ItemDo guidelines provide evidence-based guidance to health professionals on promoting developmentally appropriate chronic condition self-management in children? A systematic review(Sage, 2018-09-23) Saxby, Nicole; Beggs, Sean; Kariyawasam, Nadish; Battersby, Malcolm Wayne; Lawn, Sharon JoyObjectives To determine whether evidence-based practice guidelines promote developmentally appropriate chronic condition self-management for children with asthma, type 1 diabetes mellitus, and cystic fibrosis. Methods Systematic review of clinical guidelines current as at 22 September 2017, including assessment of quality of each guideline using the iCAHE ‘Guideline Quality Checklist’, and mapping of the supporting evidence. Results Fifteen guidelines were identified: asthma (n=7) and type 1 diabetes mellitus (n=7), CF (n=1). Guideline quality was variable, and 11 different grading systems were used. In total, there were 28 recommendations promoting age/developmental considerations. Recommendations focused on: collaboration (n=15), chronic condition self-management education (n= 17), clinicians’ skills (n= 4); personalized action plans (n=3), problem-solving (n=2); and the assessment of children’s chronic condition self-management needs (n=3). Developmental transitions are highlighted as important time points in some guidelines: preschool (n=2), and adolescence (n=3). All guidelines encouraged triadic partnerships between children, adult caregivers and clinicians. Evidence supporting the developmental aspects of the guidelines’ recommendations was poor; only 14 out of 57 journals listed as evidence were concordant. Discussion Current guidelines articulate that developmentally appropriate chronic condition self-management is important; however, more work needs to be done to translate the concept into practical clinical tools. ItemAmbulance Employees Association – Scoping Literature Reviews drawing on qualitative literature to address the physical, psychological, psychobiological, and psychosocial health of operational ambulance staff and interventions to address the impact of workplace stressors.(Flinders University, 2019-04) Lawn, Sharon Joy; Willis, Eileen Mary; Roberts, Louise; Couzner, Leah; Mohammadi, Leila; Goble, ElizabethParamedics have in many ways been ‘the forgotten profession’ within the healthcare system. This situation has arisen due to the tendency to traditionally ‘silo’ health professions into their specific disciplines. It is also a consequence of the physical separation of out-of-hospital care from hospital and other community clinical work that has tended to create a barrier to inter-professional understanding and collaboration, and to the fact that, in Australia, paramedics have often been in a portfolio other than health. The result has been that ambulance personnel and organisations are faced with the legacy of, and negative effects on, mental well-being that their role and the environments they work within create. The nature of the work, the uncontrolled and often unpredictable environments, the everyday experience of trauma, and the cumulative nature of that trauma all play a key role in the development and impact of mental distress and psychological injury. Organisational and occupational factors such as workload, work demands, shift work, limited time for debriefing or downtime, the hierarchical nature of supervision, and the lack of recognition are clearly shown to have effects on the well-being of ambulance personnel that are as significant as, if not greater than, the nature of the work itself. The following excerpt from a submission to the Senate Committee Inquiry into the Mental health and well-being of emergency first responders succinctly identifies the operational and organisational factors which influence mental health and well-being within the pre-hospital setting. This commissioned review brings together the available literature from both peer-reviewed articles, public sources, and senate submissions to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. ItemExploring General Practitioners’ Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia(MDPI, 2018-12-06) Wlodarczyk, Julian; Lawn, Sharon Joy; Powell, Kathryn; Crawford, Gregory Brian; McMahon, Janne; Burke, Judy; Woodforde, Lyn; Kent, Martha; Howell, Cate; Litt, John CharlesThe prevalence of people seeking care for Borderline Personality Disorder (BPD) in primary care is four to five times higher than in the general population. Therefore, general practitioners (GPs) are important sources of assessment, diagnosis, treatment, and care for these patients, as well as important providers of early intervention and long-term management for mental health and associated comorbidities. A thematic analysis of two focus groups with 12 GPs in South Australia (in discussion with 10 academic, clinical, and lived experience stakeholders) highlighted many challenges faced by GPs providing care to patients with BPD. Major