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2.
BMJ Paediatr Open ; 3(1): e000487, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31646191

RESUMEN

Urinary tract infections (UTIs) are a common and potentially serious bacterial infection of childhood. History and examination findings can be non-specific, so a urine sample is required to diagnose UTI. Sample collection in young precontinent children can be challenging. Bedside dipstick tests are useful for screening, but urine culture is required for diagnostic confirmation. Antibiotic therapy must be guided by local guidelines due to increasing antibiotic resistance. Duration of therapy and indications for imaging remain controversial topics and guidelines lack consensus. This article presents an overview of paediatric UTI diagnosis and management, with highlights of recent advances and evidence updates.

3.
Aust N Z J Public Health ; 43(6): 582-588, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31577863

RESUMEN

OBJECTIVE: To quantify barriers to healthcare for young people (12-24 years) and identify socio-demographic correlates and predictors. METHODS: This cross-sectional survey targeted young people living in New South Wales, Australia, with oversampling of marginalised groups. Principles Component Analysis (PCA) identified clusters of barriers. Ordinal regression identified predictors of each barrier cluster. RESULTS: A total of 1,416 young people completed surveys. Participants with chronic conditions and increasing psychological distress reported a greater number of barriers. Of 11 potential barriers to visiting a health service, cost was most common (45.8%). The PCA identified three clusters: structural barriers (61.3%), attitudinal barriers (44.1%) and barriers relating to emerging autonomy (33.8%). CONCLUSIONS: Barriers to healthcare reported by young people are multi-dimensional and have changed over time. Structural barriers, especially cost, are the most prominent among young people. Approaches to overcome structural barriers need to be addressed to better support marginalised young people's healthcare access. Implications for public health: Understanding predictors of different barrier types can inform more targeted approaches to improving access. Equitable access to healthcare is a priority for early diagnosis and treatment in young people, especially reducing out of pocket costs.


Asunto(s)
Actitud del Personal de Salud , Prestación de Atención de Salud/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Adolescente , Niño , Estudios Transversales , Femenino , Humanos , Internet , Masculino , Nueva Gales del Sur , Marginación Social , Encuestas y Cuestionarios , Poblaciones Vulnerables , Adulto Joven
4.
JMIR Ment Health ; 6(10): e13189, 2019 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-31625945

RESUMEN

BACKGROUND: Mental health and substance use disorders are the main causes of disability among adolescents and young adults yet fewer than half experiencing these problems seek professional help. Young people frequently search the Web for health information and services, suggesting that Web-based modalities might promote help-seeking among young people who need it. To support young people in their help-seeking, we developed a Web-based mental health service navigation website called Link. Link is based on the Theory of Planned Behavior and connects young people with treatment based on the type and severity of mental health symptoms that they report. OBJECTIVE: The study aimed to investigate the effect of Link on young people's positive affect (PA) compared with usual help-seeking strategies immediately post intervention. Secondary objectives included testing the effect of Link on negative affect (NA), psychological distress, barriers to help-seeking, and help-seeking intentions. METHODS: Young people, aged between 18 and 25 years, were recruited on the Web from an open access website to participate in a randomized controlled trial. Participants were stratified by gender and psychological distress into either the intervention arm (Link) or the control arm (usual help-seeking strategies). Baseline, immediate postintervention, 1-month, and 3-month surveys were self-reported and administered on the Web. Measures included the PA and NA scales, Kessler psychological distress scale (K10), barriers to adolescent help-seeking scale (BASH), and the general help-seeking questionnaire (GHSQ). RESULTS: In total 413 young people were recruited to the trial (intervention, n=205; control, n=208) and 78% (160/205) of those randomized to the intervention arm visited the Link website. There was no evidence to support a difference between the intervention and control arms on the primary outcome, with PA increasing equally by approximately 30% between baseline and 3 months in both arms. NA decreased for the intervention arm compared with the control arm with a difference of 1.4 (95% CI 0.2-2.5) points immediately after the intervention and 2.6 (95% CI 1.1-4.1) at 1 month. K10 scores were unchanged and remained high in both arms. No changes were found on the BASH or GHSQ; however, participants in the intervention arm appeared more satisfied with their help-seeking process and outcomes at 1 and 3 months postintervention. CONCLUSIONS: The process of prompting young people to seek mental health information and services appears to improve their affective state and increase help-seeking intentions, regardless of whether they use a Web-based dedicated youth-focused tool, such as Link, or their usual search strategies. However, young people report greater satisfaction using tools designed specifically for them, which may encourage future help-seeking. The ability of Web-based tools to match mental health needs with appropriate care should be explored further. CLINICAL TRIAL: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366731.

