'No-Frills Prils': GPs' views on drug costs and therapeutic interchange of angiotensin-converting enzyme inhibitors: a qualitative study.

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.

Is immunisation for children and young people in statutory care in Victoria 'all too hard'? A qualitative study with health professionals.

This formative study aimed to identify health professionals' perspectives on vaccination issues among children in statutory out-of-home care in Victoria. Eight health professionals, drawn from a purposive Victorian sample known to be proactive in addressing the vaccination needs of children in out-of-home care, took part in semi-structured interviews. Questions addressed participants' views about roles and responsibilities, barriers and enabling factors affecting vaccination, and ideas about systems improvements. Interview transcripts were analysed thematically. The main themes that emerged were health professionals' observations about vaccine hesitancy among significant adults in the out-of-home care sector, the paucity of child medical history information available and diffuse responsibility for the provision of legal consent to vaccination. More accurate immunisation status monitoring appears warranted for children in out-of-home care. Unless the collection and maintenance of child medical records improves and vaccination consent processes are streamlined, health professionals will be limited in their capacity to provide efficient vaccination services to these children. Research on vaccine hesitancy among staff and carers in the statutory care sector may be of value. This study supports other Australian research that indicates these children may require more targeted, inter-sectoral immunisation approaches.

Children and young people in out-of-home care: canaries in the coal mine of healthcare commissioning.

Australian Primary Health Networks could pioneer local health service reform for children and young people living in out-of-home care. Significant maltreatment, the leading cause of placement of 0-17-year-olds under the protective canopy of foster, kinship and residential care (described collectively as out-of-home care) left more than 50000 children vulnerable to poor health outcomes in 2013-14. Opportunistic health care is inadequate to meet the chronic and complex health needs of maltreated children. This article reviews some critical lessons from English commissioning and US healthcare marketplace reforms in an attempt to better meet the needs of children and young people in out-of-home care. It identifies key questions that Australian Primary Health Networks would need to resolve if they were to follow overseas trends and adopt health service commissioning as a means to provide more effective and efficient health care for this at-risk population.

The red tape waltz. Where multi-centre ethical and research governance review can step on the toes of good research practice.

How could it happen that the very processes intended to assure ethical research in Australia might, themselves, undermine good research practice? This paper describes one PhD candidate's recent experiences of multi-centre review for a Human Research Ethics Committee approved, low/negligible risk, qualitative study, at the crossroad of health services research and organisational research. A retrospective review of international literature about multi-centre review processes revealed that many of these experiences were not unique and might have been expected, notwithstanding Australian efforts at harmonisation of multi-centre review. This paper examines not only the burden of red-tape that was applied to a small doctoral study, but also the way in which the red-tape threatened the anonymity of potential study participants and risked exposing them to undue pressure and distress. These experiences support the view that harmonisation initiatives have not yet developed as the Australian National Health and Medical Research Council may have hoped and that further attention is needed to harmonise research governance processes.

Children and young people in out-of-home care - improving access to primary care.

This article forms part of our 'Access' series for 2012, profiling organisations that provide primary healthcare to groups who are disadvantaged or have difficulty accessing mainstream services. The aim of this series is to describe the area of need, the innovative strategies that have been developed by specific organisations to address this need, and make recommendations to help GPs improve access to disadvantaged populations in their own community.

Children and young people in out-of-home care: are GPs ready and willing to provide comprehensive health assessments for this vulnerable group?

Children living in out-of-home care because of abuse or neglect are among the most vulnerable in Australia. In 2005 the Royal Australasian College of Physicians highlighted the need for increased attention to the health of such children and recommended regular health assessment. This qualitative study explored the views of a purposive sample of 20 GPs about what would influence GP willingness and readiness to undertake comprehensive health assessments for children entering out-of-home care. Ethical concerns, training, professional development needs, medico-legal issues, workforce and financial pressures and communication problems with the child protection sector were among key factors identified. Professional values about continuity of health care for children emerged as a new issue with important policy implications. This is the first in-depth study in Australia of GP perspectives about systematic health assessments for children in child protection and sheds new light on the low GP uptake of such assessments for at-risk population groups.