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1.
BMC Health Serv Res ; 19(1): 524, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349841

RESUMO

BACKGROUND: Mental illness is a leading cause of illness and disability and around 75% of people suffering mental illness do not have access to adequate care. In Australia, nearly half the population experiences mental illness at some point in their life. The Australian Government developed a National program called Partners in Recovery (PIR) to support those with severe and persistent mental illness. The program was implemented through 48 consortia across Australia. One of these was led by the Nepean Blue Mountains Medicare Local who adapted the program according to its specific local needs. METHODS: We conducted an early evaluation of the PIR program in Nepean Blue Mountains (NBMPIR) using a program logic model (PLM) to frame the evaluation and complemented this with an additional thematic analysis. Participants (n = 73) included clients and carers, program management and staff of the Consortium and other partners and agencies, and clinical, allied health, and other service providers. Our PLM utilised multiple data sources that included document review, open and closed survey questions, and semi-structured interviews. Quantitative data received a descriptive analysis and qualitative data was analysed both in alignment with the PLM framework and inductively. RESULTS: We aligned our results to PLM domains of inputs, activities, outputs, outcomes and impacts. The NBMPIR consortium implemented a recovery approach and provided greater access to services by enhancing healthcare provider partnerships. Our thematic analysis further described five key themes of collaboration; communication; functioning of PIR; structural/organisational challenges; and understanding of PIR approaches. Facilitators and barriers to the NBMPIR program centred on the alignment of vision and purpose; building an efficient system; getting the message out and sharing information; understanding roles and support and training of staff; building capacity and systems change; addressing service gaps; and engaging peers. CONCLUSIONS: Our study provided helpful insights into the coordinated management of complex mental illness. The NBMPIR's focus on partnerships and governance, service coordination, and systems change has relevance for others engaged in this work. This PLM effectively mapped the program, including its processes and resources, and is a useful framework providing a baseline for future evaluations. Full report available at https://researchdirect.westernsydney.edu.au/islandora/object/uws:33977/.

2.
Women Birth ; 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31153777

RESUMO

BACKGROUND: Addressing smoking cessation during pregnancy among Aboriginal women is a national priority under the Closing the Gap campaign. There is a need to measure and report interventions to support Aboriginal women during pregnancy. AIM: To quantitatively assess women's smoking experiences over a 12 week ICAN QUIT in Pregnancy program. METHODS: Aboriginal women and/or women expecting an Aboriginal baby reported their smoking experiences through repeated cross-sectional survey at baseline, four weeks, and 12 weeks. Self-reported nicotine dependence measures (heaviness of smoking index, strength of urges and frequency of urges to smoke), intentions to quit smoking, quit attempts, use of nicotine replacement therapy were gathered as well as a carbon-monoxide measure at each time point. RESULTS: Expectant mothers (n=22) of Aboriginal babies participated from six Aboriginal Community Controlled Health Services between November 2016 and July 2017. At 12 weeks women reported (n=17) low heaviness of smoking index 1.21 with high strength of urges 2.64 and frequency of urges 3.00; 12/13 (92%) reported likely/very likely to quit smoking, made a mean 1.67 number of quit attempts, three women (13.6%) quit smoking (validated); 5/16 (31%) reported using nicotine replacement therapy. DISCUSSION: Participating women made multiple quit attempts demonstrating motivation to quit smoking. Smoking cessation interventions should be tailored to address high strength and frequency of nicotine dependence despite low consumption. CONCLUSION: Prolonged smoking cessation support is recommended to address physical, behavioural and psychological aspect of smoking. Cessation support should address previous quitting experiences to assess smoking dependence and tailoring of support. TRIAL REGISTRATION: Australian and New Zealand Clinicial Trials Registry (Ref #ACTRN12616001603404).

