Identifying best-practice features of diabetic retinopathy treatment models for Aboriginal and Torres Strait Islander Australians.

OBJECTIVE: Indigenous Australians are nearly three times more likely to have diabetes than non-Indigenous Australians. The prevalence of diabetes-related vision impairment for Indigenous Australians is 5.5% compared to 1.5% for non-Indigenous Australians, and treatment rates are lower for Indigenous Australians. Despite this situation, there is limited evidence on effective service delivery models for diabetic retinopathy care and treatment. This study seeks to identify best-practice features of diabetic retinopathy care that could be used to inform current and future service delivery models for Indigenous Australians with diabetic retinopathy. SETTING: All states, territories and geographic remoteness categories in Australia. PARTICIPANTS: Eight ophthalmologists engaged in providing eye healthcare to Indigenous Australians. DESIGN: Semi-structured interviews were conducted. The Framework Approach was used to conduct a thematic analysis of the interviews to facilitate identification of key themes and issues that emerged from these discussions. RESULTS: Seven best-practice features for service delivery of diabetic retinopathy treatment for Indigenous Australians were identified. These were: cultural safety, affordability and accessibility, partnerships with key stakeholders, timeliness, integration with primary care, clarity of guidelines, and clinician attitude and motivation. CONCLUSION: The findings from this study identified seven best-practice features for diabetic retinopathy treatment. These have the potential to inform and influence how care is delivered to Indigenous Australians. Although further research is warranted to capture other service provider inputs and Indigenous end-user perspectives, these features in the meantime can begin to inform the decisions of the Indigenous eyecare sector on policy reforms and best-practice diabetic retinopathy treatment approaches.

Your Quest Begins Now! EBMQuest, a Digital Interactive Fiction Module for Medical Student Engagement in Evidence-Based Practice.

Although evidence-based medicine (EBM) has gained increasing focus in medical education, there remains considerable need for innovative approaches to engage learners. We developed a novel online interactive fiction module "EBMQuest", where students navigate three clinical scenarios requiring use of EBM resources for successful progression. Student feedback was strongly positive, with an overall program rating of 4.64 (Good-Very Good). Online interactive fiction should be further explored as a means of delivering innovative medical education.

Telehealth quality check: Is it time for national standards?

BACKGROUND: Telehealth has seen rapid but unregulated growth in Australia during the COVID-19 pandemic, facilitated by the interim establishment of a universal Medicare Benefits Schedule item for telehealth consultations. Consumers and healthcare providers, including many general practitioners, have turned to telehealth with enthusiasm. OBJECTIVE: The aim of this article is to present evidence and analysis supporting the adoption of national telehealth standards in Australia. DISCUSSION: Despite efforts by professional organisations to develop telehealth standards, Australia lacks a national telehealth strategy and a unified set of shared standards for clinical governance and quality assurance that can be applied across the health system. To ensure consumer safety and support healthcare providers in telehealth, a national regulatory framework and telehealth standards should be established on the basis of the latest evidence on safety and quality in all forms of telehealth.

A narrative review and synthesis to inform health workforce preparation for the Health Care Homes model in primary healthcare in Australia.

The Australian Government Health Care Homes (HCH) model recently implemented in general practice targets people with chronic complex conditions. Identifying how general practitioners (GPs) and practice nurses (PNs) can work within this model is important given existing health workforce challenges. A narrative review and synthesis has been undertaken to develop a preliminary understanding of this, incorporating literature describing health workforce challenges, GP and PN functions, and team-based care; supplemented by interviews with key informants from within the primary healthcare system. Narrative synthesis principles guided literature analysis. Interview data were thematically analysed. A clear rationale for health workforce reform was ascertained and functions for the GP and PN under the HCH model were determined. The model was found to be an opportunity for an enhanced PN role in a team-based approach to care with the GP. Challenges to advancing the PN role and team-based care were identified, including the medical dominance of the health system and the significant culture change required by general practices to fully implement the model. Enablers included strong nursing leadership and improved ongoing education for PNs to unlock their capacity. The HCH model is an opportunity to strengthen primary healthcare, provided concerted action is taken regarding these challenges and enablers.

Emerging Needs of People Living With HIV Receiving Community-Based Nursing in an Australian Setting.

