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Pu D, Cameron P, Chapman W, Greenstock L, Sanci L, Callisaya ML, Haines T. Virtual emergency care in Victoria: Stakeholder perspectives of strengths, weaknesses, and barriers and facilitators of service scale-up. Australas Emerg Care 2024; 27:102-108. [PMID: 37852805 DOI: 10.1016/j.auec.2023.10.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Virtual emergency services have been proposed as an alternative service model to conventional in-person emergency department attendance. METHODS Twenty participants were interviewed: 10 emergency medicine physicians, 4 health care consumers, and 6 other health care professionals. Conventional content analysis was performed on the interview transcriptions to identify perceived strengths and weaknesses of the VED, and barriers and facilitators to scaling-up the VED. RESULTS VEDs are perceived as a convenient approach to provide and receive emergency care while ensuring safety and quality of care, however some patients may still need to attend the ED in person for physical assessments. There is currently a lack of evidence, guidelines, and resources to support their implementation. Most of the potential and existing barriers and facilitators for scaling-up the VED were related to their effectiveness, reach and adoption. Broader public health contextual factors were viewed as barriers, while potential actions to address resources and costs could be facilitators. CONCLUSIONS VEDs were viewed as a convenient service model to provide care, can not replace all in-person visits. Current policies and guidelines are insufficient for wider implementation. Most of the barriers and facilitators for its scaling-up were related to VED effectiveness and delivery.
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Affiliation(s)
- Dai Pu
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia; Monash Partners Academic Health Science Centre, Australia.
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Emergency and Trauma Centre, The Alfred Hospital, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Australia; Melbourne Academic Centre for Health, Australia
| | | | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; The ALIVE National Centre for Mental Health Research Translation, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Australia; Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia; Monash Partners Academic Health Science Centre, Australia
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Bittleston H, Hocking JS, Temple-Smith M, Sanci L, Goller JL, Coombe J. What sexual and reproductive health issues do young people want to discuss with a doctor, and why haven't they done so? Findings from an online survey. Sex Reprod Healthc 2024; 40:100966. [PMID: 38522395 DOI: 10.1016/j.srhc.2024.100966] [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: 12/06/2023] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Young people are a priority group for sexual and reproductive health (SRH) care. We considered which SRH topics young Australians want to discuss with a general practitioner (GP) and explored barriers they encounter to discussing these issues. METHODS We conducted an online survey (2nd May - 21st June 2022) of Australians aged 16-29 years. Participants were asked to identify from a list of SRH topics which they wanted to discuss, but never had, with a GP. Those who selected any topic/s (with 'undiscussed SRH issues') were asked a free-text follow-up question about what prevented them from discussing issues. We explored characteristics associated with having undiscussed issues using multivariate logistic regression. Free-text comments were analysed using content analysis. RESULTS A total of 1887 people completed relevant survey questions. Most (67.1 %) were women and 48.5 % were heterosexual. Two-thirds (67.0 %) had a usual GP. Nearly half (45.6 %) had undiscussed issues. Most commonly, women wanted to discuss cervical screening and sexual problems, and men wanted to discuss sexual problems and STIs. Participants who were male, older, heterosexual, and with a usual GP were least likely to have undiscussed issues. Barriers to accessing care for SRH were identified from free-text comments, including discomfort, lack of opportunity, fear of negative outcomes, low priority of SRH issues, and perceptions about the role and expertise of GPs. CONCLUSIONS Many young people would welcome more preventative SRH care. Young people may be reassured that all issues, including sexual difficulties and dysfunction, are appropriate to discuss with a GP.
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Affiliation(s)
- H Bittleston
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia.
| | - J S Hocking
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
| | - M Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - L Sanci
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - J L Goller
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
| | - J Coombe
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
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Manski-Nankervis JA, Canaway R, Chidgey C, Emery J, Sanci L, Hocking JS, Davidson S, Swan I, Boyle D. Data Resource Profile: Primary Care Audit, Teaching and Research Open Network (Patron). Int J Epidemiol 2024; 53:dyae002. [PMID: 38302745 PMCID: PMC10834357 DOI: 10.1093/ije/dyae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Canaway
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Christine Chidgey
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Jon Emery
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Lena Sanci
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Sandra Davidson
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Indi Swan
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Dougie Boyle
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
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Thai TTH, Engel L, Perez JK, Tan EJ, Eades S, Sanci L, Mihalopoulos C. A systematic review of health state utility values and psychometric performance of generic preference-based instruments for children and adolescents with mental health problems. Qual Life Res 2023; 32:3005-3026. [PMID: 37237136 PMCID: PMC10522744 DOI: 10.1007/s11136-023-03441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
AIMS This paper aims to systematically identify reported health state utility values (HSUVs) in children and adolescents with mental health problems (MHPs) aged less than 25 years; to summarise the techniques used to elicit HSUVs; and to examine the psychometric performance of the identified multi-attribute utility instruments (MAUIs) used in this space. METHODS A systematic review was conducted following PRISMA guidelines. Peer-reviewed studies published in English, reporting HSUVs for children and adolescents with MHPs using direct or indirect valuation methods were searched in six databases. RESULTS We found 38 studies reporting HSUVs for 12 types of MHPs across 12 countries between 2005 and October 2021. Attention deficit hyperactivity disorder (ADHD) and depression are the most explored MHPs. Disruptive Behaviour Disorder was associated with the lowest reported HSUVs of 0.06 while cannabis use disorder was associated with the highest HSUVs of 0.88. Indirect valuation method through the use of MAUIs (95% of included studies) was the most frequently used approach, while direct valuation methods (Standard Gamble, Time Trade-Off) were only used to derive HSUVs in ADHD. This review found limited evidence of the psychometric performance of MAUIs used in children and adolescents with MHPs. CONCLUSION This review provides an overview of HSUVs of various MHPs, the current practice to generate HSUVs, and the psychometric performance of MAUIs used in children and adolescents with MHPs. It highlights the need for more rigorous and extensive psychometric assessments to produce evidence on the suitability of MAUIs used in this area.
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Affiliation(s)
- Thao T H Thai
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Joahna Kevin Perez
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Eng Joo Tan
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 780 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 780 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Loveday S, Balgovind M, Hall T, Goldfeld S, Sanci L, Hiscock H. Emotional work of getting help: a qualitative analysis of caregiver-perceived barriers to responding to childhood adversity. Arch Dis Child 2023; 108:857-861. [PMID: 37290933 DOI: 10.1136/archdischild-2023-325473] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore caregivers' experiences and challenges of accessing help for adversity across both health and social care sectors. DESIGN Qualitative study design using semistructured interviews to explore how caregivers accessed services across health and social care. Interviews were audio recorded, transcribed verbatim and analysed using reflexive thematic analysis. SETTING Families living in the city of Wyndham, Victoria, Australia. PARTICIPANTS 17 caregivers of children aged 0-8 years. RESULTS Five main themes emerged. (1) Emotional work of getting help. Caregivers described that getting help for life challenges was both emotionally taxing and effortful. (2) Trusting relationships are key. Engagement was related to the degree of relational practice and whether they felt judged or demeaned. (3) Wanting to manage on your own. There was a strong desire by caregivers to be independent and to only seek help when it was absolutely necessary. (4) Importance of knowing help was available and how to access it. (5) Overcoming service access barriers including long waiting times, restricted service criteria, transport issues and out-of-pocket expenses. CONCLUSIONS Caregivers highlighted a multitude of barriers to getting help for life challenges. Addressing these barriers will require services to become more flexible and codesign best approaches with families in ongoing partnership. Improving community knowledge of available services and building trusting relationships is the first step to overcoming these barriers.
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Affiliation(s)
- Sarah Loveday
- Health Services Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Manisha Balgovind
- Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Tess Hall
- Health Services Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Policy and Equity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Health Services Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia
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Hall T, Constable L, Loveday S, Honisett S, Schreurs N, Goldfeld S, Loftus H, Jones R, Reupert A, Yap MBH, Woolfenden S, Montgomery A, Dalziel K, Bailey C, Pringle G, Fisher J, Forell S, Eapen V, Haslam R, Sanci L, Eastwood J, Hiscock H. Identifying and responding to family adversity in Australian community and primary health settings: a multi-site cross sectional study. Front Public Health 2023; 11:1147721. [PMID: 37771827 PMCID: PMC10525396 DOI: 10.3389/fpubh.2023.1147721] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background Unaddressed family adversity has potentially modifiable, negative biopsychosocial impacts across the life course. Little is known about how Australian health and social practitioners identify and respond to family adversity in community and primary health settings. Objective To describe, in two Australian community health services: (1) the number of adversities experienced by caregivers, (2) practitioner identification of caregivers experiencing adversity, (3) practitioner response to caregivers experiencing adversity, and (4) caregiver uptake of referrals. Methods Survey of caregivers of children aged 0-8 years attending community health services in Victoria and New South Wales (NSW). Analysis described frequencies of caregiver self-reported: (1) experiences of adversity, (2) practitioner identification of adversity, (3) practitioner response to adversity, and (4) referral uptake. Analyses were sub-grouped by three adversity domains and site. Results 349 caregivers (Victoria: n = 234; NSW: n = 115) completed the survey of whom 88% reported experiencing one or more family adversities. The median number of adversities was 4 (2-6). Only 43% of participants were directly asked about or discussed an adversity with a practitioner in the previous 6 months (Victoria: 30%; NSW: 68%). Among caregivers experiencing adversity, 30% received direct support (Victoria: 23%; NSW: 43%), and 14% received a referral (Victoria: 10%; NSW: 22%) for at least one adversity. Overall, 74% of caregivers accepted referrals when extended. Conclusion The needs of Australian families experiencing high rates of adversity are not systematically identified nor responded to in community health services. This leaves significant scope for reform and enhancement of service responses to families experiencing adversity.
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Affiliation(s)
- Teresa Hall
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Leanne Constable
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Sarah Loveday
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Suzy Honisett
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Natalie Schreurs
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Hayley Loftus
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Renee Jones
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Reupert
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Marie B. H. Yap
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Sue Woolfenden
- Sydney Institute Women, Children and their Families, Sydney Local Health District, Croydon, NSW, Australia
- Discipline of Paediatrics, University of New South Wales, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Alicia Montgomery
- Sydney Institute Women, Children and Their Families, Sydney Local Health District, Camperdown, NSW, Australia
| | - Kim Dalziel
- Health Economics Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Cate Bailey
- Health Economics Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Glenn Pringle
- Innovation and Community Care, IPC Health, Wyndham Vale, VIC, Australia
| | - Jane Fisher
- Global and Women's Health, Monash University, Clayton, VIC, Australia
| | - Suzie Forell
- Health Justice Australia, Darlinghurst, Sydney, NSW, Australia
- School of Law, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Infant Child and Adolescent Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Ric Haslam
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Parkville, VIC, Australia
| | - John Eastwood
- Sydney Institute Women, Children and Their Families, Sydney Local Health District, Camperdown, NSW, Australia
| | - Harriet Hiscock
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Health Services and Economics, Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Health Services Research Unit, The Royal Children's Hospital, Parkville, VIC, Australia
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Hocking JS, Watson C, Chondros P, Sawyer SM, Ride J, Temple-Smith M, Boyle D, Skinner R, Patton GC, Lim MSC, Pirkis J, Johnson C, Newton S, Wardley A, Blashki G, Guy R, Dalziel K, Sanci L. Will a fee-for-service payment for a young people's health assessment in general practice increase the detection of health risk behaviours and health conditions? Protocol for a cluster randomised controlled trial (RAd Health Trial). BMJ Open 2023; 13:e074154. [PMID: 37586870 PMCID: PMC10432627 DOI: 10.1136/bmjopen-2023-074154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Adolescence is a period of major transition in physical, cognitive, social and emotional development, and the peak time for the onset of mental health conditions, substance use disorders and sexual and reproductive health risks. Prevention and treatment during this time can improve health and well-being now and into the future. However, despite clinical guidelines recommending annual preventive health assessments for young people, health professionals cite lack of consultation time and adequate funding as key barriers. This trial aims to determine whether a specific fee-for-service ('rebate payment') for a young person's health assessment, is effective and cost-effective at increasing the detection and management of health risk behaviours and conditions among young people. METHODS AND ANALYSIS This cluster randomised controlled trial will be conducted in Australian general practice. 42 general practices (clusters) will be randomly allocated 1:1 to either an intervention arm where general practitioners receive a rebate payment for each annual health assessment undertaken for 14-24-year-olds during a 2 year study period, or a control arm (no rebate). The rebate amount will be based on the Medical Benefits Schedule (Australia's list of health professional services subsidised by the Australian Government) currently available for similar age-based assessments. Our primary outcome will be the annual rate of risk behaviours and health conditions recorded in the patient electronic health record (eg, alcohol/drug use, sexual activity and mental health issues). Secondary outcomes include the annual rate of patient management activities related to health risks and conditions identified (eg, contraception prescribed, sexually transmitted infection tests ordered). A process evaluation will assess acceptability, adoption, fidelity and sustainability of the rebate; an economic evaluation will assess its cost-effectiveness. Analyses will be intention-to-treat. ETHICS AND DISSEMINATION Ethics approval has been obtained from University of Melbourne Human and Research Ethics Committee (2022-23435-29990-3). Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000114741.
