DEPARTMENT OF GENERAL PRACTICE
UNIVERSITY OF MELBOURNE
Dr Meredith Temple Smith
Research Training Coordinator
Primary Care Research Unit
P: 03 8344 3371
E: m.temple-smith@unimelb.edu.au
Congratulations to 2007 RDP Fellow Susan Webster on her prolific output for 2008! Work conducted by Susan for her Master of Primary Health Care thesis has been published by General Practice Victoria as a research report1. Susan's research is examining an important and timely issue – the involvement of general practice as a partner in the health assessment of children entering out-of-home care. The report is available at <www.gpv.org.au>.
Susan has made oral presentations of this work at five conferences, including two international 3,4, two national2,6 and one state conference5 and presented a poster at one national conference as well. We look forward to reading her completed thesis.
References
1 Webster SM and Temple-Smith M. Factors influencing general practice willingness and readiness to undertake comprehensive health assessments for children and young people entering out-of-home care. A summary report of the preliminary findings of a study with Victorian general practitioners. General Practice Victoria, August 2008
2 Webster S. Can GPs better assess the health of children and young people entering out-of-home care? Association of Children's Welfare Agencies (ACWA) Conference, Sydney Convention Centre, 18-20 August 2008
3 Webster S. General Practice health assessment of children and young people entering out-of-home care in Victoria . World Organisation of Family Doctors (WONCA) Asia Pacific Regional Conference 2008; combined with Royal Australian College of General Practitioners Annual Scientific Convention. Melbourne Convention & Exhibition Centre, 2-5 October 2008
4 Webster S. General Practice as a new partner in improving health and well-being in children and young people entering protective care. Medical Women's International Association Western Pacific Region Congress, Sofitel Hotel, Melbourne, 17-19 October 2008
5 Webster S. What do GPs and children in foster care have in common? Results of a study about GP health assessments for children and young people entering out-of-home care in Victoria. 2008 Victorian Primary Health Care Research, Evaluation and Development (VicPHCRED) Conference, Monash Conference Centre, Melbourne, 7 November 2008
6 Webster S. Exploring general practice as a new partner in improving the health and well-being of children and young people entering out-of-home care in Victoria. Association for the Wellbeing of Children in Healthcare (AWCH) and Children's Hospitals Australasia (CHA) Children's Health Conference. Health Care for Kids - the People, the Map and the Measure. Manly Pacific Hotel, Sydney, 17-18 November 2008
7 Webster S and Temple-Smith M. Poster: General Practice health assessment of children and young people entering out-of-home care in Victoria. Australian General Practice Network Forum, 2008 Darwin Convention Centre, 29 Oct - 1 Nov 2008
DEPARTMENT OF GENERAL PRACTICE
MONASH UNIVERSITY
Wendy Lee
MPhil (research) candidate,
2007 RDP fellow
P: 03 9489 9579
E: wendy.lee@med.monash.edu.au
Women aged 20-24 is the most common age-group to present for a termination of pregnancy (TOP).
However, a growing number of TOPs are occurring in women over 35. In 1992, a survey in New South Wales showed that 12% of women over 35 had a TOP. In 2006, 17% were reported in South Australian women over 35. Recently, Abigail et al found an increase in TOP among women aged 30-50 between 1996 and 2006. Our study seeks to determine the reasons for TOP in women over 35 attending a private termination clinic in Melbourne. It is a two-phase study.
Phase 1 explored the range of women's reasons for TOP and their contraceptive practices pre-TOP. Medical records of fifty women over 35 and fifty women under 25 who had TOP in February 2007 were examined for reasons for TOP. Key characteristics and contraceptive practices were also determined. This audit found over 70% of women had three or more reasons for TOP. Of the five most cited reasons for TOP, three were common to both age-groups: ‘focus on career/study', ‘emotionally not ready for children', and ‘financial reasons'. For women over 35, the other two most cited reasons were ‘already with dependent children' and ‘completed family'. Eighty percent of women in both age-groups were in established relationships. Twenty eight percent of women under 25 and 44% of women over 35 had experienced at least one previous TOP. One-third of women over 35 did not use contraception pre-TOP compared to a quarter of women under 25. About 50% of women in both age-groups used non-hormonal methods pre-TOP. The results imply that women over 35 should also be regularly assessed for their contraceptive needs and current practices.
