 CENTRE FOR REMOTE HEALTH
FLINDERS UNIVERSITY
Pim Kuipers
Senior Research Fellow
P: 08 8951 4702
E: pim.kuipers@
flinders.edu.au
Pim Kuipers holds a PHCRED Mid-Career Fellowship. His research includes an examination of the model of Community Based Rehabilitation (CBR). As a result of his work in this area he was recently invited to contribute towards The Lancet special issue on disability and rehabilitation. He wrote a 'perspectives' piece and contributed to a 'commentary' article.
Disability, health, and international development
A few years ago I spent some time in a remote southern province of Laos to evaluate a disability and development project. In the course of this work, I met people with disabilities and their family members who told me of the reality of their struggles, the discrimination they faced, their health, social and support needs, and what the project had achieved. I encountered disabled children who despite enormous obstacles managed to engage in school, as well as villagers with disabilities whose lives had been transformed through participation in income-generation projects that gave them new skills, an income and a key role in the community.
Kuipers P. (2009). Disability, health, and international development. The Lancet. 374(9704), 1813.
Community-based rehabilitation: opportunity and challenge
Community-based rehabilitation (CBR) is the main way in which disabled people in most of the world have any chance of accessing rehabilitation services. CBR was first promoted by WHO in the mid-1970s to address the shortage of rehabilitation assistance by providing services in the community with use of local resources. The strategy drew on the principles of primary health care, accepted international rehabilitation practices of the time, and also existing local practices.
Hartley S, Finkenflugel H, Kuipers P, Thomas M. (2009). Community-based rehabilitation: opportunity and challenge. The Lancet. 374(9704), 1803-1804.
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.
2009 saw another year of growth for the NRGP with 17 member practices and an increasing interest in research projects. Our 3rd NRGP Forum was held at The Oak Resort, Sunsets at the Bay, Salamander Bay on 28 November 2009, where 26 people attended in a friendly collegiate atmosphere.
Inspiring guest speakers are hallmarks of our Forums, and this year we were privileged to have Dr Geoff Mitchell, Professor of General Practice and Palliative Care, University of Queensland and Dr Dan Lasserson, Clinical Lecturer, University of Oxford, who shared the difficulties and successes of their most interesting research journeys. Their research commenced with the desire to share and explore their observations in medical practice.
Nine short research presentations on a variety of topics were held and included current NRGP research and participation in other research in our region and the Sydney region. Briefly, research included: Occupational Violence in GP; Procedural skills for GP registrars; Waiting Room Ambience Project (WRAP); Community Stroke Study; Physical Activity Coaching; Palliative Care needs assessment project; Warfarin and AF study; Thirst and Salt intake; and UNSW Research Centre opportunities for funded research.
Importantly, the Forum offered the opportunity to informally workshop two research ideas, Strokes in the community and Thirst and the use of salt.
The 2009 NRGP Forum was once again a successful day, focusing on sharing research information and discussing research ideas in a friendly environment. We look forward to continuing to provide support to staff of NRGP member practices to facilitate the conduct of practice-based primary care research during 2010.
PHCRED Queensland
Lily Cheung
P: 0466 113 688
E: l.cheung@uq.edu.au
Fantastic Fellows from Queensland
An annual highlight of the PHCRED Queensland program is the Fellows Day which provides our emergent primary health care researchers with an opportunity to showcase the work they have been doing over the past year.
In 2009 the program was jam-packed with 16 Fellows presenting their work to their peers. Topics ranged from child and maternal health to palliative care, with a strong focus on health service improvements including quality initiatives in team-care and improving care in the emergency room setting.
Presentations highlighted an enormous amount of work that had been conducted by the Fellows over and above their busy professional roles. All the presenters spoke with enthusiasm and commitment about their research, despite many facing unexpected challenges along the way.
 The two-day event also provided the Fellows with an opportunity to attend two workshops, one on grant-writing and the other on publishing findings from their work.