6.
J Med Internet Res ; 21(7): e13065, 2019 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-31333199

RESUMEN

BACKGROUND: Little empirical evidence is available to support the effectiveness and cost-effectiveness of internet interventions to increase help-seeking behavior for mental health in young adults. OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of a Web-based mental health help-seeking navigation tool (Link) in comparison with usual help-seeking strategies. METHODS: A cost-utility analysis alongside the main randomized trial of Link was conducted from the Australian health care sector perspective. Young adults aged 18 to 25 years were randomized to the Link intervention (n=205) or usual care (n=208) with 1- and 3-month follow-ups. The primary outcome of this study was quality-adjusted life years (QALYs) measured by the assessment of quality of life-4D. Costs were calculated based on the self-reported resource use questionnaire and were reported in 2015 Australian dollars. Primary analyses were conducted as intention-to-treat and reported as incremental cost-effectiveness ratios. Completer analyses were conducted in a sensitivity analysis. RESULTS: Significantly more QALYs were gained in the intervention group than the control group (0.15 vs 0.14; P<.001). The intervention was associated with significantly lower health professional consultation costs at 1-month follow-up (mean costs Aus $98 vs Aus $162; P<.05). Costs of hospital services were lower at 3 months in the intervention arm (mean costs Aus $47 vs Aus $101); however, there was insufficient sample size to detect a significant difference between the groups. There were no statistically significant differences in the total costs between the 2 arms. Relative to the control group, those who received the intervention experienced 0.01 more QALYs (0.00-0.02) and had lower total health sector costs of Aus -$81 (Aus -$348 to Aus $186) over 3 months. The intervention was found to be more effective and less costly compared with usual help-seeking strategies. The intervention was 100% likely to be cost-effective below a willingness-to-pay value-for-money threshold of Aus $28,033 per QALY. Results were robust in the sensitivity analysis. CONCLUSIONS: Our study found that the online youth mental health help-seeking Web service is a cost-effective intervention for young people aged 18 to 25 years compared with usual search strategies. Further research is required to confirm these results. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=366731.

7.
Aust J Gen Pract ; 48(6): 389-394, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31220890

RESUMEN

BACKGROUND AND OBJECTIVES: Australia's high rate of unintended pregnancy could be lowered by increasing long-acting reversible contraception (LARC) use. Influences on Australian women's choice of less effective methods are not well understood. This qualitative study explored factors that influence young women's contraceptive choices. METHOD: Semi-structured interviews were conducted with women aged 18-24 years until data saturation. Interviews were audio-recorded, transcribed and thematically analysed. RESULTS: Contraceptive choice was influenced by factors including contraceptive knowledge, side effects, cultural norms, fear, control and social context. Women often initiated contraceptive use for non contraceptive purposes such as management of acne or period pain, and failed to reconsider new methods when needing contraception, revealing one possible explanation for low LARC use. DISCUSSION: Findings indicate that women's contraceptive choices need regular review. Information about relative efficacy of contraceptive methods is necessary should women's reasons for using contraception include birth control in addition to non-contraceptive benefits.

