Building capacity in those who deliver palliative care services to Aboriginal and Torres Strait Islander peoples.

The role of culture in palliative care for Aboriginal and Torres Strait Islander peoples builds on over 60 000 years of history and includes meaningful practices to support a good "finishing up". The Gwandalan National Palliative Care Project aims to build capacity in those who deliver palliative care to embed culturally responsive care in all end-of-life settings. Community consultation, value co-creation and user-centred design ensured that diverse Aboriginal and Torres Strait Islander perspectives informed the Gwandalan curriculum. Emerging communities of practice serve as yarning circles where barriers to and enablers of service delivery can be shared and addressed collaboratively.

Creating person-centred health care value together.

In this article we ask: to what extent is person-centred care truly embedded in our system, and are we making the most of the policy levers that could help? We describe person-centred care, shine a light on deficits in the health system, and point to some policy enablers to support person-centred care. Cultural change and a commitment to value-based health care are required. We highlight the merit in adopting and acting on patient-reported measures as an indicator of what matters to the patient, the need for integrated data systems, and the role of a co-creation approach. Most importantly, we underscore the importance of funding reform and consumer leadership.

Factors affecting the embedding of integrated primary-secondary care into a health district.

With the aging population, the tide of chronic disease is rising with attendant increases in health service need. Integrated care and patient-centred approaches, which established partnerships between a regional Hospital and health service (HHS), the local primary health network and local general practitioners (GPs), were identified as exemplars of an approach needed to support growing community health needs. This paper summarises the findings from a process evaluation of four GP-specialist care integration programs with the aim of identifying recommendations for embedding integrated GP-specialist care into routine practice within the HHS. The process evaluation of the integration programs drew on input from a multidisciplinary expert advisory group and data collected through face-to-face semi-structured interviews with key stakeholders, as well as surveys of participating GPs and patients. Overarching findings were identified and grouped under six themes: interdisciplinary teamwork; communication and information exchange; the use of shared care guidelines or pathways; training and education; access and accessibility; and funding. Within each theme, key challenges and enablers emerged. The findings of this study highlight benefits and challenges associated with the establishment of integrated care between primary and secondary care providers, leading to the development of key recommendations for routine integration.

On the road to value co-creation in health care: the role of consumers in defining the destination, planning the journey and sharing the drive.

The role of consumers is now extending beyond being passive health care recipients and even active participants in their own care to involvement in innovation and value co-creation in health care - from being "users and choosers" to becoming "makers and shapers" of services. For active dialogue to occur in co-creation, consumers must become equal partners with health care organisations and providers, with the focus on areas of interest to all parties. The use of value co-creation in health care involves embedding the approach across the whole health care system - from the microsystem level to the mesosystem and the entire macrosystem.

Quality tools and resources to support organisational improvement integral to high-quality primary care: a systematic review of published and grey literature.

OBJECTIVE: To conduct a systematic review of the literature to identify existing online primary care quality improvement tools and resources to support organisational improvement related to the seven elements in the Primary Care Practice Improvement Tool (PC-PIT), with the identified tools and resources to progress to a Delphi study for further assessment of relevance and utility. STUDY DESIGN: Systematic review of the international published and grey literature. DATA SOURCES: CINAHL, Embase and PubMed databases were searched in March 2014 for articles published between January 2004 and December 2013. GreyNet International and other relevant websites and repositories were also searched in March-April 2014 for documents dated between 1992 and 2012. STUDY SELECTION: All citations were imported into a bibliographic database. Published and unpublished tools and resources were included in the review if they were in English, related to primary care quality improvement and addressed any of the seven PC-PIT elements of a high-performing practice. Tools and resources that met the eligibility criteria were then evaluated for their accessibility, relevance, utility and comprehensiveness using a four-criteria appraisal framework. DATA EXTRACTION AND SYNTHESIS: We used a data extraction template to systematically extract information from eligible tools and resources. A content analysis approach was used to explore the tools and resources and collate relevant information: name of the tool or resource, year and country of development, author, name of the organisation that provided access and its URL, accessibility information or problems, overview of each tool or resource and the quality improvement element(s) it addresses. If available, a copy of the tool or resource was downloaded into the bibliographic database, along with supporting evidence (published or unpublished) on its use in primary care. CONCLUSIONS: This systematic review identified 53 tools and resources that can potentially be provided as part of a suite of tools and resources to support primary care practices in improving the quality of their practice, to achieve improved health outcomes.

The Partners in Recovery program: mental health commissioning using value co-creation.

The Australian Government's Partners in Recovery (PIR) program established a new form of mental health intervention which required multiple sectors, services and consumers to work in a more collaborative way. Brisbane North Primary Health Network applied a value co-creation approach with partners and end users, engaging more than 100 organisations in the development of a funding submission to PIR. Engagement platforms were established and continue to provide opportunities for new co-creation experiences. Initially, seven provider agencies - later expanded to eight to include an Aboriginal and Torres Strait Islander provider organisation - worked collaboratively as a Consortium Management Committee. The co-creation development process has been part of achieving the co-created outcomes, which include new initiatives, changes to existing interventions and referral practices, and an increased understanding and awareness of end users' needs.

Key elements of high-quality practice organisation in primary health care: a systematic review.

