DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF SYDNEY
Dr Raechelle Rubinstein
PHC RED Coordinator
P: 02 9556 7200
E: raechelle@gp.med.usyd.edu.au
The final stage of our 2007 RCBI Program ended on a high note. A former RDP Fellow completed her PhD, our 2007 RDP Fellows gave presentations at the 4th Biennial NSW PHC Research and Evaluation Conference and at the Health Services Research Association of Australia and New Zealand Conference, and early career researchers (one an RDP Fellow) submitted three articles to peer reviewed journals.
We are looking forward to the commencement of our 2008 RCBI Program. It features a number of opportunities, including an RDP award, early career researcher bursaries and writing grants. The 2007 RDP Fellows, Penny Abbott and Sam Stott, will continue their research in 2008 under the RDP. We are currently planning a program of research skills workshops and research seminars. Visiting academics, Professor Deborah Saltman and Dr Gail Louw, both from the Institute of Postgraduate Medicine at Brighton & Sussex Medical School, will present research seminars in February on aspects of postgraduate education in the UK and Systematic Reviews.
Youth Health Research Interest Group (YHRIG), a research network supported by our RCB Program, will present a Workshop at this year's GP & PHC Research Conference in Hobart. YHRIG has hosted successful workshops at previous conferences. YHRIG members have displayed enormous commitment not only to youth health research but also to promoting young people's physical and emotional wellbeing throughout Australia, and we are pleased that their individual and collective voices are being heeded. The Workshop promises to be most stimulating, and we look forward to seeing you there.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF NEWCASTLE
Georgina Cotter
NRGP Project Officer
P: 02 4968 6735
E: georgina.cotter@newcastle.edu.au
 In late 2006 the Discipline of General Practice was awarded a small research infrastructure grant from the University of Newcastle to establish a practice-based research network. The Network of Research General Practices (NRGP) for the Hunter, New England and Central Coast is a new initiative which builds on the success of our Health Evaluation and Research Network (HEARNet). The NRGP is a network of General Practices spanning from the Central Coast to the New England Region. The NRGP is committed to fostering a culture of inquiry and building research capacity among general practitioners and general practice staff, in order to produce research findings of relevance to their clinical practice and to that of the wider general practice community. To achieve this mission we are using a ‘bottom-up' rather than ‘top-down' approach where we support network members to develop their own research questions and then help to facilitate the conduct of this research based in their practice. During 2007 the NRGP received infrastructure support from the PHCRED Program based in the Discipline of General Practice, University of Newcastle.
To date 13 general practice surgeries have joined the network and several more are interested in joining. Staff of member practices are currently participating in research into occupational violence in general practice. During our first NRGP Forum held at Tuscany Wine Estate (Hunter Valley) on 16-17 November, 16 members were able to discuss research ideas, network with others interested in primary care research and workshop research proposals. During 2008 we plan to provide research training and support to staff of NRGP member practices to facilitate practice-based primary care research.
UNIVERSITY DEPARTMENT OF RURAL HEALTH NORTHERN NSW
UNIVERSITY OF NEWCASTLE
Rod Cooper
PHCRED Coordinator
P: 02 67678465
E: rodney.cooper@hnehealth.nsw.gov.au
Out of NICU but not home yet… the postcode lottery of birth
 Ruth Kreamer (Hunter New England Area Health Service) recently completed her RDP Fellowship. Part of her clinical role is to support parents of premature babies (=34 weeks gestation) at Tamworth Rural Referral Hospital (TRRH). This update describes her research project.
Rural parents with premature babies can wait weeks in regional hospitals for their babies to gain weight prior to discharge, often on top of long stays in metropolitan Neonatal Intensive Care Units (NICU). To find out more about their needs and experiences, Ruth developed a survey to help inform service delivery. Twenty mothers of premature babies who had been patients at TRRH in 2006 were followed up, with 13 mothers agreeing to participate in a telephone survey.
