DISCIPLINE OF GP
UNIVERSITY OF QUEENSLAND
Geoffrey Spurling
Senior Lecturer
P: 07 3275 5388
E: g.spurling@uq.edu.au
PHCRED has funded my role in the adult indigenous health check research proposal to evaluate its role in primary care.
We aimed to examine demographic information, health status and outcomes of the health check for urban indigenous adults attending the Inala Indigenous Health Service. Data was collected from consented routine adult indigenous health checks in the course of the clinic's daily activity and will be analysed.
Logistic regression of multiple variables will be undertaken when the target sample of 400 health checks is reached.
After the first 101 health checks were analysed it was found that, 95% were aboriginal, 3% Torres Strait Islander and 1% both. Fifty two percent were female, the age spread was even and 40% worked full time. Twenty percent suffered overcrowding or conflict at home. Fifty seven percent were smokers, 46% were identified as problem drinkers and 21% used illicit drugs. Thirteen percent were hypertensive, 41% had waist measures greater than 100cm and 60% were overweight or obese. Thirty five percent did 30 minutes or more of exercise per day. Forty four percent of health checks resulted in a new medication, 50% in a new referral, 73% in an investigation, and 40% in immunisation and there was one new diagnosis: breast cancer.
The health status information for our clinic community will provide useful feedback to staff, the community and for planning health promotion. Our findings also demonstrate that the health check is a tool associated with high rates of preventive activities, referrals, medications and investigations, which should lead to better health outcomes.
This research topic has been selected as a paper presentation at this year's General Practice and Primary Health Care Research Conference.
PHCRED QUEENSLAND
Denise Schultz
Statewide Coordinator
P: 07 3346 4905
E: d.schultz@uq.edu.au
Queensland join forces for a policy showcase
More than 150 state health executives, academic leaders, consumers and clinicians attended the first Primary Health Care Research Showcase in Brisbane to explore opportunities for collaboration in research and policy development. The Showcase was hosted by the Primary Health Care Research, Evaluation and Development (PHCRED) Queensland Strategy. Showcase Chair, Professor Judy Searle, Dean of School of Medicine at Griffith University , said that the day provided a real grassroots level opportunity to bridge the gulf that is often present between clinical practice and research.
The sessions looked at chronic disease management, workforce issues and world class best evidence examples of innovative research being trialled across Queensland designed to improve patient care. Presentations can be viewed at <www.som.uq.edu.au/research/phcredqld/2008ResearchShowcase.htm>. Qld government's Minister for Health, Stephen Robertson outlined the importance of building networks with primary health care clinicians, particularly in the management of heart disease and diabetes. He said he was particularly encouraged by pilot projects being run in Queensland addressing the integration of new provider roles and better integration with services in the community.
Deputy Secretary from the Australian government's Department of Health and Ageing, Mr Philip Davies also spoke about the opportunities that may be created working across primary and secondary services. He outlined the important impact the PHCRED program had on providing resources to foster collaborative research that engage and utilised the primary health care sector. Assoc Professor Libby Kalucy, Director of Primary Health Care Research Information Service chaired a forum that provided the guests with an opportunity to explore potential collaborations in research that could inform and improve chronic disease management.
In summing up the vibrant and dynamic discussion, Professor Judy Searle suggested that the Showcase had provided a very real opportunity to get policy-makers, researchers, clinicians and consumers on the same page when it came to improving the care of chronic disease in the ageing population.
MOUNT ISA CENTRE FOR RURAL AND REMOTE HEALTH
Dr Stephanie De La Rue
Research Manager
P: 07 4744 7913
E: Stephanie.delarue@jcu.edu.au
Carole Reeve, a Public Health Registrar at Mt Isa Centre for Rural and Remote Health was funded in 2007 through the Research Capacity Building Initiative under the Researcher Development Program. She has been involved in a simple study designed to look at vaccine uptake using a school based program for delivery.
A local Mount Isa General Practice received the tender to provide the school-based program through which year 8 students are to receive Hepatitis B and varicella-zoster vaccination, year 10 students to receive diphtheria-tetanus-acellular pertussis (DTPa) vaccine, and female year 10, 11 and 12 students to receive three doses of the Human Papilloma Virus (HPV) vaccination.