themes were: (1) Challenges Surrounding Diagnosis of BPD; (2) Comorbidities and Clinical Complexity; (3) Difficulties with Patient Behaviour and the GP–Patient Relationship; and (4) Finding and Navigating Systems for Support. Health service pathways for this high-risk/high-need patient group are dependent on the quality of care that GPs provide, which is dependent on GPs’ capacity to identify and understand BPD. GPs also need to be supported sufficiently in order to develop the skills that are necessary to provide effective care for BPD patients. Systemic barriers and healthcare policy, to the extent that they dictate the organisation of primary care, are prominent structural factors obstructing GPs’ attempts to address multiple comorbidities for patients with BPD. Several strategies are suggested to support GPs supporting patients with BPD. ItemExtinction of gambling cue-reactivity: A pilot study in a problem gambling treatment setting(MedDocs Publishers, 2018-11-14) Riley, Ben; Baigent, Michael Ferris; Harris, Sharon; Larsen, Amii; Nye, Tracey; Battersby, Malcolm WayneClinical interventions which focus on extinction learn-ing have been shown to reduce craving and relapse in substance related and behavioural addictions. This paper reports a small pilot study with 20 problem gamblers re-ferred for treatment by a local court diversion program. We investigated the use of portable heart rate monitors to measure the effectiveness of Cue Exposure Therapy (CET) in extinguishing gambling cue-reactivity. Cue-reactivity pro-cedures consisted of a relaxation period followed by in-vivo exposure with response prevention in a gambling environ-ment. Cue exposure therapy was manualised. Dependent measures comprised both self-report (gambling urge and problem gambling questionnaire) and physiologic measures (heart rate). Significant increases in heart rate were ob-served during in-vivo pre-CET but not post-CET (p < 0.001). Following CET, significant reductions across all dependent variables were observed (p ≤ 0.001) with within-group ef-fect sizes ranging between r = -.55 and -.61. Overall, the results of this small pilot study support the feasibility and acceptability of the use of portable heart rate monitors to observe the extinction of gambling cue-reactivity. Portable heart rate monitors may provide a novel and useful tool for therapists and their problem gambling patients to monitor gambling cue-reactivity during treatment. Further research is needed to evaluate whether extinction of cue-reactivity can reduce problem gambling relapse. ItemDeveloping a screening tool to recognise social determinants of health in Australian clinical settings(Sax Institute, 2018-11-01) Browne-Yung, Kathryn; Freeman, Toby; Battersby, Malcolm Wayne; McEvoy, Doug R; Baum, FranObjective and importance of study: The importance of social determinants for individual health recovery outcomes is well recognised in public health. However, no succinct social health screening (SHS) tool exists that has beendeveloped with information from clinicians and patients. This proof-of-concept study asked health consumer advocates, patients and clinicians about their attitudes towards social determinants of health (SDH) and the usefulness of an SHS tool for collecting these data for use in clinical settings. We then developed a streamlined SHS tool to bring this knowledge to clinicians, and conducted a proof-of-concept trial to check its acceptability with patients and clinicians. Methods: This qualitative study had two stages. Stage 1 involved focus groups with health consumer advocates and interviews with clinicians about the draft SHS tool. Stage 2 involved refining the SHS tool and piloting it with 50 new patients in anxiety disorder and sleep disorder clinics, which often treat patients living in disadvantaged socio-economic conditions. The tool was evaluated by patients and clinicians. The data were analysed using framework analysis. Results: All interviewees were positive about the benefits of addressing SDH in clinical practice to help reduce health inequities. We developed and refined an SHS tool that could be completed by patients (‘self-complete’). Conclusion: The response to introducing an SHS tool in clinical settings was positive. Further piloting across diverse clinical settings is required to determine efficacy. This tool promotes public health equity outcomes by improving clinician understanding of individual social circumstances, and has the potential to provide useful epidemiological data on SDH. ItemTrust and Community Treatment Orders(Frontiers in Psychiatry, 2019-05-20) McMillan, John; Lawn, Sharon Joy; Delany-Crowe, ToniThere are conflicting views about the benefits of community treatment orders (CTOs) for people with mental illness. While there is a significant literature on the coercive nature of CTOs, there is less on the impact that CTOs have upon trust. A recovery-oriented approach requires a trusting