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STOCKTAKE OF PRIMARY HEALTH CARE RESEARCH IN AUSTRALIA

Yen L, Kalucy L, Ward N, Katterl R, McIntyre E and Patterson S

Since the commencement of the Primary Health Care Research, Evaluation and Development (PHCRED) strategy in 2000, research targeted on Primary Health Care services, and on the health care system as it relates to Primary Health Care has been a focus for many academic and clinical primary health care researchers. Over that period, 46 research grants have been awarded through the competitive grant system led by the Australian Primary Health Care Research Institute (APHCRI) and 166 projects through the National Health and Medical Research Council. In addition, the Research Capacity Building Initiative has focused on developing capacity within the primary health care researcher community through education, awareness raising, mentoring, and research. Of particular note has been the development of the Practice Based Research Networks, which have provided opportunities for clinicians to become active in research and for collaborations between academic and clinical practitioners.

In light of the development of primary health care research over the past 10 years, and the current agenda for reform, this work by APHCRI and the Primary Health Care Research and Information Service (PHC RIS) set out to do three things:
• provide a stocktake of the current state of primary health care research in Australia
• identify the current strengths and weaknesses of Australian primary health care research in light of current health priorities
• identify ways in which current research gaps might be addressed.

Report

 

KNOWLEDGE BROKERAGE LITERATURE REVIEW, WORKSHOP AND REVIEW

Parker R, Ward N, Davies P and Edwards M (research complete)

Funding has been provided by the Department of Health and Ageing for APHCRI to undertake a project on Knowledge Brokerage. There are three components to this project:
• a literature review
• a workshop which was held in Brisbane in November
• a review of APHCRI’s performance to obtain the views of researchers (both APHCRI-funded and non APHCRI-funded) and research users on the effectiveness of APHCRI’s processes for funding research and disseminating the knowledge it generates.

Literature review
A Research Assistant (Nathaniel Ward) was employed to undertake a comprehensive literature review. This is now complete and a paper has been drafted for publication.

Workshop
A workshop was held in Brisbane on 24 October and 30 people attended. The purpose of the workshop was to devise a knowledge brokering framework for the next five years to assist APHCRI and PHC RIS implement an effective action-based program. The workshop was facilitated by Emeritus Professor Meredith Edwards and a report of the outcomes has been submitted to APHCRI.

Review
Professor Philip Davies undertook this review and he submitted his report in January 2010.

A final report encompassing all these elements was presented to the Department of Health and Ageing in February 2010. It will soon be made available through the APHCRI article management system.

 

PART-TIME GENERAL PRACTITIONERS IN THE ACT: WHAT ARE THE FACILITATORS AND BARRIERS FOR PART-TIME CLINICAL GENERAL PRACTICE?

Douglas K, Dwan K and Forrest L (research complete)

Summary
The significant GP shortage in the ACT is well documented. Although a simple headcount of GP numbers would indicate adequate number of GPs per head of population, due to the large number of GPs who work part-time in the mainstream clinical general practice setting, the number of full-time equivalent GPs per head of population is amongst the lowest in Australia.

This qualitative study of sessional GPs in the ACT was commissioned to help address issues that prevent greater participation of part-time general practitioners in the ACT clinical workforce. Its policy recommendations were incorporated into subsequent material produced by ACT Health and the ACT Division of General Practice.

Key findings
• GPs in part-time clinical practice are involved in a wide variety of other roles within the health care system.
• There is limited capacity among part time GPs to increase their mainstream clinical role.
• The advantages of working part-time were described in terms of flexibility, sustainability and a more balanced lifestyle. Many doctors also articulated that they felt that part-time clinical work enabled them to work more effectively particularly with complex issues.
• Disadvantages of part-time work include providing continuity of care to patients, modest remuneration, not meeting demands of patients regarding access and ensuring they retained skills in the all facets of mainstream clinical general practice.

Policy recommendations
• Every effort should be made to facilitate the involvement of GPs in sessional clinical practice and non-clinical roles.
• Attract GPs to Canberra by promoting the opportunities the area offers.

