BROKEN HILL UNIVERISTY DEPARTMENT OF RURAL HEALTH
UNIVERSITY OF SYDNEY
Frances Boreland
Research Officer
PHC RED Program
P: 08 8080 1279
E: fboreland@gwahs.health.gov.nsw.au
Broken Hill University Department of Rural Health (BHUDRH) is working in partnership with the Greater Western Area Health Service (GWAHS) to develop the research skills of Clinical Nurse Consultants within the region.
A short course in research skills covering the basics of epidemiology, questionnaire design, qualitative research and data analysis is being run as a combination of a two-day face to face workshop followed by a series of video-conferences.
Delivering part of the course by video-conferencing takes advantage of existing telehealth facilities and allows people to participate while reducing the need for travel and time away from the workplace.
The course is funded by both GWAHS, which obtained funding to cover the cost of teleconferencing and travel to the workshop and is providing overall coordination, and the BHUDRH PHCRED program, which is providing the teaching and tutorial support.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF NEWCASTLE
Susan Goode
PHCRED Program Coordinator
P: 02 4968 6737
E: susan.goode@newcastle.edu.au
General Practice workforce has been a topic of interest for researchers from the Discipline of General Practice (DGP), University of Newcastle for several years. From 2004-2006 staff from the PHCRED Program contributed to the evaluation of the Cessnock Uni-Clinic. In early 2005 the DGP commenced an evaluation of the Clinic including several objectives relating to Primary Health Care (PHC): service providers (workforce), service provision, services accessed, screening rates and an economic evaluation.
The Clinic has been operating since October 2004 and is a joint project of the Hunter New England Area Health Service and University of Newcastle with funding from the state and commonwealth governments. The Clinic is trialling a model of service delivery around a multidisciplinary PHC team where nurses and allied health professionals work within GP-led teams. A major driving force in the establishment of the Clinic was the shortage of PHC services together with the high rates of chronic disease and low socioeconomic status. Patients reported difficulty in getting GP appointments, long waiting periods for community health services and difficulty in accessing health services in neighbouring towns due to poor public transport and high demand.
The DGP's evaluation found that the Clinic had contributed variety to the general practice workforce in Cessnock, although it had not altered the GP:population ratio in the Cessnock Local Government Area. The Clinic was (and continues to be) an important teaching practice, taking both GP registrars and under-graduate students. The addition this modern, team-orientated general practice entity is likely to make it easier to recruit GPs and other health professionals to the town in the future (the Clinic has recruited two more GPs to Cessnock since the conclusion of the evaluation).
Since completing this evaluation, the Clinic premises have been extended to allow a doubling of GP, nursing and allied health services allowing for an increasing range of specialised PHC services to be offered and increased integration with other PHC services in the town.
PRIMARY HEALH CARE: RESEARCH FOR THE FUTURE
4th Annual Tasmanian PHCRED Symposium
1 November 2007, Launceston
Ellen McIntyre, PHC RIS & Theresa Doherty, Tas PHCRED Statewide Coordinator
 Interesting and diverse presentations, good chairmanship and insightful discussions was how Professor Mark Nelson summed up the 4th annual Tasmanian PHCRED Symposium attended by over 40 delegates from around Tasmania and the mainland. It demonstrated the unmitigated success of the PHCRED Strategy both in increasing the number of primary health care researchers as well as in producing research relevant to policy and practice.
Special guest speaker Joan Henderson spoke passionately about BEACH and SAND and demonstrated how this useful information has been used to improve health outcomes. She also outlined the tools they had developed and validated over the years. These have now been made available for others to use <www.fmrc.org.au/> for more information.
Researchers from the Menzies Research Institute, the Department of Rural Health, School of Sociology and Social Work, Centre for Human Movement, and the State Department of Health and Human Services, presented a wealth of research information. Examples include Charlotte McKercher's research in young adults suggesting there is a negative association with exercise and mood disorder; Nick Towle's outline on researching food choices that are made at children's sporting events and Tania Winzenberg's presentation of the prevalence of vitamin D deficiency of a large cohort of children and the impact this has on bone mineral density.