therapeutic relationship and the coercion inherent in the CTO process may make it difficult for trust to be built, nurtured, and sustained between workers and patients. Our aim was therefore to examine the role of trust within the CTO experience for mental health workers and patients on CTOs. Methods: We conducted a thematic discourse analysis of 8 in-depth interviews with people who were currently on a CTO and 10 interviews with multi-disciplinary mental health workers in Adelaide, Australia (total N = 18 interviews). The interviews were coded and analyzed with the assistance of a patient representative. The findings reveal the challenges and opportunities for trust within the coercive relationship of a CTO. Findings: We found that patients have diverse experiences of CTOs and that trust or mistrust played an import role in whether or not they found the CTO beneficial. ItemEmbedding and sustaining motivational interviewing in clinical environments: a concurrent iterative mixed methods study(Springer, 2019-05-22) Lim, David; Schoo, Adrian Martinus M; Lawn, Sharon Joy; Litt, John CharlesMotivational interviewing (MI) is internationally recognised as an effective intervention to facilitate health-related behaviour change; although, how it is best implemented and maintained in everyday clinical practice is not so clear. The aim of this study is to understand how MI as an intervention can be embedded and sustained in the clinical practice and learning environments. Methods A concurrent iterative mixed methodology was utilised. Data collection occurred in two parts: a scoping review to identify reported barriers and enablers to embedding and sustaining MI in healthcare settings, and a survey of health professionals at an international clinical educator workshop on the topic. Results from both methods were integrated at the analysis phase (‘following a thread’) to understand how MI is embedded and the fidelity sustained in the clinical environments. Complexity theory as a conceptualising framework was utilised. Results Eleven studies were included, and 30 health professionals were surveyed. Sustainability of MI at micro-clinical levels can be fostered through use of enabling technology, focus on patient-centred care, personnel development and process improvement. At the meso-organisational level, developing shared vision, creating opportunities and an organisational culture supportive of continuous learning are relevant issues. At the macro levels, adopting systems thinking and a learning organisation approach is important for sustaining MI. Conclusions In addressing the recognised barriers to embedding and sustaining MI in health service provisions, clinical educators could potentially play a central role as change agents within and across the complex clinical system. ItemReducing Smoking Among People With Schizophrenia: Perspectives on Priorities for Advancing Research(Frontiers, 2018-12-18) Baker, Amanda; Robson, Debbie; Lawn, Sharon Joy; Steinberg, Marc L.; Bucci, Sandra; McNeill, Ann; Castle, David; Bonevski, BillieAlthough tobacco smoking is very common among people with schizophrenia and has devastating effects on health, strategies to ameliorate the risk are lacking. Some studies have reported promising results yet quit rates are much lower than in the general population. There is a need to advance research into smoking cessation efforts among people with schizophrenia. We posed the following question to five leading international experts in the field: “What are the top three research ideas we need to prioritize in order to advance the field of reducing smoking amongst people with schizophrenia?” They identified three broad priorities: (i) deeper understanding about the relationship between smoking, smoking cessation and symptomatology; (ii) targeted, adaptive and responsive behavioral interventions evaluated with smarter methodologies; and (iii) improvements in delivery of interventions. Efforts should be made to establish a collaborative international research agenda. ItemTeachable moments: how can the community capitalise on existing and future support services to improve the mental health and wellbeing of ‘new’ fathers?(Flinders University, 2018-12) Venning, Anthony; Herd, Madeleine; Smith, David; Lawn, Sharon Joy; Mohammadi, Leila; Glover, FionaThe South Australian Mental Health Commission (SAMHC) released the South Australian Mental Health Strategic Plan in December 2017, with the aim of building, sustaining and strengthening the mental health and wellbeing of South Australians. Given the prevalence of fathers who experience anxiety and depression during their partner’s pregnancy and following the birth of their baby, and the tendency of this population to be less likely to seek out help for these issues, SMS4DadsSA – a perinatal mental health support pilot project for expectant fathers – was approved as one of the inaugural projects to commence implementation of the