Designing a decision aid for cancer prevention: a qualitative study.

OBJECTIVES: Australian guidelines recommend people aged 50-70 years old consider taking low-dose aspirin to reduce their risk of colorectal cancer. The aim was to design sex-specific decision aids (DAs) with clinician and consumer input, including expected frequency trees (EFTs) to communicate the risks and benefits of taking aspirin. METHODS: Semi-structured interviews were conducted with clinicians. Focus groups were conducted with consumers. The interview schedules covered ease of comprehension, design, potential effects on decision-making, and approaches to implementation of the DAs. Thematic analysis was employed; independent coding by 2 researchers was inductive. Themes were developed through consensus between authors. RESULTS: Sixty-four clinicians were interviewed over 6 months in 2019. Twelve consumers aged 50-70 years participated in two focus groups in February and March 2020. The clinicians agreed that the EFTs would be helpful to facilitate a discussion with patients but suggested including an additional estimate of the effects of aspirin on all-cause mortality. The consumers felt favourable about the DAs and suggested changes to the design and wording to ease comprehension. CONCLUSION: DAs were designed to communicate the risks and benefits of low-dose aspirin for disease prevention. The DAs are currently being trialled in general practice to determine their impact on informed decision-making and aspirin uptake.

Aspirin can help to prevent bowel cancer up by to 25% and the chances of dying from it by up to 33%. Australian guidelines recommend that people aged 50­70 years old to consider taking low-dose aspirin to reduce their risk of bowel cancer. To encourage GPs and their patients to discuss the guidelines, we designed a brochure called a decision aid with the help of clinicians and people in the community of Victoria, Australia. The decision aid covered the benefits and risks of taking aspirin. Clinicians participated in interviews and provided feedback on the statistics presented in a chart called an expected frequency tree. People in the community participated in group discussions and improved the design and comprehension of the decision aid. The clinicians and people who participated in this study do not fully represent the diversity of the Australian population, as they were mostly white and highly educated. We are now testing if the decision aid is effective for supporting a discussion between patients and general practitioners, helping their patients make an informed decision about taking aspirin, and whether it encourages them to take aspirin daily after being shown the decision aid in general practice.

Challenging the status quo: results of an acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesian primary care.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in Indonesia. Focused HDP management pathways for Indonesian primary care practice have been developed from a consensus development process. However, the acceptability and feasibility of the pathways in practice have not been explored. This study reports on the implementation process of the pathways to determine their acceptability and feasibility in Indonesian practice. METHODS: The pathways were implemented in three public primary care clinics (Puskesmas) in Yogyakarta province for a month, guided by implementation science frameworks of Medical Research Council (MRC) and the Practical Robust Implementation and Sustainability Model (PRISM). The participating providers (general practitioners (GPs), midwives, and nurses) were asked to use recommendations in the pathways for a month. The pathway implementation evaluations were then conducted using clinical audits and a triangulation of observations, focus groups (FGs), and interviews with all of the participants. Clinical audit data were analysed descriptively, and qualitative data were analysed using a mix of the inductive-deductive approach of thematic analysis. RESULTS: A total of 50 primary care providers, four obstetricians, a maternal division officer in the local health office and 61 patients agreed to participate, and 48 of the recruited participants participated in evaluation FGs or interviews. All of the providers in the Puskesmas attempted to apply recommendations from the pathways to various degrees, mainly adopting preeclampsia risk factor screenings and HDP monitoring. The participants expressed that the recommendations empowered their practice when it came to HDP management. However, their practices were challenged by professional boundaries and hierarchical barriers among health care professionals, limited clinical resources, and regulations from the local health office. Suggestions for future scale-up studies were also mentioned, such as involving champion obstetricians and providing more patient education toolkits. CONCLUSION: The HDP management pathways are acceptable and feasible in Indonesian primary care. A further scale-up study is desired and can be initiated with investigations to minimise the implementation challenges and enhance the pathways' value in primary care practice.

Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. METHODS: Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants' agreement and further suggestions. The participants' agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants' responses and suggestions to the free text questions were analysed thematically. RESULTS: A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8-100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. CONCLUSIONS: Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.