Other presentations focussed on diabetes risk factor reduction, gay men's construction of masculinity and mental health help-seeking pathways, the use of seat walkers, Tai Chai and improved fall risk factors in older adults, art as therapy in physical rehabilitation, community gardens and the link between quality improvement and capacity building.
GREATER GREEN TRIANGLE UNIVERSITY DEPARTMENT OF RURAL HEALTH
FLINDERS AND DEAKIN UNIVERSITIES
Rachel Boak
Research Fellow, PHCRED Coordinator
P: 03 5563 3502
E: rachel.boak@greaterhealth.org
PHCRED Bursary Holder program – Supporting PHC research
Since 2004, the GGT UDRH's PHCRED bursary holder program has provided academic and financial support to the research projects of more than 20 practitioners, consumers, and researchers. The bursary program was developed with the aim of increasing the pool of primary health care researchers by up-skilling early-mid career researchers, and supporting the sustainable advancement of research careers in primary health care. Here Carmel Brady reports that she had always played with the idea of returning to further study, and that the PHCRED bursary holder program is helping her achieve that goal.
Carmel works part time in the health care field, and also manages several home based businesses. She began working in the disability sector in 1981, following the International Year of the Disabled. Carmel describes this time as ‘very exciting and challenging' as it was the beginning of de-institutionalisation of the disabled. Over the years, she has worked for a variety of organisations, including the Western Region Alcohol and Drug Centre, Lifeline, and others that focus on farm safety and women's health. Over the last few years, Carmel has been involved with project work and states “…I enjoy the challenge, flexibility and variety this work offers”.
Her bursary project is titled “Community Southwest: identifying regional research capacity”. She states there is “…quite a lot of support to increase medical and public health research capacity…my interest has always been at the service delivery end of community health”. Her project is focused on investigating the research capacity amongst staff of Community Southwest.
Community Southwest is a collaboration of the nine major non-government organisations within the Warrnambool Victoria region. Community Southwest utilises shared planning to improve services, and also supports research interests among members.
Carmel considers being a bursary holder a good opportunity to gain some supervised research experience as well as focusing on one of her professional interests, however, insists that the project ‘has to be made a priority' to ensure that it stays on track.
For further information about the GGT UDRH bursary holder program please contact:
Rachel Boak
P: 03 5563 3502
E: rachel.boak@greaterhealth.org
or visit www.greaterhealth.org/research/health-services-research/3/
PHCRED TRI-STATE COLLABORATION EVENT
2007 Annual State Conference
11 September 2007, Adelaide
Sarah Eckermann, PHC RIS
The PHCRED Tri-State Collaboration Event on the 11 September 2007 in Adelaide proved to be a wonderful opportunity for delegates to meet, share ideas and gain wisdom. The conference spoilt attendees with a feast of information about recently completed research from South Australia, the Northern Territory and the Greater Green Triangle (GGT).
Dr Rachael Humeniuk, International Coordinator WHO ASSIST Programme WHO Collaborating Centre Department of Pharmacology University of Adelaide spoke about the Findings of the WHO ASSIST Phase III study. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an eight item questionnaire developed in 1997 by World Health Organisation (WHO) clinical researchers in response to the burden of disease caused by substance use. The ASSIST screens for problem/risky use of tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives, hallucinogens, inhalants and opioids.
Dr Margaret Scrimgeour's, Course Co-ordinator, Social Contexts of Education, University of South Australia, presentation focused on the recent history of Indigenous health research reform in Australia and provided suggestions for developing and maintaining ethical and collaborative relationships between Aboriginal and Torres Strait Islander peoples and professional researchers.