The final report will be made available soon from the APHCRI article management system.

 

CHRONIC DISEASE MANAGEMENT PLANS: WHO RECEIVES THEM AND DO THEY MAKE A DIFFERENCE TO USE OF HEALTH CARE SERVICES AND HEALTH OUTCOMES?

Yen L, Douglas K, Kljakovic M and Korda R (research in progress)

This study is part of a larger project, the Serious and Continuing Illness Policy and Practice Study (SCIPPS). SCIPPS is a National Health and Medical Research Council (NHMRC) funded project administered by the Menzies Centre for Health Policy which aims to develop interventions and policy options to improve outcomes for people with chronic illness such as chronic heart failure, diabetes and chronic obstructive pulmonary disease. Ms Laurann Yen, Associate Professor Kirsty Douglas, Professor Marjan Kljakovic and Dr Rosemary Korda will conduct the project in two parts. In the first phase, data from the SCIPPS 45+ study will be used to develop a profile of people with chronic illness which will be linked to the use of the chronic illness management items (721-729) in the Medicare Benefits Schedule. In the second phase, the study will examine the relationship between the use of these items and service utilisation, particularly hospital admission and emergency department attendance by people with chronic illness.

 

DUPLICATION IN PATHOLOGY

Yen L, McRae I and Douglas K (research in progress)

Ms Laurann Yen, Dr Ian McRae and Associate Professor Kirsty Douglas began to investigate the potential of reducing the costs of unnecessary duplication within primary care and between primary care and secondary care. Duplication in pathology testing was chosen as the area of inquiry. The project has three core elements: a review of the literature; collection and analysis of patient experience through focus groups in an urban and one rural area and an analysis of the intention to share results of pathology tests between practitioners working in primary and secondary care. The report of the literature review is in draft and the transcripts of the patient experiences are being analysed. This project is being carried out in collaboration with the Menzies Centre for Health Policy.

 

WHAT IS THE LIKELY IMPACT ON HEALTH, DEMAND FOR HEALTH SERVICES AND PROVISION OF HEALTH SERVICES OF THE GLOBAL FINANCIAL CRISIS IN AUSTRALIA?

McRae I (research in progress)

It is clear that the global financial crisis has already begun to increase unemployment rates in Australia and has had other direct effects on individual incomes. In the longer term, there is a need to assess the impact of a major downturn on health outcomes and activities.

In the short term, however, the downturn provides an opportunity to:

• consider the existing research and Australian history on the impact of economic change on the health system;
• predict what will happen; and
• observe whether it is likely changes in the demand for health services will be such as to require any policy change.

Dr Ian McRae will examine the existing literature on the effect of business cycles on health care market and attempt to estimate the likely effects of the current financial downturn.

 

EVALUATION OF THE ACT NURSE-LED WALK-IN CENTRE

Parker R, Forrest L Desborough J and McRae I (research in progress)

Associate Professor Rhian Parker, Dr Laura Forrest, Ms Jane Desborough and Dr Ian McRae are leading the independent evaluation of the newly established ACT nurse-led walk-in centre. The APHCRI research team have examined the literature to assess the international evidence of the effectiveness of nurse-led walk-in centres and a publication is currently being prepared.

The walk-in centre evaluation will examine the effectiveness of the nurse-led walk-in centre in the ACT in terms of the structure, process and outcomes. This evaluation will assess patients’ access to the walk-in centre, the quality and appropriateness of care, the impact of the walk-in centre on other health care providers and the cost effectiveness of the walk-in centre.

 

THE USE OF TECHNOLOGIES FOR SHARING INFORMATION IN PRIMARY HEATH CARE

Douglas K (research in progress)

There is an impetus to increase the use of clinical information technologies in the Australian health system. The National e-Health Strategic Plan includes a commitment to the development of electronic systems to manage care better and to improve health outcomes. Nothing is known about whether using clinical information technologies in primary care reduces medical errors, affects duplication of service or contributes to improved patient outcomes. Associate Professor Kirsty Douglas will investigate the use of information services in primary care by staff to inform patients or to transfer information to other providers.