3.
BMJ Open ; 9(6): e025293, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167863

RESUMO

OBJECTIVES: This study aimed to examine the impact of the 'ICAN QUIT in Pregnancy' intervention on individual health providers (HPs) smoking cessation care (SCC) knowledge, attitudes and practices in general, and specifically regarding nicotine replacement therapy (NRT) prescription. DESIGN: Step-wedge clustered randomised controlled study. HPs answered a preintervention and 1-6 months postintervention survey. SETTING: Six Aboriginal Medical Services (AMSs) in three states of Australia. PARTICIPANTS: All HPs were invited to participate. Of 93 eligible, 50 consented (54%), 45 completed the presurvey (90%) and 20 the post (40%). INTERVENTION: Included three 1-hour webinar sessions, educational resource package and free oral NRT. OUTCOMES: HPs knowledge was measured using two composite scores-one from all 24 true/false statements, and one from 12 NRT-specific statements. Self-assessment of 22 attitudes to providing SCC were measured using a five-point Likert scale (Strongly disagree to Strongly agree). Two composite mean scores were calculated-one for 15 general SCC attitudes, and one for 7 NRT-specific attitudes. Self-reported provision of SCC components was measured on a five-point Likert scale (Never to Always). Feasibility outcomes, and data collected on the service and patient level are reported elsewhere. RESULTS: Mean knowledge composite scores improved from pre to post (78% vs 84% correct, difference 5.95, 95% CI 1.57 to 10.32). Mean NRT-specific knowledge composite score also improved (68% vs 79% correct, difference 9.9, 95% CI 3.66 to 16.14). Mean attitude composite score improved (3.65 (SD 0.4) to 3.87 (SD 0.4), difference 0.23, 95% CI 0.05 to 0.41). Mean NRT-specific attitudes composite score also improved (3.37 (SD 0.6) to 3.64 (SD 0.7), difference 0.36, 95% CI 0.13 to 0.6). Self-reported practices were unchanged, including prescribing NRT. CONCLUSIONS: A multicomponent culturally sensitive intervention in AMSs was feasible, and might improve HPs provision of SCC to pregnant Aboriginal women. Changes in NRT prescription rates may require additional intensive measures. TRIAL REGISTRATION NUMBER: ACTRN 12616001603404; Results.

4.
Health Promot J Austr ; 30(3): 317-323, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30869806

RESUMO

ISSUE ADDRESSED: The Samoan community in Australia has one of the highest rates of diabetes in Australia. We explored the experiences and perceptions of Samoan patients living with diabetes and their family members. METHODS: Semi-structured interviews were conducted with adults from a Samoan background living in Australia who had diabetes and their family members. Participants were recruited from a single general practice with a high proportion of Pacific Islander patients, through self-response to waiting room flyers. Inductive thematic analysis was conducted using a constructivist-grounded theory approach. This qualitative project was part of the developmental phase of a larger project aiming to promote healthy lifestyles and decrease diabetes in the Samoan community in Sydney, Australia. RESULTS: Twenty participants, aged 36-67 years, were interviewed. The majority was men (n = 13) and all were migrants to Australia. Participants reported a range of barriers to early detection and self-management of diabetes, including dietary practices common within their culture and the role of church and religion. They identified that pride in their heritage and role within families could be a barrier to care but also provided an opportunity for health promotion. CONCLUSIONS: The cultural factors which influence the risk and management of diabetes in the Samoan community in Australia can be the barriers to health change but also provide opportunities for culturally targeted diabetes education and health promotion. SO WHAT?: These findings will inform the development of approaches for the prevention and management of diabetes within the Samoan-Australian community. These include health-promotion initiatives which take into account the role of cultural dietary practices, diabetes stigma, cultural pride and working with churches.

5.
BMC Med Educ ; 18(1): 276, 2018 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-30466411

RESUMO

Following publication of the original article [1], the author reported that Fig. 1 was missing.