Ms Susannah Eliott, CEO, Australian Science Media Centre, spoke about the role of the ASMC, gave advice to the audience on dealing with the news media, and introduced the concept of riding the news wave. The AMSC is an independent information service for news reporters, it works to provide journalists with accurate up to date information and puts them in contact with experts in the field when major science news stories hit the headlines.
Other presentations focused on Aboriginal Rural and Remote Health, Research Impact, Chronic Disease Management, the Link Between Primary Health Care and Acute Care and Mental Health.
Conference abstracts are available from the following website:
Web: www.phcredtristate.org.au/
SCHOOL OF MEDICINE PRIMARY HEALTH CARE RESEARCH
UNIVERSITY OF NOTRE DAME
Tom Brett
Assoc Prof and Director Notre Dame PHCRED
P: 08 9433 0258
E: tbrett@nd.edu.au
Notre Dame PHCRED has been involved in two workforce issues in recent months.
WA PHCRED Conference
The WA PHCRED conference held at the Perth Zoo in November devoted one session to workforce issues. Dr Simon Towler gave a plenary presentation on the proposed reforms to the WA Health system and the implications for primary care.
Four papers followed on how general practice in WA will cope with the surging numbers of new medical students and graduates:
- Prof Jon Emery (UWA) Undergraduate teaching and vertical integration in general practice
- A/Prof Tom Brett (Notre Dame) General practice training for post-graduate years 1-3
- Hileke Van Osch (WAGPET) Vocational training for general practice
- Prof Campbell Murdoch (Rural Clinical Schools) Rural training pathway.
New doctor numbers in WA will double by 2012 and treble shortly after that. Shorter hospital stays mean student exposure to real patients in hospital settings is getting harder. Recent contraction in applicants for GP training posts coupled with a shift to better work-life balance means fewer GPs looking after patients just when medical schools look to general practice to provide more teaching.
The papers engendered some lively discussion with a lot of emphasis on the excessive demands on general practice without adequate compensation for the effort or the provision of proper infrastructure for the practices. It is an area that is set to occupy the interests of many GPs in the coming years.
GP Retirement intentions study
Notre Dame PHCRED is currently undertaking a GP Retirement intentions study in conjunction with four WA Divisions of general practice. The study targets 45-65 year old GPs on their plans for retirement as well as looking at factors that might encourage them to stay longer in the workforce. It is hoped to complete the study by early 2008.
THE STATE OF PRIMARY HEALTH CARE
2007 Annual State Conference
3 November 2007, Perth
Ellen McIntyre, PHC RIS & Tracy Reibel, PHCRED WA Statewide Coordinator
 With the statement that “Research is good for the mind and staves off Alzheimer's” Professor Max Kamien opened the annual PHCRED WA conference and the delegates began their memorable feast of research, ideas and stimulating discussion and networking. In addition to research presentations from university departments, Divisions of General Practice and practitioners, the keynote speakers from the Department of Health WA were outstanding in their contribution.
Simon Towler (Executive Director, Health Policy and Clinical Reform, Health WA) indicated how crucial primary health care research and researchers were in the planning of health care and delivery and would like to establish a critical partnership with the PHCRED research group to work together on an innovation and learning cycle. He outlined how the health service is currently spending more on the worried well rather than the sick. With an ageing population we need to focus on keeping this group well so that the health system is not overburdened with the care of the frail aged.
Professor Ken Wyatt (Director, Office of Aboriginal Health) stimulated vigorous discussion of matters crucial to Indigenous health outlining some very successful initiatives that could be implemented more broadly. He also showed that health should not be seen in isolation but is closely entwined with education, housing, and other domains. Michael Mitchell who spoke of the development and implementation of the Statewide Indigenous Mental Health Service and Marisa Gilles who presented on the issues surrounding overseas trained doctors working in rural and remote Aboriginal health settings contributed to the enthusiastic debate that followed.