Some key findings were that, 46% waited up to four weeks for their babies to be discharged while 15% waited up to eight weeks. Forty-six percent resided between 50 and 400 kms away from the hospital. In spite of the long wait, 54% reported helpful staff as a positive with 76% agreeing that formal support activities including testimonials from other mothers of premature babies would have been helpful.
The time required for a baby to be ready for discharge posed multiple, complex challenges for rural families to negotiate, often with little support. With nearly half of the surveyed mothers living >50 kms from the hospital, the dilemma of juggling family needs including other young children, against the needs of their new baby presented unique difficulties. The findings of this pilot survey highlight a need to provide more meaningful and beneficial support to parents during this difficult time of enforced waiting.
GREATER GREEN TRIANGLE UNIVERSITY DEPARTMENT OF RURAL HEALTH
FLINDERS AND DEAKIN UNIVERSITIES
Professor James Dunbar
Director
P: 03 55633504
E: director@greaterhealth.org
Greater Green Triangle University Department of Rural Health (GGT UDRH) researchers were funded by the Australian Primary Health Care Research Institute (APHCRI) to investigate options for optimising the Australian primary health care workforce. A systematic review of the evidence on the contribution of organisational development (OD) to optimising the workforce in primary care was undertaken by Professor James Dunbar and his team.
The policy context for optimising the Australian primary care workforce:
Healthcare systems worldwide are facing pressure from an ageing population, improved health care technologies, increasing emphasis on effectiveness and efficiency, changes to traditional professional roles, workforce shortages and generational changes in approaches to working.
To be successful in securing a capable and professional workforce in the global marketplace designers of health systems will need to consider not only the nature and levels of remuneration but the culture and climate of the workplace. Organisational development (OD) can contribute to success in the workforce market. OD is the application of behavioural science action research and systems theory to human systems to increase the internal and external effectiveness of the organisation, especially in managing change, using participative processes that involve all those affected. A workforce with good leadership and teamwork will deliver high quality care.
Key findings on the contribution of approaches to organisational change (OD) in optimising the primary care workforce
- OD is widely used in the general economy, but its use in health services, especially primary care, is less evident
- Efforts to change clinical practice by influencing individuals have proved ineffective unless the organisation within which they work is ready to change
- Performance in health care organisations is inextricably linked to leadership, culture, and collaboration
- OD can contribute to better chronic disease management:
- through the Collaboratives methodology
- by improving teamwork, communication, integration, coordination
- by building clinical networks across organisational boundaries.
Policy recommendations
- The establishment of a small, expert centre for clinical leadership to:
- work with leading Divisions and practices on real change problems in real time
- optimise delivery of chronic disease management across organisational boundaries
- adapt the Quality Team Development program for Australia.
For more information on the review please contact:
Professor James Dunbar
E: director@greaterhealth.org
Or Professor Prasuna Reddy
E: director.HSR@greaterhealth.org
Or Dr Adrian Schoo
E: adrian.schoo@greaterhealth.org
PHCRED Queensland
Jacquii Burgess
Media and marketing officer
Discipline of General Practice, University of Queensland
P: 0407 789 078
E: jacquii@uq.edu.au
The Queensland Primary Health Care Research, Evaluation and Development (PHCRED) Collaboration has once again taken its research education roadshow to primary health care practitioners working in rural and remote areas in North Queensland.
The roadshow stopped at Longreach, Emerald and Biloela, providing participants with an introduction to project implementation. Participants in the three one-day courses workshopped a mock community project including project planning and evaluation and reporting.
Workshop participants had a range of research skills and came from a variety of health fields including community health, nutrition, sexual health, health promotion, indigenous health, child and youth health, aged care, and allied health services.
The workshops provided a forum for practitioners to learn new evaluation and planning skills and share their research interests and projects with people working in similar fields.
This roadshow follows the success of a research roadshow undertaken in Far North Queensland earlier this year, which included Weipa, Innisfail and the Atherton Tableland. The feedback from these roadshows has been very positive, providing much appreciated research education for practitioners living in rural and remote areas in Queensland.