6.
BMC Med Educ ; 18(1): 236, 2018 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-30309368

RESUMO

BACKGROUND: Promoting cultural competence of health professionals working with Aboriginal and Torres Strait Islander communities is key to improving health outcomes. Cultural Educators and Cultural Mentors (CE/ CMs) have critical roles in Australian general practice training, yet these are not well understood. METHODS: Guided by a CE/CM Network, our research team including experienced CE/CMs, used surveys and semi-structured interviews to explore these roles and investigate best practice in employment and support. Participants sampled from stakeholders involved in general practice education across Australia included CE/CMs, Medical Educators, General Practice Supervisors and Registrars, and representatives of Regional Training Organisations, Indigenous Health Training Posts and other key organisations. We undertook thematic analysis using a framework approach, refined further in team discussions that privileged views of CE/ CM members. RESULTS: Participants comprised 95 interviewees and 55 survey respondents. We organised our findings under three overarching themes: understandings about cultural education and mentoring; employment and support of CE/CMs; and delivery and evaluation of cultural education and mentoring. Our findings supported a central role for Aboriginal and Torres Strait Islander CE/CMs in face-to-face Registrar education about culture and history and related impacts on health and healthcare. Cultural education was reported to provide base-line learning as preparation for clinical practice whilst cultural mentoring was seen as longitudinal, relationship-based learning. Mentoring was particularly valued by Registrars working in Aboriginal and Torres Strait Islander communities. Challenges described with employment and support included difficulties in finding people with skills and authority to undertake this demanding work. Remuneration was problematic, particularly for CMs whose work-time is difficult to quantify, and who are often employed in other roles and sometimes not paid. Other improved support recommended included appropriate employment terms and conditions, flexibility in role definitions, and professional development. Recommendations concerning implementation and evaluation included valuing of cultural education, greater provision of mentoring, partnerships with Medical Educators, and engagement of CE/CMs in rigorous evaluation and assessment processes. CONCLUSIONS: Our research highlights the importance of the unique CE/CM roles and describes challenges in sustaining them. Professional and organisational support is needed to ensure delivery of respectful and effective cultural education within general practitioner training.

7.
Artigo em Inglês | MEDLINE | ID: mdl-30220094

RESUMO

ISSUE ADDRESSED: Housing renewal is a common urban housing and development strategy internationally. An intended result is increased social inclusion and well-being of residents through public housing de-concentration. In this study, we examined challenges encountered during the process of housing renewal from the perspectives of community-based staff and volunteers. METHODS: We conducted semi-structured qualitative interviews with housing and community workers, service managers and community volunteers who were working with residents experiencing housing renewal in an outer metropolitan estate in New South Wales. We analysed the data thematically. RESULTS: Seventeen participants were interviewed in a mix of individual and group interviews. Housing workers uncovered substantial resident health and social support needs during housing assessments. Promoting access to services and supporting the mental health and social connectedness of residents into the future were seen as key goals and challenges. However, lack of clarity on which services and community resources would exist in the new neighbourhood at the completion of the renewal project made this more difficult, particularly when supporting the social housing residents who were remaining in the changing community. CONCLUSIONS: Supporting the mental health and well-being of residents experiencing housing renewal is an important role of community-based workers, volunteers and service providers. This includes facilitating access to health care and other services and promoting social connectedness in the emerging community. Increased clarity on what community resources and services will be available subsequent to redevelopment will assist in these aims. SO WHAT?: Early knowledge of what community resources and services will be in place long term in communities undergoing housing renewal will allow staff and volunteers to better support the health and well-being of residents.