PHCRED Queensland organisers were delighted with the results of the day, having a full presentation attendance from the 2009 Fellows. PHCRED Queensland Coordinator Denise Schultz said the program had worked very hard over the year to ensure that the Fellows were well supported.
The turnout and the quality of the work presented was unrivalled by previous events. The day culminated in a Fellows Dinner providing opportunities for networking and continued discussions from the day.
2010 is already gearing up to be a bigger and better year in Queensland as the PHCRED program turns its attention to a Research and Policy Showcase in March, and recruits team-based research projects to continue on the success achieved by the program to date.
CENTRE FOR PRIMARY HEALTH CARE AND EQUITY
UNIVERSITY OF NEW SOUTH WALES
Suzan Mehmet
Research Network Administrator/Coordinator
P: 02 9616 8520
E: s.mehmet@unsw.edu.au
The UNSW Research Capacity Building Initiative currently has enthusiastic trainees Della Maneze and John Widdup continuing with the Research Development Program in 2010.
Della Maneze is well known to the UNSW team. She was involved with research published in the Australian and New Zealand Journal of Public Health (ANZJPH) looking at Kava use amongst Tongan males in South Western Sydney (SSW). Della is an overseas trained doctor, working as a Multicultural Health Worker.
Currently, she is working on a project focusing on enhancing integrated care for chronic disease, spearheaded by Professor Siaw-Teng Liaw. Her project focuses on the integration of care in the management of diabetes for patients hospitalised at Fairfield Hospital.
Della calls herself a newbie in research and says “What little knowledge I gain is beneficial. Sometimes when you are deeply immersed into it, you don’t realise what you have learnt. But on reflection and applying it to a different study, you realise you have learnt quite a lot”.
Working on her project in this way has meant that she has deepened her understanding of the research process. She gives the example of constructing survey tools: “Really thinking deeply about the [information and] questions so I don’t miss a thing, scrutinising where that question can lead or not lead that will be of more benefit to the research”.
Her expectations of the RDP have been grounded by the learning process. “I was expecting to be a whiz in research when I joined but that has not happened yet but overall, I am happy about what I have gained so far”, she says.
John Widdup is a Podiatrist working in private practice in SSW. Also having worked as an Aboriginal foot educator in urban and remote communities, he continues to be interested in diabetes and the high risk foot.
His project looks at the utilisation rates of early childhood services by Aboriginal infants within an urban population, with a particular focus on determining if there is any discrepancy with utilisation rates between Aboriginal and non-Aboriginal infants. John is being supervised by Dr Elizabeth Comino and assisted by Vana Webster.
John was met with some indifference when showing results to some project stakeholders: “Trying to explain the findings of my investigations, particularly when the results didn’t favour the particular stakeholder you are addressing, was a challenging and a little hostile ordeal. Being able to interpret any findings in the appropriate context I have found to be very important”.
He feels that he has had the opportunity to develop not only new research skills but also his abilities in project management: “I have had the opportunity to experience developing a project from start to finish, so I feel I have learnt new skills at every step. In particular, I have developed skills in managing stakeholders involved with the project, the process of applying for ethics approval and data analysis including understanding and interpreting results”.
His RDP experience has exceeded his expectations: “I have, to a large degree, been able to design and perform my own project when I was expecting that I would be working on a project assisting someone else”.
Both RDP's hope to continue as researchers and are keen to pursue PhDs in the future.
ABORIGINAL HEALTH STREAM
NORTHERN RIVERS UNIVERSITY DEPARTMENT OF RURAL HEALTH
Janelle Stirling
Associate Professor Aboriginal Health
P: 02 6620 7697
E: Janelle.Stirling@ncahs.health.nsw.gov.au
The Northern Rivers University Department of Rural Health (NRUDRH) PHCRED program has been working for a number of years on the development and implementation of program called Walking through Research. The program includes mentoring and introductory training in Aboriginal health research in a culturally safe learning environment. The original program was aimed at Aboriginal Health Workers working in the local area. While this program had some successes, limitations were identified in that workers found it difficult to implement their learni ngs in the workplace due to other demands and a lack of support structures for research.