This conference has continued the successful partnership with RACGP in WA to ensure that this event will continue to be seen as being very worthwhile and not to be missed. Abstracts from paper presentations will be available on the PHCRED WA website at the end of November – <www.phcredwa.org.au/go/project-list>.
DEPARTMENT OF GENERAL PRACTICE
THE UNIVERSITY OF MELBOURNE
Hayley Shaw
Research Development Coordinator
P: 03 8344 9050
E: h.shaw@unimelb.edu.au
Researchers at the Department of General Practice were sponsored by the Australian Primary Health Care Research Institute (APHCRI) to investigate strategies revolving around Australia's medical workforce shortage. Professor Jane Gunn led a project investigating the role of generalism in the 2020 primary care team and Dr Grant Blashki a systematic review of the evidence for psychological treatments in primary care. An outline of the projects is given below.
What is the place of generalism in the 2020 primary care team?
The Australian health care system is rapidly moving towards a team approach for general practice. To help inform future workforce reforms in the changing context of general practice, a systematic narrative literature review of the place of generalism in the 2020 primary care team has been undertaken. The review found that generalism in health care has been written about over the past 50 years, but there has been no agreement upon a definition of what generalism is. The research team have identified the essential dimensions of generalism and represented these as the continual interaction of three essential dimensions - ways of being (values and principles); ways of knowing (types of knowledge); and ways of doing (types of actions). Policy options to strengthen the place of generalism in the 2020 primary care team are now being developed. For more information on the study, please contact Dr Lucio Naccarella <l.naccarella@unimelb.edu.au>.
Systematic Review of Psychological Treatments in Primary Care - The Australian Psychological Treatments (APT) Project
The recent Australian primary mental healthcare reforms by the Federal government have opened up consumer access to psychological treatments from allied health providers. Such initiatives need to be tied to current evidence from the literature in relation to local health systems. A systematic review of the evidence for psychological treatments in primary care was undertaken. From the 69 studies reviewed, there was support for the effectiveness and cost-effectiveness of psychologist provided treatments for depression and anxiety. The use of collaborative models of health-care was particularly effective.
The researchers hope to encourage practitioners and policy advisors to consider how to use such evidence to continue to build world-leading models of primary mental health care.
For more information on the study please contact:
Dr Grant Blashki
E: gblashki@unimelb.edu.au
or Dr Richard Moulding
E: moulding@unimelb.edu.au
SCHOOL OF PRIMARY HEALTH CARE
MONASH UNIVERSITY
Professor Shane Thomas
Director of Primary Care Research
P: 03 8575-2245
E: Shane.Thomas@med.monash.edu.au
Older people, successful ageing and primary care research
Older people constitute an increasing proportion of the Australian community and they use a high proportion of primary health care services provided to the community. Monash researchers Prof Colette Browning, Prof Shane Thomas, Prof Daniel O'Connor and Dr Jane Sims with Prof Hal Kendig from Sydney University have recently received a NHMRC Project Grant to continue their studies of “Health, wellbeing, disability and service pathways in older (80+) Australians”.
The Melbourne Longitudinal Studies of Healthy Ageing (MELSHA) project has run since 1994 when a baseline survey of 1000 people aged 65 years and over living in non-institutional settings was conducted in Melbourne, Australia. The sample has been followed up annually since that time.
The study is a large omnibus one and data has been collected from the participants on conditions including continence, musculoskeletal and cardiovascular disease, falls and injuries, confusion, pain, medication use, depression and mental health, health behaviours (nutrition, exercise, social activity), wellbeing and service use (health services, community services, and residential care). As at end 2006, outcomes were known for 90 per cent of the initial study sample, an outstandingly low loss to sample.
The purpose of the study is to identify modifiable risk and protective factors that impact upon successful ageing. The study program has entered an exciting phase as we now have outcomes data for a large proportion of the study sample. Recent related work led by Professors Bowning and Thomas has focussed on the development of an agreed local and international definition of successful ageing.