The effectiveness of interprofessional education for the management of diabetes and oral health: A systematic review.

Diabetes and oral disease are becoming increasingly prevalent in Australia and share a bidirectional relationship. Despite this relationship, collaboration between the medical and dental professions is limited. This study assessed the available evidence of interprofessional educational programs on diabetes and oral health management and their effects on knowledge and confidence of health professionals involved. This review included randomized and non-randomized-controlled trials and before-and-after comparison studies in English with no limits on the year of publication. Electronic databases Medline, EMBASE, Emcare, and CINAHL were systematically searched and studies were critically appraised. Nineteen articles were identified from 411 for full-text screening. Four studies of a quasi-experimental design with a pre- and posttest evaluation were included in the review. Of these, three studies reported positive changes in the participants' knowledge of the roles of other healthcare professionals with improved attitudes toward interprofessional collaboration and communication, and one reported increased confidence of medical and dental professionals when working in an interprofessional team. Interprofessional education should improve health professionals' attitudes and knowledge of the roles of other health professionals in managing diabetes and oral health and their confidence in working together. However, given the limited availability of interprofessional education on diabetes and oral health management, continuous research in this area would improve the evidence base.

The elephant in the room: an exploratory study of hypertensive disorders of pregnancy (HDP) management in Indonesian primary care settings.

BACKGROUND: Indonesia has the highest maternal mortality rate in South East Asia, that a third of the mortality is caused by hypertensive disorders of pregnancy (HDP), including preeclampsia and eclampsia. Research suggests that maternal deaths from HDP are avoidable with appropriate initial management in primary care. However, little is known regarding the exact way HDP management is conducted in Indonesian primary care. This research aims to explore the way HDP management is provided, including its barriers and facilitators in Indonesian primary care settings. METHODS: This research applied a practical qualitative methodology using interviews with a topic guide. It is guided by the implementation science framework of the Medical Research Council (MRC) framework and Practical Robust Implementation and Sustainability Model (PRISM) to design and evaluate complex healthcare interventions. Primary care key stakeholders from Yogyakarta province were recruited from May-December 2018. The interviews were conducted in face-to-face, telephone, and teleconference interviews. Data from the interviews were analysed thematically using a mix of inductive and deductive approaches. RESULTS: A total of 24 participants were interviewed, consisting of four general practitioners, five midwives, three nurses, three obstetricians, a cardiologist, five policymakers and three women with a previous history of HDP. Referrals are the usual management performed for HDP women in primary care and the primary care providers' practice is challenged by three identified themes: (i) providers' limited confidence to perform HDP management, (ii) fragmented continuity of care, and (iii) community beliefs. Many participants also desired to have more focused guidance to improve HDP management in primary care practice. CONCLUSION: Even though Indonesian antenatal care and referrals are generally accessible, there are many challenges and fragmentation of HDP management. The most prominent challenge is the primary care providers' lack of confidence in performing the management and the 'elephant' of an urgent need of practice guidelines in primary care that has never been appropriately described in the literature. Further development of an evidence-based primary care-focused guidance will potentially improve primary care providers' skills to perform optimal HDP management and provide appropriate education to their patients.

Cultural respect in general practice: a cluster randomised controlled trial.

OBJECTIVE: To examine whether the Ways of Thinking and Ways of Doing (WoTWoD) cultural respect framework improves clinically appropriate anticipatory care in general practice and the cultural respect levels of medical practice staff. DESIGN: Mixed methods, cluster randomised controlled trial with a participatory action research approach. SETTING, PARTICIPANTS: Fifty-six general practices in Sydney and Melbourne, 2014-2017. INTERVENTION: WoTWoD encompasses a toolkit (ten scenarios illustrating cross-cultural behaviour in clinical practice), one half-day workshop, cultural mentor support for practices, and a local care partnership between participating Medicare locals/primary health networks and local Aboriginal Community Controlled Health Services for guiding the program and facilitating community engagement. The intervention lasted 12 months at each practice. MAJOR OUTCOMES: Rates of claims for MBS item 715 (health assessment for Aboriginal and Torres Strait Islander People) and recording of chronic disease risk factors; changes in cultural quotient (CQ) scores of practice staff. RESULTS: Complete results were available for 28 intervention (135 GPs, 807 Indigenous patients) and 25 control practices (210 GPs, 1554 Indigenous patients). 12-Month rates of MBS item 715 claims and recording of risk factors for the two groups were not statistically significantly different, nor were mean changes in CQ scores, regardless of staff category and practice attributes. CONCLUSION: The WoTWoD program did not increase the rate of Indigenous health checks or improve cultural respect scores in general practice. Conceptual, methodologic, and contextual factors that influence cultural mentorship, culturally respectful clinical practice, and Indigenous health care require further investigation. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry ACTRN12614000797673.

