with Australia New Zealand Clinical Trials Registry (ACTRN12613001068752). Date of registration: 24 September 2013.
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Affiliation(s)
- Penelope Abbott
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | | | | | - Deborah Askew
- Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia. .,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Queensland Health, Brisbane, QLD, Australia.
| | - Robyn Walsh
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Kelvin Kong
- University of Newcastle, Newcastle, NSW, Australia.
| | - Federico Girosi
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Chelsea Bond
- Indigenous Studies Research Network, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Peter Morris
- Menzies School of Health Research, Darwin, NT, Australia.
| | - Sanja Lujic
- School of Medicine, Western Sydney University, Sydney, NSW, Australia. .,Centre for Big Data Research in Health, University of NSW, Sydney, NSW, Australia.
| | - Wendy Hu
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Tim Usherwood
- Sydney Medical School Westmead, University of Sydney, Sydney, NSW, Australia.
| | - Sissy Tyson
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Queensland Health, Brisbane, QLD, Australia.
| | - Geoffrey Spurling
- Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia. .,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (Inala Indigenous Health Service), Queensland Health, Brisbane, QLD, Australia.
| | - Markeeta Douglas
- Awabakal Aboriginal Primary Health Care Centre, Newcastle, NSW, Australia.
| | - Kira Schubert
- Awabakal Aboriginal Primary Health Care Centre, Newcastle, NSW, Australia.
| | - Shavaun Chapman
- Winnunga Nimmityjah Aboriginal Health Service, Canberra, ACT, Australia.
| | - Nadeem Siddiqui
- Winnunga Nimmityjah Aboriginal Health Service, Canberra, ACT, Australia.
| | - Reeion Murray
- Winnunga Nimmityjah Aboriginal Health Service, Canberra, ACT, Australia.
| | - Keitha Rabbitt
- Aboriginal and Torres Strait Islander Community Health Services, Brisbane, QLD, Australia.
| | - Bobby Porykali
- Aboriginal and Torres Strait Islander Community Health Services, Brisbane, QLD, Australia.
| | - Cheryl Woodall
- Tharawal Aboriginal Corporation, Sydney, NSW, Australia.
| | - Tina Newman
- Tharawal Aboriginal Corporation, Sydney, NSW, Australia.
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
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Reath J, Abbott P, Dadich A, Hosseinzadeh H, Hu W, Kang M, Usherwood T, Murray C, Bourne C. Evaluation of a sexually transmissible infections education program: Lessons for general practice learning. Aust Fam Physician 2016; 45:123-128. [PMID: 27052049] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The New South Wales (NSW) Sexually Transmissible Infections Program Unit (STIPU) produced nine resources to support the diagnosis and management of sexually transmissible infections (STIs) in general practice. OBJECTIVE In this study, we explored the processes of developing the resources and outcomes achieved. METHODS We analysed project documents and undertook a focus group interview with the STIPU Working Group to evaluate resource development and dissemination. Interviews with general practitioners (GPs) and practice nurses (PNs), combined with previously reported survey findings, provided an outcomes evaluation. RESULTS STIPU used a rigorous, multimodal approach to develop evidence-based clinical resources. GPs and PNs received information opportunistically rather than through targeted searches unless they had a particular interest. GPs were less aware of online re-sources. DISCUSSION STIPU's best practice translation of clinical guidelines could be enhanced by promotion of online resources, links through general practice software, strong engagement with general practice organisations, and developing the role of PNs.
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Affiliation(s)
- Jennifer Reath
- MBBS, MMed, FRACGP is the Peter Brennan Chair of General Practice, School of Medicine, University of Western Sydney, New South Wales
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Barton CA, Tam CWM, Abbott P, Liaw ST. Ethical considerations in recruiting primary care patients to research studies. Aust Fam Physician 2016; 45:144-148. [PMID: 27052053] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND How patients are selected and subsequently invited to take part in research has important implications for gaining informed, voluntary consent. OBJECTIVE This article identifies and discusses common ethical issues that are faced by researchers when recruiting patients from primary care settings. DISCUSSION Recruiting primary care patients for research studies should be guided by the core ethical values of merit and integrity, respect, justice and beneficence. Issues of patient privacy and risk of coercion are major concerns when selecting and recruiting primary care patients, but the ethical issues will depend on the type of research and the potential risks to participants. The National Statement on Ethical Conduct in Human Research, and Australian privacy laws and principles, should be reviewed to ensure recruitment meets contemporary ethical standards prior to submitting a study protocol for ethical review.