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Affiliation(s)
- Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cathy Watson
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patty Chondros
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jemimah Ride
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Health Economics Group, Monash University, Melbourne, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas Boyle
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Skinner
- University of Sydney, Sydney, New South Wales, Australia
| | - George C Patton
- Centre for Adolescent Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline Johnson
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sara Newton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amelia Wardley
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Guy
- Sexual Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Dalziel
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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Ke T, Li W, Sanci L, Reavley N, Williams I, Russell MA. The mental health of international university students from China during the COVID-19 pandemic and the protective effect of social support: A longitudinal study. J Affect Disord 2023; 328:13-21. [PMID: 36758874 PMCID: PMC9902340 DOI: 10.1016/j.jad.2023.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND During the COVID-19 pandemic Chinese international students were reported to experience racism, food security issues and social isolation. However, no study has investigated the prevalence of these issues and the potential for worsening mental health in this population group during the pandemic. Therefore, this study aimed to examine the effect of this pandemic on the mental health of Chinese international students living in Australia and China, and the protective effect of social support. METHODS Data were extracted from a survey of Australian university students (April-June 2019) and follow-up during the pandemic (Sept-Oct 2020). The prevalence of anxiety, major depression and pandemic-related stressors was reported. Multivariable logistic regression was used to assess the association between country of residence, social support (baseline/follow-up), and follow-up self-reported mental health. RESULTS With the pandemic, there was a substantial increase in the prevalence of anxiety (24.7 % vs 45.7 %) and major depression (22.1 % vs 43.8 %). Major depression was less likely to be reported by international students in China (34.8 %) than in Australia (46.3 %). Students with high social support during the pandemic were less likely to report major depression (Adjusted OR:0.15 [95 % CI 0.06,0.34]), although this effect was not observed longitudinally (Adjusted OR:1.03 [95 % CI 0.58,1.83]). LIMITATION Post pandemic improvement in mental health cannot be assessed. CONCLUSION The pandemic appeared to have had a strong negative effect on Chinese international university students' mental health. Those living in Australia were more likely to experience poorer mental health, highlighting the need for increased support to this group.
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Affiliation(s)
- Tianhui Ke
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Wenjing Li
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Lena Sanci
- Department of General Pratice, Melbourne Medical School, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Ian Williams
- Department of General Pratice, Melbourne Medical School, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Melissa A Russell
- Centre of Epidemiology and Biostatics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia.
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9
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El-Hayek C, Barzegar S, Faux N, Doyle K, Pillai P, Mutch SJ, Vaisey A, Ward R, Sanci L, Dunn AG, Hellard ME, Hocking JS, Verspoor K, Boyle DI. An evaluation of existing text de-identification tools for use with patient progress notes from Australian general practice. Int J Med Inform 2023; 173:105021. [PMID: 36870249 DOI: 10.1016/j.ijmedinf.2023.105021] [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: 09/01/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Digitized patient progress notes from general practice represent a significant resource for clinical and public health research but cannot feasibly and ethically be used for these purposes without automated de-identification. Internationally, several open-source natural language processing tools have been developed, however, given wide variations in clinical documentation practices, these cannot be utilized without appropriate review. We evaluated the performance of four de-identification tools and assessed their suitability for customization to Australian general practice progress notes. METHODS Four tools were selected: three rule-based (HMS Scrubber, MIT De-id, Philter) and one machine learning (MIST). 300 patient progress notes from three general practice clinics were manually annotated with personally identifying information. We conducted a pairwise comparison between the manual annotations and patient identifiers automatically detected by each tool, measuring recall (sensitivity), precision (positive predictive value), f1-score (harmonic mean of precision and recall), and f2-score (weighs recall 2x higher than precision). Error analysis was also conducted to better understand each tool's structure and performance. RESULTS Manual annotation detected 701 identifiers in seven categories. The rule-based tools detected identifiers in six categories and MIST in three. Philter achieved the highest aggregate recall (67%) and the highest recall for NAME (87%). HMS Scrubber achieved the highest recall for DATE (94%) and all tools performed poorly on LOCATION. MIST achieved the highest precision for NAME and DATE while also achieving similar recall to the rule-based tools for DATE and highest recall for LOCATION. Philter had the lowest aggregate precision (37%), however preliminary adjustments of its rules and dictionaries showed a substantial reduction in false positives. CONCLUSION Existing off-the-shelf solutions for automated de-identification of clinical text are not immediately suitable for our context without modification. Philter is the most promising candidate due to its high recall and flexibility however will require extensive revising of its pattern matching rules and dictionaries.
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Affiliation(s)
- Carol El-Hayek
- Burnet Institute, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Australia.
| | - Siamak Barzegar
- School of Computing and Information Systems, University of Melbourne, Australia
| | - Noel Faux
- Melbourne Data Analytics Platform, University of Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Kim Doyle
- Melbourne Data Analytics Platform, University of Melbourne, Australia
| | - Priyanka Pillai
- Melbourne Data Analytics Platform, University of Melbourne, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Simon J Mutch
- Melbourne Data Analytics Platform, University of Melbourne, Australia
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Roger Ward
- Department of General Practice and Primary Care, University of Melbourne, Australia
| | - Lena Sanci
- Department of General Practice and Primary Care, University of Melbourne, Australia
| | - Adam G Dunn
- School of Medical Sciences, University of Sydney, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Karin Verspoor
- School of Computing and Information Systems, University of Melbourne, Australia; School of Computing Technologies, RMIT University, Melbourne, Australia
| | - Douglas Ir Boyle
- Department of General Practice and Primary Care, University of Melbourne, Australia
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10
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Newton SL, Johnson C, Wardley A, Bittleston H, Watson C, Hocking JS, Sanci L. Considerations for conducting a young person's health assessment in the general practice setting: Insights from key informants in Victoria. Aust J Gen Pract 2023; 52:235-240. [PMID: 37021450 DOI: 10.31128/ajgp-05-22-6423] [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: 04/07/2023]
Abstract
BACKGROUND AND OBJECTIVES There have been calls for a Medicare Benefits Schedule rebate to support a young person's health assessment in general practice. The aim of this study was to understand Victorian providers' needs and perspectives about implementing young people's health assessments in general practice. METHOD Focus groups and interviews were conducted over Zoom with current general practitioners (GPs), practice nurses (PNs) and practice managers (PMs). A qualitative descriptive approach and conventional content analysis were used. RESULTS Two focus groups and five interviews were conducted between September and November 2021. Participants (11 GPs, nine PNs and three PMs) represented metropolitan (n = 11), regional (n = 10) and rural (n = 2) Victoria. Key facilitators to implementing a young person's health assessment included established clinic systems and staff roles as well as the potential to empower young people. Key barriers included scheduling logistics and billing structures. DISCUSSION Key informants generated substantive stakeholder perspectives to aid planning and implementing young people's health assessments in general practice.
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Affiliation(s)
- Sarah L Newton
- MA, Research Officer, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic
| | - Caroline Johnson
- MBBS, FRACGP, PhD, Senior Lecturer, Department of General Practice, The University of Melbourne, Melbourne, Vic; General Practitioner, Melbourne, Vic
| | - Amelia Wardley
- MPH, Research Officer, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic
| | - Helen Bittleston
- BA (Hons), MPH, Research Assistant, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic
| | - Cathy Watson
- PhD, MNSc, Post Grad Dip (Women@s Health), BA, RN, RM, Research Fellow, Department of General Practice, School of Primary and Allied Health Care, Monash University, Vic
| | - Jane S Hocking
- BAppSc, MPH, MHlthSc, PhD, Head, Sexual Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic
| | - Lena Sanci
- MBBS, PhD, FRACGP, Head, Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic
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11
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Chen KY, Chu W, Jones R, Vuillermin P, Fuller D, Tran D, Sanci L, Shanthikumar S, Carlin J, Hiscock H. Modifiable factors associated with pediatric asthma readmissions: a multi-center linked cohort study. J Asthma 2023; 60:708-717. [PMID: 35748560 DOI: 10.1080/02770903.2022.2089996] [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: 10/17/2022]
Abstract
OBJECTIVES To (a) identify rates of hospital readmission and emergency department (ED) re-presentation for asthma within a 12-month period, (b) estimate the effects of modifiable hospital, general practitioner (GP) and home environmental factors on hospital readmission, ED re-presentations and rescue oral corticosteroid use. METHODS We recruited 767 children aged 3-18 years who were admitted to 3 hospitals in Victoria, Australia between 2017 and 2018 with a validated diagnosis of asthma on chart review. Primary outcome was hospital readmission with asthma within 12 months of index admission. Secondary outcomes were ED re-presentation for asthma and rescue oral corticosteroid use. All outcomes were identified through linked administrative datasets. Their caregivers and 277 nominated GPs completed study surveys regarding the home environment and their usual asthma management practices respectively. RESULTS Within 12 months of an index admission for asthma 263 (34.3%) participants were readmitted to a hospital for asthma, with participants between the ages of 3-5 years accounting for 69.2% of those readmitted. The estimated effect of GP reported guideline discordant care on the odds of readmission was OR 1.57, 95% CI 1.00-2.47, p = 0.05. None of the hospital or home environmental factors appeared to be associated with hospital readmissions. CONCLUSIONS Hospital readmissions among Australian children with asthma are increasing, and linked datasets are important for objectively identifying the health services burden of asthma. They also confirm the important role of the GP in the management of pediatric asthma.
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Affiliation(s)
- Katherine Yh Chen
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of General Medicine, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Wanyu Chu
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Renee Jones
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Peter Vuillermin
- School of Medicine, Deakin University, Geelong, VIC, Australia
- Department of Paedatrics, University Hospital Geelong, Geelong, VIC, Australia
| | - David Fuller
- School of Medicine, Deakin University, Geelong, VIC, Australia
- Department of Paedatrics, University Hospital Geelong, Geelong, VIC, Australia
| | - David Tran
- Department of Pediatrics, Northern Health, Epping, VIC, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Parkville, VIC, Australia
| | - Shivanthan Shanthikumar
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Parkville, VIC, Australia
- Respiratory Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - John Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute and The University of Melbourne, Parkville, VIC, Australia
| | - Harriet Hiscock
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Centre for Community and Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
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12
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Moussa D, Wallace J, Manski-Nankervis JA, Doyle JS, Nguyen L, Boyle D, Stoové MA, Asselin J, Valaydon Z, Ahad M, Glasgow S, New K, Hocking JS, Sanci L, Thompson A, Hellard M, Howell J. Assessment of a primary care e-support package of automated case finding, simplified treatment algorithm and decision support to increase hepatitis B treatment uptake in primary care clinics in Australia (SIMPLY-B Study): protocol for a pilot evaluation. BMJ Open 2023; 13:e070663. [PMID: 36927591 PMCID: PMC10030932 DOI: 10.1136/bmjopen-2022-070663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Despite the availability of effective, subsidised hepatitis B treatment, linkage to care and treatment rates remain very low globally. In Australia, specially trained primary care physicians (general practitioner, GPs) can prescribe hepatitis B treatment, however, most hepatitis B care occurs in specialist clinics. Increasing hepatitis B management by GPs in primary care clinics is essential to achieve national hepatitis B linkage to care and treatment targets by 2030.This pilot study determines the feasibility, acceptability and effectiveness of Simply B, a novel GP hepatitis B e-support package designed to increase hepatitis B management by GPs in primary care clinics. METHODS AND ANALYSIS This study will be conducted in three parts:Part A: A prospective open-label pilot intervention study, comparing the proportion of people with hepatitis B who are managed by their GP in primary care clinics before, 12 months and 24 months after implementation of the Simply B electronic hepatitis B support package.Part B: A nested qualitative health services feasibility study using semistructured interviews and thematic analysisPart C: Cost-effectiveness analysis. ETHICS AND DISSEMINATION This study has received ethics approval by St Vincent's Hospital. Data management and analysis will be centralised through the Department of Gastroenterology, St Vincent's Hospital. TRIAL REGISTRATION NUMBER NCT05614466.
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Affiliation(s)
- Dina Moussa
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, Victoria, Australia
| | - Jo-Anne Manski-Nankervis
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Burnet Institute, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Long Nguyen
- Burnet Institute, Melbourne, Victoria, Australia
| | - Douglas Boyle
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | | | | | - Zina Valaydon
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Marvad Ahad
- Burnet Institute, Melbourne, Victoria, Australia
| | - Susanne Glasgow
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kate New
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jane S Hocking
- School of Population and Global Health, Univerisy of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Alexander Thompson
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Jess Howell
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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13
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Russell MA, Reavley N, Williams I, Li W, Tarzia L, Chondros P, Sanci L. Changes in mental health across the COVID-19 pandemic for local and international university students in Australia: a cohort study. BMC Psychol 2023; 11:55. [PMID: 36855196 PMCID: PMC9973240 DOI: 10.1186/s40359-023-01075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/03/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Previous research has indicated that university students experienced substantial mental health issues during the global COVID-19 pandemic, but few studies have considered changes relative to pre-pandemic levels across population groups. Hence, the aim of this study was to compare changes in mental health and associated stressors across the pandemic for international and local university students studying in Australia. METHODS In a cohort of 4407 university students, we assessed depression (Patient Health Questionnaire 2), anxiety (Generalized Anxiety Disorder-2), social support (Medical Outcomes Study-Social Support Survey), inability to afford food, fear of partner, and experiences of discrimination, both pre-pandemic (April-May 2019) and during the pandemic (September-October 2020). Change in prevalence between local and international students were estimated with logistic regression, adjusting for baseline factors. RESULTS Compared to local students, international students experienced an increase in probable major depression (odds ratio (OR) 1.43, 95% Confidence Interval (CI) 1.23, 1.66), low social support (OR 2.63, 95% CI 2.23, 3.11), inability to afford food (OR 5.21, 95% CI 3.97, 6.83) race-based discrimination (OR 2.21, 95% CI 1.82, 2.68) and fear of partner (OR 3.46, 95% CI 2.26, 5.13). Interaction analyses indicated that these issues were more likely to be experienced by students living outside their country of origin, inclusive of international students based in Australia (depression p value interaction term 0.02). CONCLUSION The pandemic had a substantial negative impact on international students, particularly those living outside of their country of origin during the pandemic. The inequalities exacerbated by the pandemic were present prior to the pandemic and are likely to continue post-pandemic without action. Interventions to build the supports for international students need to be urgently explored.