8.
BMC Fam Pract ; 19(1): 134, 2018 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-30060756

RESUMO

BACKGROUND: Colorectal cancer (CRC) survivors experience difficulty navigating complex care pathways. Sharing care between GPs and specialist services has been proposed to improve health outcomes in cancer survivors following hospital discharge. Culturally and Linguistically Diverse (CALD) groups are known to have poorer outcomes following cancer treatment but little is known about their perceptions of shared care following surgery for CRC. This study aimed to explore how non-English-speaking and English-speaking patients perceive care to be coordinated amongst various health practitioners. METHODS: This was a qualitative study using data from face to face semi-structured interviews and one focus group in a culturally diverse area of Sydney with non-English-speaking and English-speaking CRC survivors. Participants were recruited in community settings and were interviewed in English, Spanish or Vietnamese. Interviews were recorded, transcribed, and analysed by researchers fluent in those languages. Data were coded and analysed thematically. RESULTS: Twenty-two CRC survivors participated in the study. Participants from non-English-speaking and English-speaking groups described similar barriers to care, but non-English-speaking participants described additional communication difficulties and perceived discrimination. Non-English-speaking participants relied on family members and bilingual GPs for assistance with communication and care coordination. Factors that influenced the care pathways used by participants and how care was shared between the specialist and GP included patient and practitioner preference, accessibility, complexity of care needs, and requirements for assistance with understanding information and navigating the health system, that were particularly difficult for non-English-speaking CRC survivors. CONCLUSIONS: Both non-English-speaking and English-speaking CRC survivors described a blend of specialist-led or GP-led care depending on the complexity of care required, informational needs, and how engaged and accessible they perceived the specialist or GP to be. Findings from this study highlight the role of the bilingual GP in assisting CALD participants to understand information and to navigate their care pathways following CRC surgery.

10.
BMC Med Educ ; 18(1): 3, 2018 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-29291725

RESUMO

BACKGROUND: One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students. METHODS: Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings. RESULTS: Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system. CONCLUSION: Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expanding interest into a field they had not previously considered. An important aspect of such learning is the opportunity to overcome negative preconceptions of consultations with prisoners.


Assuntos
Escolha da Profissão , Medicina Geral/educação , Prisões , Estudantes de Medicina , Educação de Graduação em Medicina , Feminino , Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Teoria Psicológica , Pesquisa Qualitativa , Estudantes de Medicina/psicologia , Inquéritos e Questionários
11.
Aust J Rural Health ; 26(1): 6-13, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29131469

RESUMO

The objective of this review was to synthesise evidence on the health and social support needs of Aboriginal and Torres Strait Islander people leaving prison and on programs which aid successful community re-entry. A systematic literature review was undertaken of peer-reviewed and grey literature published between 2001 and 2013, focusing on the post-release needs of Aboriginal and Torres Strait Islander adults and pre- and post-release programs. Aboriginal and Torres Strait Islander people have high health and social support needs on leaving prison. There is little literature evidence that re-entry programs commonly consider health needs, support linkages with primary care or Aboriginal Medical Services, or are designed in consideration of the particular needs of Aboriginal and Torres Strait Islander people. In the absence of evaluative evidence on re-entry programs in this group, we have synthesised the best practice recommendations. Re-entry programs must be culturally competent in design and delivery, holistic, take a long-term view, involve families and communities, demonstrate interagency coordination and promote linkages between prison and community-based services. There is an urgent need for accessible pre- and post-release programs which meet the particular needs of Aboriginal and Torres Strait Islander people, including their health needs. Programs must be flexible, comprehensive and accessible to those on remand or with short sentences. Stronger linkage with primary care and Aboriginal and Torres Strait Islander community controlled health organisations is recommended.


Assuntos
Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Prisioneiros/educação , Apoio Social , Adulto , Idoso , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Pesquisa Qualitativa
12.
BMJ Open ; 7(10): e017281, 2017 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-29042386