OBJECTIVES: To identify elements that are integral to high-quality practice and determine considerations relating to high-quality practice organisation in primary care. STUDY DESIGN: A narrative systematic review of published and grey literature. DATA SOURCES: Electronic databases (PubMed, CINAHL, the Cochrane Library, Embase, Emerald Insight, PsycInfo, the Primary Health Care Research and Information Service website, Google Scholar) were searched in November 2013 and used to identify articles published in English from 2002 to 2013. Reference lists of included articles were searched for relevant unpublished articles and reports. DATA SYNTHESIS: Data were configured at the study level to allow for the inclusion of findings from a broad range of study types. Ten elements were most often included in the existing organisational assessment tools. A further three elements were identified from an inductive thematic analysis of descriptive articles, and were noted as important considerations in effective quality improvement in primary care settings. CONCLUSION: Although there are some validated tools available to primary care that identify and build quality, most are single-strategy approaches developed outside health care settings. There are currently no validated organisational improvement tools, designed specifically for primary health care, which combine all elements of practice improvement and whose use does not require extensive external facilitation.

Development and pilot study of the Primary Care Practice Improvement Tool (PC-PIT): an innovative approach.

OBJECTIVE: To assess the usability and validity of the Primary Care Practice Improvement Tool (PC-PIT), a practice performance improvement tool based on 13 key elements identified by a systematic review. It was co-created with a range of partners and designed specifically for primary health care. DESIGN: This pilot study examined the PC-PIT using a formative assessment framework and mixed-methods research design. SETTING AND PARTICIPANTS: Six high-functioning general practices in Queensland, Australia, between February and July 2013. A total of 28 staff participated - 10 general practitioners, six practice or community nurses, 12 administrators (four practice managers; one business manager and eight reception or general administrative staff). MAIN OUTCOME MEASURES: Readability, content validity and staff perceptions of the PC-PIT. RESULTS: The PC-PIT offers an appropriate and acceptable approach to internal quality improvement in general practice. Quantitative assessment scores and qualitative data from all staff identified two areas in which the PC-PIT required modification: a reduction in the indicative reading age, and simplification of governance-related terms and concepts. CONCLUSION: The PC-PIT provides an innovative approach to address the complexity of organisational improvement in general practice and primary health care. This initial validation will be used to develop a suite of supporting, high-quality and free-to-access resources to enhance the use of the PC-PIT in general practice. Based on these findings, a national trial is now underway.

A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia.

OBJECTIVE: To review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. STUDY DESIGN: Systematic review of peer-reviewed literature. DATA SOURCES: PubMed and Embase databases were searched in December 2012 for studies published in English between January 2007 and December 2012. STUDY SELECTION: Studies of any type were included if they defined PCMH using the Patient-Centered Primary Care Collaborative Joint Principles, and reported data on challenges and barriers to implementation and adoption of the PCMH model. DATA EXTRACTION: One researcher with content knowledge in the area abstracted data relating to the review objective and study design from eligible articles. A second researcher reviewed the abstracted data alongside the original article to check for accuracy and completeness. DATA SYNTHESIS: Thematic synthesis was used to in three stages: free line-by-line coding of data; organisation of "free codes" into related areas to construct "descriptive" themes and develop "analytical" themes. The main barriers identified related to: challenges with the transformation process; difficulties associated with change management; challenges in implementing and using an electronic health record that administers principles of PCMH; challenges with funding and appropriate payment models; insufficient resources and infrastructure within practices; and inadequate measures of performance. CONCLUSION: This systematic review documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable evidence for Australian clinicians, policymakers, and organisations approaching adoption of PCMH elements within reform initiatives in this country.

Wound care costs in general practice - a cross-sectional study.

BACKGROUND: The management of wounds presents a significant burden to healthcare services, consuming a large amount of resources. This study aimed to determine the cost of wound care in general practice by conducting an audit of current wound management practices. METHODS: Eighteen general practices collected data on wound care episodes over a period of 14 days during December 2011. RESULTS: For most of the 332 wound care episodes, the total cost was greater than the total income, resulting in a net loss to the practice. General practitioner care was the greatest contributor to the total cost and the overwhelming majority of income was from Medicare Benefits Schedule billing items. DISCUSSION: In most cases, general practices are not recouping the costs of wound care. There is a need for policy makers and general practices to review wound care funding and practices to ensure equitable best practice care is being provided.

Information resource needs and preference of queensland general practitioners on complementary medicines: result of a needs assessment.

Objectives. To explore in a cohort of Queensland (Qld) GPs' their attitudes to; knowledge about; and practice behaviour regarding complementary medicines (CMs), and to identify their perceptions of need for information resources on CMs. Design. A faxed self-administered survey to a random sample of 800 GPs in Qld. Participants. 463 completed surveys were returned, representing a 58% response rate. Results. The majority of GPs had a positive attitude about incorporating CMs in their clinical practice; however, only 12% perceived they had adequate knowledge to be able to advise patients about CMs. GPs most preferred evidence-based resources for receiving information on CMs (fact sheets, booklets, and journals) that contain clinical, pharmacological, and toxicological information. Most GPs perceived a need for an information resource on herbal medicines, vitamins, minerals, and trace elements, and nutritional supplements. Conclusion. GPs are open to integrating CMs into their clinical practice. They identify a current lack of knowledge coupled with a substantive level of interest to learn more. GPs perceive a high level of need for information resources on CMs. These resources should be developed and readily available to GPs to increase their knowledge about CMs and better equip them in communicating with patients about CMs use.