 

SOCIO-ECONOMIC FACTORS AND SUPPORT MECHANISMS INFLUENCING THE INDIVIDUAL’S CAPACITY TO MAINTAIN SELF CARE IN THE MANAGEMENT OF CHRONIC ILLNESS

McRae I and Yen L (research in progress)

A survey of older Australians has been conducted to address questions around the financial impact of chronic disease. A sample of 10,000 National Seniors Australia members was selected with representation across age and State categories. A response of 4,574 was received and data has now been entered and cleaned and preliminary analysis is being undertaken. The proportions of the sample with chronic diseases is broadly in line with the wider population. The sample is better educated, and much more likely to have private health insurance, but does not appear to have a significantly higher income than the wider population. Initial analysis of the data will focus on:

• the extent chronic illness drives reduction in workforce participation
• factors associated with the level of self rated health and quality of life
• what drives the need for assistance with personal care
• the medical and related costs of chronic diseases and the relationship of this expenditure to household income.

This project is being carried out in collaboration with the Menzies Centre for Health Policy.

PRACTICE NURSE MANAGEMENT OF OVERWEIGHT AND OBESITY

Parker R, Forrest L and Sargent G (research in progress)

Associate Professor Rhian Parker, Dr Laura Forrest and Ms Ginny Sargent are examining the feasibility and acceptability of practice nurse management of overweight and obesity in primary care. This multi-staged project began with a review of the literature examining practice nurses’ knowledge, beliefs and attitudes about overweight and obesity and their perceived role in the management of overweight and obesity. The literature review also documented models of practice nurse management of overweight and obesity which have been implemented in primary care. This review is currently being prepared for publication.

The second stage of the project aims to investigate socio-economic disadvantage as a predictor of overweight and obesity in women. Women who are socio-economically disadvantaged will be interviewed to examine: their experiences of weight management, body image, beliefs about nutrition and physical activity; access to healthy food, family food provision, support received from health care services with regard to weight management; and types of health promotion interventions that they would find acceptable. These women’s experiences and views will inform the development of a practice nurse-led intervention for weight management in primary health care.

The development of the primary health care based intervention has involved bringing together a research team involving researchers and clinicians from ANU, Canberra University and The University of Melbourne. The team members specialise in exercise physiology, nutrition, motivational interviewing, nursing and general practice. This intervention is currently being refined and applications are being made to external funding bodies.

 

PREVALENCE AND INCIDENCE OF PATIENT-INITIATED VIOLENCE IN AUSTRALIAN GENERAL PRACTICE

Parker R, Ceramidas D and Forrest L (research complete)

The Department of Health and Ageing engaged APHCRI to conduct a national study examining the incidence and prevalence of violence and aggression perpetrated by patients, patients’ family members or friends towards general practice staff in Australia. Associate Professor Rhian Parker, Dr Dagmar Ceramidas and Dr Laura Forrest have undertaken a comprehensive literature review, stakeholder consultations and a qualitative exploration of general practice staffs’ experiences of violence and aggression in their workplace. A national survey of general practices will determine the prevalence and incidence of violence and aggression. The final report was submitted to the Department of Health and Ageing in March 2010.

 

INTERPROFESSIONAL WORKING: DEVELOPING AND EVALUATING AN EDUCATIONAL PROGRAM TO PROMOTE TEAMWORK IN GENERAL PRACTICE

Philips C, Hall S, Anderson K and Dwan K (research in progress)

Working in general practice increasingly involves interprofessional collaboration, particularly between nurses and doctors. Both the National Primary Health Care Strategy and the draft report of the National Health and Hospitals Reform Commission have emphasized the importance of better teamwork as a strategy to improve health outcomes and professional resilience. In Australia, the numbers of nurses in general practice has nearly doubled since 2003, and the majority of general practices now have at least one nurse. This rapid increase in nurses in general practice creates both a need and an opportunity to enhance our teaching of interprofessional working for GP registrars, whose professional future is likely to be conducted as members of general practice teams rather than as solo practitioners.

