FACULTY OF HEALTH SCIENCES & MEDICINE
BOND UNIVERSITY
Dr Elly Scheermeyer
PHCRED Coordinator
P: +61 7 5595 4411
E: escheerm@bond.edu.au
This year Professor Van Driel, Director of PHCRED and Associate Dean of Research at Bond University, has been working together with three other leading Primary Health Care researchers, Dr John Furler and Dr Marie Pirotta from Melbourne University, and from Newcastle University, Dr Parker Magin. All four are involved in the PHCRED program and are committed on furthering the aims of the Brisbane International Initiative (BII).
Originally they met in September 2007 at the University of Oxford where they were part of a selected group of 12 researchers participating in a seminar on leadership in Primary Care Research to establish a network to advance the discipline of Primary Care Research. Professor Chris Del Mar, Dean of Health Sciences and Medicine at Bond University, was one of the initiators of the BII and facilitated the 2007 seminar.
In April 2009, Drs Furler, Pirotta and Magin visited Bond University for a three day workshop with Professor Van Driel to discuss research collaborations between their departments and how to advance the networking between early and mid-career primary care researchers in Australia. All three visitors presented their research projects and interests in seminars and met with relevant Faculty staff and students to encourage research and networking.
In May Prof Van Driel visited Dr Magin in Newcastle and in July the whole group met again at the GP & PHC Research Conference in Melbourne to continue the collaboration.
“What is unique about our group is that most research is not based on a common topic, rather we are focused on a common goal of advancing Primary Care research” said Professor Mieke Van Driel.
Professor Van Driel’s research focuses on the implementation of evidence in a clinical setting. Dr Furler specialises in equity issues and the implementation of diabetes care. Dr Pirotta has an interest in complementary treatments in women’s health and Dr Magin focuses on qualitative and quantitative research in different areas, including skin diseases and violence in the workplace.
“It is very enriching to be involved in this group and learn from each others’ skills, we now look at things in a different light” said Professor Van Driel.
The BII-OZ group, as they call themselves, has published and collaborated in organising conference workshops on developing innovative methods of assessment of research impact and drive a network to support early and mid-career primary care researchers. They are keen to progress their collaborations with external funding internationally.
“It is such a significant area of research as it is so close to impacting on people’s lives, thus it is important for us to join together” said Professor Van Driel.
The final gathering of the 2007 Brisbane International Initiative cohort is scheduled for September 2009, held again at Oxford University; however the group remains committed to working together to advance Primary Health Care research.
“It is our goal orientated vision that will keep us continuing in our efforts in the area of Primary Health Care research” said Professor Van Driel.
BROKEN HILL UNIVERSITY DEPARTMENT OF RURAL HEALTH
UNIVERSITY OF SYDNEY
Frances Boreland
Research Officer, PHCRED Program
P: +61 8 8080 1279
E: fboreland@gwahs.health.nsw.gov.au
Many papers languish in bottom drawers because finding quality time to think and write can be a huge challenge for busy professionals. To try to overcome this the Broken Hill UDRH recently trialled a Writing Week, during which participants were supported to revise a paper with the aim of getting to final draft stage by the end of the week.
Participants were provided with dedicated quiet office space if they didn’t have that already, and daily one-on-one mentoring sessions were available on request, and taken up by most. The week started with a brief introduction to paper writing and the value of mind maps for planning them, and then people were free to write. The camaraderie among participants was helped along by quick ‘touching base’ sessions at the beginning of each day, lunch on the fourth day and wine and cheese at the end of the week.
Although no-one quite managed to get to final draft stage by the end of the week, all of the papers were substantially progressed, and the week was considered such a success that two dedicated writing periods will be included in the BHUDRH work plan next year. In the meantime, participants are intending to maintain a more team-based approach to writing, keeping up to date with each other’s progress and swapping drafts for comment.
NORTHERN RIVERS UNIVERSITY DEPARTMENT OF RURAL HEALTH
Cecily Barrack
RDP Clinician/ Adjunct Lecturer
P: +61 2 66207570
E: Cecily.Barrack@ncahs.health.nsw.gov.au
The increasing incidence of fall related injuries, predominantly fractures, is a major health issue. In Australia during 2005/2006 there were 48 409 hospitalisations for minimal trauma fractures (MTF) in people aged over 40 years. Subsequent health care is fragmented, focused on acute fracture management and frequently the opportunity for prevention of future fractures is not addressed.
The Preventing Future Fractures (PFF) was a three phase study with baseline measures, a one-year intervention and post-intervention repeat measures at an intervention and a control site. Measurements were taken from file audit and post discharge patient interviews conducted in a Northern NSW population hospitalised for a MTF.
Regional clinicians developed a low cost model of care ($14k per year) that aimed to identify and assess osteoporosis risk during admission, communicate fracture risk and provide clinical information to support GPs to implement effective fracture prevention management in this highest risk population.
Early findings demonstrated statistically significant increased rates in the intervention site of communication of risk to patients, investigation for Vitamin D deficiency during admission, and patients self reporting taking osteoporosis medication post-discharge.