Phase 2, in recruitment stage, will involve semi-structured interviews of women over 35 and women under 25. It aims to explore women's beliefs and reasons for contraceptive use/non-use and for deciding on TOP.
References
Adelson P, Frommer M, Weisberg E. (1995). A survey of women seeking termination of pregnancy in New South Wales. MJA, 16 Oct; 163: 419-422.
Chan A, Scott J, Nguyen A-M, Sage L. (2007). Pregnancy outcome in South Australia 2006. Adelaide: Pregnancy Outcome Unit, South Australian Department of Health. Available at: www.health.sa.gov.au/pehs/pregnancyoutcome.htm [Accessed 20 April 2008].
Abigail W, Power C, Belan I. (2008). Changing patterns in women seeking terminations of pregnancy: A trend analysis of data from one service provider 1996-2006. Aus N Z J Public Health. 32: 230-237.
DEPARTMENT OF RURAL AND INDIGENOUS HEALTH
MONASH UNIVERSITY
Jowey Lim
PHCRED program manager
P: 0422 545 488
E: Jowey.lim@med.monash.edu.au
Funding boost for rural research into primary healthcare
The PHCRED program from the Monash University Department of Rural and Indigenous Health in Moe has distributed $40,000 to primary healthcare organisations and professionals in the Latrobe Valley to bolster research into areas including mental health, inter-professional research, diabetes and Indigenous health.
The applications were assessed and ranked by members of the PHCRED Advisory Committee; Anna Chapman, the PHCRED statewide coordinator and Rod Wellard, the Director of GetGP.
"The PHCRED funds will now help nine recipients in regional centres to pursue research that will ultimately benefit the lives of people in rural Australia. This is an enormous boost for researchers at all stages of their career," said PHCRED Program Manager Jowey Lim.
Among the recipients, Koorie PhD candidate Samuel Crane received a $3,500 scholarship to assist him with research into Indigenous health.
"[My research] will strengthen the Koorie community with newfound knowledge that will aid in shortening the gap in life expectancy between Koorie and non-Koorie people."
PHCRED also distributed three major grants of $10,000, which are dedicated respectively to mental health, general practice and inter-professional education.
Thanks to the Interprofessional Education Research Grant, Mr Daniel Carbone of the Central Highlands General Practice Network will now be able to translate five years of diabetes research into a learning module that teaches other primary healthcare professionals how to systematically assess diabetes outcomes in general practice.
The successful PHCRED grant applicants are:
- Bruce Osborne, Latrobe Regional Hospital (Mental Health Research Grant $10,000)
- Malcolm McKelvie, GetGP Ltd (General Practice Grant $10,000)
- Mr Daniel Carbone, Central highlands General Practice Network Inc. (Interprofessional Education Research Grant $10,000)
- Dr Vaughan Speck and Dr Susan Elizabeth Clarke, Tanjil Place Medical, Moe (Clinical Audits Grant $1850 and Writing Grant $1800)
- Cheryl Martin, Central Victoria General Practice Network (Bendigo) (Research Network Grant, $1500)
- Naomi Downing, Latrobe Community Health Service (Research Network Grant, $1000)
- Samuel Crane (Koori PhD candidate) (Scholarship, $3500)
- Dannielle Taylor, Latrobe Regional Hospital (Scholarship, $1500)
- Katherine Gray, Gippsland Medical School (Research module Evaluation and Development grant, $700).
VIC PHCRED Forum
 The 2nd Annual VIC PHCRED Conference
7 November 2008
Ellen McIntyre, PHC RIS & Anna Chapman, Statewide Coordinator, VIC PHCRED
This conference focussed primarily on the research conducted by 18 of the 2008 and 2007 Researcher Development Program Fellows from the departments of general practice and rural health of the Universities of Melbourne, Monash and the Greater Green Triangle UDRH.