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Affiliation(s)
- Melissa A. Russell
- grid.1008.90000 0001 2179 088XCentre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Nicola Reavley
- grid.1008.90000 0001 2179 088XCentre of Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ian Williams
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Wenjing Li
- grid.1008.90000 0001 2179 088XCentre of Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Laura Tarzia
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Patty Chondros
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Lena Sanci
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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14
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Pu D, Palmer V, Greenstock L, Pigott C, Peeters A, Sanci L, Callisaya M, Browning C, Chapman W, Haines T. Identifying Public Healthcare Priorities in Virtual Care for Older Adults: A Participatory Research Study. Int J Environ Res Public Health 2023; 20:4015. [PMID: 36901031 PMCID: PMC10002071 DOI: 10.3390/ijerph20054015] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED There has been increasing adoption and implementation of virtual healthcare in recent years, especially with COVID-19 impacting the world. As a result, virtual care initiatives may not undergo stringent quality control processes to ensure that they are appropriate to their context and meet sector needs. The two objectives of this study were to identify virtual care initiatives for older adults currently in use in Victoria and virtual care challenges that could be prioritised for further investigation and scale-up and to understand why certain virtual care initiatives and challenges are prioritised over others for investigation and scale-up. METHODS This project used an Emerging Design approach. A survey of public health services in the state of Victoria in Australia was first carried out, followed by the co-production of research and healthcare priorities with key stakeholders in the areas of primary care, hospital care, consumer representation, research, and government. The survey was used to gather existing virtual care initiatives for older adults and any associated challenges. Co-production processes consisted of individual ratings of initiatives and group-based discussions to identify priority virtual care initiatives and challenges to be addressed for future scale-up. Stakeholders nominated their top three virtual initiatives following discussions. RESULTS Telehealth was nominated as the highest priority initiative type for scaling up, with virtual emergency department models of care nominated as the highest priority within this category. Remote monitoring was voted as a top priority for further investigations. The top virtual care challenge was data sharing across services and settings, and the user-friendliness of virtual care platforms was nominated as the top priority for further investigation. CONCLUSIONS Stakeholders prioritised public health virtual care initiatives that are easy to adopt and address needs that are perceived to be more immediate (acute more so than chronic care). Virtual care initiatives that incorporate more technology and integrated elements are valued, but more information is needed to inform their potential scale-up.
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Affiliation(s)
- Dai Pu
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC 3199, Australia
- Monash Partners Academic Health Science Centre, Clayton, VIC 3168, Australia
| | - Victoria Palmer
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Louise Greenstock
- Western Alliance Academic Health Science Centre, Warrnambool, VIC 3280, Australia
| | - Cathie Pigott
- Monash Partners Academic Health Science Centre, Clayton, VIC 3168, Australia
| | - Anna Peeters
- Western Alliance Academic Health Science Centre, Warrnambool, VIC 3280, Australia
- Institute for Health Transformation, Deakin University, Melbourne, VIC 3125, Australia
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Michele Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia
| | - Colette Browning
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC 3350, Australia
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, ACT 2601, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC 3199, Australia
- Monash Partners Academic Health Science Centre, Clayton, VIC 3168, Australia
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15
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Chen KY, Jones R, Lei S, Shanthikumar S, Sanci L, Carlin J, Hiscock H. Primary health care utilization and hospital readmission in children with asthma: a multi-site linked data cohort study. J Asthma 2023:1-8. [PMID: 36594684 DOI: 10.1080/02770903.2022.2164200] [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: 01/04/2023]
Abstract
OBJECTIVES To (1) describe primary health care utilization and (2) estimate the effect of primary care early follow-up, continuity, regularity, frequency, and long consultations on asthma hospital readmission, including secondary outcomes of emergency (ED) presentations, asthma preventer adherence, and use of rescue oral corticosteroids within 12 months. METHODS An Australian multi-site cohort study of 767 children aged 3-18 years admitted with asthma between 2017 and 2018, followed up for at least 12 months with outcome and primary care exposure data obtained through linked administrative datasets. We estimated the effect of primary care utilization through a modified Poisson regression adjusting for child age, asthma severity, socioeconomic status and self-reported GP characteristics. RESULTS The median number of general practitioner (GP) consultations, unique GPs and clinics visited was 9, 5, and 4, respectively. GP care was irregular and lacked continuity, only 152 (19.8%) children visited their usual GP on more than 60% of occasions. After adjusting for confounders, there was overall weak indication of effects due to any of the exposures. Increased frequency of GP visits was associated with reduced readmissions (4-14 visits associated with risk ratio of 0.71, 95% CI 0.50-1.00, p = 0.05) and ED presentations (>14 visits associated risk ratio 0.62, 95% CI 0.42-0.91, p = 0.02). CONCLUSIONS Our study demonstrates that primary care use by children with asthma is often irregular and lacking in continuity. This highlights the importance of improving accessibility, consistency in care, and streamlining discharge communication from acute health services.
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Affiliation(s)
- Katherine Yh Chen
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Renee Jones
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shaoke Lei
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shivanthan Shanthikumar
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Parkville, VIC, Australia.,Respiratory Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Parkville, VIC, Australia
| | - John Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute and The University of Melbourne, Parkville, VIC, Australia
| | - Harriet Hiscock
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Community and Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
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16
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Jones R, Hiscock H, Shanthikumar S, Lei S, Sanci L, Chen K. Exploring gaps and opportunities in primary care following an asthma hospital admission: a multisite mixed-methods study of three data sources. Arch Dis Child 2023; 108:385-391. [PMID: 36599627 DOI: 10.1136/archdischild-2022-324114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Explore gaps and opportunities in primary care for children following a hospital admission for asthma. DESIGN Exploratory mixed-methods, using linked hospital and primary care administration data. SETTING Eligible children, aged 3-18 years, admitted to one of three hospitals in Victoria, Australia between 2017 and 2018 with a clinical diagnosis of asthma. RESULTS 767 caregivers of eligible children participated, 39 caregivers completed a semistructured interview and 277 general practitioners (GPs) caring for 360 children completed a survey. Over 90% (n=706) of caregivers reported their child had a regular GP. However, few (14.1%, n=108) attended a GP in the 24 hours prior to index admission or in the 7 days after (35.8%, n=275). Children readmitted for asthma (34.2%, n=263), compared with those not readmitted (65.8%, n=504), were less likely to have visited a GP in the non-acute phase of their asthma in the 12 months after index admission (22.1% vs 42.1%, respectively), and their GP was more likely to report not knowing the child had an asthma admission (52.8% vs 39.2%, respectively). Fewer GPs reported being extremely confident managing children with poorly controlled asthma (11.9%, n=43) or post-discharge (16.7%, n=60), compared with children with well-controlled asthma (36.4%, n=131), with no difference by child readmission status. CONCLUSIONS Given the exploratory design and descriptive approach, it is unknown if the differences by child readmission status have any causal relationship with readmission. Nonetheless, improving preventative patterns of primary care visits, timely communication between hospitals and primary care providers, and guideline concordant care by GPs are needed.
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Affiliation(s)
- Renee Jones
- Health Services and Economics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Health Services and Economics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Shivanthan Shanthikumar
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Respiratory and Sleep Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Shaoke Lei
- Health Services and Economics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Health Services Research Unit, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Lena Sanci
- General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Chen
- Health Services and Economics, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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17
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Biezen R, Kaufman J, Hoq M, Manski-Nankervis JA, Sanci L, Bell JS, Leask J, Seale H, Munro J, Suryawijaya Ong D, Oliver J, Jos C, Tuckerman J, Bagot K, Danchin M. Factors impacting COVID-19 vaccine decision making in older adults and people with underlying conditions in Victoria, Australia: A cross-sectional survey. Hum Vaccin Immunother 2022; 18:2147770. [PMID: 36573307 PMCID: PMC9891679 DOI: 10.1080/21645515.2022.2147770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Australia's COVID-19 vaccine rollout included prioritizing older adults and those with underlying conditions. However, little was known around the factors impacting their decision to accept the vaccine. This study aimed to assess vaccine intentions, information needs, and preferences of people prioritized to receive the COVID-19 vaccine at the start of the Australian vaccine rollout. A cross-sectional online survey of people aged ≥70 years or 18-69 with chronic or underlying conditions was conducted between 12 February and 26 March 2021 in Victoria, Australia. The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework and items informed the survey design and framing of results. Bivariate logistic regression was used to investigate the association between intention to accept a COVID-19 vaccine and demographic characteristics. In total, 1828 eligible people completed the survey. Intention to vaccinate was highest among those ≥70 years (89.6%, n = 824/920) versus those aged 18-69 years (83.8%, n = 761/908), with 91% (n = 1641/1803) of respondents agreeing that getting a COVID-19 vaccine was important to their health. Reported vaccine safety (aOR 1.4, 95% CI 1.1 to 1.8) and efficacy (aOR 1.9, 95% CI 1.5 to 2.3) were associated with intention to accept a COVID-19 vaccine. Concerns around serious illness, long-term effects, and insufficient vaccine testing were factors for not accepting a COVID-19 vaccine. Preferred communication methods included discussion with healthcare providers, with primary care providers identified as the most trusted information source. This study identified factors influencing the prioritized public's COVID-19 vaccine decision-making, including information preferences. These details can support future vaccination rollouts.
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Affiliation(s)
- Ruby Biezen
- Department of General Practice, University of Melbourne, Melbourne, Australia,CONTACT Ruby Biezen Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Melbourne, Vic3004, Australia
| | - Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Monsurul Hoq
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Lena Sanci
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Australia
| | - Jane Munro
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | | | - Jane Oliver
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia,The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Australia
| | - Carol Jos
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Kathleen Bagot
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Australia,Department of General Medicine, The Royal Children’s Hospital, Melbourne, Australia
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18
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Sanci L, Williams I, Russell M, Chondros P, Duncan AM, Tarzia L, Peter D, Lim MSY, Tomyn A, Minas H. Towards a health promoting university: descriptive findings on health, wellbeing and academic performance amongst university students in Australia. BMC Public Health 2022; 22:2430. [PMID: 36575509 PMCID: PMC9792939 DOI: 10.1186/s12889-022-14690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Universities are increasingly recognised as institutions where health and wellbeing can be promoted to maximise academic outcomes, career transitions, and lifelong positive health behaviours. There is concern about the mental health of university students and other factors which affect academic outcomes particularly for subgroups such as international students. There are few cohort studies of the breadth of issues that can impact on mental health and academic outcomes for both local and international students. We conducted a baseline prevalence survey of students at a large Australian university covering health, academic, and social determinants of wellbeing. The purpose was to inform the university's new student health and wellbeing framework with a view to follow-up to determine predictors of mental ill-health and academic outcomes in the subsequent year. In this paper we present the baseline prevalence data and report on selected mental health and health care access issues for local and international students. METHODS The entire university population as of April 2019 of over 56,375 students aged 18 or above were invited to complete the online survey. Questions explored eight domains: demographic characteristics, general health and wellbeing, mental health, risk taking behaviours, psychosocial stressors, learning and academic factors, social and cultural environment, and awareness of and access to health and wellbeing services. Records of academic results were also accessed and matched with survey data for a large subset of students providing consent. RESULTS Fourteen thousand eight hundred eighty (26.4%) students commenced our survey and were representative of the entire student population on demographic characteristics. Three quarters were aged between 18 to 25 years and one third were international students. Eighty-five percent consented to access of their academic records. Similar proportions of local and international students experienced symptoms of a depression or anxiety disorder, however international students were less aware of and less likely to access available health services both inside and external to the university. We also reported on the prevalence of: general lifestyle factors (diet, exercise, amount of daily sleep); risk-taking behaviours (including alcohol, tobacco and other drug use; unprotected sexual activity); psychosocial stressors (financial, intimate partner violence, discrimination, academic stressors, acculturative stress); subjects failed; resilience; social supports; social media use; and health services accessed online. CONCLUSIONS This rigorous and comprehensive examination of the health status of local and international students in an Australian university student population establishes the prevalence of mental health issues and other psychosocial determinants of health and wellbeing, along with academic performance. This study will inform a university-wide student wellbeing framework to guide health and wellbeing promotion and is a baseline for a 12-month follow-up of the cohort in 2020 during the COVID-19 pandemic.
