ItemFocus on... Tools for measuring change in chronic disease management in primary care(Primary Health Care Research & Information Service, 2006-07) Roach, S; Kalucy, L; McIntyre, EllenMain Messages: Valid and reliable tools and instruments exist to measure organisational processes relevant to chronic disease management. The tools can be used by GPs, Divisions of General Practice, and other primary care practitioners and organisations as part of routine organisation change, and by researchers as part of specific evaluation or research projects. The use of appropriate tools can monitor progress and contribute to quality improvement and to the evidence base about ways to bring about change. Selection of the appropriate tool should be based on the specific aims of each intervention. The tools most likely to be relevant, valid and useful in Australian primary care are: Assessment of Chronic Illness Care—evaluates utilisation of elements of the chronic care model. Patient Assessment of Chronic Illness Care—assesses patient’s perception of the use of the chronic care model. Primary Care Assessment Survey—captures patient perspectives on aspects of the doctor patient relationship. General Practice Assessment Questionnaire—covers access, interpersonal aspects of patient care and continuity of care. Team Climate inventory—maps shared perceptions of team functioning. ItemThe Closing the Gap Initiative: Successes and ongoing challenges for divisions of general practice(2012) Anikeeva, Olga; Katterl, Rachel; Bywood, Petra TeresiaBackground This article presents an evaluation of the activities undertaken by divisions of general practice to improve Indigenous Australians’ access to mainstream primary care. Methods Data were obtained from 12 month reports for the 2009–10 reporting period. Data from 86 divisions were thematically analysed using NVivo 9 software. Results Most divisions provided positive comments regarding their involvement in the program. The main barriers to access among Indigenous Australians were cost, inadequate transport, lack of cultural sensitivity and staffing shortages. The activities undertaken to address barriers included awareness raising, distribution of resources, cultural safety training and employing Indigenous staff. Stakeholder involvement was achieved through community consultation and establishment of advisory committees. Discussion While most divisions were satisfied with their progress, ongoing challenges were identified with regard to effective identification of Indigenous patients and lack of interest among some practice staff. These need to be addressed though ongoing cultural awareness training. ItemThe contribution of Primary Health Care Research, Evaluation and Development-supported research to primary health care policy and practice(2012) Brown, Lynsey; McIntyre, EllenThe importance of primary health care (PHC) research is well understood yet conducting this research can be challenging. Barriers include a lack of funding, support and opportunity. In 2000 the Australian government introduced the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy to address the gap in high-quality research. One component of the strategy, the Research Capacity Building Initiative, provided funding to university departments of general practice and rural health, allowing them to expand their pool of researchers and produce more research relevant to policy and practice. This study investigates the impact of phase two of the PHCRED Strategy by analysing peer-reviewed publications from PHCRED-supported departments. Research output was recorded from 2006 to 2010 incorporating 661 publications in 212 journals. Rural departments often had fewer resources than urban departments yet demonstrated steady research contributions focusing on issues relevant to their community. Since its inception the PHCRED Strategy has enabled development of research capacity and contributed to the body of PHC knowledge. While PHC is a diverse field, reflected in the publications produced, the themes underlying much of this work were representative of current health reform and the priority areas and building blocks of the National PHC Strategy. ItemSocial media in primary health care: Opportunities to enhance education, communication and collaboration among professionals in rural and remote locations: Did you know? Practical practice pointers(2013) Anikeeva, Olga; Bywood, Petra TeresiaSocial media are revolutionising the way people socialise, interact and do business. Where traditional health promotional posters and brochures have had limited impact on health outcomes, social media provide an exciting new way to deliver health messages. Social media include websites such as Facebook and LinkedIn, Wikis, blogs and microblogs (e.g., Twitter). In the health care sector, these media have the potential to enhance communication between allied health and other primary health care professionals by enabling collaboration between a variety of stakeholders. The types of communication may range from individual messages sent to group members through to broad public announcements. The ability to join special interest or professional organisation groups further enhances communication and collaboration between members. Wikis can be used in a particular project to encourage collaboration between multiple stakeholders, including allied health professionals, other health care providers and patients. Blogs and microblogs can be used to build connections between allied health and other health care professionals, through the formation of networks based on a particular topic. These technologies are beneficial for professionals located in rural and remote areas, as they enable participation across geographical boundaries. Barriers to utilising these technologies include lack of training, time pressure, an increase in workload and a preference for the traditional approach to collaboration. Professionals may also be concerned about privacy, potential information overload and the lack of moderation that may compromise the accuracy of information disseminated through social media. To increase participation, allied health professionals need to be actively involved in the design and implementation of social media tools. Financial incentives and comprehensive training are likely to encourage adoption. If the identified barriers are addressed, these tools have great potential for increasing and improving communication and collaboration between professionals ItemVideo-based telehealth in Australian primary health care: Current use and future potential(2013) Raven, Melissa; Butler, Caryn; Bywood, Petra