While the lifespan of people living with HIV (PLWH) in Australia has increased, a minority still experience poor health outcomes and have complex needs. Few studies address this group's emerging needs. Our study, a component of a larger evaluation, aimed to identify current and projected needs of PLWH receiving HIV community nursing. We undertook a cross-sectional survey to identify clients' support needs and explore their future concerns. There were 120 of 140 PLWH who met our eligibility criteria to participate in the survey; 86 responded. Respondents overrepresented minority, disadvantaged groups. Mental health support was the most common care reported (86.8%). Respondents' self-identified needs included access to health care, dealing with pain, anticipated grief due to friends dying, and maintaining independence. Time since HIV diagnosis and sexual orientation were primary variables for which differences were observed. Our study highlights the importance of developing and sustaining HIV specialist community nursing services for aging PLWH.

Consumer awareness, satisfaction, motivation and perceived benefits from using an after-hours GP helpline - A mixed methods study.

BACKGROUND: The 'after hours GP helpline' (AGPH) was added to the nurse triage and advice services in Australia in July 2011 with the intention of improving access to general practitioner (GP) advice in the after-hours period. OBJECTIVE: The objectives of the article are to examine consumer awareness, satisfaction, motivation for use and perceived benefits of using the AGPH. METHODS: A mixed-methods approach used secondary data on population awareness and caller satisfaction, and an in-depth qualitative study of consumers. RESULTS: Awareness of the service was low but satisfaction was high. Users called the service because they did not know what to do, were afraid and/or could not access a health service after hours. Users derived reassurance and increased confidence in managing their health. DISCUSSION: A conceptual model identifying three experiential domains of dependence, access and health literacy illustrates the relationship between motivation for use and perceived benefits. The model may help to target the service to those who will benefit most.

Patient intention and self-reported compliance in relation to emergency department attendance after using an after hours GP helpline.

OBJECTIVE: To determine ED attendance and compliance with GP advice following a call to an after hours telephone triage and advice service. METHODS: A descriptive study of users' of an after hours helpline self-reported ED attendance and compliance with GP recommendation, based on routinely collected service data and telephone survey results for 2783 callers in 2011-2012. The outcome measure was self-reported health service utilisation following advice from a GP on an after hours helpline. RESULTS: One-third of the sample - 934 callers - intended to visit the ED. Of these, 504 (54%, 95% CI 50.7%-57.2%) reported taking other less urgent options. The GP assessment confirmed the original intention for 224 callers (24%, 95% CI 21.2%-26.9%). However, 151 patients (16%, 95% CI 13.8%-18.6%) did attend the ED as they had originally intended despite the GP's recommendation to seek less serious care, whereas a further 55 patients (6%, 95% CI 4.4%-7.6%) assessed by the GP as requiring ED care chose a less serious option. Fifty-five per cent of all callers who attended ED did not intend to visit the ED prior to their call. The overall net result was a small reduction in ED attendance compared with original intentions. CONCLUSION: An after hours GP helpline may divert some callers intending to go to the ED to other care. However, patient non-compliance may limit the capacity of telephone triage and advice service to reduce demand for ED. Further research is needed to better understand the effect of the service.

Who uses the 'after hours GP helpline'? A profile of users of an after-hours primary care helpline.

BACKGROUND: The 'after hours GP helpline' was added to the existing 24-hour nurse triage and advice lines in Australia in July 2011. Its objective is to improve access to GP advice in the after-hours period. OBJECTIVE: The objective of this study was to describe the user profile of an after-hours primary care helpline during its first two years of operation, including age, gender, location and relative socioeconomic advantage of users. METHODS: The study undertook a retrospective review and descriptive analysis of the use and user characteristics during a two-year period in 2011-13. RESULTS: The service handled more than 300,000 calls in the study period. It was well used by parents of young children, women, those living in remote areas and those who identified as Aboriginal and Torres Strait Islander. Older people and rural residents were proportionally lower users of the service. All socioeconomic rankings were represented, with highest call rates in less advantaged areas. DISCUSSION: Targeted promotion may assist high-need groups to benefit from after-hours telephone-based primary care advice when face-to-face GP services are unavailable.

The league of extraordinary generalists: a qualitative study of professional identity and perceptions of role of GPs working on a national after hours helpline in Australia.