RESUMO

INTRODUCTION: Gout is increasing despite effective therapies to lower serum urate concentrations to 0.36 mmol/L or less, which, if sustained, significantly reduces acute attacks of gout. Adherence to urate-lowering therapy (ULT) is poor, with rates of less than 50% 1 year after initiation of ULT. Attempts to increase adherence in gout patients have been disappointing. We aim to evaluate the effectiveness of use of a personal, self-management, 'smartphone' application (app) to achieve target serum urate concentrations in people with gout. We hypothesise that personalised feedback of serum urate concentrations will improve adherence to ULT. METHODS AND ANALYSIS: Setting and designPrimary care. A prospective, cluster randomised (by general practitioner (GP) practices), controlled trial. PARTICIPANTS: GP practices will be randomised to either intervention or control clusters with their patients allocated to the same cluster. INTERVENTION: The intervention group will have access to the Healthy.me app tailored for the self-management of gout. The control group patients will have access to the same app modified to remove all functions except the Gout Attack Diary. PRIMARY AND SECONDARY OUTCOMES: The proportion of patients whose serum urate concentrations are less than or equal to 0.36 mmol/L after 6 months. Secondary outcomes will be proportions of patients achieving target urate concentrations at 12 months, ULT adherence rates, serum urate concentrations at 6 and 12 months, rates of attacks of gout, quality of life estimations and process and economic evaluations. The study is designed to detect a ≥30% improvement in the intervention group above the expected 50% achievement of target serum urate at 6 months in the control group: power 0.80, significance level 0.05, assumed 'dropout' rate 20%. ETHICS AND DISSEMINATION: This study has been approved by the University of New South Wales Human Research Ethics Committee. Study findings will be disseminated in international conferences and peer-reviewed journal. TRIAL REGISTRATION NUMBER: ACTRN12616000455460.


Assuntos
Gota/terapia , Internet , Projetos de Pesquisa , Autogestão/métodos , Alopurinol/uso terapêutico , Supressores da Gota/uso terapêutico , Humanos , Cooperação do Paciente , Estudos Prospectivos , Qualidade de Vida , Ácido Úrico/sangue
13.
Artigo em Inglês | MEDLINE | ID: mdl-28961160

RESUMO

Australian Aboriginal pregnant women have a high smoking prevalence (45%). Health professionals lack adequate educational resources to manage smoking. Resources need to be tailored to ensure saliency, cultural-sensitivity and account for diversity of Indigenous populations. As part of an intervention to improve health professionals' smoking cessation care in Aboriginal pregnant women, a resource package was developed collaboratively with two Aboriginal Medical Services. The purpose of this study was to assess and validate this resource package. A multi-centred community-based participatory 4-step process (with three Aboriginal Medical Services from three Australian states), included: (1) Scientific review by an expert panel (2) 'Suitability of Materials' scoring by two Aboriginal Health Workers (3) Readability scores (4) Focus groups with health professionals. Content was analysed using six pre-determined themes (attraction, comprehension, self-efficacy, graphics and layout, cultural acceptability, and persuasion), with further inductive analysis for emerging themes. Suitability of Material scoring was adequate or superior. Average readability was grade 6.4 for patient resources (range 5.1-7.2), and 9.8 for health provider resources (range 8.5-10.6). Emergent themes included 'Getting the message right'; 'Engaging with family'; 'Needing visual aids'; and 'Requiring practicality under a tight timeframe'. Results were presented back to a Stakeholder and Consumer Aboriginal Advisory Panel and resources were adjusted accordingly. This process ensured materials used for the intervention were culturally responsive, evidence-based and useful. This novel formative evaluation protocol could be adapted for other Indigenous and culturally diverse interventions. The added value of this time-consuming and costly process is yet to be justified in research, and might impact the potential adaption by other projects.


Assuntos
Educação em Saúde/métodos , Pessoal de Saúde , Grupo com Ancestrais Oceânicos , Gestantes , Abandono do Hábito de Fumar/métodos , Adulto , Austrália , Feminino , Grupos Focais , Humanos , Gravidez , Autoeficácia , Fumar
14.
BMJ Open ; 7(8): e016095, 2017 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-28780551