The diversity of topics reflected the extensive range of research in primary health care in Australia. Populations that were researched included country youth, Indigenous people, Holocaust survivors, women who had been abused in childhood, drug users, refugees, the elderly, infertile women, children in foster care and women choosing termination of pregnancy. Other presentations focussed on health promoting hospitals and clinical data management by Divisions of General Practice.
Given the early research career stage of the presenters, much of the research focussed on literature reviews. It was thus most encouraging to hear how these researchers were planning to progress their research and indeed to hear from the four 2007 RDPs, what they had achieved in the past year.
The research journeys presented by Kerry Hampton and Adeline Lee from Monash University and Carolyn Ee and Greg Meyland from Melbourne University all highlighted the value of the Researcher Development Program that had not only supported them financially but also provided them with other support such as supervisors, mentors, workshops, courses, seminars, networks and opportunities to attend conferences such as the GP & PHC Research Conference.
Keynote speaker Professor Sally Green, Director of the Australasian Cochrane Centre, spoke eloquently of her research journey and the benefits of being both a practitioner and researcher. She reflected on how research can be “all breakthrough and no follow through” and urged delegates to think about the end-point of their research. In particular, Sally encouraged us to think about how to best package evidence to be more policy friendly.
Abstracts and presentations are available at <http://www.vicphcred.monash.edu.au/>
SPENCER GULF RURAL HEALTH SCHOOL
Gary Misan
Associate Professor - Research
P: 08 8647 6011
E: gary.misan@unisa.edu.au
Helen Mills, a Researcher Development Program (RDP) Fellow, is a dental therapist by profession who works for the SA Dental Service and has experience in child and adolescent dental health including significant experience working in Aboriginal communities where she has witnessed firsthand the effects of poor health literacy on health outcomes.
Helen's study is titled Measuring health literacy in a regional population. For the purposes of this study, Health literacy (HL) is defined as a person's capacity to process health information and then to be able to use that information to understand and discuss their health and make appropriate decisions regarding their health.
Low HL can result in poorer health outcomes for the individual and also result in increased health care cost. A better understanding of the level of HL in populations will assist in i) developing strategies to address low HL, and ii) allow tailoring of primary health care programs to better meet the needs of populations. The aim of this project is to determine the health literacy levels in a regional community and their association with health outcomes and in particular the management of Type II Diabetes (T2D).
A secondary aim is to validate a screening tool which is simpler than the current available instrument (Test for Functional Health Literacy in Adults - TOFHLA). Study subjects will be selected from participants enrolled in the Whyalla Intergenerational Study of Health (WISH) which is a longitudinal cohort study investigating the prevalence of chronic disease and associated behaviours in 1200 households in Whyalla. HL will be determined using both TOFHLA and a simpler screening tool described in the literature. HL will be correlated with socio-economic indicators and self-reported T2D and HbA1c levels recorded previously in the WISH participants.
Helen expects that her findings together with the results of the validation of the simpler HL screening tool will provide a better understanding of the levels of health literacy and their implications for people in Whyalla. It is hoped that findings will inform changes in the structure and delivery of future community level primary health care and health promotion programs. This study is currently underway and is expected to be completed by the end of March 2009.
DEPARTMENT OF GENERAL PRACTICE
FLINDERS UNIVERSITY
Linda Isherwood
RDP Fellow
P: 08 8204 3182
E: linda.isherwood@flinders.edu.au
As a well-designed research plan is of vital importance, I have personally found mind-mapping to be a useful tool in the planning of my RDP project focusing on emergency admissions at Flinders Medical Centre.
Mind mapping (also known as idea mapping and concept mapping) is an excellent tool for planning projects, organising and clarifying thoughts, problem solving, and brainstorming. A mind map is a diagram or visual representation of a chosen topic or idea, and makes use of key words, images and colours. Of value for both work and personal use, mind maps encourage creative thinking.
The rules for producing mind maps are very simple and can be adapted to your own personal style:
- in the centre of a blank piece of paper (in landscape orientation) write a word or image which represents the topic that you wish to explore
- think of major ideas or themes connected with the topic and represent each one with a line (or branch) radiating outwards from the central topic. Name each of the branches with a keyword or image.