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Affiliation(s)
- Christopher A Barton
- PhD, MMedSci, BSc, is Research Fellow, Department of General Practice, University of Adelaide, South Australia
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Abbott P, Magin P, Hu W. Healthcare delivery for women in prison: a medical record review. Aust J Prim Health 2016; 22:523-529. [PMID: 27157887 DOI: 10.1071/py15110] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 11/04/2015] [Indexed: 11/23/2022]
Abstract
When women come into prison, many have unmet health needs. In this study we examine the health care provided to women in prison and their identified health needs, and discuss opportunities for improved healthcare delivery. We undertook a medical record review of women released from a minimum 6-week period of incarceration in New South Wales correctional centres between May 2013 and January 2014. Records from 231 periods of incarceration were reviewed. At reception, 52% of women were identified as having anxiety or depression. Hearing health was not documented despite 30% of records being of women from an Aboriginal and Torres Strait Islander background, a high-risk group for whom hearing screening is recommended. Most women had multiple in-prison clinical contacts, including interactions with general and specialised nurses (97%), general practitioners (65%) and psychiatrists (35%). At release, 49% were on psychotropic medication and most required ongoing management for: mental health (71%), substance misuse (65%) and physical health (61%) problems. External specialist appointments were pending in 7% at release. Health management plans generated in prison were not always completed before release for reasons including custodial factors and waits for hospital-based appointments. Provision of effective health care in prison requires improved integration with community health services, including timely access to a wide range of health services while women are in prison, and continuity of care at release.
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Affiliation(s)
- Penelope Abbott
- Department of General Practice, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Parker Magin
- Discipline of General Practice, University of Newcastle, Newbolds Building, University Drive, Newcastle, NSW 2308, Australia
| | - Wendy Hu
- Medical Education Unit, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Green A, DiGiacomo M, Luckett T, Abbott P, Davidson PM, Delaney J, Delaney P. Cross-sector collaborations in Aboriginal and Torres Strait Islander childhood disability: a systematic integrative review and theory-based synthesis. Int J Equity Health 2014; 13:126. [PMID: 25519053 PMCID: PMC4307173 DOI: 10.1186/s12939-014-0126-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/09/2014] [Indexed: 01/08/2023] Open
Abstract
Introduction Aboriginal and Torres Strait Islander children in Australia experience a higher prevalence of disability and socio-economic disadvantage than other Australian children. Early intervention is vital for improved health outcomes, but complex and fragmented service provision impedes access. There have been international and national policy shifts towards inter-sector collaborative responses to disability, but more needs to be known about how collaboration works in practice. Methods A systematic integrative literature review using a narrative synthesis of peer-reviewed and grey literature was undertaken to describe components of inter- and intra-sector collaborations among services to Aboriginal and Torres Strait Islander children with a disability and their families. The findings were synthesized using the conceptual model of the ecological framework. Results Thirteen articles published in a peer-reviewed journal and 18 articles from the grey literature met inclusion criteria. Important factors in inter- and intra-sector collaborations identified included: structure of government departments and agencies, and policies at the macro- (government) system level; communication, financial and human resources, and service delivery setting at the exo- (organizational) system level; and relationships and inter- and intra-professional learning at the meso- (provider) system level. Conclusions The policy shift towards inter-sector collaborative approaches represents an opportunity for the health, education and social service sectors and their providers to work collaboratively in innovative ways to improve service access for Aboriginal and Torres Strait Islander children with a disability and their families. The findings of this review depict a national snapshot of collaboration, but as each community is unique, further research into collaboration within local contexts is required to ensure collaborative solutions to improve service access are responsive to local needs and sustainable.