Developing management pathways for hypertensive disorders of pregnancy (HDP) in Indonesian primary care: a study protocol.

BACKGROUND: National and international guidelines for the management of hypertensive disorders of pregnancy (HDP) are available in developing countries. However, more detailed clinical pathways for primary care settings are limited. This study focuses on Indonesia, where 72% of women who died from HDP and its complications had received less appropriate treatment according to international guidelines. There is an urgent need to develop primary care focused pathways that enable general practitioners (GPs), midwives and other relevant providers to manage HDP better. OBJECTIVES: This paper describes a study protocol for the development of HDP management pathways for Indonesian primary care settings. METHODS: This study design is informed by Implementation Science theories and consists of three phases. The exploratory phase will involve conducting semi-structured interviews with key Indonesian primary care stakeholders to explore their experiences and views on HDP management. The development phase will apply evidence from the literature review and results of the exploratory phase to develop HDP management pathways contextualised to Indonesian primary care settings. Consensus will be sought from approximately 50 experts, consist of general practitioners (GPs), midwives, obstetricians, nurses and policy makers using Delphi technique survey. The evaluation phase will involve a pilot study to evaluate the pathways' acceptability and feasibility in a sample of Indonesian primary care practices using mixed methods. DISCUSSION: The implementation science frameworks inform and guide the phases in this study. Qualitative interviews in the exploratory phase are conducive to eliciting opinions from key stakeholders. Using Delphi technique at the development phase is suitable to seek participants' consensus on HDP management in primary care. Observations, focus group discussions, interviews as well as analysis of patients' medical records at the evaluation phase are expected to provide a comprehensive investigation of the implementation of the pathways in practice settings.

Screening and diagnosis of chronic kidney disease in people with type 2 diabetes attending Australian general practice.

Australian guidelines recommend annual screening and monitoring of chronic kidney disease (CKD) in people with type 2 diabetes (T2D). A cross-sectional study utilising data from NPS MedicineWise MedicineInsight program from June 2015 to May 2016 was undertaken to explore: (1) the proportion of patients with T2D attending general practice who have had screening for, or ongoing monitoring of, CKD; (2) the proportion of patients without a documented diagnosis of CKD who have pathology consistent with CKD diagnosis; and (3) the patient factors associated with screening and the recording of a diagnosis of CKD. Of 90550 patients with T2D, 44394 (49.0%) were appropriately screened or monitored. There were 8030 (8.9%) patients with a recorded diagnosis of CKD, whereas 6597 (7.3%) patients had no recorded diagnosis of CKD despite pathology consistent with a diagnosis. Older age and diagnosis of hypertension or hyperlipidaemia were associated with increased odds of CKD diagnosis being recorded. Older patients, males, those with recorded diagnoses of hypertension or hyperlipidaemia and those who had their medical record opened more frequently were more likely to be screened appropriately. Screening and monitoring of CKD appears suboptimal. Research to explore barriers to screening, recording and monitoring of CKD, and strategies to address these, is required.

Safe and effective cultural mentorship in general practice.