8.
Int J Equity Health ; 18(1): 41, 2019 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-30832651

RESUMEN

BACKGROUND: Young people have unique social, emotional and developmental needs that require a welcoming and responsive health system, and policies that support their access to health care. Those who are socially or culturally marginalised may face additional challenges in navigating health care, contributing to health inequity. The aim of this study was to understand health system navigation, including the role of technology, for young people belonging to one or more marginalised groups, in order to inform youth health policy in New South Wales, Australia. METHODS: This qualitative longitudinal study involved 2-4 interviews each over 6 to 12 months with marginalised young people aged 12-24 years living in NSW. The analysis used Nvivo software and grounded theory. RESULTS: We interviewed 41 young people at baseline who were living in rural or remote areas, sexuality and/or gender diverse, refugee, homeless, and/or Aboriginal. A retention rate of over 85% was achieved. Nineteen belonged to more than one marginalised group allowing an exploration of intersectionality. General practitioners (family physicians) were the most commonly accessed service throughout the study period. Participants were ambivalent about their healthcare journeys. Qualitative analysis identified five themes: 1. Technology brings opportunities to understand, connect and engage with services 2. Healthcare journeys are shaped by decisions weighing up convenience, engagement, effectiveness and affordability. 3. Marginalised young people perceive and experience multiple forms of discrimination leading to forgone care. 4. Multiple marginalisation makes health system navigation more challenging 5. The impact of health system complexity and fragmentation may be mitigated by system knowledge and navigation support CONCLUSIONS: The compounding effects of multiple discrimination and access barriers were experienced more strongly for young people belonging to mutiple marginalised groups. We identify several areas for improving clinical practice and policy. Integrating technology and social media into processes that facilitate access and navigation, providing respectful and welcoming services that recognise diversity, improving health literacy and involving professionals in advocacy and navigation support may help to address these issues.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Equidad en Salud , Accesibilidad a los Servicios de Salud , Marginación Social , Adolescente , Niño , Femenino , Política de Salud , Humanos , Estudios Longitudinales , Masculino , Nueva Gales del Sur , Investigación Cualitativa , Adulto Joven
9.
J Prim Health Care ; 10(1): 76-80, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-30068455

RESUMEN

INTRODUCTION Previous research on general practitioner (GP) referrals in adult populations demonstrated that patient pressure influenced referral practice. No research has been conducted to investigate how involvement of a parent influences paediatric referrals. AIM To investigate whether GPs who report parental influence on their decision to refer paediatric patients differ in their referral patterns from GPs who do not report parental influence. METHOD A mail survey of 400 GPs who had referred at least two children to paediatric specialist outpatient clinics during 2014 was distributed. RESULTS The response rate was 67% (n = 254). For initial referrals, 27% of GPs stated that parental request frequently or almost always influenced their referral decision. For returning referrals, 63% of GPs experienced parental influence to renew a referral because a paediatrician wanted a child to return; 49% of GPs experienced influence to renew a referral because a parent wanted to continue care with a paediatrician. Experiencing parental influence was associated with increased likelihood for frequent referrals in order for a paediatrician to take over management of a child's condition. DISCUSSION GPs who frequently refer with a goal for a paediatrician to take over management of a child's condition also report that parental request almost always influences their decision to refer.


Asunto(s)
Médicos Generales/estadística & datos numéricos , Padres , Pediatría/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Australia , Toma de Decisiones , Metas , Humanos , Pautas de la Práctica en Medicina/estadística & datos numéricos
10.
JMIR Mhealth Uhealth ; 6(4): e105, 2018 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-29691209

RESUMEN

BACKGROUND: Technology-based screening of young people for mental health disorders and health compromising behaviors in general practice increases the disclosure of sensitive health issues and improves patient-centered care. However, few studies investigate how general practitioners (GPs) and practice support staff (receptionists and practice managers) integrate screening technology into their routine work, including the problems that arise and how the staff surmount them. OBJECTIVE: The aim of this study was to investigate the implementation of a health and lifestyle screening app, Check Up GP, for young people aged 14 to 25 years attending an Australian general practice. METHODS: We conducted an in-depth implementation case study of Check Up GP in one general practice clinic, with methodology informed by action research. Semistructured interviews and focus groups were conducted with GPs and support staff at the end of the implementation period. Data were thematically analyzed and mapped to normalization process theory constructs. We also analyzed the number of times we supported staff, the location where young people completed Check Up GP, and whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of taking their appointment. RESULTS: A total of 4 GPs and 10 support staff at the clinic participated in the study, with all except 3 receptionists participating in the final interviews and focus groups. During the 2-month implementation period, the technology and administration of Check Up GP was iterated through 4 major quality improvement cycles in response to the needs of the staff. This resulted in a reduction in the average time taken to complete Check Up GP from 14 min to 10 min, improved SMS text messaging for young people, and a more consistent description of the app by receptionists to young people. In the first weeks of implementation, researchers needed to regularly support staff with the app's administration; however, this support decreased over time, even as usage rose slightly. The majority of young people (73/87, 84%) completed Check Up GP in the waiting room, with less than half (35/80, 44%) having received an SMS from the clinic with a link to the tool. Participating staff valued Check Up GP, particularly its facilitation of youth-friendly practice. However, there was at first a lack of organizational systems and capacity to implement the app and also initially a reliance on researchers to facilitate the process. CONCLUSIONS: The implementation of a screening app in the dynamic and time-restricted general practice setting presents a range of technical and administrative challenges. Successful implementation of a screening app is possible but requires adequate time and intensive facilitation. More resources, external to staff, are needed to drive and support sustainable technology innovation and implementation in general practice settings.

