Cultivating participatory approaches in health promotion planning, delivery, and evaluation: A case study of an academic-health service partnership in rural Victoria.

ISSUE ADDRESSED: Community participation in planning, delivery, and evaluation of health promotion (HP) programs is a poorly explored topic. However, this approach has the potential to improve health outcomes and reduce health inequities, particularly for residents of rural and remote areas. METHODS: This case study describes the outputs of an academic-health service partnership in rural Victoria. The collaboration has led to the implementation and ongoing evaluation of a microgrant program for HP which integrates community participation principles in the foundations of the program and its evaluation. RESULTS: To date, 10 funded projects have been brought to completion, with COVID-19 having disturbed both grant distribution and funded activity implementation. Semi-structured interviews with health service officers served to clarify conceptualisation and operationalization of HP principles. Focus groups with health service management and officers contributed to building an overarching evaluation framework for the HP team's activities. Finally, the specific methodological evaluation framework for the microgrant program was developed through a collaborative workshop with the HP team and grantees. CONCLUSIONS: Fostering community participation in HP planning, delivery, and evaluation, especially in rural areas, is feasible as evidenced by the experience described in this case study. The forthcoming evaluation results will help clarify the impact of community participation on health-related outcomes. SO WHAT?: Documentation and dissemination of processes used to increase community participation in HP programs is essential to grow the knowledge base around what works and what doesn't, and for whom.

Suicide-related crisis presentations to a rural emergency department: A retrospective cohort study.

OBJECTIVE: The study sought to investigate the profile and characteristics of suicide-related crisis presentations and factors associated with repeat presentations to a rural hospital Emergency Department (ED). METHOD: This retrospective cohort study examined suicide-related crisis presentation data from a rural ED for the years 2008-2018 inclusive. Descriptive statistical analyses included demographic characteristics and trends over time. Factors associated with increased likelihood to re-present to the ED for suicide-related crisis were identified using Odds Ratio analyses. RESULTS: First Nations People, adolescents and young adults were at increased risk of presentation. Suicidal crisis presentations had increased well beyond that which might be accorded to the catchment's population increase and almost a third of presentations involved individuals re-presenting in suicide-related crisis. Repeat presentation was positively associated with younger age, less acute triage category, discharge to the community and leaving the ED before/during treatment. CONCLUSIONS: This study illustrates the importance of flagging, follow-up and support of rural repeat presenters to reduce further suicidal behaviours and presentation. Findings support the need for culturally safe and appropriate interventions and follow-up services. It is recommended to extend approach this to non-ED settings.

Evaluation Methods in Community Microgrant Programs for Health Promotion: A Scoping Review.

CONTEXT: Evaluating community-based health promotion programs is an essential aspect of public health programming to ensure evidence-based practices, justify limited resource allocation, and share knowledge about promising strategies. Community microgrant schemes represent a viable strategy to strengthen local health promotion, yet limited guidance exists surrounding the evaluation of such programs. OBJECTIVE: This research aimed to map methods used in evaluating community microgrants programs for health promotion. DESIGN: A scoping review in accordance with Joanna Briggs Institute methodology. ELIGIBILITY CRITERIA: Peer-reviewed academic and gray literature, which evaluated processes and/or outcomes of nonprescriptive community-based microgrant program for health promotion in high-income countries. STUDY SELECTION: Literature was identified through MEDLINE, Scopus, CINAHL, and EMBASE databases, Google and DuckDuckGo browsers, and hand-searching key reference lists. Articles were screened by title, abstract, and then full-text. MAIN OUTCOME MEASURES: Review findings were mapped according to included sources' evaluation methodologies. RESULTS: Eighteen academic publications describing 14 microgrant programs met the inclusion criteria. These spanned the years 1996 to 2020 and were located across 5 countries. Evaluation methods were very similar in terms of design (mixed-methods case studies) and focus (both processes and outcomes) and yet varied widely with regard to measurements and data collection. Few made explicit the use of an evaluation framework, chose to involve stakeholders in the evaluation process, or discussed application and dissemination of evaluation findings. DISCUSSION: Community-based microgrant programs for health promotion are a promising model in diverse settings and with various health priorities and targets, yet robust evaluations of their implementation and effectiveness are lacking. The review highlights the need to further develop and support evaluation practices in public health, even in small-scale programs with limited budgets.