This work is being used to inform the application of sophisticated modelling techniques to identify risk and protective factors in MELSHA. In this latest phase of the work funded by the NHMRC, particular emphasis is being paid to the impacts that timely primary care interventions may have upon successful ageing.
SUPPORTING NETWORKS: SHOWCASING NEW RESEARCH FROM GENERAL PRACTICE
2007 Inaugural VIC PHCRED Conference
2 November 2007, Melbourne
Ellen McIntyre, PHC RIS & Christopher Anderson, acting Vic PHCRED Statewide Coordinator
Networking was alive and well during this, the inaugural VIC PHCRED Conference. Delegates heard of the research journeys of researchers Rebecca Jessop, Tshepo Rasekaba, Helen Plousi and Danielle Mazza and how the mentoring, supervision and support they received along the way influenced their research careers.
The many research presentations demonstrated the diverse nature of primary health care research while at the same time indicated the research strengths of the departments in which the presenters are located. In the area of youth health, Claudio Villella spoke of the relationship between motivation, readiness and treatment engagement for young people with substance abuse issues, in and beyond custody. Susan Webster described her plan to study the influences of GPs to undertake health assessments for children entering out-of-home care. Philip Mendes outlined how the physical and emotional health of young people transitioning from state out-of-home care can be improved while PhD student Helen Plousi focussed on risk factors for binge-eating disorder in adolescents.
Populations at risk was the theme for Julie Wang and Eamonn O'Toole. Julie hopes to use her research to improve disease awareness in populations at high risk of chronic hepatitis B infection while Eamonn is exploring the barriers and facilitators for the Indigenous population managing Type 2 Diabetes.
Both Kerry Hampton and Wendy Lee are researching women's health – fertility awareness among women attending fertility clinic and reasons for termination of pregnancy in older women.
Research in general practice was the focus for both Hubert van Doorn who analysed practice data and will use this to better understand mental health care delivery and Daniel Carbone who described how he had been able to engage three general practices to conduct research.
Research being undertaken by Liz Moore and Christine Longman both relate to GPs –what patients with alcohol dependence think of their GP and influences in GP prescribing of pharmacotherapy for opioid dependence. Pharmacist Kerran Melgaard also focussed on pharmacy, looking at the factors that affect professional satisfaction amongst rural pharmacists.
As Professor Shane Thomas concluded “this was the best VIC PHCRED Conference to date”.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF QUEENSLAND
Jacquii Burgess
Media officer
PHCRED Qld
P: 0407 789 078
E: jacquii@uq.edu.au
Primary health care professionals from around Queensland gathered in Brisbane recently to share research activities they'd been involved with over the past 12 months as part of the Primary Health Care Research Evaluation and Development (PHCRED) Fellowship program.
Twenty researchers spoke on a variety of topics ranging from Indigenous men's urinary health, and using SMS reminders to improve refill compliance, to sex as a treatment effect modifier in heart failure. For some fellows, it was their first time presenting.
The aim of the PHCRED Fellowships was to develop the research skills of clinicians by conducting quality research on topics relevant to primary health care practice.
Sallie Gardner investigated managing stress, anxiety and depression among medical students using an online intervention with email support. Sallie's research showed that an intervention based on cognitive behavioural theory could benefit first year medical students in preventing and managing stress, anxiety and mood disorders.
Erin McMeniman's research looked at skin diseases in the first two years of life for children living in a remote Indigenous community in East Arnhem Land. The aim of her research was to describe the prevalence, frequency and cause of infectious skin diseases in this population. Initial findings show that by the age of two, 73% of the children had presented with scabies and 84% had presented with skin sores.
Many of the researchers also took part in a writing retreat, which provided tips on report writing and getting research published.
PHCRED Fellows from Bond University, Griffith University, James Cook University, University of Queensland, and the University Department of Rural Health, Mount Isa Centre for Rural and Remote Health took part in the meeting.
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