Data was collected on the number of consent forms returned, the number declined, the number of students actually vaccinated, the number requiring catch-up vaccination and the number completing the full course of immunisations. Also recorded were adverse events. The total cohort of girls eligible for HPV vaccination was 304:
- Returned consent forms 285 or 94%
- Consented to vaccination 275 or 90%
- Declined vaccination 13 or 4.3%.
When compared with the other adolescent vaccinations given at the same schools and at the same time HPV coverage was higher. There were only three significant adverse events, three girls fainted at the time of immunisation but recovered immediately.
HPV immunisation has good uptake and is well tolerated. Integrating school immunisation provision with General Practice provides continuity with preschool immunisations and provides a convenient location for parents to bring children who have missed out on immunisations or would like further discussion.
This study has now been published in the latest Communicable Disease Intelligence Volume 32 Number 1, March 2008. See <www.health.gov.au/internet/main/publishing.nsf/content/cda-pubs-cdi-cdicur.htm>
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF NEWCASTLE
Susan Goode
PHCRED Coordinator
P: 02 4968 6737
E: susan.goode@newcastle.edu.au
The CAPRE Program at the Discipline of General Practice has appointed three RDP fellows for 2008.
Jeremy Bramston: I'm a general practitioner in Woy Woy in charge of a large multidisciplinary team that delivers health care to about 2000 patients a week. I've done a little research in the past in varying areas from the design of an auditory synthesizer to working out why rats wiggle their whiskers. This time around I'm focusing on what I have experience in, that is general practice. I'm interested in skill mixing in general practice and how to delegate and or replace doctor tasks with nursing tasks. This is a long term project which will encompass more than a PhD.
Bernard Goldman: During my early career I worked as a lawyer in the area of constitutional law and advising. For 10 years I have held management positions in law and program delivery. I have had long standing involvement in Indigenous issues particularly in relation to culture and economic development. My wife, Mary Price, is a GP. It may explain why my main research interest to date relates to the personality of the GP. My research topic is whether remote GPs differ significantly in hardiness compared to GPs living in the city.
Jacqui Trinne: I have been living in Newcastle since 2007 following my relocation from the remote north of South Australia. I was employed by the SA Health Commission to procure funding to develop and implement the Building Healthy Communities in remote Australia project. As a RHD candidate with the University of Newcastle looking to work in partnership with Hunter New England Health, I have been fortunate enough to gain an RDP Fellowship. The aim of the project is to identify a structure to progress implementation of proposed Standards. These Standards are to enhance capacity in mainstream services and strengthen partnerships with Aboriginal Community controlled organisations.
UDRH NORTHERN NSW
UNIVERSITY OF NEWCASTLE
Dr Jenny May
Rural GP Academic
P: 02 6767 8481
E: jenny.may@hneheath.nsw.gov.au
Susan Goode
PHCRED Coordinator
P: 02 4968 6737
E: susan.goode@newcastle.edu.au
The Primary Health Care Research Capacity Building Programs (based in the Discipline of General Practice and University Department of Rural Health Northern NSW) at the University of Newcastle continue to facilitate the Hunter, New England and Central Coast Network of Research General Practices (NRGP). The NRGP is committed to fostering a culture of inquiry and building research capacity among general practice staff in order to produce research findings of relevance to clinical practice.
With the support of the NRGP, Dr Jenny May was successful in her application to the Royal Australian College of General Practice (RACGP) for a 2008 Family Medical Care, Education and Research Grant (FMCER). Jenny is a GP based in Tamworth who works as a clinician at the Peel Health Centre and as a GP Academic in the UDRH Northern NSW. Jenny's research is a cross-sectional study of occupational violence in general practice (including both GPs and non-GP staff).
The NRGP is providing the practice-based infrastructure to enable Jenny to conduct her research, as well as, mentoring, assistance with grant writing and preparing the ethics application. She is currently collecting cross-sectional data with invitations to participate in the study being sent to all staff (both GP and non-GP) of the 13 NRGP member practices. The NRGP will then provide training for Jenny in data analysis and interpretation.
Other NRGP members are also supported to develop research questions and proposals that may be supported through the NRGP. For example, we are collaborating with a team of practice-based GPs to review the procedural skills that GP Registrars are taught. This project is in its early stages and funding is currently being sought to progress it further.
Preliminary findings of these projects and other research ideas will be discussed by NRGP members at the 2nd Annual NRGP Forum to be held later this year.