Barriers and Facilitators to Screening for Cognitive Impairment in Australian Rural Health Services: A Pilot Study.

Australian National standards recommend routine screening for all adults over 65 years by health organisations that provide care for patients with cognitive impairment. Despite this, screening rates are low and, when implemented, screening is often not done well. This qualitative pilot study investigates barriers and facilitators to cognitive screening for older people in rural and regional Victoria, Australia. Focus groups and interviews were undertaken with staff across two health services. Data were analysed via thematic analysis and contextualized within the i-PARIHS framework. Key facilitators of screening included legislation, staff buy-in, clinical experience, appropriate training, and interorganisational relationships. Collaborative implementation processes, time, and workloads were considerations in a recently accredited tertiary care setting. Lack of specialist services, familiarity with patients, and infrastructural issues may be barriers exacerbated in rural settings. In lieu of rural specialist services, interorganisational relationships should be leveraged to facilitate referring 'outwards' rather than 'upwards'.

Audiologists' perspective on the treatment of ear-related ear, nose, and throat conditions in rural Victoria.

OBJECTIVES: To understand the experience of audiologists in managing and treating ear-related ear, nose and throat conditions in rural areas, and to identify the compounding factors that influence patient outcomes and potential targets for intervention. DESIGN: A focus group was conducted using a qualitative descriptive approach. Responses were audio-recorded, transcribed and thematically analysed. SETTING: The focus group was conducted in the rural town of Mildura in the state of Victoria, Australia. PARTICIPANTS: A sample of 19 audiologists from Victoria participated, of which 14 were rurally based and 5 were metropolitan-based. The length of participants' professional experience ranged from 1 to 43 years. RESULTS: Long wait lists, and a lack of locally based ear, nose and throat surgeons were identified as barriers to the treatment of ear-related ear, nose and throat conditions. Open communication between health services and efficient care for time-sensitive conditions were seen as outcomes of good practice. Hand hygiene, nose-blowing, reducing tobacco smoke exposure and promoting the use of noise protective equipment were the 4 community health campaigns mentioned to support ear care for those residing in rural areas. Additional themes of ear conditions, treatment, management and primary health care were identified. CONCLUSION: Improving referral pathways for the treatment of ear-related ear, nose and throat conditions, and providing education about ear, nose and throat assessment and treatment in primary health care settings could increase appropriate referrals, improve patient outcomes and reduce wait periods for treatment.

A seat at the table: Regional, rural and remote health research and impact.

AIMS: Across higher education, systems and policies explicitly address the impact of research. This paper contributes to the impact and engagement discussion from a regional, rural and remote perspective. We focus on how impact and engagement fit with regional, rural and remote research and explore strategies that can be employed to enhance impact and engagement in a rural health research context. CONTEXT: The impact agenda in Australia is a response to a worldwide call for demonstrable change or potential for change resulting from university research. As funding models evolve to integrate impact, there are increased pressures for universities and academics to plan for, evidence and report on it. The current lack of focus on impact in regional, rural and remote research may further disadvantage regional, rural and remote researchers' prospects for career progression and funding opportunities. APPROACH: Ignoring or avoiding impact will marginalise rural researchers and research. We discuss the definitions of impact and engagement as they apply to rural research and argue that engagement and impact must be commensurate with employment conditions. To platform regional, rural and remote impact, we provide strategies to assist researchers and administrators in building impact and engagement into their research and academic culture. CONCLUSION: The message to researchers is that impact is here to stay. The high levels of rural engagement can lead to impact, but we need to be clever at providing clear evidence to make that visible.