strategic plan. In order to gain a broader understanding of the evidence base in the area of ‘new’ fathers, and to position the future outcomes of the pilot project, SAMHC decided to collaborate with Flinders University to undertake a research analysis of the efficacy of interventions that seek to improve the mental health of ‘new’ fathers. Given the wide range of methodologies and designs of research in this area, a narrative synthesis, as compared to a meta-synthesis or meta-analysis, was chosen to capture these objectives. ItemHidden care: revelations of a case‐note audit of physical health care in a community mental health service(Wiley, 2018-05-24) Lawn, Sharon Joy; Zabeen, Sara; Rowlands, Nikki; Picot, SharonPeople with severe mental illness (SMI) are widely reported to be at an increased risk of morbidity and premature death due to physical health conditions. Mental health nurses are ideally placed to address physical and mental health comorbidity as part of their day‐to‐day practice. This study involved an audit of hardcopy and electronic clinical case‐notes of a random sample of 100 people with SMI case managed by community mental health service in metropolitan South Australia, to determine how well physical health conditions and risk factors, screening, and follow‐up are recorded within their service records. Every contact between 1 July 2015 and 30 June 2016 was read. One‐way ANOVA, Scheffe's test, and Fisher's exact test determined any significant associations across audit variables, which included gender, age, income, living arrangement, diagnosis, lifestyle factors, recording of physical health measures, and carer status. A focus on physical health care was evident from everyday case‐note records; however, because this information was ‘buried’ within the plethora of entries and not brought to the fore with other key information about the person's psychiatric needs, it remained difficult to gain a full picture of potential gaps in physical health care for this population. Under‐reporting, gaps and inconsistencies in the systematic recording of physical health information for this population are likely to undermine the quality of care they receive from mental health services, the ability of mental health service providers to respond in a timely way to their physical healthcare needs, and their communication with other healthcare providers. ItemPain self-management: easier said than done? Factors associated with early dropout from pain self-management in a rural primary care population(Oxford University Press, 2018-09-06) Hardman, Ruth; Lawn, Sharon Joy; Tsourtos, GeorgeObjective To explore whether psychosocial or demographic factors are associated with early dropout from pain self-management in a rural, low–socioeconomic status population. Design Secondary analysis of retrospective data. Setting Multidisciplinary pain clinic located in an outer regional area of Australia.Subjects One hundred eighty-six people attending a public community health center with chronic noncancer pain (mean age 54.9 years; 58.1% women; 81.7% in receipt of government benefit as their primary source of income). Methods Bivariate analysis and logistic regression, with early dropout as the dependent variable and a range of demographic and psychological independent variables. Results Following bivariate analysis, early dropout was significantly associated (P < 0.05) with male gender, younger age, history of substance use, being a past victim of assault/abuse, receiving unemployment or disability benefit, having literacy difficulties, higher pain catastrophizing score, higher daily opioid dose, and not holding a multifactorial belief about the cause of pain. Logistic regression analysis resulted in three significant predictors of dropout: substance use history (P = 0.002), past victim of assault or abuse (P = 0.029), high pain catastrophising score (P = 0.048); and one of engagement: holding a multifactorial belief about pain cause (P = 0.005). Conclusions In a rural, low–socioeconomic status population, addressing social stressors related to lifetime adversity may be important to increasing engagement in pain self-management. Lack of attention to these factors may increase health inequity among those most disabled by chronic pain. Further research into dropout and engagement, especially among disadvantaged populations, is recommended. ItemSelf-management programs for Aboriginal and Torres Strait Islander Peoples with chronic conditions: a rapid review(SAGE Publications, 2017-12-29) Moore, Ellie; Lawn, Sharon Joy; Oster, Candice; Morello, AndreaObjectives Review the evidence for the effectiveness of chronic condition self-management programs applied to Aboriginal and Torres Strait Islander Peoples. Methods A rapid review methodology was followed to develop an evidence summary from peer-reviewed and grey literature. Results Only seven peer-reviewed studies were identified. The evidence indicated