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Affiliation(s)
- Anna Green
- Center for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Michelle DiGiacomo
- Center for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Tim Luckett
- Center for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Penelope Abbott
- University of Western Sydney, Locked Bag 1797, Penrith, NSW, 1797, Australia.
| | - Patricia Mary Davidson
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Joanne Delaney
- Aboriginal Medical Service Western Sydney, PO Box 3160, Mt Druitt, NSW, 2770, Australia.
| | - Patricia Delaney
- Aboriginal Medical Service Western Sydney, PO Box 3160, Mt Druitt, NSW, 2770, Australia.
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Abbott P, Rosenkranz S, Hu W, Gunasekera H, Reath J. The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of childhood ear disease. BMC Fam Pract 2014; 15:181. [PMID: 25522872 PMCID: PMC4308896 DOI: 10.1186/s12875-014-0181-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Tympanometry and pneumatic otoscopy are recommended for diagnosis of otitis media, but are not frequently used by general practitioners (GPs). We examined how, after targeted short training, GP diagnosis and management of childhood ear disease was changed by the addition of these techniques to non-pneumatic otoscopy. We further explored factors influencing the uptake of these techniques. METHODS Between 2011 and 2012, we used a crossover experimental design to determine associations between tympanometry and pneumatic otoscopy and the GP diagnosis and management of ear disease in children aged 6 months to 6 years. GPs recorded a diagnosis and management plan after examining ears using non-pneumatic otoscopy, and another after using either tympanometry or pneumatic otoscopy. We compared diagnosis, prescription of oral antibiotics and planned GP follow-up at these two steps between the tympanometry and pneumatic otoscopy groups. We interviewed participants about their views regarding these techniques and analysed these data thematically. RESULTS Thirteen GPs recorded 694 ear examinations on 347 children: 347 examinations with non-pneumatic otoscopy; then 196 using tympanometry; and 151 using pneumatic otoscopy. Tympanometry was more likely to be associated with changes in diagnosis (χ (2) = 28.64, df 1, p < 0.001) and planned GP follow-up (χ (2) = 9.24, df 1, p < 0.01) than pneumatic otoscopy. Change in oral antibiotic prescription was no different between the two techniques. GPs preferred tympanometry to pneumatic otoscopy, but cost was a barrier to ongoing use. Pneumatic otoscopy was considered the more difficult skill. GPs were not convinced that the increased detection of middle ear effusion afforded by tympanometry and pneumatic otoscopy resulted in benefit to general practice patients. CONCLUSION Tympanometry was more likely than pneumatic otoscopy to change GP diagnoses and follow-up plans of childhood ear disease. Tympanometry may require less training than pneumatic otoscopy. GPs preferred tympanometry due to ease of use and interpretation; however, perceived high cost inhibited their intent to use it in the future. Training, cost and perceived lack of patient benefit are barriers to the use of tympanometry and pneumatic otoscopy in general practice.
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Affiliation(s)
- Penelope Abbott
- Department of General Practice, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Sara Rosenkranz
- Department of Human Nutrition, Kansas State University, Manhattan, USA.
| | - Wendy Hu
- Medical Education Unit, School of Medicine, University of Western Sydney, Sydney, Australia.
| | - Hasantha Gunasekera
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia.
| | - Jennifer Reath
- Department of General Practice, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Abbott P, Reath J, Gordon E, Dave D, Harnden C, Hu W, Kozianski E, Carriage C. General Practitioner Supervisor assessment and teaching of Registrars consulting with Aboriginal patients - is cultural competence adequately considered? BMC Med Educ 2014; 14:167. [PMID: 25115609 PMCID: PMC4136400 DOI: 10.1186/1472-6920-14-167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/29/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND General Practitioner (GP) Supervisors have a key yet poorly defined role in promoting the cultural competence of GP Registrars who provide healthcare to Aboriginal and Torres Strait Islander people during their training placements. Given the markedly poorer health of Indigenous Australians, it is important that GP training and supervision of Registrars includes assessment and teaching which address the well documented barriers to accessing health care. METHODS A simulated consultation between a GP Registrar and an Aboriginal patient, which illustrated inadequacies in communication and cultural awareness, was viewed by GP Supervisors and Medical Educators during two workshops in 2012. Participants documented teaching points arising from the consultation which they would prioritise in supervision provided to the Registrar. Content analysis was performed to determine the type and detail of the planned feedback. Field notes from workshop discussions and participant evaluations were used to gain insight into participant confidence in cross cultural supervision. RESULTS Sixty four of 75 GPs who attended the workshops participated in the research. Although all documented plans for detailed teaching on the Registrar's generic communication and consultation skills, only 72% referred to culture or to the patient's Aboriginality. Few GPs (8%) documented a plan to advise on national health initiatives supporting access for Aboriginal and Torres Strait Islander people. A lack of Supervisor confidence in providing guidance on cross cultural consulting with Aboriginal patients was identified. CONCLUSIONS The role of GP Supervisors in promoting the cultural competence of GP Registrars consulting with Aboriginal and Torres Strait Islander patients could be strengthened. A sole focus on generic communication and consultation skills may lead to inadequate consideration of the health disparities faced by Indigenous peoples and of the need to ensure Registrars utilise health supports designed to decrease the disadvantage faced by vulnerable populations.