- sub-branches can then be added to the ends of the main branches – these represent ideas connected to the main themes. Again use words or images to describe the sub-branches.
- continue developing sub-branches until the original idea is explored fully.
- use as much colour and images as you can, eg. each major theme (along with its sub-themes) could be drawn in a different colour.
- try not to judge your ideas as they appear – just map ideas down as they occur and decide on their relevance later.
Although mind maps are initially best created using pens and paper, software is available to help in their presentation, eg. iMindMap and MindGenius.
For further information on mind mapping and examples of mind maps, try visiting the following websites: <www.mind-mapping.co.uk> and <www.buzanworld.com> or read The Mind Map Book by Tony and Barry Buzan.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF SYDNEY
Dr Raechelle Rubinstein
PHCRED Coordinator
P: 02 9556 7200
E: raechelle@gp.med.usyd.edu.au
Our Researcher Development Fellow (RDP) Fellows – Penny Abbott, Sam Stott and Melinda Prince – are busy working towards completing their research projects by the end of the year.
All three presented their research at the NSW RDP Forum on 14 November.
Penny Abbott presented her research earlier this year at the CRIAH (Coalition for Research to Improve Aboriginal Health) Conference (Sydney), the GP & PHC Research Conference (Hobart) and the Population Health Congress (Brisbane).
Sam Stott also presented her research this year at the National Health Reform Conference (Sydney), the GP & PHC Research Conference (Hobart) and the Australian & New Zealand Adolescent Health Conference (Melbourne).
Melinda Prince will present her research for the first time at the RDP Forum.
We held a series of highly successful, interactive research skills training short courses/workshops for early-mid career researchers, commencing in July.
These included:
- Introduction to Qualitative Methodology in Health Research (17 July)
- Qualitative Research Techniques (24 July, 31 July)
- Launching Your Research (14 August)
- presented by Dr Maria Amigo and Dr Raechelle Rubinstein
- Project Development Workshop (4 September) presented by Dr Abbas Haghshenas, Dr Raechelle Rubinstein and Dr Penny Abbott;
- Introduction to Mixed Methods Research (28 August) presented by Dr Abbas Haghshenas
- Action Research in Healthcare , presented by Dr Ian Hughes and Associate Professor Shankar Sankaran (20 November).
Some 150 places were allocated at the sessions. The feedback received was extremely positive, with participants reporting that the sessions had given them the skills and confidence to commence their own research. Participants included students, practitioners and staff from a wide range of universities and organisations.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF NEWCASTLE
Georgina Cotter
NRGP Project Officer
P: 02 4968 6735
E: georgina.cotter@newcastle.edu.au
The Network of Research General Practices (NRGP) for the Hunter, New England and Central Coast is committed to fostering a culture of inquiry and building research capacity among GPs and staff.
 The NRGP has been building momentum, growing in number from 13 to 16 member practices in the past 12 months, and with increasing interest in research projects. The momentum was reflected at our second NRGP Forum, held at Harbourview on Queens Wharf on 1st November, where 20 people attended in a most convivial and collegiate atmosphere.
In the morning we were inspired by our guest speakers, Dr Ian Cook and Emeritus Professor Charles Bridges-Webb, and enjoyed six presentations from fellow NRGP members on a variety of recent research projects. The range of research presented and the discussion generated by the experiences and problems encountered was informative, and provided an insight into the world of research. The role of Divisions and ethics applications also made for lively discussion.
One NRGP project is examining the core procedural skills that all GP registrars are taught during GP training. The project was work-shopped at last year's Forum, and has since become a research project supported by GP Training Valley to Coast. It is a great example of how we can support NRGP members to develop their own research questions and then help to facilitate the conduct of this research. Feedback on recently completed NRGP projects on occupational violence affecting general practice staff was also presented to the Forum.
In the afternoon, two workshops explored different research ideas proposed by members – Dr Simon Holliday's ‘methadone prescribing in general practice' and Dr Joachim Sturmberg's 'just a simple script study'. Members remarked that these brainstorming sessions were invaluable for clarifying ideas and working through research protocols in a supportive environment.