Palliative Care in Rural Aboriginal Communities: Conversations Around Experiences and Needs.

The aim of this study was to investigate the experiences and needs of Aboriginal community members with regard to rural community-based palliative care. Conversations with Aboriginal Elders were conducted. (In this Aboriginal community, Elders was not confined to older age. It referred to community leaders and includes [younger] emerging leaders.) The results were analyzed using descriptive analysis. Our study showed that there was a general lack of understanding of palliative care as distinct from curative care and limited awareness of services available. There was a strong need for clear information and on-call and practical support. Some concerns were expressed regarding limited awareness among health care providers of specific cultural needs. However, the home-based nature of palliative care was not, in itself, perceived as a barrier, provided that appropriate respect was displayed. We concluded that the current lack of understanding and awareness of services still impedes access to, and utilization of, care. More attention is needed for specific cultural needs. Adoption of a cultural humility approach for the promotion and delivery of palliative care seems to best fit the expressed needs and experiences of the participants.

Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review.

BACKGROUND: Healthcare systems are overloaded and changing. In response to growing demands on the healthcare systems, new models of healthcare delivery are emerging. Community paramedicine is a novel approach in which paramedics use their knowledge and skills beyond emergency health response to contribute to preventative and rehabilitative health. In our systematic review, we aimed to identify evidence of the community paramedicine role in care delivery for elderly patients, with an additional focus on palliative care, and the possible impact of this role on the wider healthcare system. METHODS: A systematic review of peer-reviewed literature from MEDLINE, Embase, CINAHL, and Web of Sciences was undertaken to identify relevant full-text articles in English published until October 3, 2019. Additional inclusion criteria were studies focussing on extended care paramedics or community paramedics caring for elderly patients. Case studies were excluded. All papers were screened by at least two authors and underwent a quality assessment, using the Joanna Briggs Institute appraisal checklists for cross sectional, qualitative, cohort, and randomised controlled trial studies to assess the methodological quality of the articles. A process of narrative synthesis was used to summarise the data. RESULTS: Ten studies, across 13 articles, provided clear evidence that Community Paramedic programs had a positive impact on the health of patients and on the wider healthcare system. The role of a Community Paramedic was often a combination of four aspects: assessment, referral, education and communication. Limited evidence was available on the involvement of Community Paramedics in palliative and end-of-life care and in care delivery in residential aged care facilities. Observed challenges were a lack of additional training, and the need for proper integration and understanding of their role in the healthcare system. CONCLUSIONS: The use of community paramedics in care delivery could be beneficial to both patients' health and the wider healthcare system. They already play a promising role in improving the care of our elderly population. With consistent adherence to the training curriculum and effective integration within the wider healthcare system, community paramedics have the potential to take on specialised roles in residential aged care facilities and palliative and end-of-life care.

Factors influencing the engagement of cancer patients with advance care planning: A scoping review.

INTRODUCTION: Advance care planning (ACP) is increasingly regarded as the best way to optimise end-of-life (EOL) care. Studies have examined a multitude of factors impacting on the lagging uptake of ACP. In the current study, we specifically focused on patient factors related to the uptake of ACP in adult cancer patients. METHODS: A scoping review was conducted, for which we searched the CINAHL, Cochrane, MEDLINE and PsycINFO databases (January 2013-December 2018). Studies exploring patient-related factors influencing the uptake of ACP in cancer patients were eligible for inclusion. RESULTS: Eleven papers and two overarching themes: person-related (e.g. socio-demographic) factors and "comprehension and awareness," were identified. White, well-educated patients with a support network were more likely to be involved in ACP. However, there is limited comprehension and awareness among cancer patients regarding ACP. CONCLUSIONS: The identified themes warrant a tailored approach to ACP. With regard to person-related factors, the existing body of knowledge on health literacy, disparities and shared decision-making should be used when designing strategies to improve ACP uptake. Further, our findings regarding "comprehension and awareness" suggest that ACP should not be limited to a narrow process without acknowledging the complexity surrounding personalised cancer care near the EOL.

