Evidence-based brief interventions targeting acute mental health presentations for children and adolescents: systematic review.

BACKGROUND: Brief intervention services provide rapid, mobile and flexible short-term delivery of interventions to resolve mental health crises. These interventions may provide an alternative pathway to the emergency department or in-patient psychiatric services for children and young people (CYP), presenting with an acute mental health condition. AIMS: To synthesise evidence on the effectiveness of brief interventions in improving mental health outcomes for CYP (0-17 years) presenting with an acute mental health condition. METHOD: A systematic literature search was conducted, and the studies' methodological quality was assessed. Five databases were searched for peer-reviewed articles between January 2000 and September 2022. RESULTS: We synthesised 30 articles on the effectiveness of brief interventions in the form of (a) crisis intervention, (b) integrated services, (c) group therapies, (d) individualised therapy, (e) parent-child dyadic therapy, (f) general services, (g) pharmacotherapy, (h) assessment services, (i) safety and risk planning and (j) in-hospital treatment, to improve outcomes for CYP with an acute mental health condition. Among included studies, one study was rated as providing a high level of evidence based on the National Health and Medical Research Council levels of evidence hierarchy scale, which was a crisis intervention showing a reduction in length of stay and return emergency department visits. Other studies, of moderate-quality evidence, described multimodal brief interventions that suggested beneficial effects. CONCLUSIONS: This review provides evidence to substantiate the benefits of brief interventions, in different settings, to reduce the burden of in-patient hospital and readmission rates to the emergency department.

Evidence-based long term interventions targeting acute mental health presentations for children and adolescents: systematic review.

Background: Long term intervention services have proven to be effective in improving mental health (MH) outcomes and the quality of life for children and young people (CYP). Aim: To synthesize evidence on the effectiveness of long-term interventions in improving MH outcomes for CYP, 0-17 years, presenting with MH conditions. Methods: A systematic search was carried out and the methodological quality of included long term MH intervention studies were assessed. Six databases were searched for peer-reviewed articles between January 2000 and September 2022. Results: We found 30 studies that reported on the effectiveness of a range of long-term MH interventions in the form of (i) group therapy, (ii) multisystemic behavior therapy, (iii) general services, (iv) integrated services, (v) psychotherapy, (vi) intensive intervention services, (vii) comprehensive collaborative care, (viii) parent training, and (ix) home outreach service. Among the included studies, seven were rated as high level of evidence based on the National Health and Medical Research Council (NHMRC) levels of evidence hierarchy scale and seven were of moderate quality evidence. Others were rated as lower-quality evidence. Among the studies providing high quality evidence, most were reported for group therapy, general services, and psychotherapy studies demonstrating beneficial effects. Conclusion: This systematic review provides evidence to demonstrate the benefits of a range of long-term interventions, in a range of settings, can be effective in improving MH outcomes for CYP and their families. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022323324.

Predicting Communication Skills Outcomes for Preschool Children with Autism Spectrum Disorder Following Early Intervention.

Purpose: This study aims to assess changes in the receptive and expressive language skills and to determine if the baseline characteristics such as communication, cognitive and motor skills, predict outcomes in preschool children with Autism Spectrum Disorder (ASD) following early intervention. Methods: We recruited 64 children participating in the Early Start Denver Model (ESDM) early intervention program at an Autism Specific Early Learning and Care Center (ASELCC) in Australia. Baseline characteristics across various developmental domains was measured using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd Edition (VABS-II), and the ESDM Curriculum Checklist. Linear mixed-effects models were used to examine the effects of the intervention on outcomes. Fixed-effects such as time, groups (verbal and minimally verbal), and time-by-group interactions were assessed whilst adjusting for covariates. Further, multiple linear regression models were used to determine if the baseline characteristics were significant predictors of the outcomes following the early intervention. Results: Among the 64 children who participated in this study, 38 children were verbal, whereas 26 were deemed to have minimal verbal skills. The mean age of the sample was 4.1 years with a significant male predilection (83%) and from a culturally and linguistically diverse (CALD) background (64%). Findings of the linear mixed effects model showed significant within and between group differences in the ESDM subscales, indicating higher magnitude of changes in the verbal group compared to the minimally verbal group. Finally, the multiple linear regression models suggested that baseline MSEL visual reception and expressive language scores were predictive of changes in the ESDM receptive and expressive communication scores. Conclusion: Understanding a child's baseline skill levels may provide valuable clues regarding what interventions would work best, or which interventions may be less suitable for individual preschool-aged children with ASD.