RESUMO

INTRODUCTION: Indigenous women have the highest smoking prevalence during pregnancy (47%) in Australia. Health professionals report lack of knowledge, skills and confidence to effectively manage smoking among pregnant women in general. We developed a behaviour change intervention aimed to improve health professionals' management of smoking in Indigenous pregnant women-the Indigenous Counselling And Nicotine (ICAN) QUIT in Pregnancy. This intervention includes webinar training for health professionals, an educational resources package for health professionals and pregnant women, free oral nicotine replacement therapy (NRT) for pregnant women, and audit and feedback on health professionals' performance.The aim of this study is to test the feasibility and acceptability of the ICAN QUIT in Pregnancy intervention to improve health professionals' provision of evidence-based culturally responsive smoking cessation care to Australian Indigenous pregnant smokers. METHODS AND ANALYSIS: This protocol describes the design of a step-wedge cluster randomised pilot study. Six Aboriginal Medical Services (AMSs) are randomised into three clusters. Clusters receive the intervention staggered by 1 month. Health professionals report on their knowledge and skills pretraining and post-training and at the end of the study. Pregnant women are recruited and followed up for 3 months. The primary outcome is the recruitment rate of pregnant women. Secondary outcomes include feasibility of recruitment and follow-up of participating women, and webinar training of health professionals, measured using a designated log; and measures of effectiveness outcomes, including quit rates and NRT prescription rates. ETHICS AND DISSEMINATION: In accordance with the Aboriginal Health and Medical Research Council guidelines, this study has been developed in collaboration with a Stakeholder and Consumer Aboriginal Advisory Panel (SCAAP). The SCAAP provides cultural consultation, advice and direction to ensure that implementation is acceptable and respectful to the Aboriginal communities involved. Results will be disseminated to AMSs, Aboriginal communities and national Aboriginal bodies. REGISTRATION DETAILS: This protocol (version 4, 14 October 2016) is registered with the Australian and New Zealand Clinical Trials Registry (Ref #: ACTRN12616001603404).


Assuntos
Aconselhamento Diretivo/métodos , Serviços de Saúde do Indígena , Grupo com Ancestrais Oceânicos , Gestantes/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa , Abandono do Hábito de Fumar/psicologia , Fumar Tabaco/prevenção & controle , Adulto , Austrália , Análise por Conglomerados , Estudos de Viabilidade , Feminino , Educação em Saúde , Serviços de Saúde do Indígena/normas , Humanos , Recém-Nascido , Projetos Piloto , Gravidez , Gestantes/etnologia , Prevenção do Hábito de Fumar , Resultado do Tratamento , Adulto Jovem
15.
Aust J Prim Health ; 23(4): 391-396, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28514993

RESUMO

This consumer-led research investigated the client experiences and the individual and community benefits of a community-based cancer support service operating in a regional setting. The study included cross-sectional surveys, focus group discussions and key-informant interviews. In total, 114 clients, 28 carers and 20 therapists were surveyed; three client focus groups were conducted and five directors and staff were interviewed. For many clients and carers, the warm welcome experienced at first contact sets the tone for a long-term association with the organisation. The feeling of being cared for extends to the broader community and living with cancer becomes more than survivorship. Integral to the organisational model are opportunity (second-hand) shops that enable subsidised complementary therapies and other services, offer a way of giving back and assist disadvantaged community members. The organisational model has benefits, not only for people living with cancer and their families, but also for the wider community.

16.
Int J Equity Health ; 16(1): 3, 2017 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-28056999

RESUMO

BACKGROUND: People who have been in custody are more likely to experience multiple, long standing health issues. They are at high risk of illness and injury post release and experience poor access to health services both of which contribute to high rates of recidivism. The study was conducted to examine Aboriginal and non-Aboriginal former prisoners' risk of hospitalisation and rehospitalisation in the five years post release from custody and identified the common reasons for hospitalisations. METHODS: Common reasons for hospital admission were identified by conducting descriptive analysis of linked data, related to former prisoners, from NSW Ministry of Health and Corrective Services NSW. This relied upon admitted patient data for 1899 patients. Of this cohort, 1075 people had been admitted to hospital at least once and remained out of custody over a five year period. The independent variables we studied included age, sex, and whether or not the person was Aboriginal. We conducted univariate and multivariate analysis on the following dependent variables: number of admissions over five years after release; more than one admission; days between custody and first hospitalisation; and days between first and second hospitalisation. RESULTS: Mental and behavioural disorders, injuries and poisoning, and infectious or parasitic diseases were the three most common reasons for admission. Aboriginal and non-Aboriginal former prisoners had a broadly similar pattern of reasons for admission. Yet Aboriginal former prisoners were more likely than non-Aboriginal former prisoners to have a shorter mean interval between hospital admission and readmission (187 days compared to 259 days, t = 2.90, p-0.004). CONCLUSIONS: Despite poorer health among Aboriginal people, there were broadly similar patterns of reasons for admission to hospital among Aboriginal and non-Aboriginal former prisoners. There may be a number of explanations for this. The cohort was not a representative sample of the NSW prison population. There was an overrepresentation of individuals with cognitive disability (intellectual disability, acquired brain injury, dementia, fetal alcohol spectrum disorder) in the study population, which may have impacted on this group accessing hospital health care. Alternatively perhaps there were fewer presentations to hospital by Aboriginal former prisoners despite a greater need. The shorter interval between hospital admission and readmission for Aboriginal former prisoners may suggest the need for better follow up care in the community after discharge from hospital. This presents an opportunity for primary health care services to work more closely with hospitals to identify and manage Aboriginal former prisoners discharged from hospital so as to prevent readmission.