that group programs, particularly the Stanford Program, and structured individual chronic condition self-management programs were of good quality for Aboriginal and Torres Strait Islander Peoples, although these need to be integrated into practice in order to see the greatest benefits. The Flinders Program showed promise as a standardised program with content designed specifically with and for these populations. Numerous grey literature sources were identified, many using strong participatory approaches developed locally within Aboriginal and Torres Strait Islander Peoples. However, few of these programs have been subject to rigorous evaluation. Discussion Despite the significant focus on chronic condition self-management programs to help address the burden of disease for Aboriginal and Torres Strait Islander Peoples, few studies exist that have been properly evaluated. The Closing the Gap Principles developed by the Australian Institute of Health and Welfare offer important guidance for how to proceed to maximise engagement, cultural appropriateness and ownership of program initiatives. ItemAn audit of the management of nicotine withdrawal in an Australian inpatient unit: are we there yet?(SAGE Publications, 2017-10-02) Iyer, Reena; Smith, David; Lawn, Sharon JoyObjectives: This paper reports outcomes of a clinical audit of smoke-free policy implementation within an Australian inpatient psychiatric setting. It aimed to evaluate assessment of smoking status and subsequent management of nicotine withdrawal, and investigate any patient factors influencing these processes. Methods: A total of 67 medical case notes were retrospectively analysed for inpatients admitted to psychiatric units of a general hospital in South Australia, from July to September 2015. Patient demographic variables and information from the hospital’s Smoking Assessment and Management Form (SAMF) were recorded. Data analysis involved descriptive statistics and Chi-square tests of association between dependent variables (how the SAMF was completed) and independent variables (sex, voluntary status, diagnosis). Results: The SAMF was implemented for most patients (76.1%), with 64.71% completed within 24 hours of admission; though, many were incomplete. Nicotine dependence was not properly assessed for 42.3% of smokers; 69.23% were prescribed nicotine replacement therapy (NRT), despite most scoring moderate to high nicotine dependence. No statistically significant relationships were found between patient factors and form completion. Conclusions: SAMF completion was timely for most patients; however, sections important for determining support actions remained largely incomplete, suggesting patients’ nicotine withdrawal is not being adequately addressed. More work is needed to improve inpatient staff’s assessment to ensure optimal care. ItemAdapting, Pilot Testing and Evaluating the Kick.it App to Support Smoking Cessation for Smokers with Severe Mental Illness: A Study Protocol(MDPI, 2018-02-03) Lawn, Sharon Joy; van Agteren, Joseph; Zabeen, Sara; Bertossa, Sue Ursula; Barton, Christopher Allan; Stewart, James(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking cessation intervention to assist relapse prevention and encourage sustained smoking cessation for young adults (aged 18–29 years) with SMI. (2) Methods: Using co-design principles, the researchers will adapt the Kick.it smartphone App in collaboration with a small sample of current and ex-smokers with SMI. In-depth interviews with smokers with SMI who have attempted to quit in the past 12 months and ex-smokers (i.e., those having not smoked in the past seven days) will explore their perceptions of smoking cessation support options that have been of value to them. Focus group participants will then give their feedback on the existing Kick.it App and any adaptations needed. The adapted App will then be pilot-tested with a small sample of young adult smokers with SMI interested in attempting to cut down or quit smoking, measuring utility, feasibility, acceptability, and preliminary outcomes in supporting their quit efforts. (3) Conclusions: This pilot work will inform a larger definitive trial. Dependent on recruitment success, the project may extend to also include smokers with SMI who are aged 30 years or more. ItemThe effect of ice slurry ingestion on body temperature and cycling performance in competitive athletes(Elsevier, 2018-02-02) Mejuto, Gaizka; Chalmers, Samuel; Gilbert, Stephanie; Bentley, David JThe effects of pre cooling on endurance performance are widely known. In contrast, the approach of cooling during endurance exercise in combination with pre-exercise cooling has been poorly understood. The purpose of the present study was to determine whether the effects of precooling and cooling during exercise enhance exercise performance compared to the ingestion of a thermo-neutral beverage (20 °C) or precooling alone in cycling performance. This was