Machine learning-based prediction for self-harm and suicide attempts in adolescents.

This study aimed to use machine learning (ML) models to predict the risk of self-harm and suicide attempts in adolescents. We conducted secondary analysis of cross-sectional data from the Longitudinal Study of Australian Children dataset. Several key variables at the age of 14-15 years were used to predict self-harm or suicide attempt at 16-17 years. Random forest classification models were used to select the optimal subset of predictors and subsequently make predictions. Among 2809 participants, 296 (10.54%) reported an act of self-harm and 145 (5.16%) reported attempting suicide at least once in the past 12 months. The area under the receiver operating curve was fair for self-harm (0.7397) and suicide attempt (0.7220), which outperformed the prediction strategy solely based on prior suicide or self-harm attempt (AUC: 0.6). The most important factors identified were similar, and included depressed feelings, strengths and difficulties questionnaire scores, perceptions of self, and school- and parent-related factors. The random forest classification algorithm, an ML technique, can effectively select the optimal subset of predictors from hundreds of variables to forecast the risks of suicide and self-harm among adolescents. Further research is needed to validate the utility and scalability of ML techniques in mental health research.

Sociocultural factors associated with detection of autism among culturally and linguistically diverse communities in Australia.

BACKGROUND: The age at which parents or caregivers first develop concerns about their child's development has significant implications on formal diagnosis and intervention. This study aims to determine the sociocultural factors that are associated with the age and type of first concern reported by parents of autistic children among culturally and linguistically diverse (CALD) communities in Australia. We also assessed whether sociocultural factors predict autism traits measured in terms of social affect (SA), restricted and repetitive behaviours (RRB), and calibrated severity scores (CSS). METHODS: This study is a secondary data analysis of the data collected from six Autism Specific Early Learning and Care Centres (ASELCCs) as part of the Autism Co-operative Research Centre (CRC) program between 2015 and 2019. Data analysed in this study included a family history questionnaire with sociodemographic and sociocultural information, parent-reported age and type of first concern, and clinician/researcher administered Autism Diagnostic Observation Schedule - Second Edition (ADOS-2) which includes standardised domain-wise scores of social affect (SA) and restricted and repetitive behaviours (RRB) as well as calibrated severity scores (CSS), a measure of severity of autism. Primary analysis included multivariable linear regression models to examine the predictive influence of sociodemographic and sociocultural factors on the dependant variables of age of concern (AOC) and the autism traits (SA, RRB, and CSS). RESULTS: The mean AOC in the sample was 18.18 months and the most common concerns were speech/language delay, limited social interaction, and hyperactivity/behavioural changes. The multivariable linear regression models showed factors such as increase in age of child, those from a CALD background, annual family income, sibling's autism diagnosis, and developmental concerns to be significantly associated with parental AOC. Additionally, we also found that increase in child's age and CALD status to be significant predictors of autism trait (RRB) and severity measured in terms of the CSS score. Further, females (compared to males) were associated with higher difficulties with social communication and interaction skills. CONCLUSION: Understanding key factors that contribute to early identification of autism can help tailor awareness programs for parents and caregivers, whilst also informing the development of services focused on serving all CALD communities.

Appraising risk factors of aggression in children and adolescents at psychiatric inpatient units.

This study examined predictors of aggression and assessed whether different subgroups of children and young people (CYP) display varying risks of aggressive incidents during hospitalization. Data from 10,090 children admitted to the psychiatric inpatient units of Cincinnati Children's Hospital between April 2010 and June 2021 were analysed. Multivariable logistic regression models were used to determine significant predictors associated with aggression, followed by average marginal effects and cluster analyses to rank and establish clusters by the order of predictor importance. About 32.5% reported positive history of an aggressive incident. The mean BRACHA score was doubled compared to those without a prior history. The primary analysis showed that both younger and male CYPs had higher odds of aggressive incidents. We also found that CYP with an African descent, not being able to live with both biological parents, those who reported positive history of psychiatric hospitalisation, and prior externalising behaviours had higher odds of aggressive incidents. These findings have important clinical and public health implications, as they provide valuable knowledge for healthcare professionals to improve prevention strategies for aggression amongst this vulnerable population.