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Affiliation(s)
- Lena Sanci
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Ian Williams
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Melissa Russell
- grid.1008.90000 0001 2179 088XCentre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Patty Chondros
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Ann-Maree Duncan
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Laura Tarzia
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Divya Peter
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Madeleine S. Y. Lim
- grid.1008.90000 0001 2179 088XDepartment of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Adrian Tomyn
- grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Australia
| | - Harry Minas
- grid.1008.90000 0001 2179 088XMelbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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19
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Goller JL, Coombe J, Temple-Smith M, Bittleston H, Sanci L, Guy R, Fairley C, Regan D, Carvalho N, Simpson J, Donovan B, Tomnay J, Chen MY, Estcourt C, Roeske L, Hawkes D, Saville M, Hocking JS. Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial. BMJ Open 2022; 12:e067488. [PMID: 36600435 PMCID: PMC9772683 DOI: 10.1136/bmjopen-2022-067488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting for reinfection and detecting complications including pelvic inflammatory disease (PID). In Australia, mainstream primary care (general practice) is where most chlamydia infections are diagnosed, making it a key setting for optimising chlamydia management. High reinfection and low retesting rates suggest partner notification and retesting are not uniformly provided. The Management of Chlamydia Cases in Australia (MoCCA) study seeks to address gaps in chlamydia management in Australian general practice through implementing interventions shown to improve chlamydia management in specialist services. MoCCA will focus on improving retesting, partner management (including patient-delivered partner therapy) and PID diagnosis. METHODS AND ANALYSIS MoCCA is a non-randomised implementation and feasibility trial aiming to determine how best to implement interventions to support general practice in delivering best practice chlamydia management. Our method is guided by the Consolidated Framework for Implementation Research and the Normalisation Process Theory. MoCCA interventions include a website, flow charts, fact sheets, mailed specimen kits and autofills to streamline chlamydia consultation documentation. We aim to recruit 20 general practices across three Australian states (Victoria, New South Wales, Queensland) through which we will implement the interventions over 12-18 months. Mixed methods involving qualitative and quantitative data collection and analyses (observation, interviews, surveys) from staff and patients will be undertaken to explore our intervention implementation, acceptability and uptake. Deidentified general practice and laboratory data will be used to measure pre-post chlamydia testing, retesting, reinfection and PID rates, and to estimate MoCCA intervention costs. Our findings will guide scale-up plans for Australian general practice. ETHICS AND DISSEMINATION Ethics approval was obtained from The University of Melbourne Human Research Ethics Committee (Ethics ID: 22665). Findings will be disseminated via conference presentations, peer-reviewed publications and study reports.
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Affiliation(s)
- Jane L Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca Guy
- Sexual Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David Regan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalie Carvalho
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Julie Simpson
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Claudia Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lara Roeske
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - David Hawkes
- VCS Pathology, Australian Centre for the Prevention of Cervical Cancer, Carlton, Victoria, Australia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Carlton, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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20
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Khano S, Sanci L, Woolfenden S, Zurynski Y, Dalziel K, Liaw ST, Boyle D, Freed GL, Moore C, Hodgins M, Le J, Morris TM, Germano S, Wheeler K, Lingam R, Hiscock H. Strengthening Care for Children (SC4C): protocol for a stepped wedge cluster randomised controlled trial of an integrated general practitioner-paediatrician model of primary care. BMJ Open 2022; 12:e063449. [PMID: 36171040 PMCID: PMC9644360 DOI: 10.1136/bmjopen-2022-063449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Australia's current healthcare system for children is neither sustainable nor equitable. As children (0-4 years) comprise the largest proportion of all primary care-type emergency department presentations, general practitioners (GPs) report feeling undervalued as an integral member of a child's care, and lacking in opportunities for support and training in paediatric conditions. This Strengthening Care for Children (SC4C) randomised trial aims to evaluate a novel, integrated GP-paediatrician model of care, that, if effective, will improve GP quality of care, reduce burden to hospital services and ensure children receive the right care, at the right time, closer to home. METHODS AND ANALYSIS SC4C is a stepped wedge cluster randomised controlled trial (RCT) of 22 general practice clinics in Victoria and New South Wales, Australia. General practice clinics will provide control period data before being exposed to the 12-month intervention which will be rolled out sequentially each month (one clinic per state) until all 22 clinics receive the intervention. The intervention comprises weekly GP-paediatrician co-consultation sessions; monthly case discussions; and phone and email paediatrician support, focusing on common paediatric conditions. The primary outcome of the trial is to assess the impact of the intervention as measured by the proportion of children's (0-<18 years) GP appointments that result in a hospital referral, compared with the control period. Secondary outcomes include GP quality of care; GP experience and confidence in providing paediatric care; family trust in and preference for GP care; and the sustainability of the intervention. An implementation evaluation will assess the model to inform acceptability, adaptability, scalability and sustainability, while a health economic evaluation will measure the cost-effectiveness of the intervention. ETHICS AND DISSEMINATION Human research ethics committee (HREC) approval was granted by The Royal Children's Hospital Ethics Committee in August 2020 (Project ID: 65955) and site-specific HRECs. The investigators (including Primary Health Network partners) will communicate trial results to stakeholders and participating GPs and general practice clinics via presentations and publications. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trials Registry 12620001299998.
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Affiliation(s)
- Sonia Khano
- Health Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Woolfenden
- Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia
- Department of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innnovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kim Dalziel
- School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, UNSW Australia, Fairfield, New South Wales, Australia
| | - Douglas Boyle
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Gary L Freed
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Cecilia Moore
- Clinical Sciences and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michael Hodgins
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jane Le
- Health Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | | | - Stephanie Germano
- North Western Melbourne Primary Health Network, Melbourne, Victoria, Australia
| | - Karen Wheeler
- Central and Eastern Sydney Primary Health Network, Sydney, New South Wales, Australia
| | - Raghu Lingam
- University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Harriet Hiscock
- Health Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Health Services Research Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
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21
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Hall T, Goldfeld S, Loftus H, Honisett S, Liu H, De Souza D, Bailey C, Reupert A, Yap MBH, Eapen V, Haslam R, Sanci L, Fisher J, Eastwood J, Mukumbang FC, Loveday S, Jones R, Constable L, Forell S, Morris Z, Montgomery A, Pringle G, Dalziel K, Hiscock H. Integrated Child and Family Hub models for detecting and responding to family adversity: protocol for a mixed-methods evaluation in two sites. BMJ Open 2022; 12:e055431. [PMID: 35613800 PMCID: PMC9125738 DOI: 10.1136/bmjopen-2021-055431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Integrated community healthcare Hubs may offer a 'one stop shop' for service users with complex health and social needs, and more efficiently use service resources. Various policy imperatives exist to implement Hub models of care, however, there is a dearth of research specifically evaluating Hubs targeted at families experiencing adversity. To contribute to building this evidence, we propose to co-design, test and evaluate integrated Hub models of care in two Australian community health services in low socioeconomic areas that serve families experiencing adversity: Wyndham Vale in Victoria and Marrickville in New South Wales. METHODS AND ANALYSIS This multisite convergent mixed-methods study will run over three phases to (1) develop the initial Hub programme theory through formative research; (2) test and, then, (3) refine the Hub theory using empirical data. Phase 1 involves co-design of each Hub with caregivers, community members and practitioners. Phase 2 uses caregiver and Hub practitioner surveys at baseline, and 6 and 12 months after Hub implementation, and in-depth interviews at 12 months. Two stakeholder groups will be recruited: caregivers (n=100-200 per site) and Hub practitioners (n=20-30 per site). The intervention is a co-located Hub providing health, social, legal and community services with no comparator. The primary outcomes are caregiver-reported: (i) identification of, (ii) interventions received and/or (iii) referrals received for adversity from Hub practitioners. The study also assesses child, caregiver, practitioner and system outcomes including mental health, parenting, quality of life, care experience and service linkages. Primary and secondary outcomes will be assessed by examining change in proportions/means from baseline to 6 months, from 6 to 12 months and from baseline to 12 months. Service linkages will be analysed using social network analysis. Costs of Hub implementation and a health economics analysis of unmet need will be conducted. Thematic analysis will be employed to analyse qualitative data. ETHICS AND DISSEMINATION Royal Children's Hospital and Sydney Local Health District ethics committees have approved the study (HREC/62866/RCHM-2020). Participants and stakeholders will receive results through meetings, presentations and publications. TRIAL REGISTRATION NUMBER ISRCTN55495932.
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Affiliation(s)
- Teresa Hall
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Hayley Loftus
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Suzy Honisett
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Hueiming Liu
- Centre of Health Systems Science, The George Institute for Global Health, Camperdown, New South Wales, Australia
| | - Denise De Souza
- Centre for Research in Education and Sustainability, Torrens University Australia - Fitzroy Campus, Melbourne, Victoria, Australia
| | - Cate Bailey
- Health Economics Unit, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Andrea Reupert
- Department of Education, Monash University, Melbourne, Victoria, Australia
| | | | - Valsamma Eapen
- ICAMHS, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Ric Haslam
- Mental Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - John Eastwood
- Paediatrics and Child Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Sarah Loveday
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Renee Jones
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Leanne Constable
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Suzie Forell
- Health Justice Australia, Melbourne, Victoria, Australia
| | - Zoe Morris
- Department of Education, Monash University, Melbourne, Victoria, Australia
| | - Alicia Montgomery
- Sydney Institute for Women, Children, and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | | | - Kim Dalziel
- School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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22
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Davidson SK, Sanci L, de Nicolás Izquierdo C, Watson CJ, Baltag V, Sawyer SM. Best Practice During Teleconsultations With Adolescents: A Scoping Review. J Adolesc Health 2022; 70:714-728. [PMID: 35082052 DOI: 10.1016/j.jadohealth.2021.11.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Teleconsultations are increasingly used to deliver health care, yet guidance on how to maximize health outcomes and ensure the quality and rights-based principles of adolescent health care during teleconsultations is lacking. This scoping review synthesized the literature on teleconsultations with adolescents, with the objective of informing a practical guidance for healthcare professionals. METHODS Eight databases were searched to identify articles published between 2010 and 2020 in English, French, or Spanish that provided evidence or guidance on synchronous teleconsultations with 10- to 19-year-olds. Web sites in six high-income countries and six low- to middle-income countries were also searched and a Google search was conducted. Data were analyzed using narrative synthesis. RESULTS Of 59 total references, 51 were from high-income countries. References included primary research (n = 21), reviews (n = 13), clinical guidance (n = 9), case reports (n = 9), commentaries (n = 6), and a website (n = 1). Just under half (46%) were descriptive, qualitative, or expert opinion. The main focus was mental health and behavioral disorders. DISCUSSION Good evidence on the complexities of conducting teleconsultations with adolescents is lacking. Questions remain regarding the scope and acuity of health issues for which teleconsultations are appropriate, their role in overcoming or contributing to inequalities, and the practicalities of conducting consultations.
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Affiliation(s)
- Sandra K Davidson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Cathy J Watson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA), World Health Organization (WHO), Geneva, Switzerland
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
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23
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Vujovich-Dunn C, Wand H, Brotherton JML, Gidding H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Skinner SR, Venn A, Davies C, Hocking J, Whop L, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson C, Lane N, Kaldor J, Guy R. Measuring school level attributable risk to support school-based HPV vaccination programs. BMC Public Health 2022; 22:822. [PMID: 35468743 PMCID: PMC9036743 DOI: 10.1186/s12889-022-13088-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/11/2021] [Accepted: 03/24/2022] [Indexed: 12/27/2022] Open
Abstract
Background In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation. Methods A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence). Results The factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1–14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7–8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9–3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7–3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6–4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3–2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76–82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31–44) and lower attendance rate (PAR = 37%, 95%CI: 29–46). Conclusion This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13088-x.