One of the recommendations from the first course delivered in 2007 was that participants would like a course workbook. In consultation with the Aboriginal Health Council of South Australia an agreement was made for the NRUDRH to purchase copies of workbooks they had developed for modification and use by the NRUDRH.
In 2009, after consulting with local Aboriginal health services, the NRUDRH decided to change the target audience. An expression of interest was sent out through our Aboriginal health research networks to identify interest in the training for community-based Aboriginal research assistants. We were aware that many projects employ local Aboriginal people who have good community connections and content knowledge; however they have not had formal research training.
The response was very positive with many project leaders indicating they had been looking for this type of training which had previously not been available. In September 2009 Shawn Wilson and Janelle Stirling delivered the course to 13 participants on campus at The University of Sydney. The feedback from the course was very positive with many students reporting comments like:
"I felt very comfortable after meeting everyone and finding out that I was not alone in learning about research".
GENERAL PRACTICE
THE UNIVERSITY OF WESTERN AUSTRALIA
Dr Caroline Bulsara
PHCRED Coordinator
P: 08 9449 5166
E: caroline.bulsara@uwa.edu.au
 Engaging undergraduate students in the primary health care research
Medical students at the University of WA (UWA) have been an important part of the PHCRED strategy in recent years. Towards to end of their third year research project they are encouraged to present their work at the PHCRED statewide conference held in November of each year. For students, having the opportunity to present their work in a supportive atmosphere creates an added interest in the research process. The opportunity also ensures that they feel part of a wider primary health care research community consisting of GPs, allied health professionals, consumer representatives and primary health care researchers.
In 2008, a third year student, Michaelia Verbeek, not only presented at the conference but also won best poster at the faculty medical student research evening at UWA with her topic, Parental attitudes to childhood obesity in a regional town in WA. This year, 2009, two students who completed their project as a team and in conjunction with the Wheatbelt GP Network, won best student presentation at the statewide PHCRED conference. Their presentation was entitled, Efficacy of Wheatbelt GP Network’s Discovering Solutions for Family Abuse Men’s Domestic Violence Program: A quality control study.
The unit coordinator, Caroline Bulsara, believes that including students in research activities during their medical studies engenders an interest in research early on. The experience also demonstrates the broad and varied scope of primary health care research. By having students present in a supportive atmosphere whereby delegates can discuss their work with them and provide positive feedback is extremely valuable.
DEPARTMENT OF GENERAL PRACTICE
MONASH UNIVERSITY AND AMBULANCE VICTORIA
Brian Steer
RDP Fellow
P: 03 9877 9116
E: Brian.Steer@med.monash.edu.au
As a leading cause of death and disability, no stone is to be left unturned in the calling to prevent, manage or support those who do or would suffer from stroke. According to the National Stroke Foundation, the role of the GP in acute stroke is unclear. It is timely that a review of the literature be conducted to discover what is known and what should be known about the role of the GP, and in particular, whether that role is clinically significant.
Support through PHCRED via the Research Development Program has made it possible to conduct a literature review so that a contribution might be made through publication.
There is evidence that whilst the individual GP may report little contact with patients suffering acute stroke, as a population the role of GPs is underestimated. It has been established that for many patients calling general practice is a crucial cause of delay to acute therapies such as thrombolysis. Preliminary results indicate that whilst most GPs believe stroke is a medical emergency, their assessments and referral may not align with best practice. In particular, there is an apparent lack of awareness of the window for thrombolysis and the need to refer immediately to a suitable hospital by calling for an ambulance.
Because the literature available is from many countries with quite different health care systems, investigation into the Australian context is required. It is important to make a distinction between issues to do with general practice, such as whether callers are triaged, and issues to do with the knowledge and management choices of individual GPs, such as the decision to visit patients, rather than call 000.