During 2009 we plan to continue to provide research training and support to staff of NRGP member practices to facilitate practice-based primary care research.
PHCRED QUEENSLAND
Lily Cheung
Research Fellow
E: lcheung@usc.edu.au
Queensland Fellows meet in Brisbane
PHCRED QUEENSLAND held its annual end of year Fellows Meeting in Brisbane last month. Eighteen new researchers presented their progress and findings from the years Fellowship programs offered through the Mount Isa Centre for Rural and Remote Health, James Cook, Bond and Griffith universities and the University of Queensland.
The range of research topics undertaken this year was very broad and highlighted the interest in a number of novel and innovative projects being conducted across Queensland. Many populations of primary health care consumers will benefit from the tangible outcomes of this research from the benefits of skateboarding workshops for young teens diagnosed with ADHD through to assessing the effectiveness of a range of treatments for the common conditions of fatty liver disease and mastitis. Here are a few examples:
 Adam Walker conducted a project to examine if skateboarding helps manage the manifestations of Attention-Deficit and Hyperactivity Disorder (ADHD). His research analysed qualitative data taken from survey responses of 37 skateboarders to reveal key physical, psychological, and social benefits of skateboarding that show potential to address several of the primary deficits that manifest with ADHD. Findings revealed the physical benefits include: weight loss and general fitness, body strengthening, increase in endurance, and balance; the psychological benefits include: stress management, internalised commitment, confidence and self esteem, focus, creativity, patience, and goal achievement; the social benefits include: making new friends, reconnecting with old friends, bringing friends together, and being part of a larger group.
Sonographer, Gillian Kennedy has a special interest in Non Alcoholic Fatty Liver Disease (NAFLD). Her research led her to investigate how many people present for Upper Abdominal scanning, with increased liver echogenicity. These ultrasonic findings preceded any other clinical or serum findings and are reversible. NAFLD is present in most people with Metabolic Syndrome, and Type 2 diabetes. Gillian's research is based on developing an intervention that could be effective in identifying and reversing liver damage in the early stages of the condition.
Maree Crepinsek is working on a systematic review of treatments currently used in the treatment of mastitis. Mastitis is a significant complication and a common problem in lactating women. Non-infective mastitis may result from milk stasis, blocked ducts, engorgement or physical injury to the breast. Infective mastitis may result from cracked nipples leading to abscess formation. Mastitis presents with a plethora of clinical symptoms, presenting unilaterally or bilaterally with breast pain, redness and swelling, associated with flu-like symptoms. Once published the review will assess the benefits and adverse outcomes associated with interventions for the prevention of mastitis following childbirth.
The Fellows Meeting is a highlight of the PHCRED Queensland annual calendar of events and provides novice researchers with an opportunity to participate in the dissemination of their research findings.
PHCRED
BOND UNIVERSITY
Gillian Kennedy
Novice Researcher
Faculty of Health Sciences and Medicine
P: 07 5595 4493
E: gkennedy@bond.edu.au
I have a background in Medical Imaging and have specifically been involved with ultrasound scanning for many years. I have recently graduated from Uni SA with a Masters in Medical Imaging (ultrasound). I have worked extensively in both New Zealand and Australia, in both public and private institutions. I spent many years working at the Royal Adelaide Hospital, in South Australia.
It was in my capacity as a Sonographer, that I first became interested in my research topic, Non Alcoholic Fatty Liver Disease. This condition is commonly seen incidentally and has, in the past, been considered benign, self limiting and unworthy of further investigation.
However, with the rising incidence of obesity, and other lifestyle induced diseases this condition may prove to be more significant than previously thought.
As NAFL is a condition associated with lifestyle, an intervention using ‘exercise as medicine' might be beneficial.
My research centres on the use of ultrasound in the diagnosis of this condition. I am currently doing a literature review of the methods used to diagnose non alcoholic fatty liver and in particular to ascertain if liver echogenicity, as seen on ultrasound, is a quantifiable and reliable measure of fatty infiltration of the liver, and if this correlates with other imaging techniques, such as MRI.