A nationwide study of COVID-19 impact on mental health-related presentations among children and adolescents to primary care practices in Australia.

This study explored the impacts of COVID-19 on the mental health (MH)-related visits to general practices (GPs) among children and young people (CYP) up to 18 years of age in Australia. This study analysed national-level data captured by the NPS MedicineWise program on monthly CYP MH-related visits per 10,000 visits to GPs from January 2014 to September 2021. We considered the pre-COVID-19 period (January 2014-February 2020) and the COVID-19 period (March 2020-September 2021). We used a Bayesian structural time series (BSTS) model to estimate the impact of COVID-19 on MH-related GP visits per 10,000 visits. A total of 103,813 out of 7,690,874 visits to GP (i.e., about 135 per 10,000 visits) were related to MH during study period. The BSTS model showed a significant increase in the overall MH-related visits during COVID-19 period (33%, 95% Credible Interval (Crl) 8.5%-56%), particularly, visits related to depressive disorders (61%, 95% Crl 29%-91%). The greatest increase was observed among females (39%, 95% Crl 12%-64%) and those living in socioeconomically least disadvantaged areas (36%, 95% Crl 1.2-71%). Our findings highlight the need for resources to be directed towards at-risk CYP to improve MH outcomes and reduce health system burden.

Quality of life in parents of autistic children: A transcultural perspective.

Introduction: The concepts of health, illness, and disability as well as the perceptions of autism and quality of life (QoL) vary greatly across cultures and across time. This study sought to explore the interplay of culture on QoL and impact on parents caring for autistic children. Methods: We used a transcultural dataset from seven countries (Australia, Hungary, Malaysia, Romania, Singapore, Spain, and the United Kingdom) with participating parents/carers reporting on the Quality of Life in Autism (QoLA) questionnaire. The QoLA questionnaire is a validated measure of QoL for parents of autistic children, with Part A subscale measuring parental QoL and part B subscale assessing the parental impact of the child's autism spectrum disorder (ASD) symptoms or features. We used the Quade's ranked analysis of covariance to determine significant differences between the countries in relation to QoLA Part A and Part B scores while adjusting for baseline differences using covariates such as parents' gender, child's age, and gender. Additionally, a post-hoc analysis with Bonferroni correction was also conducted to examine multiple pairwise comparisons. Results and conclusion: We found that while the effect of features of ASD (Part B subscale) stayed strongly comparable between cultures, the self-reported parental QoL was most likely determined by different aspects of culture in different countries. It is concluded that while the ASD symptoms or features appear to affect parents in the same way across different countries, the parental QoL may be a culturally informed construct.

Fluoride Content of Ready-to-Eat Infant Foods and Drinks in Australia.

The use of fluoride is effective in preventing dental caries. However, an excessive intake of fluoride leads to dental fluorosis, making it necessary to regularly monitor the fluoride intake especially for infants. There is hitherto a lack of information on fluoride content in infant foods from an Australian perspective. Therefore, this study aims to estimate the amount of fluoride content from a range of commercially available ready-to-eat (RTE) infant foods and drinks available in Australia. Based on an external calibration method, potentiometry involving a fluoride ion selective electrode and a silver|silver chloride reference electrode was conducted to analyse the fluoride content of a total of 326 solid food samples and 49 liquid food samples in this work. Our results showed an overall median (range) fluoride content of 0.16 (0.001-2.8) µg F/g of solid food samples, and 0.020 (0.002-1.2) µg F/mL of liquid food samples. In addition, ~77.5% of the liquid samples revealed a fluoride content < 0.05% µg F/mL. The highest variation of fluoride concentration (0.014-0.92 µg F/g) was found in formulas for ≥6 month-old infants. We have attributed the wide fluoride content variations in ready-to-eat infant foods and drinks to the processing steps, different ingredients and their origins, including water. In general, we found the fluoride content in most of the collected samples from Australian markets to be high and may therefore carry a risk of dental fluorosis. These results highlight the need for parents to receive appropriate information on the fluoride content of ready-to-eat infant food and drinks.