11.
J Adolesc Health ; 62(4): 365-381, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29429819

RESUMEN

PURPOSE: This systematic review examines how marginalized young people access and engage with health services and navigate health-care systems in high-income countries. METHODS: Medline, CINAHL, PsychInfo, The University of Sydney Library database, and Google Scholar were searched to identify qualitative and quantitative original research, published from 2006 to 2017, that focused on selected definitions of marginalized young people (12 to 24 years), their parents/carers, and/or health professionals working with these populations. A thematic synthesis was undertaken identifying themes across and between groups on barriers and/or facilitators to access, engagement, and/or navigation of health-care systems. RESULTS: Of 1,796 articles identified, 68 studies in the final selection focused on marginalized young people who were homeless (n = 20), living in rural areas (n = 14), of refugee background (n = 11), gender and/or sexuality diverse (n = 11), indigenous (n = 4), low income (n = 4), young offenders (n = 2), or living with a disability (n = 2). Studies were from the United States, Australia, Canada, United Kingdom, New Zealand, and Portugal, including 44 qualitative, 16 quantitative, and 8 mixed-method study types. Sample sizes ranged from 3 to 1,388. Eight themes were identified relating to ability to recognize and understand health issues; service knowledge and attitudes toward help seeking; structural barriers; professionals' knowledge, skills, attitudes; service environments and structures; ability to navigate the health system; youth participation; and technology opportunities. CONCLUSIONS: Marginalized young people experience barriers in addition to those common to all young people. Future studies should consider the role of technology in access, engagement, and health system navigation, and the impact of intersectionality between marginalized groups.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Marginación Social/psicología , Adolescente , Países Desarrollados , Salud Global , Personal de Salud/organización & administración , Humanos , Internet , Investigación Cualitativa , Adulto Joven
12.
J Paediatr Child Health ; 54(2): 183-187, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28876494

RESUMEN

AIM: To determine (i) the proportion of different referral sources for new referrals to paediatric specialist outpatient clinics and (ii) any association of referral source with utilisation of additional health services. METHODS: Survey of parents presenting with their child at five paediatric specialist outpatient clinics at two Melbourne public hospitals. RESULTS: Just over half (52%) of the respondents were referred by a general practitioner (GP). The remainder were referred by a paediatrician (27%) at hospital discharge (16%) or from the ED (6%). Most respondents (71%) reported that their child also has a referral to see another specialist for the same health concern but had not yet had the consultation; 44% had consulted another doctor for the same health concern between receiving the referral and the appointment. Paediatrician referrals were more likely to see another specialist for the same health concern compared to other referral sources (P = 0.032). CONCLUSION: Only half of the referrals of new patients to paediatric specialist outpatient clinics come from GPs. Future research should investigate whether multiple referral sources have a negative impact on the co-ordination and cost of paediatric health care.


Asunto(s)
Médicos Generales , Pediatría , Derivación y Consulta , Especialización , Instituciones de Atención Ambulatoria , Australia , Niño , Salud del Niño , Preescolar , Humanos , Lactante , Atención Primaria de Salud , Derivación y Consulta/estadística & datos numéricos , Encuestas y Cuestionarios
13.
Aust J Gen Pract ; 47(12): 829-834, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-31212399

RESUMEN

Background: Adolescence is characterised by rapid changes in physical, cognitive, emotional and social development, and by experimentation and risk-taking, extending from the age of approximately 10 years into the early adult years. Developmental milestones achieved include a sense of identity, autonomy, a value system, peer relationships and financial independence. However, for around one in four adolescents, risktaking and mental health issues threaten healthy biopsychosocial development. Such risks are rarely detected in clinical practice without deliberate assessment within a youth-friendly framework. Objectives: The aim of this paper is to provide an update on risk-taking behaviours in adolescence and highlight tips for re-orienting general practice towards youth-friendly preventive care for adolescents. Discussion: General practice remains the health service most often accessed by young people and has important functions of engaging young people, providing positive experiences of healthcare, detecting risk and protective factors, and intervening early to promote healthy development. Future health system developments must ensure general practice has adequate time and support to provide effective preventive adolescent healthcare.