Assuntos
Direito Penal , Acesso aos Serviços de Saúde , Hospitalização , Grupo com Ancestrais Oceânicos , Prisões , Adulto , Austrália , Feminino , Humanos , Infecção , Estudos Longitudinais , Masculino , Transtornos Mentais , Pessoa de Meia-Idade , Morbidade , Doenças Parasitárias , Readmissão do Paciente , Envenenamento , Prisioneiros , Risco , Ferimentos e Lesões , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 16(1): 382, 2016 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-27903257

RESUMO

BACKGROUND: There is mounting evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene during pregnancy. A recognised and important point of influence is their interaction with health professionals, particularly when receiving Antenatal Care. However, there is limited evidence about the perceptions of ANC providers in Australia toward the provision of perinatal oral healthcare. This study was undertaken to explore the knowledge, attitudes and practices of Antenatal Care (ANC) providers in New South Wales (NSW), Australia providing perinatal oral healthcare and to identify barriers to and predictors of their practices in this area. METHODS: A cross sectional survey was undertaken of ANC providers (general practitioners, obstetricians/gynaecologists and midwives) practising in NSW, Australia. Participants were recruited through their professional organisations via email, postal mail, and networking at conferences. The survey addressed the domains of knowledge, attitude, barriers and practices towards oral healthcare, along with demographics. Data was entered into SPSS software and analysed using descriptive and inferential statistics. RESULTS: A total of 393 surveys (17.6% response rate) were completed comprising 124 general practitioners, 74 obstetricians/gynaecologists and 195 midwives. The results showed limited knowledge among ANC providers regarding the impact of poor maternal oral health on pregnancy/infant outcomes. Most (99%) participants agreed that maternal oral health was important yet few were discussing the importance of oral health or advising women to visit a dentist (16.4-21.5%). Further, less than a third felt they had the skills to provide oral health advice during pregnancy. ANC providers who were more knowledgeable about maternal oral health, had training and information in this area and greater experience, were more likely to engage in practices addressing the oral health of pregnant women. CONCLUSION: The findings suggest that ANC providers in NSW are not focussing on oral health with pregnant women. ANC providers seem willing to discuss oral health if they have appropriate education/training and information in this area. Further research at a national level is required to confirm whether these findings are similar in all Australian states.


Assuntos
Ginecologia , Tocologia , Obstetrícia , Saúde Bucal , Padrões de Prática Médica , Cuidado Pré-Natal , Adulto , Atitude do Pessoal de Saúde , Competência Clínica , Estudos Transversais , Aconselhamento Diretivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Saúde Bucal/educação , Higiene Bucal , Gravidez , Resultado da Gravidez , Inquéritos e Questionários
18.
Aust Fam Physician ; 45(3): 123-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27052049