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Affiliation(s)
- C Vujovich-Dunn
- University of New South Wales, Kirby Institute, Kensington, Australia.
| | - H Wand
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - J M L Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Population Health, East Melbourne, Victoria, Australia.,University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - H Gidding
- University of Sydney, Northern Clinical School, Sydney, Australia.,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia.,School of Population Health, University of New South Wales, Kensington, Australia.,National Centre for Immunisation Research and Surveillance, Sydney, Australia
| | - J Sisnowski
- University of New South Wales, Kirby Institute, Kensington, Australia.,Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia
| | - R Lorch
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - M Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - V Sheppeard
- Communicable Diseases Branch, NSW Health, St Leonards, New South Wales, Australia.,University of Sydney, Sydney School of Public Health, Camperdown, NSW, Australia
| | - P Effler
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - S R Skinner
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian, Australia
| | - C Davies
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - J Hocking
- University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - L Whop
- Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia.,Menzies School of Health Research, Charles Darwin University, Cairns, QLD, Australia
| | - J Leask
- National Centre for Immunisation Research and Surveillance, Sydney, Australia.,University of Sydney, Sydney Nursing School, Faculty of Medicine and Health, Camperdown, NSW, Australia
| | - K Canfell
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - L Sanci
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Smith
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - M Kang
- University of Sydney, Westmead Clinical School, Sydney, New South Wales, Australia
| | - M Temple-Smith
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Kidd
- Flinders University, Southgate Institute for Health, Society and Equity, Bedford Park, South Australia, Australia
| | - S Burns
- Curtin University, School of Population Health, Bentley, WA, Australia
| | - L Selvey
- University of Queensland, School of Public Health, St Lucia, QLD, Australia
| | - D Meijer
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - S Ennis
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - C Thomson
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - N Lane
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - J Kaldor
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - R Guy
- University of New South Wales, Kirby Institute, Kensington, Australia
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24
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Waller D, Robards F, Schneider CH, Sanci L, Steinbeck K, Gibson S, Usherwood T, Hawke C, Jan S, Kong M, Kang M. Building evidence into youth health policy: a case study of the Access 3 knowledge translation forum. Health Res Policy Syst 2022; 20:44. [PMID: 35443690 PMCID: PMC9022323 DOI: 10.1186/s12961-022-00845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective integration of evidence and youth perspectives into policy is crucial for supporting the future health and well-being of young people. The aim of this project was to translate evidence from the Access 3 project to support development of a new state policy on youth health and well-being within New South Wales (NSW), Australia. Ensuring the active contribution of young people within policy development was a key objective of the knowledge translation (KT) process. METHODS The KT activity consisted of a 1-day facilitated forum with 64 purposively sampled stakeholders. Participants included eight young people, 14 policy-makers, 15 academics, 22 clinicians or managers from NSW health services, four general practitioners and one mental health service worker. Research to be translated came from the synthesized findings of the NSW Access 3 project. The design of the forum included stakeholder presentations and group workshops, guided by the 2003 Lavis et al. KT framework that was improved by the Grimshaw et al. KT framework in 2012. Members of the Access 3 research team took on the role of knowledge brokers throughout the KT process. Participant satisfaction with the workshop was evaluated using a brief self-report survey. Policy uptake was determined through examination of the subsequent NSW Youth Health Framework 2017-2024. RESULTS A total of 25 policy recommendations were established through the workshop, and these were grouped into six themes that broadly aligned with the synthesized findings from the Access 3 project. The six policy themes were (1) technology solutions, (2) integrated care and investment to build capacity, (3) adolescent health checks, (4) workforce, (5) youth participation and (6) youth health indicators. Forum members were asked to vote on the importance of individual recommendations. These policy recommendations were subsequently presented to the NSW Ministry of Health, with some evidence of policy uptake identified. The majority of participants rated the forum positively. CONCLUSIONS The utilization of KT theories and active youth engagement led to the successful translation of research evidence and youth perspectives into NSW youth health policy. Future research should examine the implementation of policy arising from these KT efforts.
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Affiliation(s)
- Daniel Waller
- Faculty of Health, University of Technology Sydney, Ultimo, Australia. .,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia. .,School of Public Health, Faculty of Health, University of Technology Sydney, Level 8, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia.
| | - Fiona Robards
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | - Lena Sanci
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | | | - Sally Gibson
- New South Wales Ministry of Health, St Leonards, Australia
| | - Tim Usherwood
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Catherine Hawke
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Marlene Kong
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Melissa Kang
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Manski-Nankervis JA, Davidson S, Hiscock H, Hallinan C, Ride J, Lingam V, Holman J, Baird A, McKeown E, Sanci L. Primary care consumers' experiences and opinions of a telehealth consultation delivered via video during the COVID-19 pandemic. Aust J Prim Health 2022; 28:224-231. [PMID: 35287793 DOI: 10.1071/py21193] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
Abstract
This study examined consumers' experiences and opinions of a videoconference with a primary healthcare professional, and estimated the value of travel and time savings for consumers compared with face-to-face consultations. The online survey was conducted in Melbourne, Australia, between October 2020 and May 2021. The sample (n = 499) was highly educated (Bachelor degree or higher, 79%; 393/499), predominately female (70%; 347/499), mainly spoke English at home (78%; 390/499) and had a mean age of 31.8 years (s.d. 11.40). Reduced travel time (27%; 271/499) and avoiding exposure to COVID-19 (23%; 228/499) were the main reasons consumers chose a videoconference. Mental health and behavioural issues were the main reason for the consultation (38%; 241/499) and 69% (346/499) of consultations were with a general practitioner. Perceptions of the quality of care were uniformly high, with 84% (419/499) of respondents believing videoconference was equivalent to a face-to-face consultation. No association was found between reporting that telehealth was equivalent to a face-to-face consultation and education, language, health status, reason for consultation or provider type. The average time saved per consultation was 1 h and 39 min, and the average transport-related saving was A$14.29. High rates of acceptance and substantial cost savings observed in this study warrant further investigation to inform the longer-term role of videoconferences, and telehealth more broadly, in the Australian primary care system.
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Affiliation(s)
- Jo-Anne Manski-Nankervis
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia; and Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Sandra Davidson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia
| | - Harriet Hiscock
- Health Services Research Unit, The Royal Children's Hospital, 50 Flemington Road, Melbourne, Vic. 3052, Australia; and Health Services, Murdoch Children's Research Institute, 50 Flemington Road, Melbourne, Vic. 3052, Australia; and Department of Paediatrics, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Christine Hallinan
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia
| | - Jemimah Ride
- Health Economics Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Vignesh Lingam
- South Eastern Melbourne Primary Health Network, Heatherton, Vic. 3202, Australia
| | - Jessica Holman
- North Western Melbourne Primary Health Network, Parkville, Vic. 3052, Australia
| | - Andrew Baird
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia
| | - Emma McKeown
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia; and North Western Melbourne Primary Health Network, Parkville, Vic. 3052, Australia
| | - Lena Sanci
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3010, Australia
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26
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Lim MSY, Hocking JS, Sanci L, Temple-Smith M. A systematic review of international students' sexual health knowledge, behaviours, and attitudes. Sex Health 2022; 19:1-16. [PMID: 35177186 DOI: 10.1071/sh21073] [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: 04/09/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022]
Abstract
The demand for higher education has increased student mobility across the world. Studying abroad provides an opportunity for young adults to engage in sexual behaviours, some of which may be risky. Yet, little is known about international students' current sexual health knowledge or practices. The aim of this review was to identify their sexual health knowledge, behaviours, and attitudes. A search of five databases yielded 21 studies that met inclusion criteria. These studies used quantitative (n=13), qualitative (n=7) and mixed methods (n=1) and included a total of 4666 international and exchange students from diverse cultural backgrounds. Findings were grouped into three themes: sexual health knowledge, sexual behaviours, and sexual health attitudes. Asian international students had poorer levels of knowledge, suggesting a need for culturally appropriate sex education. They were less sexually experienced and were older than domestic students at first age of sex. Fewer engaged in risky sexual behaviours when compared to domestic students. They also reported fewer sexual partners and higher condom usage. However, culture influenced the sexual behaviours and attitudes of international students; in particular, Asian female international students, who tested risk-taking behaviours, such as casual sex, in more liberal Western countries. Appropriate intervention and further education are needed to decrease international students' sexual health risks.
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Affiliation(s)
- Madeleine S Y Lim
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
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27
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Kaufman J, Bagot KL, Tuckerman J, Biezen R, Oliver J, Jos C, Ong DS, Manski‐Nankervis J, Seale H, Sanci L, Munro J, Bell JS, Leask J, Danchin M. Qualitative exploration of intentions, concerns and information needs of vaccine-hesitant adults initially prioritised to receive COVID-19 vaccines in Australia. Aust N Z J Public Health 2022; 46:16-24. [PMID: 34897909 PMCID: PMC9968588 DOI: 10.1111/1753-6405.13184] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine. METHOD In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations. RESULTS Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines.
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Affiliation(s)
- Jessica Kaufman
- Murdoch Children's Research Institute, Victoria,Department of Paediatrics, The University of Melbourne, Victoria,Correspondence to: Dr Jessica Kaufman, Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052
| | | | - Jane Tuckerman
- Murdoch Children's Research Institute, Victoria,Department of Paediatrics, The University of Melbourne, Victoria
| | - Ruby Biezen
- Department of General Practice, The University of Melbourne, Victoria
| | - Jane Oliver
- Murdoch Children's Research Institute, Victoria,The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Victoria
| | - Carol Jos
- Murdoch Children's Research Institute, Victoria
| | | | | | - Holly Seale
- School of Population Health, University of New South Wales, New South Wales
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Victoria
| | - Jane Munro
- Murdoch Children's Research Institute, Victoria,The Royal Children's Hospital, Victoria
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, New South Wales
| | - Margie Danchin
- Murdoch Children's Research Institute, Victoria,Department of Paediatrics, The University of Melbourne, Victoria,The Royal Children's Hospital, Victoria
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28
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Abstract
CONTEXT Adverse childhood experiences (ACEs) are associated with increased risk of poor mental health outcomes. Although there is interest in screening for ACEs for early identification and intervention, it is not known whether screening improves outcomes for children. OBJECTIVE To systematically review whether screening for ACEs in children leads to an increase in (1) identification of ACEs, (2) referrals to services, (3) increased uptake of services, and (4) improved mental health outcomes for children and parents. DATA SOURCES Ovid Medline, PsycINFO, CINAHL, and Center for Clinical and Translational Research electronic databases were searched between 2009 and 2021. STUDY SELECTION Studies were included if researchers screened for current ACEs in children aged 0 to 12 years and they had a control comparison. DATA EXTRACTION Information was extracted, including study characteristics, sample demographics, screening tool characteristics, referral rates to services, uptake rates, and mental health outcomes. RESULTS A total of 5816 articles were screened, with 4 articles meeting inclusion criteria. Screening for ACEs increases identification of adversity and may increase referrals to services. There are limited data about whether this leads to an increase in referral uptake by families. There are no reported data addressing mental health outcomes. LIMITATIONS There are few published control trials of moderate quality. CONCLUSIONS There is limited evidence that screening for ACEs improves identification of childhood adversity and may improve referrals. If we are to realize the hypothesized benefits of ACEs screening on child and parent mental health, it is essential to understand the barriers for families taking up referrals.
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Affiliation(s)
- Sarah Loveday
- Health Services,Centre for Community Child Health, The Royal Children’s Hospital, Melbourne, Victoria, Australia,Address correspondence to Sarah Loveday, MBChB, Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia. E-mail:
| | | | | | | | | | - Sharon Goldfeld
- Policy and Equity, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Paediatrics, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia,Centre for Community Child Health, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Health Services,Paediatrics, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia,Centre for Community Child Health, The Royal Children’s Hospital, Melbourne, Victoria, Australia
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29
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Tait R, Ivers R, Marino JL, Doherty D, Graham PL, Cunich M, Sanci L, Steinbeck K, Straker L, Skinner SR. Mental health and behavioural factors involved in road traffic crashes by young adults: analysis of the Raine Study. J Epidemiol Community Health 2021; 76:556-562. [PMID: 34965969 DOI: 10.1136/jech-2021-218039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Road traffic crashes (RTC) are a leading cause of mortality and morbidity in young people. Severe mental health and behavioural conditions increase the likelihood of RTC, as do a range of driving-risk activities. METHOD We used data from the Raine Study, a prebirth cohort from Perth, Australia, to assess the relationship between measures of common mental health or behavioural conditions (Child Behavior Checklist Internalising and Externalising scores) at age 17 and subsequent RTC by 27 years, controlling for substance use and driving-risk activities. RESULTS By 27 years of age, of 937 participants, 386 (41.2%) reported zero crashes and 551 (58.8%) reported ≥1 crashes. In the baseline Poisson model, increased Externalising scores (eg, aggression and delinquency) were associated with increased RTC (incidence rate ratio (IRR)=1.02, 95% CI 1.01 to 1.02): increased Internalising scores (eg, anxiety and depression) were associated with fewer RTC (IRR=0.99, 95% CI 0.98 to 1.00). In the fully adjusted model, the mental health measures were not significant (Externalising IRR=1.01, 95% CI 0.99 to 1.02: Internalising IRR=0.99, 95% CI 0.99 to 1.00). Risky driver activities, such as falling asleep while driving (IRR=1.34), more frequent use of a hands-free telephone (IRR=1.35) and more frequent hostility towards other drivers (IRR=1.30) increased the rate of RTC. CONCLUSION Measures of mental health scores at age 17 were not predictive of subsequent RTC, after adjusting for measures of driving-risk activities. We need to better understand the determinants of externalising and risky driving behaviours if we are to address the increased risk of RTC.
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Affiliation(s)
- Robert Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Rebecca Ivers
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer L Marino
- Department of Obstetrics and Gynaecology, University of Melbourne & Royal Women's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,School of Population Health and Global Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Dorota Doherty
- Division of Obstetrics and Gynaecology, Faculty of Medicine and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Women and Infants Research Foundation, Subiaco, Western Australia, Australia
| | - Petra L Graham
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT) and Department of Mathematics and Statistics, Macquarie University, Sydney, New South Wales, Australia
| | - Michelle Cunich
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, New South Wales, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia.,The ANZAC Research Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, New South Wales, Australia.,Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Katharine Steinbeck
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Leon Straker
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - S Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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30
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Kaufman J, Bagot KL, Hoq M, Leask J, Seale H, Biezen R, Sanci L, Manski-Nankervis JA, Bell JS, Munro J, Jos C, Ong DS, Oliver J, Tuckerman J, Danchin M. Factors Influencing Australian Healthcare Workers' COVID-19 Vaccine Intentions across Settings: A Cross-Sectional Survey. Vaccines (Basel) 2021; 10:3. [PMID: 35062664 PMCID: PMC8781521 DOI: 10.3390/vaccines10010003] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 12/21/2022] Open
Abstract
Healthcare workers' COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February-26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - Kathleen L. Bagot
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
| | - Monsurul Hoq
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney 2052, Australia;
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney 2052, Australia;
| | - Ruby Biezen
- Department of General Practice, University of Melbourne, Carlton 3010, Australia; (R.B.); (L.S.); (J.-A.M.-N.)