Asunto(s)
Conducta del Adolescente/psicología , Asunción de Riesgos , Adolescente , Australia/epidemiología , Humanos , Trastornos Mentales/epidemiología , Estado Nutricional , Trastornos Relacionados con Sustancias/epidemiología
14.
Aust Fam Physician ; 46(10): 710-715, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29036768

RESUMEN

BACKGROUND: The use of long-acting reversible contraceptives (LARCs) is globally accepted as a strategy that is successful in decreasing rates of unintended pregnancy, especially in very young women. Currently, Australia has very low uptake rates of LARC. OBJECTIVE: The aim of this paper is to explore the latest information on using LARCs as first-line contraception in young women. DISCUSSION: Low uptake of LARCs may be related to Australia's prevailing cultural norm of oral contraception, and practitioner and patient misperceptions of the safety and efficacy of LARC, which have been dispelled in recent years. LARCs are widely recommended by professional bodies and the World Health Organization (WHO) as first-line contraception for young women as they are safe, effective and reversible. Young women should be offered the choice of a LARC as part of a fully informed decision for their first form of contraception.


Asunto(s)
Conducta de Elección , Médicos Generales/psicología , Anticoncepción Reversible de Larga Duración/métodos , Mujeres/educación , Adolescente , Conducta Anticonceptiva/psicología , Desogestrel/uso terapéutico , Femenino , Humanos , Dispositivos Intrauterinos/normas , Pautas de la Práctica en Medicina/normas , Embarazo , Embarazo no Planeado/psicología , Mujeres/psicología , Adulto Joven
15.
BMJ Open ; 7(8): e017047, 2017 08 07.
Artículo en Inglés | MEDLINE | ID: mdl-28790044

RESUMEN

BACKGROUND: The integration of digital technology into everyday lives of young people has become widespread. It is not known whether and how technology influences barriers and facilitators to healthcare, and whether and how young people navigate between face-to-face and virtual healthcare. To provide new knowledge essential to policy and practice, we designed a study that would explore health system access and navigation in the digital age. The study objectives are to: (1) describe experiences of young people accessing and navigating the health system in New South Wales (NSW), Australia; (2) identify barriers and facilitators to healthcare for young people and how these vary between groups; (3) describe health system inefficiencies, particularly for young people who are marginalised; (4) provide policy-relevant knowledge translation of the research data. METHODS AND ANALYSIS: This mixed methods study has four parts, including: (1) a cross-sectional survey of young people (12-24 years) residing in NSW, Australia; (2) a longitudinal, qualitative study of a subsample of marginalised young people (defined as young people who: identify as Aboriginal and/or Torres Strait Islander; are experiencing homelessness; identify as sexuality and/or gender diverse; are of refugee or vulnerable migrant background; and/or live in rural or remote NSW); (3) interviews with professionals; (4) a knowledge translation forum. ETHICS AND DISSEMINATION: Ethics approvals were sought and granted. Data collection commenced in March 2016 and will continue until June 2017. This study will gather practice and policy-relevant intelligence about contemporary experiences of young people and health services, with a unique focus on five different groups of marginalised young people, documenting their experiences over time. Access 3 will explore navigation around all levels of the health system, determine whether digital technology is integrated into this, and if so how, and will translate findings into policy-relevant recommendations.


Asunto(s)
Informática Aplicada a la Salud de los Consumidores , Accesibilidad a los Servicios de Salud , Estado de Salud , Proyectos de Investigación , Adolescente , Actitud Frente a la Salud , Niño , Estudios Transversales , Humanos , Internet , Estudios Longitudinales , Nueva Gales del Sur , Grupo de Ascendencia Oceánica , Investigación Cualitativa , Autoinforme , Adulto Joven
16.
JMIR Mhealth Uhealth ; 5(8): e118, 2017 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-28801302