Representatives from Bond University , Griffith University , James Cook University , Mount Isa Centre for Rural and Remote Health and The University of Queensland led the workshops.
The PHCRED program is an initiative funded by the Commonwealth Department of Health and Ageing to undertake research and evaluation capacity building within the primary health care professions.
GENERAL PRACTICE AND RURAL MEDICINE
JAMES COOK UNIVERSITY
Robyn Preston
PHCRED Coordinator
P: 07 4796 3383
E: robyn.preston@jcu.edu.au
For PHCRED-JCU 2007 was a productive and exciting year. After two years of planning and development, we are set to deliver our new Graduate Certificate in Primary Health Care (PHC) Research. GP and Academic, Dr Sarah Larkins will coordinate this on-line delivered course. Sarah has recently submitted her PhD and holds a part-time appointment with a local family practice.
Four RDP Fellows were supported with two leading to PhDs. As well as delivering workshops and individual support our on-line research modules continue to be very popular. Our research was disseminated at conferences, in journals and online. As usual, the GP & PHC research conference was fantastic and gave us a great opportunity to meet up with our PHCRED friends from across Australia.
Collaboration with local, statewide and national partners was also a highlight. Stronger ties were developed with the two local Divisions and a pilot research capacity building project has been launched with the Queensland Health Northern Zone Workforce Directorate. Our first collaborative project will be with Allied Health professionals in the Torres Strait - so we really are covering the North!
We are coordinating a three site study of Acute Otitis Externa (Tropical Ear), a clinic issue that confronts many GPs in North Queensland. The Mackay Research Group is undertaking the study: Does topical chloramphenicol reduce the incidence of wound infection . To improve our support and infrastructure we are currently conducting an evaluation of our research groups.
In November we farewelled Professor Craig Veitch as Director of the PHCRED program at JCU. Craig has supported, encouraged and promoted PHC researchers in regional and remote North Queensland since the RCBI's inception. We wish Craig all the best with his new role at the University of Sydney. We welcome A/Prof Richard Murray, Head of the School of Medicine and Dentistry, as our new Director.
We hope to see you at the next GP & PHC Research Conference in Hobart where we will deliver a pre-conference workshop on Indigenous Research Capacity Building.
BOND UNIVERSITY
Karen G Smith
Consultant Exercise Physiologist
Private Practice
P: 0414632801
E: karengsmith@hotmail.com
Considerable research has been undertaken to determine the amount of physical activity (PA) required to yield health gains. Nonetheless, long-term PA compliance is fundamental for health promotion and disease prevention.
A portable, cost-effective PA intervention, the Dr Cornish Walking Program (CWP), does aim to provide for many key processes required for PA change and is unique because it is the only walking program that allows continuous supervision of a significant number of people.
As a medically based, pace-control system, the CWP not only ensures that individual exercise prescription recommendations for optimal physiological adaptation are met, but also provides the opportunity to evoke cognitive and behavioural processes of change.
The aim of this randomised controlled trial is to examine the effectiveness of supplementing two current strategies used to promote physical activity in persons with or who are at risk of developing chronic disease, with participation at the CWP.
Compared to either two half-hour exercise consultations with an exercise physiologist (EPC) or a typical hospital rehabilitation/chronic disease management service (CDM), complimentary participation two days per week at the CWP:
- increases training compliance
- improves the likelihood that participants will remain consistently physically active 3, 6 and 12 months post-intervention
- results in an increase in positive health outcomes (eg. cardiovascular fitness, BP, cholesterol, glucose).
Enormous resources have been spent to enhance public access to PA support programs that are aimed at reducing sedentary behaviour. The results of the intended research will help to determine if current strategies are enough to change PA behaviours and whether supplementary activity programs, such as the CWP, have a greater impact on PA compliance. If such a PA intervention can improve consistency and produce a permanent behavioural change, clearly population health benefits will follow, thereby reducing the burden on the health care system.