BACKGROUND: Closing the gap in health and welfare for Aboriginal and Torres Strait Islander peoples is an ongoing challenge. OBJECTIVE: The objectives of this article are to conceptualise and operationalise models of cultural mentorship within a multifaceted practice-based program to facilitate culturally and clinically appropriate care. METHODS: Participatory action research and workshops were conducted with Aboriginal Elders, Aboriginal health workers (AHWs), Indigenous health project officers (IHPOs) and staff from participating Medicare Locals (MLs). RESULTS: Roles and responsibilities in a cultural mentorship relationship were defined, along with potential benefits and harm. Mentors and mentees should be comfortable with their own identity and/or ethnicity before engaging in a mentorship relationship. Mutual trust is implicit and participants must be prepared, flexible and mutually respectful to achieve mutual goals. The cultural mentorship model includes Aboriginal Elders and local care partnerships of Aboriginal community-controlled and primary care organisations, and practice mentorship teams of a local AHW/IHPO, research project officer and, where available, ML practice support officer. DISCUSSION: A successful cultural mentorship model is multi-level and safe, and requires mutual trust and respect, time and resources. Potential benefits include equitable access to, and use of, safe quality care for Aboriginal and Torres Strait Islander patients in general practice.

Exploring Aboriginal patients' experiences of cardiac care at a major metropolitan hospital in Melbourne.

Objectives The aim of the present study was to explore Aboriginal patients' lived experiences of cardiac care at a major metropolitan hospital in Melbourne. Methods The study was a qualitative study involving in-depth interviews with a purposive sample of 10 Aboriginal patients who had been treated in the cardiology unit at the study hospital during 2012-13. A phenomenological approach was used to analyse the data. Results Eight themes emerged from the data, each concerning various aspects of participants' experiences: 'dislike of hospitals', 'system failures', 'engagement with hospital staff', 'experiences of racism', 'health literacy and information needs', 'self-identifying as Aboriginal', 'family involvement in care' and 'going home and difficulties adapting'. Most participants had positive experiences of the cardiac care, but hospitalisation was often challenging because of a sense of dislocation and disorientation. The stress of hospitalisation was greatly mediated by positive engagements with staff, but at times exacerbated by system failures or negative experiences. Conclusion Cardiac crises are stressful and hospital stays were particularly disorienting for Aboriginal people dislocated from their home land and community. What is known about the topic? Aboriginal people have higher mortality rates due to cardiovascular diseases compared with other Australians. Along with different factors contributing to the life expectancy gap, Aboriginal people also face significant barriers in the use of the healthcare system. What does this paper add? Aboriginal patients' lived experience of cardiac care at a major metropolitan hospital in Melbourne is explored in this paper. Different issues were revealed during their interaction with the hospital staff and the hospital system in conjunction with their cultural aspect of patient care. What are the implications for practitioners? Positive interactions with staff, ongoing support from family and community, culturally appropriate cardiac rehabilitation programs can improve the cardiac care experiences of Aboriginal patients.

Improving cultural respect to improve Aboriginal health in general practice: a multi-methods and multi-perspective pragmatic study.

BACKGROUND: To address the gap in access to healthcare between Aboriginal people and other Australians, we developed Ways of Thinking, Ways of Doing (WoTWoD) to embed cultural respect into routine clinical practice. WoTWoD includes a workshop, toolkit and cultural mentors in a partnership of general practice and Aboriginal organisations. The aim of this study was to examine the im-pact of WoTWoD on cultural respect, health checks and risk factor management for Aboriginal patients in general practice. METHODS: A multi-methods and multi-perspective pre- and-post-intervention pragmatic study with 10 general practices was undertaken, using information from medical records, practice staff, cultural mentors and patients. RESULTS: Cultural respect, service and clinical measures improved after implementing WoTWoD. Qualitative information confirmed and explained improvements. Knowledge of Aboriginal history needed further improvement. DISCUSSION: The WoTWoD may improve culturally appropriate care in general practice. Further research requires adequately powered randomised controlled trials.

E-prescription: views and acceptance of general practitioners and pharmacists in Greater Sydney.