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Affiliation(s)
- Penelope Abbott
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith
NSW 2751, Australia
| | - Jennifer Reath
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith
NSW 2751, Australia
| | - Elaine Gordon
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith
NSW 2751, Australia
| | - Darshana Dave
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith
NSW 2751, Australia
| | - Chris Harnden
- Northern Territory General Practice and Training, Penrith, Australia
| | - Wendy Hu
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith
NSW 2751, Australia
| | - Emma Kozianski
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith
NSW 2751, Australia
| | - Cris Carriage
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith
NSW 2751, Australia
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Deshmukh T, Abbott P, Reath J. 'It's got to be another approach': an Aboriginal health worker perspective on cardiovascular risk screening and education. Aust Fam Physician 2014; 43:475-478. [PMID: 25006611] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Aboriginal Australians have a higher burden from cardiovascular disease. This study provides a new perspective from Aboriginal Health Workers (AHWs) working in the area of heart health in the Aboriginal community of western Sydney. METHODS Eight AHWs and Aboriginal nurses were interviewed and thematic analysis undertaken. Analysis was refined in group and individual discussions with participants in a participatory approach. RESULTS AHW assessment was reported to differ from the biomedical model. AHWs were seen to play an important part in cardiovascular risk assessment and education due to their access and credibility to clients. DISCUSSION AHWs are well placed and keen to be a part of the team that assesses cardiovascular risk. However, lack of recognition of the AHWs' skills and lack of access to formal training are current barriers to enhancing their role in the heart health team.
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Affiliation(s)
- Tejas Deshmukh
- MBBS, MClinTRes, Department of General Practice, School of Medicine, University of Western Sydney, NSW. Currently, Basic Physician Trainee, Westmed Network, NSW
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Deek H, Abbott P, Moore L, Davison J, Cameron S, Digiacomo M, McGrath SJ, Dharmendra T, Davidson PM. Pneumococcus in Aboriginal and Torres Strait Islander peoples: the role of Aboriginal health workers and implications for nursing practice. Contemp Nurse 2014; 46:54-8. [PMID: 24716762 DOI: 10.5172/conu.2013.46.1.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pneumonia is a common cause of hospitalization in Aboriginal and Torres Strait Islander men and women. AIM This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up. METHOD An integrative literature review, using both published and gray literature was undertaken to identify methods of screening and surveillance strategies for pneumococcus. RESULTS The literature was summarized under the following themes: Pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; culturally competent interventions and the role of Aboriginal health professionals. CONCLUSION Community controlled conditions and the role of the Aboriginal Health Workers are seen as critical to reducing health disparities. Nurses can play a critical role in bridging the gap between mainstream and community controlled organizations. Working to increase the numbers of Aboriginal health professionals is a critical step in improving health outcomes for Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Hiba Deek
- American University of Beirut, Beirut, Lebanon, 2. University of Technology Sydney, Sydney, NSW, Australia
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Abbott P, Reath J, Rosenkranz S, Usherwood T, Hu W. Increasing GP supervisor research skills - enhancing clinical practice and teaching. Aust Fam Physician 2014; 43:327-330. [PMID: 24791778] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND General practitioner (GP) supervisors have a central role in GP training. Despite critical thinking, research and evidence-based medicine being part of the GP training curriculum, GP supervisors are unlikely to have had much training or practical support to increase their use of research evidence or participate in research themselves, nor to model research activity to their registrars. OBJECTIVE This article discusses the needs, motivators and barriers to using and participating in research identified by 31 GP supervisors who attended research skills workshops in western Sydney, and potential strategies to increase their research engagement. DISCUSSION GP supervisors reported interest in increased research engagement, particularly through efficient use of research evidence to guide practice and teaching, and through input into regional research priority setting. They believed training and practical support through regional training providers, universities and Medicare Locals was needed and would allow interested teaching practices to collaborate as practice-based research networks.