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Carlton 3010, Australia; (R.B.); (L.S.); (J.-A.M.-N.)
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, University of Melbourne, Carlton 3010, Australia; (R.B.); (L.S.); (J.-A.M.-N.)
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne 3052, Australia;
| | - Jane Munro
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
- The Royal Children’s Hospital, Melbourne 3052, Australia
| | - Carol Jos
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
| | - Darren Suryawijaya Ong
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
| | - Jane Oliver
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne 3000, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne 3052, Australia; (K.L.B.); (M.H.); (J.M.); (C.J.); (D.S.O.); (J.O.); (J.T.); (M.D.)
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
- The Royal Children’s Hospital, Melbourne 3052, Australia
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31
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Vujovich-Dunn C, Skinner SR, Brotherton J, Wand H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Gidding H, Venn A, Davies C, Hocking J, Whop LJ, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson CA, Lane N, Kaldor J, Guy R. School-Level Variation in Coverage of Co-Administered dTpa and HPV Dose 1 in Three Australian States. Vaccines (Basel) 2021; 9:vaccines9101202. [PMID: 34696310 PMCID: PMC8537995 DOI: 10.3390/vaccines9101202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/14/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. METHODS HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage. RESULTS Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0). CONCLUSION The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.
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Affiliation(s)
- Cassandra Vujovich-Dunn
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- Correspondence: ; Tel.: +61-2-9348-0033
| | - Susan Rachel Skinner
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Julia Brotherton
- Population Health, VCS Foundation Ltd., East Melbourne, Melbourne 3053, Australia;
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Jana Sisnowski
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
| | - Rebecca Lorch
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Mark Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, St Leonards, Sydney 2065, Australia;
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Paul Effler
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Heather Gidding
- School of Population Health, University of New Souh Wales, Sydney 2052, Australia;
- Norther Clinical School of Sydney, University of Sydney, Camperdown, Sydney 2006, Australia
- Women and Babies Research, Kollin Intstitye, Northern Sydney Local Health District, St Leaonards, Sydney 2064, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, Sydney 2145, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian 7000, Australia;
| | - Cristyn Davies
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Lisa J. Whop
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
- Menzies School of Health Research, Charles Darwin University, Brisbane 4000, Australia
| | - Julie Leask
- Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Karen Canfell
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Lena Sanci
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Megan Smith
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Melissa Kang
- Westmead Clinical School, University of Sydney, Sydney 2006, Australia;
| | - Meredith Temple-Smith
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Michael Kidd
- Southgate Institute for Health, Flinders University, Adelaide 5042, Australia;
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth 6102, Australia;
| | - Linda Selvey
- School of Public Health, University of Queensland, Brisbane 4072, Australia;
| | - Dennis Meijer
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Sonya Ennis
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Chloe A. Thomson
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Nikole Lane
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
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Sisnowski J, Vujovich-Dunn C, Gidding H, Brotherton J, Wand H, Lorch R, Veitch M, Sheppeard V, Effler P, Skinner SR, Venn A, Davies C, Hocking J, Whop L, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson C, Lane N, Kaldor J, Guy R. Differences in school factors associated with adolescent HPV vaccination initiation and completion coverage in three Australian states. Vaccine 2021; 39:6117-6126. [PMID: 34493408 DOI: 10.1016/j.vaccine.2021.08.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Schools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake. METHODS Initiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015-2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25thpercentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage. RESULTS Median initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates. CONCLUSION This study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage.
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Affiliation(s)
- J Sisnowski
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia; Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia.
| | - C Vujovich-Dunn
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - H Gidding
- University of New South Wales, School of Public Health and Community Medicine, Kensington, Australia; National Centre for Immunisation Research and Surveillance, Westmead, Australia; The University of Sydney Northern Clinical School, St Leonards, Australia.
| | - J Brotherton
- Population Health, VCS Foundation, East Melbourne, Victoria, Australia; University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.
| | - H Wand
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - R Lorch
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - M Veitch
- Tasmanian Government, Department of Health and Human Services, Hobart, Australia.
| | - V Sheppeard
- Communicable Diseases Branch, Health Protection NSW, St Leonards, New South Wales, Australia; University of Sydney, Sydney School of Public Health, Camperdown, New South Wales, Australia.
| | - P Effler
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia.
| | - S R Skinner
- Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian, Australia.
| | - C Davies
- Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - J Hocking
- University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.
| | - L Whop
- Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia; Menzies School of Health Research, Charles Darwin University, Cairns, Queensland, Australia.
| | - J Leask
- National Centre for Immunisation Research and Surveillance, Westmead, Australia; University of Sydney, Sydney Nursing School, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - K Canfell
- Cancer Research Division, Cancer Council, New South Wales, Australia.
| | - L Sanci
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, Victoria, Australia.
| | - M Smith
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia; Cancer Research Division, Cancer Council, New South Wales, Australia.
| | - M Kang
- University of Sydney, Westmead Clinical School, New South Wales, Australia.
| | - M Temple-Smith
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, Victoria, Australia.
| | - M Kidd
- Flinders University, Southgate Institute for Health, Society and Equity, South Australia, Australia.
| | - S Burns
- Curtin University, School of Population Health, Western Australia, Australia.
| | - L Selvey
- University of Queensland, School of Public Health, Queensland, Australia.
| | - D Meijer
- Immunisation Unit, Health Protection NSW, St Leonards, New South Wales, Australia.
| | - S Ennis
- Immunisation Unit, Health Protection NSW, St Leonards, New South Wales, Australia.
| | - C Thomson
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia.
| | - N Lane
- Tasmanian Government, Department of Health and Human Services, Hobart, Australia.
| | - J Kaldor
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - R Guy
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
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Williames S, Temple-Smith M, Chondros P, Spike N, Salamone A, Magin P, Hiscock H, Sanci L. Are we preparing Victorian general practice registrars to be confident in all aspects of primary care paediatrics? Aust J Gen Pract 2021; 49:759-766. [PMID: 33123702 DOI: 10.31128/ajgp-08-19-5028] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES General practitioners provide essential primary care to paediatric patients. The aim of this study was to explore associations between prevocational paediatric experiences of general practice registrars and their confidence in providing paediatric care in the general practice setting. METHOD This was a cross-sectional observational study. Paediatric experiences and level of confidence ratings were collected using an online survey emailed to 530 Victorian general practice registrars in 2017; the response rate was 41% (217/530). Analysis used descriptive statistics, cross tabulation and Fishers' exact test. RESULTS The most common paediatric training was undertaken in a general hospital emergency department (180/197, 91%). The majority of registrars reported that they felt confident or very confident in managing acute presentations (92% for upper respiratory tract infection, 80% for asthma, 81% for immunisation), but fewer were confident in managing mental health, behavioural or developmental presentations (all <36%). DISCUSSION Registrars felt more confident managing acute presentations. However, the predominantly hospital-based prevocational paediatric training offers limited exposure to - and, thus, confidence in - managing behavioural, mental health and developmental issues. Training opportunities to address this identified gap should be explored.
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Affiliation(s)
- Suzannah Williames
- BBiomed, MD, DRANZCOG, GP Registrar, Eastern Victoria General Practice Training (EVGPT), Vic
| | - Meredith Temple-Smith
- MPH, DHSc, Professor and Director of Research Training, Deputy Head, Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic
| | - Patty Chondros
- PhD, MSc (Statistics), GDipEpid&Biost, BSc (Hons), Biostatistician, Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic
| | - Neil Spike
- MBBS, FRACGP, AM, Director of Medical Education and Training, Eastern Victoria General Practice Training, Vic; Professorial Fellow, Department of General Practice, The University of Melbourne, Vic
| | - Angelina Salamone
- MBBS, FRACGP, Director of Medical Education and Training, Murray City Country Coast GP Training, Vic
| | - Parker Magin
- PhD, FRACGP, Conjoint Professor, Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, NSW; Director, Research and Evaluation Unit, GP Synergy, NSW
| | - Harriet Hiscock
- MBBS, FRACP, MD, Group Leader, Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Vic; Director, Health Services Research Unit, The Royal Children's Hospital, Vic; Principal Fellow, Department of Paediatrics, The University of Melbourne, Vic
| | - Lena Sanci
- MBBS, PhD, FRACGP, Head, Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic
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Beaton L, Williams I, Sanci L. Exploring adolescent and clinician perspectives on Australia's national digital health record, My Health Record. Aust J Prim Health 2021; 27:102-108. [PMID: 33715770 DOI: 10.1071/py20169] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022]
Abstract
Adolescence is often a time when risk-taking behaviours emerge and attendance at primary health care is low. School-based health services can serve to improve access to health care. Clinicians play a key role in improving adolescents' health literacy and capacity to make informed care decisions. Australia's national digital health record, My Health Record (MHR), has posed significant challenges for both clinicians and adolescents in understanding impacts on patient privacy. Guidance is required on how best to communicate about MHR to adolescents. This exploratory qualitative study aims to examine adolescents' understanding of MHR, clinicians' knowledge of MHR and their use of MHR with adolescents. Focus groups with students, school health and well-being staff and semistructured interviews with GPs and nurses were undertaken in one regional and one urban secondary school-based health service in Victoria. Transcripts from audio recorded sessions were examined using thematic analysis. Resulting themes include minimal understanding and use of MHR, privacy and security concerns, possible benefits of MHR and convenience. The results suggest opportunities to address gaps in understanding and to learn from adolescents' preferences for digital health literacy education. This will support primary care clinicians to provide best-practice health care for adolescents.
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Affiliation(s)
- Laura Beaton
- Department of General Practice, The University of Melbourne, Third Floor, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia; and Corresponding author
| | - Ian Williams
- Department of General Practice, The University of Melbourne, Third Floor, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Third Floor, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
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Lim H, Sanci L, Webster S, Wilson AN, Lau P. 'No-Frills Prils': GPs' views on drug costs and therapeutic interchange of angiotensin-converting enzyme inhibitors: a qualitative study. Aust J Prim Health 2021; 27:152-157. [PMID: 33685577 DOI: 10.1071/py20208] [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: 09/10/2020] [Accepted: 12/02/2020] [Indexed: 11/23/2022]
Abstract
Medications form a significant portion of spending in primary health care. Angiotensin-converting enzyme inhibitors (ACE-Is) are among the most prescribed blood pressure medications in general practice. Medications within this class are considered therapeutically equivalent, but the cost of each ACE-I varies. Our aim was to explore cost and other factors that influence general practitioners (GPs) to prescribe a specific ACE-I and understand their views on therapeutic interchange within this drug class. We conducted a qualitative study of Australian GPs using thematic analysis. We found that GPs were aware of therapeutic equivalency within the ACE-I class, but unaware of the cost differences. Although GPs tended to adopt a prescribing preference, they were open to fewer prescribing options if there was a decreased cost to patients and the PBS, or potential to minimise prescribing error. Our findings have immediate relevance for national prescribing policies and the Pharmaceutical Benefits Scheme (PBS). The wide selection of ACE-Is that are available results in diverse prescribing patterns and may not be cost-effective for patients or the PBS. Restricting the number of drug options within the ACE-I class in primary care appears to be an acceptable drug cost-containment strategy according to our sample of GPs.
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Affiliation(s)
- Hok Lim
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 3, 780 Elizabeth Street, Melbourne, Vic. 3010, Australia; and Corresponding author
| | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 3, 780 Elizabeth Street, Melbourne, Vic. 3010, Australia
| | - Susan Webster
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 3, 780 Elizabeth Street, Melbourne, Vic. 3010, Australia
| | - Alyce N Wilson
- International Development, Burnet Institute, 85 Commercial Road, Prahran, Vic. 3181, Australia
| | - Phyllis Lau
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 3, 780 Elizabeth Street, Melbourne, Vic. 3010, Australia
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Coombe J, Goller J, Vaisey A, Bourne C, Sanci L, Bateson D, Temple-Smith M, Hocking J. New best practice guidance for general practice to reduce chlamydia-associated reproductive complications in women. Aust J Gen Pract 2021; 50:50-54. [PMID: 33543164 DOI: 10.31128/ajgp-04-20-5330] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) in Australia, with most infections diagnosed and managed in general practice. Often asymptomatic, left untreated it can cause serious reproductive complications in women. There is now global recognition of the importance of enhanced chlamydia case management to reduce the risk of repeat infection and minimise harms of pelvic inflammatory disease (PID). OBJECTIVE The aim of this article is to provide evidence-based information and resources to help general practitioners engage in partner management and retesting as part of routine STI care, in accordance with Australia's Fourth National Sexually Transmissible Infections Strategy: 2018-2022, and to provide up-to-date evidence about anorectal chlamydia and other emerging concerns in women. DISCUSSION Evidence-based information and strategies for partner management and retesting the index case are provided in this article, in addition to information regarding the detection of PID, screening and treatment of anorectal chlamydia, antimicrobial resistance, and testing and treatment in pregnancy.