BACKGROUND: Electronic prescription (e-prescription) was introduced in 2020 in Australia during the COVID-19 pandemic. This research aimed to explore general practitioners (GPs) and community pharmacists' experience with, and facilitators and barriers to, the use of e-prescription. METHODS: This qualitative study used semi-structured interviews with GPs and pharmacists in Greater Sydney to explore their experience with e-prescription. Thematic analysis used descriptive and mixed inductive and deductive approaches. The Technology Acceptance Model (TAM) was used to further interpret and organise the themes. RESULTS: Eleven GPs and nine pharmacists were interviewed. Thirteen themes were elicited, seven of which were categorised as benefits (facilitators) and six were challenges (barriers). Four facilitator themes (convenience for healthcare providers (HCPs) and patients, addressing issues with paper prescriptions, contactless nature reducing access barriers during COVID-19 lockdown, and enabling patients to manage multiple prescriptions) were mapped to the TAM construct of 'perceived usefulness'; and one facilitator (an easier process) and two barrier themes (lack of information during implementation, and technological issues) were mapped to the TAM construct of 'perceived ease of use'. Themes that fell outside these constructs were separately categorised: four barrier themes (reluctance of some patients and HCPs to change, patient expectations of 'instant prescription' and lost opportunities for best-practice care, HCPs' perceptions of inadequate governmental governance, and ongoing costs) were 'other issues with e-prescription', and two facilitator themes (providing training on the use of e-prescription for HCPs and patients, and making e-prescription more streamlined) were 'suggestions to improve'. CONCLUSION: There are many facilitators and barriers to the use of e-prescription. Our findings may inform the future promotion of e-prescription post-COVID-19 pandemic. Further research should focus on consumers' perspectives of e-prescription.

Prevalence and Associated Factors of Thyroid Nodules Among 52,003 Chinese 'Healthy' Individuals in Beijing: A Retrospective Cross-Sectional Study.

Introduction: The prevalence of thyroid nodules has been increasing, and there are few research data on the risk factors of thyroid nodules in the Chinese population. In this study, we aimed to determine the prevalence and risk factors of thyroid nodules by retrospectively investigating the physical examination records of a cohort of "healthy" individuals in Beijing, China. Methods: This was a retrospective cross-sectional study. The database of a Medical Examination Centre (MEC) was searched. Physical examination data, blood test data, and ultrasound examination data, etc., from 2015 to 2017 were accessed. Only those that recorded a thyroid ultrasound were included. Chi-square test and t-test were used to compare clinical features of individuals' age, gender, body mass index, blood pressure, blood glucose, blood lipids, uric acid, and presence of fatty liver. Risk factors for thyroid nodules were determined using multivariate logistic regression. Results: A total of 52,003 records, which included 19,901 cases with thyroid nodules, were examined. The overall prevalence rate was 38.3% (19,901/52,003): 30.2% (6,726/22,305) and 44.4% (13,175/29,698) in men and women, respectively. Of 52,003 cases, only 35,420 cases had records of all nodule-related metabolic abnormalities and were selected for cross-sectional determination of related risk factors of thyroid nodules. In male, relationships were found between thyroid nodules and increased age (p < 0.001), impaired fasting glucose (p = 0.044), diabetes (p = 0.047), decreased HDL-C (p = 0.018) and prostatic hyperplasia (p < 0.001). And in female, relationships were found between thyroid nodules and increased age (p < 0.001) and decreased HDL-C (p < 0.001). Conclusion: Thyroid nodules are common in China. This study found that thyroid nodules are associated with several metabolic indicators or metabolic diseases, although the mechanism is unclear. Further research is needed.

Late effects of polio: Interviewing general practitioners and health professionals about the need for and the means of promoting continuing professional development.

BACKGROUND AND OBJECTIVES: Polio Australia estimates tens of thousands of polio survivors are experiencing late effects of polio (LEoP), including increased cases among young women of childbearing age in some migrant communities. Because polio has been declared eradicated in Australia, the provision and uptake of education by general practitioners (GPs) and healthcare professionals (HCPs) is minimal. We explored the awareness of LEoP among HCPs and ways to enhance knowledge dissemination to improve clinical practice. METHOD: A qualitative study was undertaken, informed by a descriptive (transcendental) phenomenological approach. Semistructured interviews were audio recorded, transcribed and analysed inductively, with a conciliation among the research team used to finalise the themes. RESULTS: HCPs expressed the importance of learning about LEoP and how this may help build supportive patient-practitioner relationships and contribute to patient outcomes. Factors influencing the uptake of professional development included motivation, possibly stemming from a lack of awareness of LEoP, together with the time and logistical limitations of practice generally. DISCUSSION: Online learning activities followed by an assessment may be attractive for some HCPs, but peer-based and multidisciplinary continuing professional development activities remain preferred.