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Affiliation(s)
- Penelope Abbott
- MBBS, MPH, FRACGP is Senior Lecturer, Department of General Practice, School of Medicine, University of Western Sydney, NSW
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Deek H, Abbott P, Moore L, Davison J, Cameron S, Digiacomo M, McGrath SJ, Dharmendra T, Davidson PM. Pneumococcus in Aboriginal and Torres Strait Islanders: the role of Aboriginal Health Workers and implications for nursing practice. Contemp Nurse 2014:4079-4089. [PMID: 24484287 DOI: 10.5172/conu.2013.4079] [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] [Indexed: 11/08/2022]
Abstract
Abstract Background: Pneumonia is a common cause of hospitalization in Aboriginal and Torres Strait Islander men and women. Aim: This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up. Method: An integrative literature review, using both published and grey literature was undertaken to identify methods of screening and surveillance strategies for pneumococcus. Results: The literature was summarized under the following themes: pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; culturally competent interventions and the role of Aboriginal health professionals. Conclusion: Community controlled conditions and the role of the Aboriginal Health Workers are seen as critical to reducing health disparities. Nurses can play a critical role in bridging the gap between mainstream and community controlled organizations. Working to increase the numbers of Aboriginal health professionals is a critical step in improving health outcomes for Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Hiba Deek
- American University of Beirut, Lebanon , 2. University of Technology Sydney, Australia
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Abbott P, Dave D, Gordon E, Reath J. What do GPs need to work more effectively with Aboriginal patients? Views of Aboriginal cultural mentors and health workers. Aust Fam Physician 2014; 43:58-63. [PMID: 24563897] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Given the health inequity faced by Aboriginal people, it is important that interactions with general practitioners (GPs) are effective and that GPs are aware of issues affecting culturally competent practice. METHODS Semi-structured interviews undertaken with Aboriginal people who had a role in cultural support or mentorship of GPs and registrars in urban or large rural centres were analysed thematically. RESULTS Fourteen participants contributed to the study. They emphasised that a culturally respectful approach was the most important attribute. Other core knowledge and skills that promote effective relationships and healthcare were categorised as attitudes and approach, communication and consultation skills, culturally aware practices and applied knowledge. DISCUSSION Respectful attitudes and good communication and consultation skills need to be combined with knowledge of the historical, cultural, social, medical and system factors that impact on healthcare delivery for Aboriginal patients. Access to cultural mentorship or support is important to promote culturally competent practice.
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Affiliation(s)
- Penelope Abbott
- MBBS, MPH, FRACGP is Senior Lecturer, Department of General Practice, School of Medicine, University of Western Sydney, NSW
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Kwang S, Abbott P. The presence and distribution of bacteria in dentinal tubules of root filled teeth. Int Endod J 2013; 47:600-10. [PMID: 24111689 DOI: 10.1111/iej.12195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 07/19/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
AIM To investigate the distribution of bacteria within the dentine tubular network in a two-chamber model in order to determine a possible route of penetration. METHODOLOGY Root canals of teeth in the experimental group (n = 16) were instrumented and root filled using AH26 and gutta-percha. Canals in the teeth serving as positive (n = 1) and negative (n = 1) controls were instrumented, but not root filled. A two-chamber model was fabricated for each root - upper chambers were inoculated weekly with Streptococcus gordonii in brain-heart infusion broth over 90 days. Turbidity of the lower chamber was checked daily. Samples that showed turbidity during the experimental period and samples that showed no signs of turbidity at 90 days were fractured and prepared for SEM examination. SEM examination for the presence of bacteria within the dentinal tubules was performed in the cervical, middle and apical root thirds. In each root third, the depth of bacterial penetration was recorded as inner, middle or outer dentine. RESULTS Bacteria were most commonly detected in the cervical third (14 of 30 areas). Irrespective of the root third examined, bacteria were most commonly detected in the inner dentine (i.e. adjacent to the root canal). Only two samples demonstrated bacterial penetration in the outer dentine. CONCLUSION The dentine tubular network provides a potential pathway for bacteria to penetrate tooth roots in a two-chamber model.
