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.

Increasing general practitioner use of evidence-based medicine in teaching and clinical practice through evidence-based journal clubs.

Learning evidence-based medicine (EBM) skills is now integral to university medical education. GPs who trained before the introduction of EBM in the late 1990s have identified a lack of training in this area. Evidence-based journal clubs (EBJCs) aim to promote the application of research evidence to clinical decision making. GPs meet regularly to develop EBM skills and apply these to questions arising in their clinical practice. Over 4 years, 47 GP clinical supervisors of medical students participated in a series of EBJCs offered by a university medical school. This article presents a qualitative exploration of their views and experiences. GPs noted that participating in EBJCs improved their use of EBM in clinical practice by making them more independent learners, facilitating consistent management approaches in group practices and aligning their skills in EBM with those of current students. Barriers such as time constraints and limited access to EBM resources were also noted, and GPs discussed strategies for managing these. Opportunities for GPs who act as clinical supervisors to increase their skills in EBM are important, particularly for those GPs transitioning from a traditional medical education model to an EBM model, as they role model highest-quality patient care to students, including the need for ongoing learning.

One medical school's experience of sustaining general practice teaching in the time of COVID-19.

Challenges have been encountered in maintaining the Western Sydney University general practice program but effective strategies have been adopted to manage the impact of COVID-19.

Artspace: Enabling young women's recovery through visual arts: A qualitative study.

ISSUE ADDRESSED: This article reports the qualitative evaluation of "Artspace," an innovative clinical program combining creative arts with physical and mental health care for young women. The program, provided since 2004, comprises weekly visual arts sessions alongside a youth health clinic offering drop-in appointments with a nurse, GP and counsellor. METHODS: A qualitative evaluation of Artspace was conducted between 2016 and 2017. RESULTS: The evaluation showed that Artspace was particularly beneficial for those clients who had considerable exposure to social adversity and trauma, and were experiencing related serious health impacts. Artspace facilitated their recovery by enabling equitable access facilitation, social inclusion, creating a "holding" environment, and through the directly therapeutic benefits of artist-led arts processes. CONCLUSIONS: Our study highlights the positive impact of artist-led programs such as Artspace. It also attests to the importance of long-term sustainability of services, to allow the time needed for young people to experience genuine and sustained recovery, and to reduce the otherwise likely disadvantages associated with mental and physical health problems, as they move into their adult lives. SO WHAT?: Youth health researchers have been recommending arts programs at health services as a means of engaging young people in health care for over 15 years, however, it remains an underutilised approach in primary care settings. Our evaluation affirms the effectiveness of art programs for this, and also demonstrates that art programs can be a key contributor to recovery from the serious health impacts of adversity and trauma.

Trauma-informed care in general practice: Findings from a women's health centre evaluation.

BACKGROUND AND OBJECTIVES: Trauma and adversity have serious health consequences, particularly when experienced in early life. These health consequences can be significantly lessened if young people access appropriate care when needed. In 2004, the Blue Mountains Women's Health and Resource Centre created a Young Women's Clinic (YWC) that began providing drop-in appointments for women aged 12-25 years with a general practitioner, nurse or counsellor, as well as a group art program. METHOD: A qualitative evaluation of services provided by the YWC was conducted, drawing on 13 years of client and staff experiences. The evaluation framework was drawn from the recommendations of the NSW Centre for Advancement of Adolescent Health, the Australian Women's Health Network and the World Health Organization report on People-centred and integrated health services. RESULTS: The following principles of trauma-informed care were identified in the study: recognising the impact of trauma on consultations; tailoring consultation length to client needs; providing trauma therapy as well as physical healthcare; offering long-term, safe relationships with staff; trauma-sensitive gynaecological care; and the importance of self-care for health practitioners. DISCUSSION: Our findings demonstrate the importance of holistic general practice services in preventing and managing the long-term health consequences of adversity and trauma.

Multicenter study of the safety and effects of magnetic resonance imaging in patients with coronary sinus left ventricular pacing leads.

BACKGROUND: Magnetic resonance imaging (MRI) in patients with left ventricular (LV) leads may cause tissue or lead heating, dislodgment, venous damage, or lead dysfunction. OBJECTIVE: The purpose of this study was to determine the safety of MRI in patients with LV pacing leads. METHODS: Prospective data on patients with coronary sinus LV leads undergoing clinically indicated MRI at 3 institutions were collected. Patients were not pacemaker-dependent. Scans were performed under pacing nurse, technician, radiologist, and physicist supervision using continuous vital sign, pulse oximetry, and ECG monitoring and a 1.5-T scanner with specific absorption rate <1.5 W/kg. Devices were interrogated pre- and post-MRI, programmed to asynchronous or inhibition mode with tachyarrhythmia therapies off (if present), and reprogrammed to their original settings post-MRI. RESULTS: MRI scans (n = 42) were performed in 40 patients with non-MRI conditional LV leads between 2005 and 2013 (mean age 67 ± 9 years, n = 16 [40%] women, median lead implant duration 740 days with interquartile range 125-1173 days). MRIs were performed on the head/neck/spine (n = 35 [83%]), lower extremities (n = 4 [10%]), chest (n = 2 [5%]), and abdomen (n = 1 [2%]). There were no overall differences in pre- and post-MRI interrogation LV lead sensing (12.4 ± 6.2 mV vs 12.9 ± 6.7 mV, P = .38), impedance (724 ± 294 Ω vs 718 ± 312 Ω, P = .67), or threshold (1.4 ± 1.1 V vs 1.4 ± 1.0 V, P = .91). No individual LV lead changes required intervention. CONCLUSION: MRI scanning was performed safely in non-pacemaker-dependent patients with coronary sinus LV leads who were carefully monitored during imaging without clinically significant adverse effect on LV lead function.