The contribution of a knowledge exchange organisation in primary healthcare.

BACKGROUND: The use of relevant quality research and evidence to inform policy and practice is complex, takes time and requires skill. Over the past 20 years, a knowledge exchange organisation (the Primary Health Care Research and Information Service [PHCRIS]) has developed, implemented and evaluated ways to accelerate the use of research and evidence to strengthen Australian primary healthcare and thereby enhance health. OBJECTIVE: This paper outlines how PHCRIS operates to accelerate the use of research and evidence in primary healthcare policy and practice. DISCUSSION: PHCRIS takes an integrated approach to accelerate the use of research and evidence in primary healthcare by sharing information, research and evidence; summarising and synthesising research; building capacity; and facilitating knowledge exchange. Resources developed to support this approach have a strong emphasis on access, quality, relevance and timeliness. The success of the approach has been achieved through respectful and effective engagement with stakeholders, extensive use of technologies and continuous quality improvement.

Facilitating access to evidence: Primary Health Care Search Filter.

BACKGROUND: The evidence base developed by, and relevant to, primary health care (PHC) is rapidly increasing. With the wealth of literature available, searchers trying to find PHC-specific citations can feel overwhelmed. OBJECTIVES: Flinders Filters and the Primary Health Care Research & Information Service collaborated to develop a search filter enabling efficient and effective retrieval of relevant PHC literature. METHODS: Stage 1 involved developing a PHC Search Filter in the OvidSP Medline platform using a rigorous experimental methodology. The search filter was then translated for Web-based 'one-click searching' in PubMed during Stage 2. Stage 3 involved planning and implementing a mixed-methods evaluation. RESULTS: The search filter sensitivity was 77.0% with a post hoc relevance assessment of 78.3%. Four months after its launch, a mixed-methods study evaluated the PHC Search Filter. With 90 respondents, analysis of data from the online survey demonstrated overarching benefits, a positive response to the tool and directions for further refinement of the PHC Search Filter. DISCUSSION: Designing the PHC Search Filter followed an established method that ensures the tool offers a validated search strategy. Evaluation results suggest that the PHC Search Filter is a useful tool that is easy to navigate. Challenges for the Filter relate to access to full text articles, while challenges for the evaluation relate to the small sample size. CONCLUSIONS: The PHC Search Filter reduces the burden associated with literature searching, increases the value of the results that are received and provides a useful resource to improve the likelihood of incorporating relevant evidence into policy and practice.

Video-based telehealth in Australian primary health care: current use and future potential.

Many Australians have limited access to health-care services due to a range of barriers, including geographic distance and restricted mobility, which telehealth can potentially address. This paper reviews the current and potential use of video consultation in primary health care in Australia, drawing on international literature. There is substantial evidence of high patient satisfaction, but many studies have methodological limitations. Overall, evidence of effectiveness and cost-effectiveness is weak. There is reasonable evidence for diagnosis, home care and specialist consultations by GPs with patients present. Two telehealth initiatives using video consultation are briefly presented. Both provide evidence that video consultation has a valuable role to play, but does not obviate the need for face-to-face consultations. Video consultation challenges traditional professional roles, particularly those of nurses, and can improve health workers' skills and job satisfaction. More fundamentally, telehealth challenges the traditional distinction between primary and secondary care. This can be a source of resistance but may ultimately be one of its strengths. Appropriately targeted video consultation has much potential to improve the delivery of primary health care in Australia, particularly in rural and remote regions.

The Closing the Gap Initiative - successes and ongoing challenges for divisions of general practice.

BACKGROUND: This article presents an evaluation of the activities undertaken by divisions of general practice to improve Indigenous Australians' access to mainstream primary care. METHODS: Data were obtained from 12 month reports for the 2009-10 reporting period. Data from 86 divisions were thematically analysed using NVivo 9 software. RESULTS: Most divisions provided positive comments regarding their involvement in the program. The main barriers to access among Indigenous Australians were cost, inadequate transport, lack of cultural sensitivity and staffing shortages. The activities undertaken to address barriers included awareness raising, distribution of resources, cultural safety training and employing Indigenous staff. Stakeholder involvement was achieved through community consultation and establishment of advisory committees. DISCUSSION: While most divisions were satisfied with their progress, ongoing challenges were identified with regard to effective identification of Indigenous patients and lack of interest among some practice staff. These need to be addressed though ongoing cultural awareness training.

Drug testing in Australian schools: policy implications and considerations of punitive, deterrence and/or prevention measures.