RESUMEN

BACKGROUND: Despite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people's routine health care. OBJECTIVE: The aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people's assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people's acceptance and experience of using a screening app during regular health care. METHODS: This was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey. RESULTS: The exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (P<.001), and rated their GP higher in patient-centered care: communication and partnership (P=.01), personal relationship (P=.01), health promotion (P=.03), and interest in effect on life (P<.001). No differences were found on core indicators of youth-friendly care: trust, level of comfort, expectations met, and time to ask questions. In all, 86% (73/85) of young people felt the app was a "good idea" and only 1% (1/85) thought it a "bad idea." Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope to address unmet health needs and increased sense of preparedness, with use moderated by honesty, motivation, app content and functionality, and app administration. CONCLUSIONS: Integrating a health and lifestyle-screening app into face-to-face care can enrich young people's experience of seeing their GP, create scope to identify and address unmet health needs, and increase patient-centered care. Further research is needed to investigate the effect of using a health and lifestyle-screening app in a diverse range of clinic types and settings, and with a diverse range of GPs and youth.

17.
BMJ Open ; 7(7): e015303, 2017 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-28694345

RESUMEN

OBJECTIVE: To explore the feasibility of a dedicated online youth mental health help-seeking intervention and to evaluate using a randomised controlled trial (RCT) study design in order to identify any modifications needed before commencement of the full-scale RCT. DESIGN: A pilot RCT with 1:1 randomisation to either the intervention or comparison arm. SETTING: An online study conducted Australia-wide. PARTICIPANTS: 18-25 year olds living in Australia were recruited via social media. INTERVENTION: Link is a dedicated online mental health help-seeking navigation tool that matches user's mental health issues, severity and service-type preferences (online, phone and face-to-face) with appropriate youth-friendly services. The comparison arm was usual help-seeking strategies with a link to Google.com. MAIN OUTCOME MEASURES: The primary outcome was the number of acceptability and feasibility criteria successfully met. Intervention and study design acceptability and feasibility were assessed by nine criteria. Secondary outcomes, via online surveys (at baseline, 1 week and 1 month) measured service use, help-seeking intentions, psychological distress, barriers to help-seeking, attitudes towards mental health help-seeking, mental health literacy, satisfaction and trust. RESULTS: Fifty-one participants were randomised (intervention: n=24; comparison: n=27). Three out of four of the intervention and two out of five of the study design criteria were met. Unmet criteria could be addressed by modifications to the study design. Qualitative analysis demonstrated that Link was useful to participants and may have increased their positive experiences towards help-seeking. There were no observable differences between arms in any outcome measures and no harms were detected. CONCLUSION: Generally, the Link intervention and study design were acceptable and feasible with modifications suggested for the four out of nine unmet criteria. The main trial will hence have shorter surveys and a simpler recruitment process, use positive affect as the primary outcome and will not link to Google.com for the comparison arm. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry, ACTRN12614000386639.


Asunto(s)
Conducta de Búsqueda de Ayuda , Internet , Salud Mental , Programas Informáticos , Adolescente , Adulto , Australia , Estudios de Factibilidad , Femenino , Humanos , Masculino , Proyectos Piloto , Análisis de Regresión , Encuestas y Cuestionarios , Adulto Joven
18.
J Adolesc Health ; 61(3): 302-309, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28596103

RESUMEN

PURPOSE: The purpose of the study is to investigate whether a training intervention increases general practitioners' (GPs) detection sensitivity for probable mental disorders in young people. METHODS: Forty general practices were randomized to an intervention (29 GPs) or comparison arm (49 GPs). Intervention GPs participated in 9 hours of interactive training on youth-friendly care, psychosocial health risk screening, and responding to risk-taking behavior with motivational interviewing approaches, followed by practice visits assisting with integration of screening processes and tools. Youth aged 14-24 years attending GPs underwent a computer-assisted telephone interview about their consultation and psychosocial health risks. Having a "probable mental disorder" was defined as either scoring high on Kessler's scale of psychological distress (K10) or self-perceived mental illness. Other definitions tested were high K10; self-perceived mental illness; and high K10 and self-perceived mental illness. Psychosocial health risk screening rates, detection sensitivity, and other accuracy parameters (specificity, positive predictive value, and negative predictive value) were estimated. RESULTS: GPs' detection sensitivity improved after the intervention if having probable mental disorder was defined as high K10 score and self-perceived mental illness (odds ratio: 2.81; 95% confidence interval: 1.23-6.42). There was no significant difference in sensitivity of GPs' detection for our preferred definition, high K10 or self-perceived mental illness (.37 in both; odds ratio: .93; 95% confidence interval: .47-1.83), and detection accuracy was comparable (specificity: .84 vs. .87, positive predictive values: .54 vs. .60, and negative predictive values: .72 vs. .72). CONCLUSIONS: Improving recognition of mental disorder among young people attending primary care is likely to require a multifaceted approach targeting young people and GPs.