Strengthening learning and research in health equity - opportunities for university departments of primary health care and general practice.

This paper explores the roles of university departments of primary health care (PHC) and general practice in promoting health equity. The coronavirus disease 2019 (COVID-19) pandemic has exposed long-standing health and workforce inequities in Australia, as elsewhere. Addressing these inequities will require wide-ranging responses particularly focussed on PHC and the PHC workforce. Well-resourced university departments of PHC and general practice have potential to lead research informing PHC transformation and strategies to reduce health inequity, as well as to train and inspire a future PHC workforce. Examples from such academic departments in Australia and internationally are briefly described, and the experience of a recently established department of general practice is considered, in order to recommend enablers including institutional support, curriculum design, and partnerships with communities and between institutions. Support for community-based clinical schools, practice-based research networks and strengthening PHC research capacity will enable the PHC and general practice academy to engage more effectively in addressing health inequity.

'Touch for Health' based kinesiology interventions: An innovative qualitative research exploring clients' perspectives.

BACKGROUND AND PURPOSE: Touch for health (TFH) based kinesiology is a complementary therapy with foundations in a natural health training developed utilising techniques from chiropractic, osteopathy and acupressure therapies. Although popular, the impact of the therapy is poorly understood. The aim of this study was to understand outcomes of TFH-based kinesiology interventions that clients perceive as important in their lives. MATERIALS AND METHODS: A qualitative phenomenological approach was chosen to capture rich descriptive data. Thirteen individuals were recruited from TFH-based kinesiology practices. Focus groups included semi-structured questions, photo-elicitation and a wellness word activity to prompt discussion on impacts of interventions. Audio-recordings were transcribed, coded and grouped to develop themes. Comparisons were made and linked with the wellness model, theory of planned behaviour and mindfulness-based interventions. RESULTS: Three interrelated themes emerged: impact on awareness, experience of effects and impact on action. TFH-based kinesiology was perceived to enhance self-awareness and feelings of wellbeing, promote self-care and support new actions to manage stress and complement conventional healthcare. The use of a mind-body approach with feedback from muscle testing and less need for dialogue were valued. Photo-elicitation generated rich narratives recounting experiences after interventions. Impacts aligned with the wellness model and resembled outcomes of mindfulness-based interventions. CONCLUSION: This study provides an insight into experiences and impacts of TFH-based kinesiology. Interventions were seen to facilitate self-awareness, experiences of wellbeing and promote self-care. Findings contribute towards a knowledge-base to foster dialogue and inform TFH-based kinesiologists, health professionals, consumers and research of TFH-based kinesiology and comparative therapies.

Experience of COVID-19 Vaccination among Primary Healthcare Workers in Hong Kong: A Qualitative Study.

Studies show that coronavirus disease 2019 (COVID-19) vaccine hesitancy exists among healthcare workers (HCWs). Past personal experiences of vaccination, such as the seasonal influenza vaccination, influence individuals' intention to receive future vaccinations. This study aimed to explore the experience of COVID-19 vaccination among primary care HCWs in Hong Kong. A qualitative study using semi-structured interviews was conducted. Twenty-eight HCWs (ten doctors, ten nurses, and eight supporting staff) working in nine government-funded primary care clinics in Hong Kong who had completed at least one dose of COVID-19 vaccination were interviewed. Four themes were generated, namely, the cognitive and emotional battle of vaccine hesitancy, catalysts for vaccine acceptance, blasting vaccination myths, and being a positive influence. Providing timely, adequate, and transparent vaccine information and addressing the specific concerns of HCWs about the COVID-19 vaccine could enhance their vaccination uptake in future. Specific vaccine promotion strategies, such as the sharing of vaccination experiences targeted at different subgroups of HCWs, may improve vaccine acceptance through informational social influence.

Factors affecting prescription of sodium-glucose co-transporter 2 inhibitors in patients with type 2 diabetes mellitus with established cardiovascular disease/ chronic kidney disease in Hong Kong: a qualitative study.