UNIVERSITY DEPARTMENT OF RURAL HEALTH, BROKEN HILL
UNIVERSITY OF SYDNEY
Frances Boreland
Research Officer (PHCRED program)
P: 08 8080 1279
E: fboreland@gwahs.health.nsw.gov.au
For the Research Capacity Building program at the Broken Hill University Department of Rural Health (BHUDRH), 2008 is set to be another very productive year. In February we welcomed the arrival of Associate Professor David Perkins as Director of the Centre for Remote Health Research (a joint initiative of BHUDRH and the Greater Western Area Health Service). David was previously the Director of the Centre for Equity and Primary Health Research at the University of New South Wales, and brings a wealth of experience in the evaluation of health service delivery programs.
We have run two major workshops in Sydney in collaboration with other members of the New South Wales PHCRED Collaboration: in February David Perkins and David Lyle (Head of Department) were part of the team that provided a newly developed Project Evaluation Workshop and a subsequent Project Development Retreat for the Alliance of New South Wales Divisions. In April David Lyle and Frances Boreland helped provide a Short Course in research Skills with a subsequent Project Development Retreat for Researcher Development Placement holders across New South Wales .
All areas of the BHUDRH are now involved with research and evaluation and are developing expertise through a ‘hands on' approach, with projects ranging from evaluating the experience of students on placement in western NSW, to evaluating the effectiveness of a cultural preceptor program. Katina Kardamanidis, a Trainee Public Health Officer on a joint placement with BHUDRH and the Broken Hill Child and Family Health Centre, is developing evidence-based initiatives to increase attendance at the local blood lead screening clinic, including ways to monitor the outcome.
On a national level, David Perkins and David Lyle edited the April edition of the Australian Journal of Rural Health, which was a special issue highlighting the importance of public health and epidemiology in rural and remote health.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF SYDNEY
Dr Raechelle Rubinstein
PHC RED Coordinator
P: 02 9556 7200
E: raechelle@gp.med.usyd.edu.au
We are pleased to advise that Mr Sean Appoo and Dr Melinda Prince have been awarded 2008 RDP Fellowships by the Discipline of General Practice.
Sean Appoo recently took up the position of Tobacco Control Research Project Manager at the Aboriginal Health & Medical Research Council of NSW. Prior to that, he worked at the Sax Institute for a number of years. His RDP research project will be a literature review of tobacco interventions for Indigenous Australians. Dr Melinda Prince is a GP with a special interest in GP health and wellbeing and complementary medicine. Her RDP research project will examine urban Practice GP Registrar health and wellbeing, in particular how this group maintains a work-life balance. Both Fellows recently attended the NSW PHC Short Course on Research Methods and Project Development Retreat.
Sean and Melinda have joined Ms Sam Stott and Dr Penny Abbott, who are continuing their RDP Fellowships for a second year. Sam is a Health Promotion Officer at Youthblock Health & Resource Service. Her research topic is Youth SMS Appointment Reminder Trial. Penny is a GP at the Aboriginal Medical Service Western Sydney and a member of the Service's Chronic Care Team. Her research topic is Effectiveness of a cooking course for Aboriginal people with diabetes and those at risk of diabetes at the Aboriginal Medical Service Western Sydney. Sam and Penny will present their research at the 2008 GP & PHC Research Conference. Sam presented her research earlier this year at the National Health Care Reform Conference. Both Sam and Penny have had abstracts accepted for the Population Health Congress in Brisbane in July.
SCHOOL OF PRIMARY HEALTH CARE
MONASH UNIVERSITY
Professor Shane Thomas
Director Primary Health Care Research
P: 03 85752245
E: shane.thomas@med.monash.edu.au
Problem gambling is a serious mental health problem in the Australian community and one that is increasingly being encountered by primary health care practitioners. One to 2 per cent of the adult Australian population is classified as ‘problem gamblers' with ‘at risk gamblers' constituting an additional 2.5 to 5 per cent of the population. In Australia, people with gambling problems have a higher prevalence than people with stroke, people with CHD and a comparable prevalence with people with Type II diabetes.