BACKGROUND: Telephone triage and advice services (TTAS) have become commonplace in western health care systems particularly as an aid to patient access and demand management in the after hours period. In 2011 an after hours general practitioner (GP) helpline was established as a supplementary service to existing 24-h nurse-TTAS in Australia. Callers to the service in the after hours period who are triaged by a nurse as needing to see a GP immediately or within 24 h may speak with a GP on the line to obtain further assessment and advice. While much research has been undertaken on the roles of nurses in TTAS and the professional identities and attitudes to new technology of community-based GPs, little is known of the perceptions of role and identity of GPs providing after hours advice on primary care helplines. This qualitative study explored the perceptions of professional identity and role, motivations and contributions to the health system of GPs employed on the Australian afterhours GP helpline in 2011-2013. METHODS: The study took a phenomenographic approach seeking to understand the essence of being a telephone GP, probing professional identity while also exploring role tensions. Twelve GPs, or 15% of the helpline GP workforce participated in the qualitative study. RESULTS: The GPs experienced both personal and professional benefits and believed they were strengthening patient care and the Australian health system. However the role required a re-alignment of practice that challenged professional autonomy, the doctor-patient relationship and commitment to continuity of care. Some GPs made this role realignment more readily than others and were well suited to the helpline role. There was a strong collegial bond amongst the helpline GPs which facilitated the maintenance of professional autonomy. CONCLUSIONS: Telephone GP assessment and advice does not demonstrate the same breadth as face-to-face practice and provides little opportunity for continuity of care, but this has not prevented those performing the role from identifying as a new form of generalist. The establishment of an after hours GP helpline in Australia has seen the emergence of a new generalist primary care identity as telehealth innovators.

Cancer care coordination: building a platform for the development of care coordinator roles and ongoing evaluation.

Continuity of care is integral to the quality and safety of care provided to people with cancer and their carers. Further evidence is required to examine the contribution Nurse Cancer Care Coordinator (NCCC) roles make in improving the continuity. The aim of the present study was to clarify the assumptions underpinning the NCCC roles and provide a basis for ongoing evaluation. The project comprised a literature review and a qualitative study to develop program logic. The participants who were purposively sampled included policy makers, practitioners, patient advocates, and researchers. Both the literature and participant reports found that NCCC roles are diverse and responsive to contextual influences to coordinate care at the individual (patient), organisational, and systems levels. The application of the program logic for the development of NCCC roles was explored. The conceptualisation of NCCC roles was also examined in relation to Boundary Spanning and Relational Coordination theory. Further research is required to examine how NCCCs contribute to improving equity, safety, quality and coordination of care. The project has implications for research, policy and practice, and makes explicit existing assumptions to provide a platform for further development and evaluation of these roles.

Trachoma elimination in remote Indigenous Northern Territory communities: baseline health-promotion study.

Identify trachoma knowledge, attitudes and practice of staff in clinics, schools and community workplace settings to optimise trachoma-elimination health-promotion programs in the Katherine West Health Board region of the Northern Territory. Prior to the introduction of a suite of health promotion resources the Indigenous Eye Health Unit and Katherine West Health Board conducted a baseline survey of open, multi-choice and closed questions regarding knowledge, attitudes and practices in relation to trachoma with 72 staff members over a 6-month period in 2010-11. Data were analysed for differences between settings. Two significant barriers and one enabling factor were identified. One in five staff members in clinics and 29% of staff members in schools were unaware they lived and worked in a trachoma-endemic area. One-third of school staff and 38% of clinic staff considered it normal for children to have dirty faces. However, the majority of participants felt comfortable talking about hygiene issues with others. The presence of dirty faces in young Indigenous children underpins the continuing prevalence of trachoma. Increasing the awareness of the health effects of children's nasal and ocular secretions and changing community acceptance of dirty faces as the norm will reduce the risk of trachoma and other childhood infections. Staff in clinics, schools and community work settings can play a role in trachoma elimination by actively encouraging clean faces whenever they are dirty and by including face washing in holistic hygiene and health education. Staff in schools may need additional support. Trachoma-elimination health promotion should increase awareness of trachoma prevalence and encourage all who work and live in remote Indigenous communities to take action to promote facial cleanliness and good hygiene practices.

Well for life: a way of life.

Well for Life is an innovative public program in Victoria, Australia that focuses on improving nutrition and increasing physical activity to promote healthy aging. For more than 4 years Aged Care has funded projects for frail older people who live in Public Sector Residential Aged Care (PSRAC) facilities or attend Home and Community Care (HACC) Planned Activity Groups (PAGs). Many stereotypes exist around what frail older people can or cannot do. Well for Life challenges many of these through organizational culture and policy change and workforce development. A person-centered approach to care is adopted that emphasizes improving participants' activities of daily living and encouraging exercise and involvement. An external provider used a participatory evaluation approach to support the first phase of Well for Life. This approach enabled funded agencies to plan, implement, and monitor progress in their projects and assist them to embed Well for Life into policy and practice. The evaluation not only revealed insight into the delivery and adoption of Well for Life, but also assisted management and staff to make Well for Life a reality. Many PSRAC residents and PAG participants have reported significant gains from their involvement in Well for Life. These achievements reflect staff enthusiasm and organizational commitment to Well for Life principles. Evidence supports the benefit of improved nutrition and physical activity for people of any age and Well for Life is adding to the evidence-base for frail older people.