Assessment and recency drive skill acquisition.

BACKGROUND: The assessment of medical students' clinical skill acquisition is variable and is driven by differences in curricula and health services requirements. This project aimed to ascertain whether different assessment models impact on students' performance of as intravenous (i.v.) cannulation. Recency of practice was also explored as a factor influencing performance. METHODS: A total of 137 students in the first clinical year (years 2 or 3 of a 4-year course) of their medical degree, from four regional clinical schools, participated in a multiple-station mock objective structured clinical examination (MOSCE). Intravenous cannulation was one of the stations examined. Fifty-nine students came from a model that required the assessment of i.v. proficiency during their clinical year (model 1). Seventy-eight students came from a model that required no assessment of i.v. proficiency (model 2). Students reported their most recent clinical i.v. cannulation experience relative to the MOSCE. RESULTS: The MOSCE pass rate of 73% for students in model 1 was significantly higher than the corresponding MOSCE pass rate of 45% for students in model 2. There was a highly significant association between assessment model and MOSCE pass/fail rate. The assessment model was also highly associated with recency of practice. The assessment of medical students' clinical skill acquisition is variable CONCLUSIONS: The results support an assessment model that promotes the continuing clinical practice of i.v. cannulation. Integration of this model will require innovative approaches by staff and collaboration with affiliated organisations.

Evaluating the Impact of the Dementia Care in Hospitals Program (DCHP) on Hospital-Acquired Complications: Study Protocol.

Despite the increasing number of older people, many with cognitive impairment (CI), in hospitals, there is yet to be an evaluation of hospital-wide interventions improving the management of those with CI. In hospitalized patients with CI, there are likely to be associations between increased complications that impact on outcomes, length of stay, and costs. This prospective study will evaluate the effectiveness of an established hospital CI support program on patient outcomes, patient quality of life, staff awareness of CI, and carer satisfaction. Using a stepped-wedge, continuous-recruitment method, the pre-intervention patient data will provide the control data for usual hospital care. The intervention, the Dementia Care in Hospitals Program, provides hospital-wide CI awareness and support education, and screening for all patients aged 65+, along with a bedside alert, the Cognitive Impairment Identifier. The primary outcome is a reduction in hospital-acquired complications: urinary tract infections, pressure injuries, pneumonia and delirium. Secondary outcome measures include cost effectiveness, patient quality of life, carer satisfaction, staff awareness of CI, and staff perceived impact of care. This large-sample study across four sites offers an opportunity for research evaluation of health service functioning at a whole-of-hospital level, which is important for sustainable change in hospital practice.

Utility of split-night polysomnography in the diagnosis of upper airway resistance syndrome.

PURPOSE: Split-night polysomnography can both establish the diagnosis and titrate continuous positive airway pressure (CPAP) during a single study in patients with sleep-disordered breathing. We sought to determine if split-night polysomnography could be effectively used in upper airway resistance syndrome (UARS) without diminishing diagnostic accuracy or success of CPAP titration. METHODS: Consecutive patients diagnosed with UARS were included. Split-night studies were performed in patients meeting predefined criteria. We compared data between those undergoing traditional and split-night polysomnography. RESULTS: We included 100 consecutive patients (41.2 +/- 7.4 years, 54% men). Forty-six underwent split-night polysomnography. Groups were similar at baseline. There were no differences in polysomnography or success rate of CPAP titration. Among those not undergoing split-night studies, the mean time between diagnostic polysomnography and CPAP titration was 71.9 +/- 49.0 days. CONCLUSIONS: Split-night polysomnography can be effectively utilized to diagnose UARS and initiate CPAP therapy. This practice can reduce the number of studies needed and obviate the inherent delay in initiating CPAP therapy.