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Affiliation(s)
- S Kwang
- School of Dentistry, University of Western Australia, Nedlands, WA, Australia
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Abbott P, Dadich A, Hosseinzadeh H, Kang M, Hu W, Bourne C, Murray C, Reath J. Practice nurses and sexual health care -- enhancing team care within general practice. Aust Fam Physician 2013; 42:729-733. [PMID: 24130977] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Collaboration between general practitioners (GPs) and practice nurses (PNs) can enhance health care delivery. However, despite evidenced shortfalls in general practice-based sexual health care, the PN role in sexual health appears underdeveloped. Evaluation of New South Wales Sexually Transmissible Infections Programs Unit GP Project provided an opportunity to canvass views of GPs and PNs regarding PNs and sexual health care. METHODS A purposively sampled group of 10 PNs and nine GPs were interviewed. Interviews were transcribed and analysed thematically. RESULTS The extent and nature of PN-GP teamwork in sexual health care was variable, influenced largely by GP recognition and support of the PN role in sexual health care. Other important factors were personal PN interest and supportive practice systems. DISCUSSION The role played by PNs and a team approach to sexual health care in Australian general practice is underdeveloped. Increased recognition and support of PN roles in sexual health is needed, including supportive practice systems that facilitate team care.
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Affiliation(s)
- Penelope Abbott
- MBBS, MPH, FRACGP is Senior Lecturer, Department of General Practice, School of Medicine, University of Western Sydney, NSW
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DiGiacomo M, Delaney P, Abbott P, Davidson PM, Delaney J, Vincent F. 'Doing the hard yards': carer and provider focus group perspectives of accessing Aboriginal childhood disability services. BMC Health Serv Res 2013; 13:326. [PMID: 23958272 PMCID: PMC3765087 DOI: 10.1186/1472-6963-13-326] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 08/15/2013] [Indexed: 11/10/2022] Open
Abstract
Background Despite a high prevalence of disability, Aboriginal Australians access disability services in Australia less than non-Aboriginal Australians with a disability. The needs of Aboriginal children with disability are particularly poorly understood. They can endure long delays in treatment which can impact adversely on development. This study sought to ascertain the factors involved in accessing services and support for Aboriginal children with a disability. Methods Using the focus group method, two community forums, one for health and service providers and one for carers of Aboriginal children with a disability, were held at an Aboriginal Community Controlled Health Service (ACCHS) in the Sydney, metropolitan area of New South Wales, Australia. Framework analysis was applied to qualitative data to elucidate key issues relevant to the dimensions of access framework. Independent coding consistency checks were performed and consensus of analysis verified by the entire research team, several of whom represented the local Aboriginal community. Results Seventeen health and social service providers representing local area government and non-government-funded health and social service organisations and five carers participated in two separate forums between September and October 2011. Lack of awareness of services and inadequate availability were prominent concerns in both groups despite geographic proximity to a major metropolitan area with significant health infrastructure. Carers noted racism, insufficient or non-existent services, and the need for an enhanced role of ACCHSs and AHWs in disability support services. Providers highlighted logistical barriers and cultural and historical issues that impacted on the effectiveness of mainstream services for Aboriginal people. Conclusions Despite dedicated disability services in an urban community, geographic proximity does not mitigate lack of awareness and availability of support. This paper has enumerated a number of considerations to address provision of disability services in an urban Australian Aboriginal community including building expertise and specialist capacity within Aboriginal Health Worker positions and services. Increasing awareness of services, facilitating linkages and referrals, eliminating complexities to accessing support, and working with families and Aboriginal community organisations within a framework of resilience and empowerment to ensure a relevant and acceptable model are necessary steps to improving support and care for Aboriginal children with a disability.
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Affiliation(s)
- Michelle DiGiacomo
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Broadway, P,O, Box 123, Broadway, Australia 2007.
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