Within our research centre (The Melbourne Monash Centre for Gambling Research and Treatment) we have found in a recent study involving a community survey of 2012 Victorians that problem gamblers compared to non-gamblers had serious co-morbidities associated with their problem gambling. We found a relative risk of 18.8 for problem gamblers of having a severe mental disorder (as measured by the Kessler K-10), that they are 4.3 times more likely to engage in hazardous alcohol use (WHO-AUDIT), 3.4 times more likely to smoke daily and 5.6 times more likely to be divorced. Problem gambling is a significant clinical issue that is strongly associated with other physical and mental health problems.
In a forthcoming MJA editorial we are advocating the routine inclusion of problem gambling screening in primary health care practice. We are also collaborating in the development of clinical guidelines for the screening, assessment and treatment of people with gambling problems. The guidelines will be oriented to primary health care practitioners.
GENERAL PRACTICE
UNIVERSITY OF MELBOURNE
Dr Meredith Temple-Smith
PHCRED Coordinator
P: 03 8344 3371
E: m.temple-smith@unimelb.edu.au
I would like to introduce our 2008 PHCRED Fellows:
Dr Ann-Marie Diggins, a graduate of Otago University in New Zealand, came to Australia 19 years ago. A GP for 17 years, she works mainly at Darebin Community Health, which focuses on refugee health, but she also has interests in pharmacotherapy and indigenous health. She has been enthusiastically involved in a Balint group for four years and is currently the secretary of the Balint Society of Australia. She is interested in examining the efficacy of Balint groups in increasing GP empathy and preventing burnout.
Dr Carolyn Ee graduated from UWA in 1998, subsequently studied Traditional Chinese Medicine and joined us as an Academic Registrar in 2006. Her systematic review on acupuncture for pregnancy-related pelvic and back pain was published in the American Journal of Obstetrics and Gynecology. Carolyn is a GP and acupuncturist in a holistic clinic. She plans to conduct a randomized placebo-controlled pilot study and/or a systematic review on acupuncture for treating hot flushes in menopause.
Dr Jessica Kneebone recently completed GP training in the Northern Territory. During her five years there, she worked in Darwin, Alice Springs, Katherine and a remote Aboriginal community in Western Arnhem Land. Since moving to Melbourne, she has been working as a GP at North Richmond Community Health Centre, whilst completing a Masters of Public Health through Charles Darwin University. Jessica's passion is Indigenous health, and she is using her PHCRED project to explore GP workforce issues as they relate to Aboriginal communities.
Dr Richard Teague graduated from Monash University in 1993. Through working in general practice he developed an interest in sexual health medicine and retrained to become a sexual health physician. He now works at Carlton Clinic, Melbourne Sexual Health Centre and Turning Point and has a special interest in HIV medicine, hepatitis C and the health of injecting drug users. His research will examine the sexual health needs of injecting drug users.
PHCRED, DEPARTMENT OF GENERAL PRACTICE
FLINDERS UNIVERSITY
Linda Isherwood
RDP Fellow
P: 08 8204 3182
E: linda.isherwood@fmc.sa.gov.au
In March 2008 the PHCRED Program welcomed two new Research Development Program (RDP) Fellows to the department. They are Nova Reinfeld-Kirkman and Linda Isherwood.
Linda is a social worker who has worked in a variety of community and hospital-based mental health services in the UK and Australia. She is currently undertaking a research higher degree with the School of Social Work at Flinders University, exploring factors which assist in successful recovery from alcohol problems in the veteran population.
In her role as RDP fellow, Linda will be working on a project analysing emergency demand at Flinders Medical Centre. The project has been funded by the South Adelaide Health Service (SAHS) as part of their overall demand management strategy.
Focusing on emergency admissions of older adults to Flinders Medical Centre, the project will involve a team of research staff from PHCRED and Flinders University.
The project will use a root cause analysis methodology. Root cause analysis has traditionally been used to investigate industrial accidents and disasters.
Over the past decade, the approaches of root cause analysis have been modified and are now commonly used to explore adverse events in healthcare settings. Root cause analysis aims to identify the underlying factors that contributed to the event in question and measures that could be implemented to reduce the risk of the event occurring again.
The project intends to address the following issues:
- What are the circumstances that led to the emergency admission?
- Was the admission potentially avoidable?
- What strategies could be implemented in order to provide improved preventative management in the community and hence reduce future emergency admissions?
Nova's research project will be discussed in a later issue of PHC RIS infonet .
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