I anticipate my research will show that early intervention is beneficial and results in significant health benefits for a large proportion of the population.
GENERAL PRACTICE AND PRIMARY HEALTH CARE RESEARCH
UNIVERSITY OF NOTRE DAME AUSTRALIA , FREMANTLE
Assoc Prof Tom Brett
Director, General Practice and Primary Health Care Research, School of Medicine
P: 08 9433 0258
E: tbrett@nd.edu.au
Notre Dame Fremantle gives academic recognition to prominent GPs
Until recently, academic recognition for many experienced general practitioners who have made significant contributions to medical education and training (both undergraduate and postgraduate) and research has not been prominent among Australian medical schools and universities.
In appointing four distinguished Western Australian general practitioners to adjunct positions as Clinical Associate Professors at the School of Medicine, The University of Notre Dame Australia, Fremantle sends a clear message of support and recognition of the central role of GPs in medical education and research at the school.
 The newly appointed GPs are:
- Clinical Associate Professor Peter Wallace OAM, Pinjarra
- Clinical Associate Professor Frances Cadden, Greenwood
- Clinical Associate Professor William Walker, Mandurah
- Clinical Associate Professor Frank Jones, Mandurah.
 Each of the four GPs has over 20 years experience in providing medical services in their individual practices and communities. All are involved in the teaching and training of both undergraduate medical students and GP Registrars and all have shown a strong commitment in supporting the development of the Notre Dame medical school.
A/Profs Cadden, Walker and Jones have made significant contributions to the Fremantle Primary Study – a pilot study into risk factor modification for cardiovascular disease at their respective practices. The study has acted as a vehicle to provide hands-on early career research experience to many GPs, practice nurses and medical students. A/Prof Wallace is the current chair of the Western Australian General Practice Education and Training (WAGPET) board.
The Notre Dame School of Medicine Fremantle is delighted to have such esteemed general practitioners involved in curriculum delivery at the school and hopes that this recognition of their key role in medical education and research will inspire many of their colleagues to follow in their footsteps.
Congratulations!
PHCRED WA RACGP Forum
The 4th Annual State Conference
22 November 2008
Ellen McIntyre, PHC RIS and Lyn Brun, Statewide Coordinator, PHCRED WA
The 2008 WA conference theme Primary Health Care MATTERS! more than adequately described the focus of this conference. With presentations ranging from doctor perceptions of radiation doses and effects, to implementation and evaluation of a palliative rural respite care program and making medication information accessible to Aboriginal users, there was something of interest for every one of the 40+ delegates who attended.
The three departments funded by PHCRED (based at the University of Western Australia, the Combined University Centre for Rural Health and University of Notre Dame Australia) outlined their activities. While each was unique, collectively they provided research skills training, specialist and technical assistance, support (both financial and supervisory/mentoring) for early to mid-career researchers and the delivery of high quality research.
Keynote speaker Associate Professor Lyn Henderson-Yates, an Aboriginal woman from the Shadforth family in Derby and Director of the Centre for Indigenous Studies at the University of Notre Dame in Broome spoke passionately about the ‘Liyarn Ngarn' (the coming together of the spirit) and how disruption to this results in ill-health. She encouraged primary health care professionals to embrace the cultural and holistic needs of Aboriginal people in their practice.
Professor Nick Zwar, Professor of General Practice, UNSW, also a keynote speaker for the day, gave an excellent presentation on practice-based research networks (PBRN) sometimes seen as the ‘missing link' in the development of high quality evidence based health care of populations. PBRNs provide the organisational structure of interested practices to do large scale studies, something that is otherwise very difficult to do in general practice. In addition, PBRNs have the capacity to provide academic support, research skills training and value adding to general practices and their staff. The PBRN with which Prof Zwar is involved (PHReNet-GP) has conducted developmental studies which have been the basis for obtaining funding for large research grants that now involve these practices being a key part of research in COPD, cardiovascular disease, sleep apnoea and quit smoking.
Further information about the conference and PHCRED WA can be found at <www.phcredwa.org.au>. |