an experimental study using a randomised crossover design in which 7 cyclists underwent three trials comprising of 45 min steady state cycling (SS) at 70% VO2 max and a subsequent 10 km time trial (TT) in hot conditions (32 °C, 50% relative humidity). Rectal temperature (Tre), heat storage (HS), heart rate (HR), blood lactate concentration (BLA) and thermal sensation (TS) were measured. The intervention consisted of: (1) ingestion of thermo-neutral beverage before and during SS cycling (TN), (2) ingestion of ice slurry beverage and application of iced towels (precooling) prior to exercise, and then ingestion of thermo-neutral beverage during SS (PRE) and (3) precooling strategy as above plus ice slurry ingestion during SS cycling (PRE + MID). The intake of thermo-neutral or ice slurry beverage (14 g/kg) occurred over 30 min before and every 15 min during SS cycling. There was no significant difference in TT performance between all the conditions (P =0.72). However, PRE and PRE + MID caused a significant decrease in Tre (P < 0.05) from TN during exercise. Accordingly, both precooling and a combination of precooling and mid-cooling during exercise in hot conditions may be a practical and effective way of reducing core temperature. Future studies should investigate longer distance events and timing of ice slurry ingestion. ItemAn integrative review of e-learning in the delivery of self-management support training for health professionals(BioMed Central, 2017-10-10) Lawn, Sharon Joy; Zhi, Xiaojuan; Morello, AndreaBackground E-learning involves delivery of education through Information and Communication Technology (ITC) using a wide variety of instructional designs, including synchronous and asynchronous formats. It can be as effective as face-to-face training for many aspects of health professional training. There are, however, particular practices and skills needed in providing patient self-management support, such as partnering with patients in goal-setting, which may challenge conventional practice norms. E-learning for the delivery of self-management support (SMS) continuing education to existing health professionals is a relatively new and growing area with limited studies identifying features associated with best acquisition of skills in self-management support. Methods An integrative literature review examined what is known about e-learning for self-management support. This review included both qualitative and quantitative studies that focused on e-learning provided to existing health professionals for their continuing professional development. Papers were limited to those published in English between 2006 and 2016. Content analysis was used to organize and focus and describe the findings. Results The search returned 1505 articles, with most subsequently excluded based on their title or abstract. Fifty-two full text articles were obtained and checked, with 42 excluded because they did not meet the full criteria. Ten peer-reviewed articles were included in this review. Seven main themes emerged from the content analysis: participants and professions; time; package content; guiding theoretical framework; outcome measures; learning features or formats; and learning barriers. These themes revealed substantial heterogeneity in instructional design and other elements of e-learning applied to SMS, indicating that there is still much to understand about how best to deliver e-learning for SMS skills development. Conclusions Few e-learning approaches meet the need for high levels of interactivity, reflection, practice and application to practice for health professionals learning to deliver effective SMS. Findings suggest that the context of SMS for patients with chronic condition matters to how health professional training is delivered, to ensure partnership and person-centred care. Further creative approaches and their rigorous evaluation are needed to deliver completely online learning in this space. Blended learning that combines e-learning and face-to-face methods is suggested to support SMS skills development for health professionals. ItemDivided we fall: clinicians and academic psychiatrists need to stand together(Sage Journals, 2017-07-12) Allison, Stephen; Bastiampillai, Tarun; Battersby, Malcolm WayneObjective: Psychiatry faces urgent problems requiring united action. These problems affect academic psychiatrists in the universities, and clinicians in publicly funded mental health services. Academic units are isolated and endangered, finding it difficult to recruit. They could benefit from closer relationships with public mental health services, in terms of recruitment, shared teaching and clinical research. However, mental health services are preoccupied with their own problems, particularly in relation to acute clinical demand. How can we stand together to improve academic units and clinical psychiatry? Conclusions: Clinicians and academic psychiatrists can stand together on