RESUMO

BACKGROUND: The New South Wales (NSW) Sexually Transmissible Infections Program Unit (STIPU) produced nine resources to support the diagnosis and management of sexually transmissible infections (STIs) in general practice. OBJECTIVE: In this study, we explored the processes of developing the resources and outcomes achieved. METHODS: We analysed project documents and undertook a focus group interview with the STIPU Working Group to evaluate resource development and dissemination. Interviews with general practitioners (GPs) and practice nurses (PNs), combined with previously reported survey findings, provided an outcomes evaluation. RESULTS: STIPU used a rigorous, multimodal approach to develop evidence-based clinical resources. GPs and PNs received information opportunistically rather than through targeted searches unless they had a particular interest. GPs were less aware of online re-sources. DISCUSSION: STIPU's best practice translation of clinical guidelines could be enhanced by promotion of online resources, links through general practice software, strong engagement with general practice organisations, and developing the role of PNs.


Assuntos
Medicina Geral/educação , Clínicos Gerais/educação , Profissionais de Enfermagem/educação , Avaliação de Programas e Projetos de Saúde , Doenças Sexualmente Transmissíveis , Educação Médica Continuada/métodos , Educação Continuada em Enfermagem/métodos , Humanos , Internet , Entrevistas como Assunto , Aprendizagem , New South Wales , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Inquéritos e Questionários
19.
Trials ; 17(1): 119, 2016 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-26941013

RESUMO

BACKGROUND: Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. METHODS/DESIGN: This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 - 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. DISCUSSION: The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications. TRIAL REGISTRATION: The trial is registered with Australia New Zealand Clinical Trials Registry ( ACTRN12613001068752 ). Date of registration: 24 September 2013.


Assuntos
Antibacterianos/uso terapêutico , Grupo com Ancestrais Oceânicos , Otite Média/terapia , Conduta Expectante , Doença Aguda , Adolescente , Fatores Etários , Antibacterianos/efeitos adversos , Antibacterianos/economia , Criança , Pré-Escolar , Protocolos Clínicos , Análise Custo-Benefício , Custos de Medicamentos , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Otite Média/diagnóstico , Otite Média/economia , Otite Média/etnologia , Projetos de Pesquisa , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Saúde da População Urbana , Conduta Expectante/economia
20.
J Rheumatol ; 43(1): 144-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26568590

RESUMO

OBJECTIVE: To explore the understanding of gout and its management by patients and general practitioners (GP), and to identify barriers to optimal gout care. METHODS: Semistructured interviews were conducted with 15 GP and 22 patients in Sydney, Australia. Discussions were focused on medication adherence, experiences with gout, and education and perceptions around interventions for gout. Interviews were audio recorded, transcribed verbatim, and analyzed for themes using an analytical framework. RESULTS: Adherence to urate-lowering medications was identified as problematic by GP, but less so by patients with gout. However, patients had little appreciation of the risk of acute attacks related to variable adherence. Patients felt stigmatized that their gout diagnosis was predominantly related to perceptions that alcohol and dietary excess were causal. Patients felt they did not have enough education about gout and how to manage it. A manifestation of this was that uric acid concentrations were infrequently measured. GP were concerned that they did not know enough about managing gout and most were not familiar with current guidelines for management. For example and importantly, the strategies for reducing the risk of acute attacks when commencing urate-lowering therapy (ULT) were not well appreciated by GP or patients. CONCLUSION: Patients and GP wished to know more about gout and its management. Greater success in establishing and maintaining ULT will require further and better education to substantially benefit patients. Also, given the prevalence, and personal and societal significance of gout, innovative approaches to transforming the management of this eminently treatable disease are needed.


Assuntos
Alopurinol/administração & dosagem , Atitude Frente a Saúde , Clínicos Gerais/estatística & dados numéricos , Gota/diagnóstico , Gota/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Austrália , Gerenciamento Clínico , Progressão da Doença , Feminino , Humanos , Entrevistas como Assunto , Masculino , Educação de Pacientes como Assunto , Avaliação de Resultados da Assistência ao Paciente , Participação do Paciente , Medição de Risco , Índice de Gravidade de Doença
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