Appropriate investigations, followed by targeted interventions, may save many Australians from death or disability.
SCHOOL OF MEDICINE AND DENTISTRY
JAMES COOK UNIVERSITY
Sharon Barnwell
Communications and PA to Head of School
P: 07 4781 5025
E: sharon.barnwell@jcu.edu.au
The first graduate of James Cook University’s (JCU) Graduate Certificate of Primary Health Care Research, Valerie Alberts, said she is pleased with the focus of the course and will recommend it to others.
“As an Indigenous person, I found the content accurately reflected the cultural background and complexity of Indigenous health issues. I will be encouraging Indigenous postgraduates to consider the course,” Ms Alberts said.
Administered through the School of Medicine and Dentistry, the certificate is designed for postgraduates and health professionals to broaden their foundation for primary health care research and evaluation.
Robyn Preston, PHCRED Coordinator at JCU, said numbers in the course are expected to double over the next two years. Currently there are 21 students enrolled, eight of whom are Indigenous. The course can be completed part-time over two years, which attracted Val to enrol.
“The end result of the Graduate Certificate enabled me to get a deeper understanding of primary health care and evaluation processes. It’s an area becoming more relevant and a priority area for Indigenous health outcomes,” said Ms Alberts.
On-line discussions and teleconferencing was used to connect students. Ms Alberts said she found the flexibility of the course delivery a plus. “It means that people in full time work can do one subject per semester. Students need to be aware that the course is self-directed and self-motivation is necessary!”
Primary health care research is an area which is growing in significance, particularly in Indigenous communities. Completing the Graduate Certificate at James Cook University will allow health practitioners to embark on research projects with confidence that they have a solid knowledge base and the practical skills required to work in Indigenous health.
Students interested in furthering their knowledge as an Aboriginal Health Worker can also take advantage of a qualification in Indigenous Research Capacity Building delivered at Certificate IV or Diploma level. The course, developed by JCU, began in August 2008 through the Aboriginal Health Council of South Australia (AHCSA). From 2010 onwards it will be delivered through JCU and the AHCSA in northern Queensland. For further information about both courses contact phcred@jcu.edu.au
UNIVERSITY DEPARTMENT OF RURAL HEALTH NORTHERN NSW
UNIVERSITY OF NEWCASTLE
Sally Moy
Dietician, RDP Fellow
P: 02 6767 8443
E: Sally.Moy@hnehealth.nsw.gov.au
Sally Moy is an experienced dietitian who has worked in a number of rural settings. During the past two years Sally has been based at Tamworth Rural Referral Hospital and has developed a keen interest in the treatment of patients with eating disorders. Sally is currently involved in the Researcher Development Program (RDP) fellowship program with the University Department of Rural Health Northern NSW in Tamworth.
As a part of her research this year, Sally has undertaken a literature review to determine if there are any best practice guidelines and outcome measures for treating eating disorder patients in rural areas. The literature has revealed that a good outcome for an eating disorder patient is a weight within 10-15% of ideal body weight for height, and the return of menses in females with anorexia nervosa. It was also noted from the literature that patients treated in a multidisciplinary team have better outcomes.
The aim of Sally’s research was to determine the health outcomes of eating disorder patients (such as those with anorexia nervosa, bulimia nervosa, or Eating disorder not otherwise specified (EDNOS)) who have received dietetic treatment at Tamworth Rural Referral Hospital. Her research involved a retrospective review of medical records over the preceding five years to determine health outcomes compared to the best practice goals, as identified in the literature. Data collected included: age of patients, length of treatment, referral source, weight, height, menstruation status, compensatory behaviours, presentations to hospital and consultations with other health professionals.
Preliminary results from the raw data show that of the 39% of patients treated by the dietetic department at Tamworth Rural Referral hospital for an eating disorder who begin treatment under their ideal body weight, 36% achieved a weight within 10-15% of their ideal body weight for height at the end of treatment. A limitation of this study is that there was limited other outcome data available from the medical records.
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