Development and internal validation of the Edmonton Obesity Staging System-2 Risk screening Tool (EOSS-2 Risk Tool) for weight-related health complications: a case-control study in a representative sample of Australian adults with overweight and obesity.

OBJECTIVE: Excess weight and related health complications remain under diagnosed and poorly treated in general practice. We aimed to develop and validate a brief screening tool for determining the presence of unknown clinically significant weight-related health complications for potential application in general practice. DESIGN: We considered 14 self-reported candidate predictors of clinically significant weight-related health complications according to the Edmonton Obesity Staging System (EOSS score of ≥2) and developed models using multivariate logistic regression across training and test data sets. The final model was chosen based on the area under the receiver operating characteristic curve and the Hosmer-Lemeshow statistic; and validated using sensitivity, specificity and positive predictive value. SETTING AND PARTICIPANTS: We analysed cross-sectional data from the Australian Health Survey 2011-2013 sample aged between 18 and 65 years (n=7518) with at least overweight and obesity. RESULTS: An EOSS≥2 classification was present in 78% of the sample. Of 14 candidate risk factors, 6 (family history of diabetes, hypertension, high sugar in blood/urine, high cholesterol and self-reported bodily pain and disability) were automatically included based on definitional or obvious correlational criteria. Three variables were retained in the final multivariate model (age, self-assessed health and history of depression/anxiety). The EOSS-2 Risk Tool (index test) classified 89% of those at 'extremely high risk' (≥25 points), 67% of those at 'very high risk' (7-24 points) and 42% of those at 'high risk' (<7 points) of meeting diagnostic criteria for EOSS≥2 (reference). CONCLUSION: The EOSS-2 Risk Tool is a simple, safe and accurate screening tool for diagnostic criteria for clinically significant weight-related complications for potential application in general practice. Research to determine the feasibility and applicability of the EOSS-2 Risk Tool for improving weight management approaches in general practice is warranted.

Prevalence and risk factors of food insecurity among Libyan migrant families in Australia.

BACKGROUND: The burden of food insecurity remains a public health challenge even in high income countries, such as Australia, and especially among culturally and linguistically diverse (CALD) communities. While research has been undertaken among several migrant communities in Australia, there is a knowledge gap about food security within some ethnic minorities such as migrants from the Middle East and North Africa (MENA). This study aims to determine the prevalence and correlates of food insecurity among Libyan migrant families in Australia. METHODS: A cross-sectional design utilising an online survey and convenience sampling was used to recruit 271 participants, each representing a family, who had migrated from Libya to Australia. Food security was measured using the single-item measure taken from the Australian Health Survey (AHS) and the 18-item measure from the United States Department of Agriculture Household Food Security Survey Module (USDA HFSSM). Multivariable logistic regression was used to identify independent correlates associated with food insecurity. RESULTS: Using the single-item measure, the prevalence of food insecurity was 13.7% whereas when the 18-item questionnaire was used, more than three out of five families (72.3%) reported being food insecure. In the multivariable logistic regression analysis for the single-item measure, those living alone or with others reported higher odds of being food insecure (AOR = 2.55, 95% CI 1.05, 6.21) compared to those living with their spouse, whereas higher annual income (≥AUD 40,000) was associated with lower odds of food insecurity (AOR = 0.30, 95% CI 0.11, 0.84). Higher annual income was also associated with lower odds of food insecurity (AOR = 0.49, 95% CI 0.25, 0.94) on the 18-item measure. On both single and 18-item measures, larger family size (AOR = 1.27, 95% CI 1.07, 1.49 and AOR = 1.21, 95% CI 1.01, 1.47 respectively) was associated with increased odds of food insecurity. CONCLUSION: This study provides evidence that food insecurity amongst Libyan migrants in Australia is a widespread problem and is associated with a number of sociodemographic and socio-economic factors. The findings of this study serve to contribute to the depth and breadth of food security research among vulnerable communities, in this instance Libyan migrant families.