important matters, but it takes initiatives from local leaders to overcome the structural barriers between health services and the universities. An example is given of united action by clinicians and academic psychiatrists to address a crisis within a state mental health system. First, psychiatrists undertook independent health services research that compared the state system with those in other Australian and international jurisdictions. The comparative data was used to generate solutions, which were presented at every level from ministerial offices through to service managers. Finally, psychiatrists took up joint academic and clinical leadership roles in the university and the mental health system. This united research-led approach turned around the crisis in the state mental health system ItemManaging chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program(CSIRO Publishing, 2017-08-24) Lawn, Sharon Joy; Zabeen, Sara; Smith, David; Wilson, Ellen; Miller, Cathie; Battersby, Malcolm Wayne; Masman, KevinObjective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically. ItemShared Care Involving Cancer Specialists and Primary Care Providers - What Do Cancer Survivors Want?(Wiley, 2017-05-03) Lawn, Sharon Joy; Fallon-Ferguson, Julia; Koczwara, BogdaBackground Cancer survivors are living longer, prompting greater focus on managing cancer as a chronic condition. Shared care between primary care providers (PCPs) and cancer specialists, involving explicit partnership in how care is communicated, could ensure effective transitions between services. However, little is known about cancer patients' and survivors' preferences regarding shared care. Objective To explore Australian cancer survivors' views on shared care: what cancer survivors need from shared care; enablers and barriers to advancing shared care; and what successful shared care looks like. Setting and Participants Community forum held in Adelaide, Australia, in 2015 with 21 participants: 11 cancer survivors, 2 family caregivers, and 8 clinicians and researchers (members of PC4-Primary Care Collaborative Cancer Clinical Trials Group). Intervention Qualitative data from group discussion of the objectives. Results Participants stressed that successful shared care required patients being at the centre, ensuring accurate communication, ownership, and access to their medical records. PCPs were perceived to lack skills and confidence to lead complex cancer care. Patients expressed burden in being responsible for navigating information sharing and communication processes between health professionals and services. Effective shared care should include: shared electronic health records, key individuals as care coordinators; case conferences; shared decision making; preparing patients for self-management; building general practitioners' skills; and measuring outcomes. Discussion and Conclusions There was clear support for shared care but a lack of good examples to help guide it for this population. Recognizing cancer as a chronic condition requires a shift in how care is provided to these patients. ItemExploring the Potential for Family Carers to Support People With Mental Illness to Stop Smoking(Taylor & Francis Group, 2016-12-05) Lawn, Sharon Joy; Bowman, Jenny; Wye, Paula; Wiggers, JohnCigarette smoking poses significant health burdens for people with mental illness. They die sooner than they should, and smoking is a major contributor to their high rates of morbid chronic physical health conditions and early mortality, compared to the general population. Family carers provide important support to people with mental illness. However, family carers' perspectives of smoking by their family members with mental illness are largely absent from the research literature and from practice, despite smoking rates remaining high and quit rates remaining low for this population. We know little about how family carers are or could be involved in supporting people with mental illness who smoke to stop smoking. This paper aims to provide a discussion of the opportunities for family carers to support their family member's smoking cessation and a discussion of our preliminary research on this topic. From the available literature, it appears that family carers are well placed to support smoking cessation for this population; however, they struggled physically, philosophically, and emotionally with perceived responsibilities involving their family member's smoking and the caring role. They felt isolated and asserted that there was limited support from service providers to assist them. We concluded that family carers are important agents within the person's immediate environment who could help them to improve their smoking cessation success. This suggests also that mental health services and other health service providers could benefit from including family carers in their efforts to support smoking cessation for people with mental illness who smoke.