BACKGROUND: There have been increasing national and international calls for the introduction of drug testing as a policy measure to address harmful drug use. Such strategies have been applied in workplaces, sporting arenas, prisons and more latterly school settings. They are predicated on a belief in their efficacy in reducing drug-related harm, a need to 'send the right' message to potential users and to reassure the community at large that 'something is being done.' Rigorous examination is required of purported benefits of drug testing in schools. METHODS: A comprehensive examination was made of testing efficacy and accuracy. Australian legal and ethical issues, encompassing duty of care, rights of the child and privacy determinations, were juxtaposed with that of the United States of America. RESULTS: Evidence examined indicates no compelling case for the application of drug testing and that caution should be applied when considering drug testing as a drug detection and prevention strategy in the school setting. CONCLUSION: While this review did not support school drug testing, there are alternative evidence-based strategies that schools can implement to prevent drug-related problems among student populations.

Strategies for facilitating change in alcohol and other drugs (AOD) professional practice: a systematic review of the effectiveness of reminders and feedback.

In all areas of health research, including the alcohol and other drugs (AOD) field, funds are committed to developing and evaluating research and resources, yet little is invested into helping potential resource users understand, adopt and implement innovations. This study evaluated the effectiveness of two professional practice change interventions (reminders and feedback) that are designed to bridge the 'research-practice gap' by increasing knowledge and changing behaviour of health-care professionals and specialist AOD workers. We conducted a systematic review of general health, AOD and mental health literature (1966 to March 2005). Fourteen existing systematic reviews and 15 primary studies were assessed. Because few studies evaluated the effectiveness of reminders and feedback in the AOD context, evidence is drawn largely from the general health-care literature. Use of reminders and feedback is supported for a range of health behaviours. AOD-specific clinical behaviours that are most likely to be improved with the use of reminders or feedback include pharmacotherapy prescribing, AOD education, screening and counselling and monitoring/management of AOD treatment and/or related problems (e.g. depression). Reminders and feedback are effective strategies to facilitate professional practice change and have potential in the AOD field. However, further well-designed empirical studies are needed to assess fully the effectiveness of these professional practice change strategies in AOD-specific contexts.

Methamphetamine use among Australian workers and its implications for prevention.

INTRODUCTION AND AIMS: Little attention has been directed to the use of methamphetamine among Australian workers. To address this, a study was conducted that examined drug consumption patterns of the Australian work-force. DESIGN AND METHOD: A secondary analysis of the 2004 National Drug Strategy Household Survey (NDSHS) data was undertaken that focused on methamphetamine use among those in paid employment. RESULTS: Methamphetamine use in the past 12 months was reported by 4.0% of workers compared to 2.2% of respondents not in the paid work-force. A larger proportion of male (4.8%) than female workers (3.0%) used methamphetamine. The highest prevalence occurred among 18-29-year-old workers (11.2%; males: 12.6%; females: 9.4%), and among workers in hospitality (9.5%), construction (5.4%) and transport (5.4%) industries and among tradespeople (6.5%). Significantly more methamphetamine users reported absenteeism compared to users of other illicit drugs and non-drug users. Among respondents reporting methamphetamine use, 13.4% reported absenteeism due to illicit drug use, while 56.8% reported absenteeism due to any illness or injury. Significantly more methamphetamine users (32.9%) reported going to work under the influence than users of other illicit drugs. Compared to users of other illicit drugs, methamphetamine users were also significantly more likely to drive a car, operate heavy machinery or abuse someone while under the influence. DISCUSSION AND CONCLUSIONS: The specific details of the profile of workers using methamphetamine and the impact it has on work performance allows for the development of targeted interventions and tailored prevention strategies previously not possible.

Mitochondrial complex inhibitors preferentially damage substantia nigra dopamine neurons in rat brain slices.

Using a rat brain slice preparation, we investigated the role of energy impairment on the selective loss of dopamine neurons in the substantia nigra (SN). Brain slices (400 microm) were incubated at 35 degrees C for 2 h in the presence or absence of mitochondrial complex inhibitors, rotenone, MPP+, 3-nitropropionic acid, and antimycin A. Slices were also incubated in rotenone with excitatory amino acid (EAA) receptor antagonists, MK-801 and CNQX, to determine whether rotenone-induced damage was mediated by EAAs. The slices were then fixed, recut into 30-microm sections, and immunolabeled for tyrosine hydroxylase (TH) to identify catecholamine neurons and to quantify loss of TH-labeled dendrites after treatment. Quantitative comparison was made between SN dopamine neurons, in which rotenone-induced dendrite loss was severe, and hypothalamic A11 dopamine neurons, which were spared. Adjacent sections that were immunolabeled for calbindin or stained with cresyl violet also revealed a striking dendritic degeneration of SN neurons in rotenone-exposed slices, whereas noncatecholamine neurons, such as those in the perifornical nucleus (PeF), were more resistant. Preferential damage to SN dopamine neurons was also evident with other mitochondrial complex inhibitors, MPP+ and antimycin A. EAA receptor antagonists provided partial protection to SN neurons in slices incubated with rotenone (3 microM). The particular vulnerability of SN dopamine neurons in the slice is consistent with the vulnerability of SN in Parkinson's disease. The selective effect of mitochondrial complex inhibition in SN dopamine neurons implies a fundamental deficit in the capacity of these neurons to defend against toxic insult.