BACKGROUND: Sodium-glucose co-transporter 2 inhibitors (SGLT2 I) has cardiorenal protective properties and are recommended for patients with diabetes and established atherosclerotic cardiovascular disease (ASCVD) and/or chronic kidney disease (CKD). Although cardiorenal complications are high in diabetes and pose a significant financial burden on the Hong Kong health care system, the use of SGLT2 I in these populations remains low. And yet this issue has not been explored in Hong Kong primary care. This study aimed to explore factors affecting primary care doctors' prescribing of SGLT2 I in patients with diabetes and established ASCVD/CKD in Hong Kong. METHODS: A phenomenological qualitative research using semi-structured interviews was conducted between January and May 2021 in one Hospital Authority cluster in Hong Kong. Purposive sampling was employed to recruit primary care doctors in the cluster. The Theoretical Domains Framework (TDF) underpinned the study and guided the development of the interview questions. Data was analysed using both inductive and deductive approaches. The Consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide the reporting. RESULTS: Interviews were conducted with 17 primary care doctors. Four overarching themes were inductively identified: knowledge and previous practice patterns influence prescription, balancing risks and benefits, doctors' professional responsibilities, and system barriers. The four themes were then deductively mapped to the nine specific domains of the TDF: knowledge; intention; memory; beliefs about capabilities; beliefs about consequences; goals; role and identity; emotion; and environmental constraints. Most interviewees, to varying extent, were aware of the cardio-renal advantages and safety profile of SGLT2 I but are reluctant to prescribe or change their patients to SGLT2 I because of their knowledge gap that the cardio-renal benefits of SGLT2 I was independent of glyacemic efficacy. Other barriers included their considerations of patients' age and renal impairment, and patients' perceptions and preferences. CONCLUSIONS: Despite evidence-based recommendations of the utilisation of SGLT2 I in patients with established ASCVD/CKD, the prescription behaviour among primary care doctors was affected by various factors, most of which were amendable. Our findings will inform the development of structured interventions to address these factors to improve patients' cardio-renal outcomes.

Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review.

With type 2 diabetes prevalence increasing in Australia, and the condition associated with significant morbidity and mortality, screening for dysglycaemia in the dental setting has been proposed to identify asymptomatic individuals. Screening commences with a risk assessment, and individuals identified at elevated risk for having diabetes are then referred to their medical practitioner for confirmation of their glycemic status. Therefore, for screening to be effective, individuals need to adhere to their oral health professionals' (OHP) advice and attend their medical follow-ups. This review aims to investigate the literature on referral compliance following a risk assessment in the dental setting and identify barriers and facilitators to screened individuals' referral compliance. A scoping review of the literature was undertaken, selecting studies of diabetes screening in a dental setting that recorded compliance to referral to follow-up, and explored any barriers and facilitators to adherence. Fourteen studies were selected. The referral compliance varied from 25 % to 90%. Six studies reported barriers and facilitators to attending medical follow-ups. Barriers identified included accessibility, cost, knowledge of the condition, and OHP characteristics.

Diabetes and Oral Health (DiabOH): The Perspectives of Primary Healthcare Providers in the Management of Diabetes and Periodontitis in China and Comparison with Those in Australia.

Diabetes and periodontal disease are highly prevalent conditions around the world with a bilateral causative relationship. Research suggests that interprofessional collaboration can improve care delivery and treatment outcomes. However, there continues to be little interprofessional management of these diseases. DiabOH research aims to develop an interprofessional diabetes and oral health care model for primary health care that would be globally applicable. Community medical practitioners (CMPs), community health nurses (CNs), and dentists in Shanghai were recruited to participate in online quantitative surveys. Response data of 76 CMPs, CNs, and dentists was analysed for descriptive statistics and compared with Australian data. Health professionals in China reported that, while screening for diabetes and periodontitis, increasing patient referral and improving interprofessional collaboration would be feasible, these were not within their scope of practice. Oral health screening was rarely conducted by CMPs or CNs, while dentists were not comfortable discussing diabetes with patients. Most participants believed that better collaboration would benefit patients. Chinese professionals concurred that interprofessional collaboration is vital for the improved management of diabetes and periodontitis. These views were similar in Melbourne, except that Shanghai health professionals held increased confidence in managing patients with diabetes and were more welcoming to increased oral health training.