This project attempts to answer the questions:

1. Are the visual concepts developed by GP registrars and nurses different?
2. Are these concepts useful in developing resources for GP registrar interprofessional education?
3. How well to different approaches of interprofessional collaboration training work?

The project team comprises researchers from the ANU Medical School and APHCRI.

 

ACT CONSUMER UNDERSTANDING AND OPINION OF NURSES IN GENERAL PRACTICE

Dwan K, Godden C, Cox D and Derrett J (research in progress)

An online survey will assess the respondents' knowledge about the work of practice nurses and their opinions of what practice nurses could do. All participants will be adults and a reader-friendly confidentiality statement about the study will appear on the first page. The survey is anonymous and no identifiable information will be collected. The questions are not of a sensitive nature. Therefore, there are no known risks to individuals who engage in this survey.

The project team comprises researchers from APHCRI, the ANU Medical School and Health Care Consumers’ Association of the ACT.

 

OPTIMISING RESIDENTIAL AGED CARE WORKFORCE: LEADERSHIP AND MANAGEMENT**

Jeon YH (2009)

Australia’s ageing population together with the increasing prevalence of chronic diseases and multi-morbidity are placing the aged care sector under increasing pressure and impacts directly on those working in residential aged care settings. Strategies targeted at those in leadership and management positions in the residential aged care workforce will contribute to optimising the effectiveness of this workforce in the face of these pressures. This review systematically explores leadership and management development in aged care.
**Note: This report is available on the APHCRI Article Management System only. Users must request a password to access the material. By requesting a password, the user agrees not to disseminate or quote the material without the written consent of the author.

 

SUBMISSION TO THE NATIONAL HEALTH & HOSPITALS REFORM COMMISSION: PRIMARY HEALTH CARE WORKFORCE

Douglas K (2008)

This paper describes the outcomes of the APHCRI Primary Health Care Workforce roundtable which was held to synthesise current Australian evidence around primary health care workforce and, further, to provide policy options on how best to move primary health care workforce forward to meet these challenges. The paper also provides a brief synopsis of the evidence from APHCRI commissioned research on primary health care workforce completed in 2007.

READINESS FOR SCHOOL

Gardner K (2007)

This project led by Ms Karen Gardner from APHCRI, aimed to understand what organised primary health care approaches can contribute to childhood developmental health and well being outcomes related to readiness for school in children aged zero-to-five years.

The project had two components that were conducted in two stages. These are:

1. A systematic review and synthesis of the black and grey literatures relating to the major developmental health issues that underpin readiness for school in children zero-to-five years, known to be amenable to primary health care intervention.
2. A systematic review and synthesis of the black and grey literatures relating to best-practice approaches in organised primary health care for addressing these major developmental health issues.

IMPACT OF PERFORMANCE INDICATORS

Gardner K andSibthorpe B (2006)

National Performance Indicators (NPIs) are a key component of the National Quality and Performance System (NQPS) for Australian Divisions of General Practice, introduced by the Australian Government Department of Health and Ageing (DoHA) in March 2005 under the auspices of the Review Implementation Committee. The Australian Primary Health Care Research Institute (APHCRI) undertook a study to investigate the early impacts of the introduction of NPIs on the planning processes of Divisions.

Further information on the development of Performance Indicators can be found here.

SOUTHERN HIGHLANDS DIVISION OF GENERAL PRACTICE DIABETES PROGRAM: REPORT ON IMPLEMENTATION

Gardner K, Sibthorpe B, McRae I, Rubiano D (2006)

A number of Divisions of General Practice, including the Southern Highlands Division of General Practice (SHDGP), have implemented diabetes programs, but there is little evidence concerning their effectiveness and efficiency. We undertook an exploratory study of the implementation and costs and benefits of the SHDGP program. The results of the cost effectiveness component of the study are being published separately. This is the Report on Implementation.