Moving Forward: Rural Research & Knowledge Transfer
2007 Shepparton Research Conference
27 November 2007, Shepparton
Ellen McIntyre, PHC RIS & Elaine Tan, PHCRED Coordinator, School of Rural Health, University of Melbourne
Passion and enthusiasm were prominent as over 90 people from many rural centres in Victoria gathered for the third annual Shepparton Research Conference on rural health incorporating general practice, primary health care, integrated care and population health. It was certainly exciting to see how this conference brought together researchers, health service managers, clinicians, community organisations, Divisions of General Practice, Primary Care Partnerships, governments and decision makers to share research findings and move these forward through the ensuing discussions throughout the day.
Keynote speakers Professor Kerin O'Dea and the Honourable Dr Andrew Refshauge contributed significantly to the debates with their presentations. Kerin spoke passionately of a comprehensive national approach to preventing chronic disease among Indigenous Australians. Her presentation also indicated that changing the marketing of food could have an impact on reducing the obesity tsunami.
Andrew Refshauge used his own experience to illustrate how governments divide the ‘health cake' from getting the health budget, allocating it, spending it and how to influence it. He emphasised that with the skills shortage in health, the health sector themselves should be looking at redefining how to provide what is needed before policy makers impose these changes on us.
The 30 concurrent paper presentations and posters were diverse covering aged care, workforce, community involvement, medication and pharmacy issues, chronic disease management and women's issues. Mal Boyle's winning paper presentation focussed on the innovative DVD simulations for paramedic students, while Catherine Ferreira's winning poster described the set up and potential of the Central Highlands General Practice Network as a population health database.
The conference was rated very positively with all participants that returned the conference evaluation form rating it as either excellent (32%) or very good (68%). The majority of participants indicated that they intended to attend next year's conference.
Details for next year's conference will be featured on the web-site <http://www.ruralhealth.unimelb.edu.au/>. Information should be available in early 2008.
 Growing Together for Impact and Sustainability
The 4th Biennial NSW Primary Health Care Research & Evaluation Conference
29-30 November 2007, Sydney
Ellen McIntyre, PHC RIS & Jacque Schroeder, NSW PHCRED Statewide Coordinator
With the theme of ‘growing together for impact and sustainability', it was most appropriate that both international speaker Professor Chris van Weel, Professor of General Practice at the Radboud University Medical Centre, The Netherlands and Dr Marie Pirotta from Melbourne University focussed on practice based research networks and how researchers and practitioners can grow together to do useful research that can have impact in a sustainable framework. While Dr Pirotta acknowledged that recruitment of GPs was challenging, the opportunities these networks could afford were considered well worth the effort. The topic of practice based research networks continued throughout the conference with a seminar, stakeholder forum and concurrent papers and posters.
As part of the Phase 2 strategy in NSW to support key primary health care stakeholders to develop a research culture within their own organisations, a series of PHC leaders representing the Divisions, Aboriginal health and Area Health Services were invited to speak about current research capacity building issues within their organisations. Linda Cutler (Executive Director, Institute of Rural Clinical Services and Teaching), Sandra Bailey (CEO, Aboriginal Health and Medical Research), Kim Browne (Area Director, Population, Planning and Performance, Hunter New England Health), and Matt Hanrahan (CEO, Alliance of NSW Divisions) all spoke enthusiastically of the need for research to improve health services and provided several examples of how they had already made this happen. These included: the NSW Institute of Rural Clinical and Teaching Services (IRCST) Rural Research Capacity Building Program that encourages rural Area Health Service workers to develop research skills; the launch of the Coalition for Research to Improve Aboriginal Health (CRIAH) Tools for Collaborative Research ; the emphasis of research as part of core business for NSW Health; and the linkages already formed with Divisions and researchers.
Over 30 concurrent papers and more than 20 posters covering topics such as aged care, health promotion, research process, health service delivery, chronic disease management, rural and remote health, and mental health were delivered by passionate presenters which sparked not just robust discussion but in many cases formed the basis for further networking. All abstracts and some presentations can be found at the NSW PHC website <http://www.nswphc.unsw.edu.au/events.htm>.
|