Asunto(s)
Médicos Generales/educación , Trastornos Mentales/diagnóstico , Entrevista Motivacional/métodos , Asunción de Riesgos , Adolescente , Adulto , Medicina Familiar y Comunitaria/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Adulto Joven
19.
Aust Fam Physician ; 46(5): 328-333, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28472580

RESUMEN

BACKGROUND: Globally, 14% of women use intrauterine contraceptive devices (IUCDs) for prevention of unplanned pregnancy. In Australia, the use of IUCDs is negligible at METHODS: GPs participated in qualitative interviews in February-May 2016, exploring their knowledge, attitudes and practice around IUCDs. Data were thematically analysed. RESULTS: Overall, 17 GPs were interviewed. They identified key barriers to prescription of IUCDs as misconceptions brought to the consultation, lack of current GP inserters, and issues in referral of patients for insertion. DISCUSSION: Barriers to prescribing IUCDs create challenges for women in accessing all available contraceptive options. Potential solutions to increase IUCD uptake might include local directories of GP inserters and targeted promotion of IUCD use. Increased GP training is necessary to expand the number of current GP inserters.


Asunto(s)
Médicos Generales/psicología , Dispositivos Intrauterinos/estadística & datos numéricos , Percepción , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Embarazo no Planeado , Investigación Cualitativa , Victoria
20.
Aust Health Rev ; 41(4): 401-406, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27444417

RESUMEN

Objective The aim of the present study was to examine factors associated with: (1) parental preference to receive follow-up care for their child from a general practitioner (GP); and (2) a decision to seek treatment when there is a slight worsening of their child's condition. Methods Parents presenting with their child at any one of five paediatric out-patient clinics at two public hospitals in Melbourne (Vic., Australia) were surveyed. We performed frequency distributions, bivariate analyses and multivariate logistic regression to evaluate associations with the preference for a GP for follow-up care and treatment in case of a slight worsening. Results In all, 606 parents were recruited to the study, 283 being new presentations and 323 presenting for review. GPs were selected as the preference for follow-up care by 23% (n=142) of respondents, and 26% (n=160) reported they would seek treatment from a GP if the condition of their child were to worsen slightly. There was an increased likelihood to prefer a GP for follow-up care for new patients (odds ratio (OR) 3.10; 95% confidence interval (CI) 1.99-4.83), those attending general paediatrics clinic (OR 1.73; 95% CI 1.11-2.70), and parents with a lower level of education (OR 1.74; 95% CI 1.09-2.78). For review patients, if during the previous visit a paediatrician suggested follow-up with a GP, parents were more likely to prefer a GP as a follow-up provider (OR 6.70; 95% CI 3.42-13.10) and to seek treatment from a GP in case of a slight worsening (OR 1.86; 95% CI 1.03-3.37). Conclusion Most parents attending paediatric out-patient appointments prefer to return for follow-up care; however, a paediatrician's advice may have an important role in return of paediatric patients to primary care. What is known about the topic? In Australia, there has been a growing concern regarding long waiting times for specialist consultations in out-patient clinics and difficulties with access for new patients. This has occurred when the ratio of review attendees to new patients has tipped towards the review attendees. What does this paper add? Most parents of children attending paediatric out-patient clinics value follow-up care with paediatric specialists, even if the referring GP requested a return to their surgery. The advice of the consulting paediatrician in support of follow-up care with a GP contributes significantly to the willingness of parents to return to primary care and to seek treatment from their GP for a slight worsening of their child's condition. What are the implications for practitioners? The findings of the present study have significant implications for the discharge of patients from speciality care: paediatricians can have an important role in the return of paediatric patients to primary care.


Asunto(s)
Actitud Frente a la Salud , Toma de Decisiones , Médicos Generales/psicología , Padres/psicología , Relaciones Profesional-Familia , Preescolar , Femenino , Hospitales , Hospitales Públicos , Humanos , Lactante , Modelos Logísticos , Masculino , Pediatras , Atención Primaria de Salud , Derivación y Consulta , Encuestas y Cuestionarios , Victoria
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