Clinical usefulness of brief screening tool for activating weight management discussions in primary cARE (AWARE): A nationwide mixed methods pilot study.

OBJECTIVE: The Edmonton Obesity Staging System (EOSS) is based on weight related health complications among individuals with overweight and obesity requiring clinical intervention. We aimed to assess the clinical usefulness of a new screening tool based on the EOSS for activating weight management discussions in general practice. METHODS: We enrolled five General Practitioners (GPs) and 25 of their patients located nationwide in metropolitan areas of Australia to test the feasibility, acceptability, and accuracy of the new 'EOSS-2 Risk Tool', using cross-sectional and qualitative study designs. Diagnostic accuracy of the tool for the presence of EOSS ≥2 criteria was based on clinical information collected prospectively. To assess feasibility and applicability, we explored the views of GP and patient participants by thematic analysis of transcribed verbatim and de-identified data collected by semi-structured telephone interviews. RESULTS: Nineteen (76%) patients were aged ≥45 years, five (20%) were male, and 20 (80%) were classified with obesity. All 25 patients screened positive for EOSS ≥2 criteria by the tool. Interviews with patients continued until data saturation was reached resulting in a total of 23 interviews. Our thematic analysis revealed five themes: GP recognition of obesity as a health priority (GPs expressed strong interest in and understanding of its importance as a health priority); obesity stigma (GPs reported the tool helped them initiate health based and non-judgmental conversations with their patients); patient health literacy (GPs and patients reported increased awareness and understanding of weight related health risks), patient motivation for self-management (GPs and patients reported the tool helped focus on self-management of weight related complications), and applicability and scalability (GPs stated it was easy to use, relevant to a range of their patient groups, and scalable if integrated into existing patient management systems). CONCLUSION: The EOSS-2 Risk Tool is potentially clinically useful for activating weight management discussions in general practice. Further research is required to assess feasibility and applicability.

Food Insecurity and Food Label Comprehension among Libyan Migrants in Australia.

Food security among migrants and refugees remains an international public health issue. However, research among ethnic minorities in Australia is relatively low. This study explored the factors that influence the understanding of food labelling and food insecurity among Libyan migrants in Australia. An online survey was completed by 271 Libyan migrant families. Data collection included the 18-item US Household Food Security Survey Module (for food security) and a question from the Food Standards Australia New Zealand Consumer Label Survey (for food labelling comprehension). Multivariable logistic regression modelling was utilised to identify the predictors of food label comprehension and food security. Food insecurity prevalence was 72.7% (n = 196) while 35.8% of families (n = 97) reported limited food label understanding. Household size, food store location, and food affordability were found to be significantly related to food insecurity. However, gender, private health insurance, household annual income, education, and food store type and location were found to be significantly related to food labelling comprehension. Despite the population's high educational status and food labelling comprehension level, food insecurity remained an issue among the Libyan migrants. Policy makers should consider the incorporation of food label comprehension within a broader food security approach for migrants.

Estimating the Economic Burden of Low Health Literacy in the Blacktown Community in Sydney, Australia: A Population-Based Study.

Evidence shows that inadequate or low health literacy (LHL) levels are significantly associated with economic ramifications at the individual, employer, and health care system levels. Therefore, this study aims to estimate the economic burden of LHL among a culturally and linguistically diverse (CALD) community in Blacktown: a local government area (LGA) in Sydney, Australia. This study is a secondary analysis of cross-sectional data from publicly available datasets, including 2011 and 2016 census data and National Health Survey (NHS) data (2017-2018) from the Australian Bureau of Statistics (ABS), and figures on Disease Expenditure in Australia for 2015-2016 provided by the Australian Institute of Health and Welfare (AIHW). This study found that 20% of Blacktown residents reported low levels of active engagement with health care providers (Domain 6 of the Health Literacy Questionnaire (HLQ)), with 14% reporting a limited understanding of the health information required to take action towards improving health or making health care decisions (Domain 9 of the HLQ). The overall extra/delta cost (direct and indirect health care costs) associated with LHL in the Blacktown LGA was estimated to be between $11,785,528 and $15,432,239 in 2020. This is projected to increase to between $18,922,844 and $24,191,911 in 2030. Additionally, the extra disability-adjusted life year (DALY) value in 2020, for all chronic diseases and age-groups-comprising the extra costs incurred due to years of life lost (YLL) and years lived with disability (YLD)-was estimated at $414,231,335. The findings of our study may enable policymakers to have a deeper understanding of the economic burden of LHL in terms of its impact on the health care system and the production economy.