The PFF recently won the Supporting primary health and care in the community category at the Area Health Service 2009 Quality Awards, and the regional clinical practice baseline has been accepted for publication by the Australian Journal of Rural Health.
Thanks are due to the North Coast Area Health Service for supporting my secondment to the NRUDRH, and to the Institute of Rural Clinical Services and Teaching for assisting with funding the research.
References
Australian Institute Of Health And Welfare (2008) Australia’s Health 2008. Canberra, AIHW.
Bradley C & Pointer S. (2008). Hospitalisations Due To Falls By Older People, Australia 2005–06. Injury Research And Statistics Series Number 50. Cat. No. Injcat 122. Adelaide: AIHW.
Department Of Medicine & University Of Melbourne. (2007). The Burden Of Brittle Bones, Costs & Burden Of Osteoporosis In Australia., Sydney, Osteoporosis Australia.
National Institute Of Clinical Studies. (2003). Evidence- Practice Gaps Report. Melbourne, NICS.
Teede H, Jayasuriya I & Gilfillan C. (2007). Fracture Prevention Strategies In Patients Presenting To Australian Hospitals With Minimal-Trauma Fractures: A Major Treatment Gap. Internal Medicine Journal, 37, 674-679.
 DEPARTMENT OF GENERAL PRACTICE
MONASH UNIVERSITY
Dr Karyn Alexander
MPhil (research) candidate, 2009 RDP fellow
P: +61 3 8575 2248
E: karyn.alexander@med.monash.edu.au
The Healthy Kids Check (HKC) introduced in July 2008, aims to ensure that every four year old child has a basic health check before starting school. If the HKC is to make an effective contribution to child health surveillance it is essential to understand how individual, local and state factors influence its uptake.
The first phase of our study aims to investigate the uptake and delivery of the HKC, between July 2008 and June 2009, with regard to regional and socioeconomic factors. In the first 12 months 40 031 Healthy Kids Checks were performed. This represents approximately 16% of the population of four year olds. GPs performed 47% of these checks. Uptake varies widely across Australia with the ‘best performing’ state, Queensland at 306 services per 100 000 population and the ‘worst’, the Northern Territory at 50 per 100 000 followed by Victoria at 81. Data will be further analysed for correlations with Rural, Remote and Metropolitan Areas (RRMA) classification, Socio-Economic Indexes for Areas (SEIFA) and other socioeconomic indicators. Reasons for these regional differences will be explored.
The second phase will be employ focus groups to better understand the barriers and enablers that affect the provision of this aspect of health service. This will inform the design of an intervention that addresses the barriers to implementing HKCs in general practice.
The value of this research will be that it will inform stakeholders in a variety of health sectors (individual GPs, Divisions of General Practice and policy makers) in order that interventions can be appropriately directed.
DEPARTMENT OF GENERAL PRACTICE
UNIVERSITY OF MELBOURNE
Dr Rachel Lee
Current Academic Registrar and PHCRED Fellow
P: +61 3 8344 7276
E: rslee@unimelb.edu.au
Dr Carolyn Ee
Former Academic Registrar,
Former PHCRED Fellow and
current Master's student
E: ccee@unimelb.edu.au
PHCRED funded research training for novice academic GPs
The Victorian PHCRED research development program is very welcoming to academic GP registrars. There were three key benefits from being involved with PHCRED funded research training program. Most importantly it allowed us to meet with other early career researchers who were also grappling with similar issues and finding their feet. We met about once a fortnight, and found this to be a great opportunity to debrief about how one’s research project was going (or more usually, not going). It’s amazing how peer support can make such a difference!
From regular updates on everyone’s projects we could see the ‘warts and all’ research process unfolding and could learn from each others’ experiences and challenges. We could encourage one another when we felt disheartened, when motivation was low, or when there were problems with ethics. PHCRED fellows were from a diverse and varied background so there were always different perspectives and often very useful new insights and ideas.
The second benefit is the structured approach that the PHCRED program provides. Years of refinement have resulted in a well-paced educational program that explores the different steps on a research pathway. The program outlines a basic structure for the research year and provides some milestones to ‘hang’ your project on – particularly useful for the novice researcher. The program is led by experienced researchers who provide invaluable mentorship, guidance and support, and it was wonderful to be able to blossom under their tutelage and realise that by the end of the year you had gained a number of new research skills.
Thirdly, there was an interesting range of presentations as part of the formal PHCRED program. The combination of regular presenters, guest speakers and field visits provided a balance between continuity, and challenge and breadth.
We would highly recommend the PHCRED program as a gentle, supported way for novices to ‘dip your toe’ into research waters.
VicPHCRED
Anna Chapman
VicPHCRED Statewide Coordinator
P: +61 3 8575 2246
E: anna.chapman@med.monash.edu.au
In August, the Monash University Department of Rural and Indigenous Health (MUDRIH) in Gippsland welcomed Victorian PHCRED fellows for an Indigenous Health and Cultural Competency day.