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Affiliation(s)
- Jacqueline Coombe
- BSocSc (Hons), PhD (Gender and Health), Research Officer, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic
| | - Jane Goller
- GradDip (Nursing), MPH, MHlthSc, PhD, Research Fellow, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic
| | - Alaina Vaisey
- BSPH, MPH, Research Officer, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic
| | - Christopher Bourne
- MM (Sexual Health), FAChSHM, Head, NSW STI Programs Unit, Centre for Population Health, UNSW Sydney, NSW; Senior Staff Specialist, Sydney Sexual Health Centre, NSW; Conjoint Associate Professor, Sexual Health Program, Kirby Institute, UNSW Sydney, NSW
| | - Lena Sanci
- MBBS, PhD, FRACGP, Head, Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic
| | - Deborah Bateson
- MA (Oxon), MSc (LSHTM), MB BS, Medical Director, Family Planning, NSW; Clinical Associate Professor, Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, NSW
| | - Meredith Temple-Smith
- BSc, MPH, DHSc, Deputy Head, Director of Research Training, Department of General Practice, The University of Melbourne, Vic
| | - Jane Hocking
- BAppSc, MPH, MHlthSc, PhD, Head, Sexual Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic
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Currier D, Patton G, Sanci L, Sahabandu S, Spittal M, English D, Milner A, Pirkis J. Socioeconomic Disadvantage, Mental Health and Substance Use in Young Men in Emerging Adulthood. Behav Med 2021; 47:31-39. [PMID: 31241418 DOI: 10.1080/08964289.2019.1622504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/18/2023]
Abstract
Emerging adulthood is a neglected phase of the life course in health research. Health problems and risk behaviors at this time of life can have long-term consequences for health. The 2016 Lancet Commission on Adolescent Health and Wellbeing reported that the influence of socioeconomic factors was under-researched among adolescents and young adults. Moreover, the influence of socioeconomic factors on health has been little researched specifically in emerging adult men. We aimed to investigate associations between socioeconomic disadvantage and mental health, suicidal behavior, and substance use in young adult Australian men. Logistic regression was used to examine the association between Year 12 (high school) completion and area disadvantage on mental health, suicidal behavior, and substance use in 2,281 young men age 18-25 participating in the Australian Longitudinal Study on Male Health (Ten to Men). In unadjusted analysis both Year 12 non-completion and area disadvantage were associated with multiple adverse outcomes. In adjusted analysis Year 12 non-completion, but not area disadvantage, was associated with poorer mental health, increased odds of suicidal behavior, and substance use. Retaining young men in high school and developing health-promotion strategies targeted at those who do exit education early could both improve young men's mental health and reduce suicidal behavior and substance use in emerging adulthood.
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Affiliation(s)
- D Currier
- Centre for Mental Health, The University of Melbourne
| | - G Patton
- Centre for Adolescent Health, Murdoch Childrens Research Institute
| | - L Sanci
- Department of General Practice, The University of Melbourne
| | - S Sahabandu
- Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - M Spittal
- Centre for Mental Health, The University of Melbourne
| | - D English
- Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - A Milner
- Centre for Health Equity, The University of Melbourne
| | - J Pirkis
- Centre for Mental Health, The University of Melbourne
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Bittleston H, Coombe J, Temple-Smith M, Bateson D, Hunady J, Sanci L, Hocking JS, Goller JL. Diagnosis of pelvic inflammatory disease and barriers to conducting pelvic examinations in Australian general practice: findings from an online survey. Sex Health 2021; 18:180-186. [PMID: 33832551 DOI: 10.1071/sh20176] [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: 09/23/2020] [Accepted: 02/19/2021] [Indexed: 11/23/2022]
Abstract
Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination. METHODS An online survey investigating Australian GPs' chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis. RESULTS Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6-8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1-6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1-4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2-3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance. CONCLUSION Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID.
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Affiliation(s)
- Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia; and Corresponding author.
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3010, Australia
| | - Deborah Bateson
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Jill Hunady
- True Relationships and Reproductive Health, 230 Lutwyche Road, Windsor, Qld 4030, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3010, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Jane L Goller
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
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Kang M, Robards F, Luscombe G, Sanci L, Usherwood T. The relationship between having a regular general practitioner (GP) and the experience of healthcare barriers: a cross-sectional study among young people in NSW, Australia, with oversampling from marginalised groups. BMC Fam Pract 2020; 21:220. [PMID: 33115430 PMCID: PMC7592545 DOI: 10.1186/s12875-020-01294-8] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/22/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Young people (12-24 years) visit general practice but may not have a 'regular' general practitioner (GP). Whether continuity of GP care influences experiences with, and barriers to, health care among young people is unknown. This paper explores the association between having a regular GP and experience of healthcare barriers and attitudes to health system navigation among young people in New South Wales (NSW), Australia. METHODS This study was a cross-sectional survey administered either online or face-to-face in community settings. Young people living in NSW were recruited, with oversampling of those from five socio-culturally marginalised groups (those who were Aboriginal and Torres Strait Islander, homeless, of refugee background, in rural or remote locations, sexuality and/or gender diverse). In this analysis of a larger dataset, we examined associations between having a regular GP, demographic and health status variables, barriers to health care and attitudes to health system navigation, using chi-square tests and odds ratios. Content and thematic analyses were applied to free-text responses to explore young people's views about having a regular GP. RESULTS One thousand four hundred and sixteen young people completed the survey between 2016 and 2017. Of these, 81.1% had seen a GP in the previous 6 months and 57.8% had a regular GP. Cost was the most frequently cited barrier (45.8%) to accessing health care generally. Those with a regular GP were less likely to cite cost and other structural barriers, feeling judged, and not knowing which service to go to. Having a regular GP was associated with having more positive attitudes to health system navigation. Free-text responses provided qualitative insights, including the importance of building a relationship with one GP. CONCLUSIONS General practice is the appropriate setting for preventive health care and care coordination. Having a regular GP is associated with fewer barriers and more positive attitudes to health system navigation and may provide better engagement with and coordination of care. Strategies are needed to increase the proportion of young people who have a regular GP.
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Affiliation(s)
- Melissa Kang
- Australian Centre for Public and Population Health Research, University of Technology Sydney, Ultimo, Australia.
- Department of General Practice, The University of Sydney, Westmead Clinical School, Sydney, Australia.
- School of Public Health, Room 224, Level 8, Building 10, 235 Jones St, ULTIMO, NSW, 2007, Australia.
| | - Fiona Robards
- Department of General Practice, The University of Sydney, Westmead Clinical School, Sydney, Australia
| | | | - Lena Sanci
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - Tim Usherwood
- Department of General Practice, The University of Sydney, Westmead Clinical School, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
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LaMontagne AD, Martin R, Biezen R, Hunter B, Haikerwal M, Alexander K, Sanci L, Manski-Nankervis JA. Strengthening respiratory protection from SARS-CoV-2 in certain general practice contexts. Aust J Gen Pract 2020; 49. [PMID: 33051633 DOI: 10.31128/ajgp-covid-38] [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: 11/19/2022]
Abstract
We recommend a precautionary approach to respiratory protection for healthcare workers potentially exposed to SARS-CoV-2 until the efficacy of surgical masks can be proven.
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Affiliation(s)
- Anthony D LaMontagne
- ScD, MA, MEd, Professor of Work, Health & Wellbeing, Institute for Health Transformation, Faculty of Health, Deakin University, Vic
| | - Rhea Martin
- MPH, Infection Control Consultant, Department of General Practice, Melbourne Medical School, University of Melbourne, Vic
| | - Ruby Biezen
- MAppSc, PhD, Research Fellow, Department of General Practice, Melbourne Medical School, University of Melbourne, Vic
| | - Barbara Hunter
- PhD, Qualitative Research Fellow, Department of General Practice, Melbourne Medical School, University of Melbourne, Vic
| | - Mukesh Haikerwal
- MBChB, DipIMC RCS (Ed), DRCOG, FRACGP (Life), FAMA (Gold Medal), GP Director, Cirqit Health, Vic; Honorary Enterprise Professor, University of Melbourne, Vic
| | - Karyn Alexander
- MBChB, PhD, MPH, DCH, FRACGP, Research Fellow, Department of General Practice, Melbourne Medical School, University of Melbourne, Vic
| | - Lena Sanci
- MBBS, PhD, FRACGP, Professor & Department Head, Department of General Practice, Melbourne Medical School, University of Melbourne, Vic
| | - Jo-Anne Manski-Nankervis
- BSc (Hons), MBBS (Hons), CHIA, PhD, FRACGP, Associate Professor - General Practice, Melbourne Medical School, University of Melbourne, Vic
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41
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Affiliation(s)
- Lena Sanci
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
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42
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Abstract
BACKGROUND AND OBJECTIVES Australia's high rate of unintended pregnancy could be lowered by increasing long-acting reversible contraception (LARC) use. Influences on Australian women's choice of less effective methods are not well understood. This qualitative study explored factors that influence young women's contraceptive choices. METHOD Semi-structured interviews were conducted with women aged 18-24 years until data saturation. Interviews were audio-recorded, transcribed and thematically analysed. RESULTS Contraceptive choice was influenced by factors including contraceptive knowledge, side effects, cultural norms, fear, control and social context. Women often initiated contraceptive use for non contraceptive purposes such as management of acne or period pain, and failed to reconsider new methods when needing contraception, revealing one possible explanation for low LARC use. DISCUSSION Findings indicate that women's contraceptive choices need regular review. Information about relative efficacy of contraceptive methods is necessary should women's reasons for using contraception include birth control in addition to non-contraceptive benefits.
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Affiliation(s)
- Lily Claringbold
- BSc (Hons), MPhil student, Department of General Practice, University of Melbourne, Parkville, Vic
| | - Lena Sanci
- MBBS, PhD, FRACGP, Head of Department, Department of General Practice, University of Melbourne, Parkville, Vic
| | - Meredith Temple-Smith
- BSc, MPH, DHSc, Deputy Head of Department and Director of Research Training, Department of General Practice, University of Melbourne, Parkville, Vic
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43
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Coombe J, Goller J, Bittleston H, Vaisey A, Sanci L, Groos A, Tomnay J, Temple-Smith M, Hocking J. Sexually transmissible infections, partner notification and intimate relationships: a qualitative study exploring the perspectives of general practitioners and people with a recent chlamydia infection. Sex Health 2020; 17:503-509. [PMID: 33181063 DOI: 10.1071/sh20109] [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: 06/19/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022]
Abstract
Background Individuals diagnosed with a chlamydia infection are advised to notify their sexual partners from the previous 6 months so that they too can get tested and treated as appropriate. Partner notification is an essential component of chlamydia management, helping to prevent ongoing transmission and repeat infection in the index case. However, partner notification can be challenging, particularly in circumstances where a relationship has ended or transmission has occurred beyond the primary relationship. METHODS In this study we use data from 43 semistructured interviews with general practitioners (GPs) and people with a recent diagnosis of chlamydia. The interviews examined experiences of chlamydia case management in the general practice context. Here, we focus specifically on the effect of a chlamydia infection on intimate relationships in the context of the consultation and beyond.? RESULTS A chlamydia infection can have significant consequences for intimate relationships. Although GPs reported speaking to their patients about the importance of partner notification and participants with a recent chlamydia infection reported notifying their sexual partners, both would appreciate further support to engage in these conversations. CONCLUSIONS Conversations with patients should go beyond simply informing them of the need to notify their sexual partners from the previous 6 months, and should provide information about why partner notification is important and discuss strategies for informing partners, particularly for those in ongoing relationships. Ensuring GPs have the training and support to engage in these conversations with confidence is vital.
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Affiliation(s)
- Jacqueline Coombe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia; and Corresponding author.
| | - Jane Goller
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia
| | - Helen Bittleston
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, 3rd Floor, 780 Elizabeth Street, Carlton, Vic. 3053, Australia
| | - Anita Groos
- Communicable Diseases Branch, Queensland Department of Health, 15 Butterfield Street, Herston, Qld 4006, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, 49 Graham Street, Shepparton, Vic. 3630, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 3rd Floor, 780 Elizabeth Street, Carlton, Vic. 3053, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia
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Goller JL, Coombe J, Bourne C, Bateson D, Temple-Smith M, Tomnay J, Vaisey A, Chen MY, O Donnell H, Groos A, Sanci L, Hocking J. Patient-delivered partner therapy for chlamydia in Australia: can it become part of routine care? Sex Health 2020; 17:321-329. [PMID: 32741430 DOI: 10.1071/sh20024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022]
Abstract
Background Patient-delivered partner therapy (PDPT) is a method for an index patient to give treatment for genital chlamydia to their sexual partner(s) directly. In Australia, PDPT is considered suitable for heterosexual partners of men and women, but is not uniformly endorsed. We explored the policy environment for PDPT in Australia and considered how PDPT might become a routine option. METHODS Structured interviews were conducted with 10 key informants (KIs) representing six of eight Australian jurisdictions and documents relevant to PDPT were appraised. Interview transcripts and documents were analysed together, drawing on KIs' understanding of their jurisdiction to explore our research topics, namely the current context for PDPT, challenges, and actions needed for PDPT to become routine. RESULTS PDPT was allowable in three jurisdictions (Victoria, New South Wales, Northern Territory) where State governments have formally supported PDPT. In three jurisdictions (Western Australia, Australian Capital Territory, Tasmania), KIs viewed PDPT as potentially allowable under relevant prescribing regulations; however, no guidance was available. Concern about antimicrobial stewardship precluded PDPT inclusion in the South Australian strategy. For Queensland, KIs viewed PDPT as not allowable under current prescribing regulations and, although a Medicine and Poisons Act was passed in 2019, it is unclear if PDPT will be possible under new regulations. Clarifying the doctor-partner treating relationship and clinical guidance within a care standard were viewed as crucial for PDPT uptake, irrespective of regulatory contexts. CONCLUSION Endorsement and guidance are essential so doctors can confidently and routinely offer PDPT in respect to professional standards and regulatory requirements.