Effectiveness of a Patient-Centre Medical Home model on diabetes and other clinically relevant outcomes among primary care patients diagnosed with type-2 diabetes in Sydney, Australia.

AIM: We aim to evaluate the effectiveness of patient-centred medical home (PCMH) model in improving diabetes and clinical outcomes among primary care patients diagnosed with T2D. METHODS: The WellNet study used cohort design with a concurrent comparison group to evaluate changes in clinical outcomes across six general practices in Sydney, Australia. The treatment group comprised of 279 patients who received PCMH care whereas the matched comparison group included 3671 patients who received standard care. t-tests with analysis of covariance were conducted to evaluate significant mean differences and multivariate logistic regression was performed to determine predictors of glycaemic control at follow-up. RESULTS: WellNet patients observed slightly larger within-group mean differences compared to comparison group patients (-0.2% vs -0.04%). Additionally, WellNet patients saw a larger increase in the percentage of patients achieving glycaemic control (7.9% vs 2.3%). A statistically significant mean difference was seen in waist circumference after adjusting for covariates (-2.41 cm, 95% CI -4.72 to -0.11; p < 0.05). Findings of multivariate logistic regression analysis showed that withdrawn patients and elevated HbA1c measures at baseline were associated with poor glycaemic control at follow-up. CONCLUSION: The study findings may be beneficial to patients in terms of improved clinical outcomes and self-management support.

Factors Influencing the Early Introduction of Sugar Sweetened Beverages among Infants: Findings from the HSHK Birth Cohort Study.

Understanding the determinants of early introduction of sugar sweetened beverages (SSBs) may assist in designing effective public health interventions to prevent childhood weight related conditions (obesity). This study explores the relationship between family/infant characteristics and the early introduction of SSBs among infants in Sydney, Australia. Mothers (n = 934) from an ongoing birth cohort study were interviewed at 8, 17, 34, and 52 weeks postpartum. Multivariable logistic regression analysis was used to identify family/infant factors independently associated with the likelihood of early introduction of SSBs (<52 weeks of age). Of the 934 mothers interviewed, 42.7% (n = 399) of infants were introduced to SSBs before 52 weeks. Mothers who were born in Vietnam (adjusted Odds Ratio (AOR) = 2.14; 95% confidence interval (CI) 1.33, 3.47), other Asian countries (AOR = 1.62; 95% CI 1.02, 2.58) as well as single mothers (AOR = 3.72; 95% CI 2.46, 5.62) had higher odds of introducing SSBs early to their infants. Mothers from highly advantaged socioeconomic background (AOR = 0.43; 95% CI 0.28, 0.68), those who breastfed their baby for 17-25 weeks (AOR = 0.60; 95% CI 0.37, 0.99), 26-51 weeks (AOR = 0.65; 95% CI 0.45, 0.94), and 52 weeks or more (AOR = 0.62; 95% CI 0.43, 0.90); and those who introduced solids between 17-25 weeks (AOR = 0.58; 95% CI 0.36, 0.91) and 26 weeks or more (AOR = 0.55; 95% CI 0.34, 0.91) had reduced odds of introducing SSBs early. Tailoring health promotion programs for these vulnerable groups may delay the introduction of SSBs.

The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials.

Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving biomedical, hospital, and economic outcomes. MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported. Of the 13,820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60,617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD -0.24; 95% CI -0.35, -0.14; I2 = 76%) and increased odds of remission (OR 1.79; 95% CI 1.46, 2.21; I2 = 0%). There were significant improvements in the health-related quality of life (SMD 0.10; 95% CI 0.04, 0.15; I2 = 51%), self-management outcomes (SMD 0.24; 95% CI 0.03, 0.44; I2 = 83%), and hospital admissions (OR 0.83; 95% CI 0.70, 0.98; I2 = 0%). In terms of biomedical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17; 95% CI 0.08, 0.26; I2 = 82%). The quality of individual studies ranged from "fair" to "good" by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence. PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.

Changes in health-related quality of life before and after a 12-month enhanced primary care model among chronically ill primary care patients in Australia.

PURPOSE: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called 'WellNet'. METHODS: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. RESULTS: Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID. CONCLUSION: Patient-tailored chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.

Social determinants and behavioural factors influencing toothbrushing frequency among primary school children in rural Australian community of Lithgow, New South Wales.

OBJECTIVE: This study aims to determine the social determinants and behavioural factors influencing frequency of toothbrushing among primary school children residing in the rural community of Lithgow in New South Wales, Australia. All six primary schools of Lithgow were approached to participate in a cross-sectional survey prior to implementation of water fluoridation. A validated oral health survey questionnaire was completed by 703 parents of the children. Multivariable logistic regression analysis was employed to determine significant predictors associated with frequency of toothbrushing. RESULTS: Parents with a positive attitude towards water fluoridation had 74% higher odds (OR = 1.74, 95% CI 1.17-2.60) of their children brushing twice or more daily. Children living in a single parent household had 34% reduced odds (OR = 0.66, 95% CI 0.43-0.99) of brushing twice daily. Poor maternal oral health was significantly associated with suboptimal dental hygiene practices in children, where mothers who had any tooth extracted had 7% reduced odds of their children brushing their teeth twice or more daily (OR = 0.93, 95% CI 0.90-0.97). Subsequently, children with increased consumption of chocolates per day were less likely to brush twice or more daily. Finally, children with dental insurance had two times higher odds (OR = 2.04, 95% CI 1.40-2.96) of brushing twice daily.

Outcomes of a 12-month patient-centred medical home model in improving patient activation and self-management behaviours among primary care patients presenting with chronic diseases in Sydney, Australia: a before-and-after study.

BACKGROUND: Studies report that increased levels of patient activation is associated with increased engagement with the health care system, better adherence to treatment protocols, and improved health outcomes. This study aims to evaluate the outcomes of a 12-month Patient-Centred Medical Home (PCMH) model called 'WellNet' on the activation levels of patients with one or more chronic diseases in general practices across Northern Sydney, Australia. METHODS: A total of 636 patients aged 40 years and above with one or more chronic conditions consented to participate in the WellNet program which was delivered across six general practices in Northern Sydney, Australia. The WellNet intervention includes team-based care with general physicians and trained chronic disease management care coordinators collaborating with patients in designing a patient-tailored care plan with improved self-management support and care navigation according to the level of risk and health care needs. The level of patient activation was measured using the validated PAM 13-item scale at baseline and follow-up. A before and after case-series design was employed to determine the adjusted mean differences between baseline and 12-months using repeated measures analysis of covariance (ANCOVA). Additionally, the backward stepwise multivariable regression models were employed to identify significant predictors of activation at follow-up. RESULTS: Of the 626 patients, 420 reported their PAM scores at follow-up. The mean (SD) baseline PAM score was 57.9 (13.0). The adjusted model showed significant mean difference in PAM scores by increase of 6.5 (95% CI 5.0-8.1; p-value< 0.001) after controlling for baseline covariates. The multivariable regression models showed that older age (B = - 0.14; 95% CI -0.28, - 0.01) and private insurance (uninsured patients) (B = - 3.41; 95% CI -6.50, - 0.32) were significantly associated with lower PAM scores at 12 months whereas higher baseline PAM score (B = 0.48; 95% CI 0.37, 0.59) was significantly associated with higher follow-up PAM score. CONCLUSION: The WellNet study is the first of its kind in Australia to report on changes in the patient activation levels among patients with one or more chronic diseases. PCMH has the potential to improve patient activation and engagement which can lead to long-term health benefits and sustained self-management behaviours.