PHCRED Fellows from MUDRIH, Monash University Department of General Practice (DGP) and Melbourne University DGP were involved in the day long excursion. This excursion enabled the fellows from metropolitan Melbourne an opportunity to understand the issues faced in regards to primary health care in rural areas such as the Latrobe Valley.
The excursion featured MUDRIHs Head of Indigenous Health, Associate Professor Marlene Drysdale who spoke to the fellows about cultural issues in providing health care for Indigenous People. In addition to this, Priscilla Pyett, Associate Professor in Indigenous Health Research at MUDRIH led with a session on the issues and implications challenging rural and indigenous health research.
The experience was beneficial for all fellows, who indicated that it was a great networking and research capacity building experience for everyone involved.
The next Victorian PHCRED activity will be the State Conference which is scheduled for Monday 9 November. For details on the upcoming conference please refer to the VicPHCRED website: <www.vicphcred.monash.edu.au/>
GREATER GREEN TRIANGLE UNIVERSITY DEPARTMENT OF RURAL HEALTH
Dr Michael Coates
PHCRED Coordinator
P: +61 3 5563 3565
E: michael.coates@greaterhealth.org
The True Blue study: Is practice nurse-led collaborative care better for patients with depression, diabetes and heart disease?
In the presence of chronic disease, depression is under diagnosed and under treated despite clear evidence that it is a risk factor for poor outcomes. To improve clinical outcomes for patients with diabetes and heart disease, there is a real need to address co-morbid depression. Time in GP consultations is too limited and another model of care is needed to effectively detect and manage depression needs. Practice nurse-led collaborative care is one such model.
An exploratory trial of such care, Depression_Treatment Evaluation Care Team (DTECT), in six rural practices in SW Victoria and SE South Australia, based on the highly-acclaimed IMPACT model operating in the USA, found that 34% of patients screened were found to be depressed but depression scores improved in the follow-up appointments. GPs and nurses showed a high acceptance of the collaborative model.
The success of DTECT led to the current True Blue study, a randomised-cluster trial funded by beyondblue, and one of the first world-wide studies of depression management alongside diabetes and heart disease management. Practice nurses are trained and assisted to provide collaborative care. Outcomes are compared to usual GP-led care. The project uses existing workforce and is entirely self-funded at the clinic level using Medicare item numbers.
Patients have 45-minute appointments with practice nurses to develop medical plans for their health, and develop up to three personal goals that will assist improving health outcomes. An appointment with the GP completes the medical plan. Practices automatically recall patients every three months over a twelve-month period to review depression scores, physiological parameters, and update goals.
Eleven general practices from Northern Rivers and Adelaide are currently participating in the study. Five were randomly allocated to the intervention cluster where the nurse-led team care is to be used, and the remaining six to the control cluster, where usual care will continue. The anecdotal evidence suggests that the nurse-led care is working to reduce depression, with the interim findings suggesting depression scores have decreased in 79% of the patients. Nurses report high acceptance of the model by patients and GPs. If clinical outcomes demonstrate a clear benefit then we hope to extend the availability of our training workshop and resources across Australia.
Reference
Morgan M, Dunbar J, Reddy P, Coates M & Leahy R. (2009). Is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes? BMC Family Practice 10: 46.
SPENCER GULF RURAL HEALTH SCHOOL (SGRHS)
A/Professor Gary Misan
Head of Research, SGRHS;
Director PHCRED, SGRHS
P: 0408 894 168
E: gary.misan@adelaide.edu.au
 “I married him for life not for lunch” was the cry from the beleaguered wife whose recently retired husband seemed always to be under her feet. This story is oft repeated in many households throughout Australia where the retired male often complains of nowhere to go and nothing to do. Well help for the women of Australia is now at hand with the advent of the communal Men’s Shed. These are a modern-day Australian phenomenon taking hold around the nation, giving men a place to go where they can join with other men, and take part in productive activities that benefit themselves and their communities.
Recent work by the author, that includes a review of the literature, has shown that Men’s Sheds can not only address men’s need for socialisation, but can also lead to improvements in social and emotional well being, physical health and mental health. This has positive implications for their partners, families and communities with men saying because they are happier within themselves their relationships with partners, family and friends have also improved.
The story doesn’t end there. As there is a growing interest in the opportunity of Men’s Sheds as a vehicle for men’s health promotion, a number of sheds are affiliated with community health services or community hospitals that employ health promotion officers and other health workers. Currently many of these staff talk to men informally over a cup of tea or coffee or offer more formal health education sessions during shed operating times or after hours. Some services offer regular blood pressure screening and other health check-ups for men who attend the sheds while others offer specific health promotion activities like healthy eating and exercise programs.
Best practice models for health promotion in these types of environments remain to be investigated and is one of the planned PHCRED research activities for SGRHS in 2010, in partnership with men’s health organisations and workers from around the state. The findings from this work will inform policy initiatives for men’s health in SA and beyond.
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