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Affiliation(s)
- Jane L Goller
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3010, Australia; and Corresponding author.
| | - Jacqueline Coombe
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3010, Australia
| | - Christopher Bourne
- NSW STI Programs Unit, NSW Ministry of Health, NSW 2010, Australia; and Sydney Sexual Health Centre, Sydney, NSW 2001, Australia
| | | | | | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, Vic. 3630, Australia
| | - Alaina Vaisey
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3010, Australia
| | - Marcus Y Chen
- Central Clinical School, Monash University, Melbourne, Vic. 3004, Australia; and Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Heather O Donnell
- Victorian Government, Department of Health and Human Services, Vic. 3000, Australia
| | - Anita Groos
- Communicable Diseases Branch, Queensland Department of Health, Brisbane, Qld 4006, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Vic. 3010, Australia
| | - Jane Hocking
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3010, Australia
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Abstract
Background Adolescence is characterised by
rapid changes in physical, cognitive,
emotional and social development,
and by experimentation and risk-taking,
extending from the age of approximately
10 years into the early adult years.
Developmental milestones achieved
include a sense of identity, autonomy,
a value system, peer relationships and
financial independence. However, for
around one in four adolescents, risktaking
and mental health issues threaten
healthy biopsychosocial development.
Such risks are rarely detected in clinical
practice without deliberate assessment
within a youth-friendly framework. Objectives The aim of this paper is to provide
an update on risk-taking behaviours
in adolescence and highlight tips for
re-orienting general practice towards
youth-friendly preventive care for
adolescents. Discussion General practice remains the health
service most often accessed by young
people and has important functions
of engaging young people, providing
positive experiences of healthcare,
detecting risk and protective factors,
and intervening early to promote
healthy development. Future health
system developments must ensure
general practice has adequate time and
support to provide effective preventive
adolescent healthcare.
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Affiliation(s)
- Lena Sanci
- MBBS, PhD, FRACGP, Associate
Professor, Department of General Practice,
Melbourne Medical School; Faculty of Medicine,
Dentistry and Health Sciences, University of
Melbourne, Vic.
| | - Marianne Webb
- PhD scholar, Masters Youth Health
& Education Management, Department of General
Practice, Melbourne Medical School; Faculty of
Medicine, Dentistry and Health Sciences, University
of Melbourne, Vic.
| | - Jane Hocking
- BAppSc, MPH, MHlthSc, PhD,
Professor, Melbourne School of Population and
Global Health; Faculty of Medicine, Dentistry and
Health Sciences, University of Melbourne, Vic.
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Sanci L, Kauer S, Thuraisingam S, Davidson S, Duncan AM, Chondros P, Mihalopoulos C, Buhagiar K. Effectiveness of a Mental Health Service Navigation Website (Link) for Young Adults: Randomized Controlled Trial. JMIR Ment Health 2019; 6:e13189. [PMID: 31625945 PMCID: PMC6913099 DOI: 10.2196/13189] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders are the main causes of disability among adolescents and young adults yet fewer than half experiencing these problems seek professional help. Young people frequently search the Web for health information and services, suggesting that Web-based modalities might promote help-seeking among young people who need it. To support young people in their help-seeking, we developed a Web-based mental health service navigation website called Link. Link is based on the Theory of Planned Behavior and connects young people with treatment based on the type and severity of mental health symptoms that they report. OBJECTIVE The study aimed to investigate the effect of Link on young people's positive affect (PA) compared with usual help-seeking strategies immediately post intervention. Secondary objectives included testing the effect of Link on negative affect (NA), psychological distress, barriers to help-seeking, and help-seeking intentions. METHODS Young people, aged between 18 and 25 years, were recruited on the Web from an open access website to participate in a randomized controlled trial. Participants were stratified by gender and psychological distress into either the intervention arm (Link) or the control arm (usual help-seeking strategies). Baseline, immediate postintervention, 1-month, and 3-month surveys were self-reported and administered on the Web. Measures included the PA and NA scales, Kessler psychological distress scale (K10), barriers to adolescent help-seeking scale (BASH), and the general help-seeking questionnaire (GHSQ). RESULTS In total 413 young people were recruited to the trial (intervention, n=205; control, n=208) and 78% (160/205) of those randomized to the intervention arm visited the Link website. There was no evidence to support a difference between the intervention and control arms on the primary outcome, with PA increasing equally by approximately 30% between baseline and 3 months in both arms. NA decreased for the intervention arm compared with the control arm with a difference of 1.4 (95% CI 0.2-2.5) points immediately after the intervention and 2.6 (95% CI 1.1-4.1) at 1 month. K10 scores were unchanged and remained high in both arms. No changes were found on the BASH or GHSQ; however, participants in the intervention arm appeared more satisfied with their help-seeking process and outcomes at 1 and 3 months postintervention. CONCLUSIONS The process of prompting young people to seek mental health information and services appears to improve their affective state and increase help-seeking intentions, regardless of whether they use a Web-based dedicated youth-focused tool, such as Link, or their usual search strategies. However, young people report greater satisfaction using tools designed specifically for them, which may encourage future help-seeking. The ability of Web-based tools to match mental health needs with appropriate care should be explored further. CLINICAL TRIAL Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366731.
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Affiliation(s)
- Lena Sanci
- Department of General Practice, University of Melbourne, Parkville, Australia
| | - Sylvia Kauer
- Department of General Practice, University of Melbourne, Parkville, Australia
| | | | - Sandra Davidson
- Department of General Practice, University of Melbourne, Parkville, Australia
| | - Ann-Maree Duncan
- Department of General Practice, University of Melbourne, Parkville, Australia
| | - Patty Chondros
- Department of General Practice, University of Melbourne, Parkville, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Australia
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Robards F, Kang M, Luscombe G, Sanci L, Steinbeck K, Jan S, Hawke C, Kong M, Usherwood T. Predictors of young people's healthcare access in the digital age. Aust N Z J Public Health 2019; 43:582-588. [PMID: 31577863 DOI: 10.1111/1753-6405.12936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To quantify barriers to healthcare for young people (12-24 years) and identify socio-demographic correlates and predictors. METHODS This cross-sectional survey targeted young people living in New South Wales, Australia, with oversampling of marginalised groups. Principles Component Analysis (PCA) identified clusters of barriers. Ordinal regression identified predictors of each barrier cluster. RESULTS A total of 1,416 young people completed surveys. Participants with chronic conditions and increasing psychological distress reported a greater number of barriers. Of 11 potential barriers to visiting a health service, cost was most common (45.8%). The PCA identified three clusters: structural barriers (61.3%), attitudinal barriers (44.1%) and barriers relating to emerging autonomy (33.8%). CONCLUSIONS Barriers to healthcare reported by young people are multi-dimensional and have changed over time. Structural barriers, especially cost, are the most prominent among young people. Approaches to overcome structural barriers need to be addressed to better support marginalised young people's healthcare access. Implications for public health: Understanding predictors of different barrier types can inform more targeted approaches to improving access. Equitable access to healthcare is a priority for early diagnosis and treatment in young people, especially reducing out of pocket costs.
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Affiliation(s)
- Fiona Robards
- Department of General Practice, The University of Sydney, Westmead Clinical School, New South Wales
| | - Melissa Kang
- Department of General Practice, The University of Sydney, Westmead Clinical School, New South Wales.,Australian Centre for Public and Population Health Research, University of Technology Sydney, New South Wales
| | | | - Lena Sanci
- Department of General Practice, University of Melbourne, Victoria
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, The University of Sydney, New South Wales
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales
| | - Catherine Hawke
- School of Rural Health, The University of Sydney, New South Wales
| | - Marlene Kong
- The Kirby Institute, University of New South Wales
| | - Tim Usherwood
- Department of General Practice, The University of Sydney, Westmead Clinical School, New South Wales.,The George Institute for Global Health, University of New South Wales
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48
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Affiliation(s)
- Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3000, Australia.
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49
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Le LKD, Sanci L, Chatterton ML, Kauer S, Buhagiar K, Mihalopoulos C. The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13065. [PMID: 31333199 PMCID: PMC6681639 DOI: 10.2196/13065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/10/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little empirical evidence is available to support the effectiveness and cost-effectiveness of internet interventions to increase help-seeking behavior for mental health in young adults. OBJECTIVE The aim of this study was to evaluate the cost-effectiveness of a Web-based mental health help-seeking navigation tool (Link) in comparison with usual help-seeking strategies. METHODS A cost-utility analysis alongside the main randomized trial of Link was conducted from the Australian health care sector perspective. Young adults aged 18 to 25 years were randomized to the Link intervention (n=205) or usual care (n=208) with 1- and 3-month follow-ups. The primary outcome of this study was quality-adjusted life years (QALYs) measured by the assessment of quality of life-4D. Costs were calculated based on the self-reported resource use questionnaire and were reported in 2015 Australian dollars. Primary analyses were conducted as intention-to-treat and reported as incremental cost-effectiveness ratios. Completer analyses were conducted in a sensitivity analysis. RESULTS Significantly more QALYs were gained in the intervention group than the control group (0.15 vs 0.14; P<.001). The intervention was associated with significantly lower health professional consultation costs at 1-month follow-up (mean costs Aus $98 vs Aus $162; P<.05). Costs of hospital services were lower at 3 months in the intervention arm (mean costs Aus $47 vs Aus $101); however, there was insufficient sample size to detect a significant difference between the groups. There were no statistically significant differences in the total costs between the 2 arms. Relative to the control group, those who received the intervention experienced 0.01 more QALYs (0.00-0.02) and had lower total health sector costs of Aus -$81 (Aus -$348 to Aus $186) over 3 months. The intervention was found to be more effective and less costly compared with usual help-seeking strategies. The intervention was 100% likely to be cost-effective below a willingness-to-pay value-for-money threshold of Aus $28,033 per QALY. Results were robust in the sensitivity analysis. CONCLUSIONS Our study found that the online youth mental health help-seeking Web service is a cost-effective intervention for young people aged 18 to 25 years compared with usual search strategies. Further research is required to confirm these results. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=366731.
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Affiliation(s)
- Long Khanh-Dao Le
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Australia
| | - Sylvia Kauer
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | | | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Australia
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50
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Robards F, Kang M, Steinbeck K, Hawke C, Jan S, Sanci L, Liew YY, Kong M, Usherwood T. Health care equity and access for marginalised young people: a longitudinal qualitative study exploring health system navigation in Australia. Int J Equity Health 2019; 18:41. [PMID: 30832651 PMCID: PMC6399978 DOI: 10.1186/s12939-019-0941-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Young people have unique social, emotional and developmental needs that require a welcoming and responsive health system, and policies that support their access to health care. Those who are socially or culturally marginalised may face additional challenges in navigating health care, contributing to health inequity. The aim of this study was to understand health system navigation, including the role of technology, for young people belonging to one or more marginalised groups, in order to inform youth health policy in New South Wales, Australia. Methods This qualitative longitudinal study involved 2–4 interviews each over 6 to 12 months with marginalised young people aged 12–24 years living in NSW. The analysis used Nvivo software and grounded theory. Results We interviewed 41 young people at baseline who were living in rural or remote areas, sexuality and/or gender diverse, refugee, homeless, and/or Aboriginal. A retention rate of over 85% was achieved. Nineteen belonged to more than one marginalised group allowing an exploration of intersectionality. General practitioners (family physicians) were the most commonly accessed service throughout the study period. Participants were ambivalent about their healthcare journeys. Qualitative analysis identified five themes:Technology brings opportunities to understand, connect and engage with services Healthcare journeys are shaped by decisions weighing up convenience, engagement, effectiveness and affordability. Marginalised young people perceive and experience multiple forms of discrimination leading to forgone care. Multiple marginalisation makes health system navigation more challenging The impact of health system complexity and fragmentation may be mitigated by system knowledge and navigation support
Conclusions The compounding effects of multiple discrimination and access barriers were experienced more strongly for young people belonging to mutiple marginalised groups. We identify several areas for improving clinical practice and policy. Integrating technology and social media into processes that facilitate access and navigation, providing respectful and welcoming services that recognise diversity, improving health literacy and involving professionals in advocacy and navigation support may help to address these issues. Electronic supplementary material The online version of this article (10.1186/s12939-019-0941-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fiona Robards
- Department of General Practice, Westmead Clinical School, The University of Sydney, PO Box 154, Westmead, NSW, 2145, Australia.
| | - Melissa Kang
- Department of General Practice, Westmead Clinical School, The University of Sydney, PO Box 154, Westmead, NSW, 2145, Australia.,University of Technology Sydney, Discipline of Public Health, Sydney, Australia
| | - Katharine Steinbeck
- The University of Sydney, Discipline of Paediatrics and Adolescent Health, Sydney, Australia
| | - Catherine Hawke
- The University of Sydney, School of Rural Health, Orange, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - Ying Ying Liew
- Department of General Practice, Westmead Clinical School, The University of Sydney, PO Box 154, Westmead, NSW, 2145, Australia
| | - Marlene Kong
- The Kirby Institute, University of New South Wales, Randwick, Australia
| | - Tim Usherwood
- Department of General Practice, Westmead Clinical School, The University of Sydney, PO Box 154, Westmead, NSW, 2145, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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