TeresiaMany Australians have limited access to health-care services due to a range of barriers, including geographic distance and restricted mobility, which telehealth can potentially address. This paper reviews the current and potential use of video consultation in primary health care in Australia, drawing on international literature. There is substantial evidence of high patient satisfaction, but many studies have methodological limitations. Overall, evidence of effectiveness and cost-effectiveness is weak. There is reasonable evidence for diagnosis, home care and specialist consultations by GPs with patients present. Two telehealth initiatives using video consultation are briefly presented. Both provide evidence that video consultation has a valuable role to play, but does not obviate the need for face-to-face consultations. Video consultation challenges traditional professional roles, particularly those of nurses, and can improve health workers’ skills and job satisfaction. More fundamentally, telehealth challenges the traditional distinction between primary and secondary care. This can be a source of resistance but may ultimately be one of its strengths. Appropriately targeted video consultation has much potential to improve the delivery of primary health care in Australia, particularly in rural and remote regions. ItemFacilitating access to evidence: Primary Health Care Search Filter(2014) Brown, Lynsey; Carne, Amanda; Bywood, Petra Teresia; McIntyre, Ellen; Damarell, Raechel; Tieman, Jennifer; Lawrence, MikaelaBackground: The evidence base developed by, and relevant to, primary health care (PHC) is rapidly increasing. With the wealth of literature available, searchers trying to ﬁnd PHC-speciﬁc citations can feel overwhelmed. Objectives: Flinders Filters and the Primary Health Care Research & Information Service collaborated to develop a search ﬁlter enabling efﬁcient and effective retrieval of relevant PHC literature. Methods: Stage 1 involved developing a PHC Search Filter in the OvidSP Medline platform using a rigor-ous experimental methodology. The search ﬁlter was then translated for Web-based ‘one-click searching’ in PubMed during Stage 2. Stage 3 involved planning and implementing a mixed-methods evaluation. Results: The search ﬁlter sensitivity was 77.0% with a post hoc relevance assessment of 78 .3%. Four months after its launch, a mixed-methods study evaluated the PHC Search Filter. With 90 respondents, analysis of data from the online survey demonstrated overarching beneﬁts, a positive response to the tool and directions for further reﬁnement of the PHC Search Filter. Discussion: Designing the PHC Search Filter follow ed an established method that ensures the tool offers a validated search strategy. Evaluation results suggest that the PHC Search Filter is a useful tool that is easy to navigate. Challenges for the Filter relate to access to full text articles, while challenges for the evaluation relate to the small sample size. Conclusions: The PHC Search Filter reduces the burden associated with literature searching, increases the value of the results that are received and provides a useful resource to improve the likelihood of incorporating relevant evidence into policy and practice. ItemPotentially Avoidable Hospitalisations: Causes, Initiatives and Challenges from a Primary Health Care Perspective(Primary Health Care Research and Information Service, 2013) Brown, Lynsey; Bywood, Petra Teresia; Katterl, Rachel; Anikeeva, Olga; Butler, Caryn; Smith, BradleyThe presentation will- • highlight some of the risk factors for potentially avoidable hospitalisations in Australia (e.g., sociodemographic characteristics, chronic conditions) based on a literature review • explore common characteristics of successful initiatives addressing potentially avoidable hospitalisations generally (e.g., integrated services, multidisciplinary teams, access, disease management) • illustrate promising interventions to specifically reduce avoidable hospital readmissions (e.g., identifying high-risk patients, education, discharge planning, follow-ups) • discuss challenges in addressing avoidable hospitalisations. ItemPrimary Health Care (PHC) Search Filter: Bringing the evidence to shore(Primary Health Care Research and Information Service, 2013) Brown, Lynsey; Carne, Amanda; McIntyre, Ellen; Tieman, Jennifer; Damarell, Raechel; Sladek, Ruth; Hagger, Christina; Katterl, RachelSurfing the internet for primary health care (PHC) literature produces waves of information that can lead a researcher to feel as though they are drowning in papers. Sifting through material to find the oysters containing pearls can be a complex task. With the PHC literature and evidence base rapidly increasing, Flinders Filters and the Primary Health Care Research & Information Service collaborated on a project to develop a search filter designed to facilitate easier access to this pool of PHC resources, by enabling efficient and effective retrieval of relevant literature. The PHC Search Filter was developed in the Ovid Medline platform with an extensive methodology comprising five phases including: constructing a gold standard set of PHC-specific articles; identifying relevant index terms and textwords; testing combinations of search terms; assessing the search strategy which performed most effectively; and translating the filter for use in PubMed to enable ‘one click searching’. This presentation will introduce the PHC Search Filter, addressing its development and showcasing the tool through an audiovisual ‘how to’ segment. In addition, the presentation will report on a mixed-methods study used to evaluate the Filter, four months after its launch. This evaluation involved extensive advertising of an online survey with individuals invited to participate regardless of whether they had used the Filter or not. With 90 respondents, the survey provided details about the overarching benefits and positive response to the tool, and directions for further refinement of the Filter. The key findings from the evaluation noted that the PHC Search Filter reduces the burden associated with literature searching, increases the value of the results that are received, and provides a useful resource to improve the likelihood of incorporating evidence into policy and practice. ItemNetworking: the Human Factor in Knowledge Exchange(Primary Health Care Research and Information Service, 2011) Hagger, Christina; McIntyre, EllenEvidence-influenced policy has become the 'gold standard' which compels a wide variety of researchers, research funders and policy makers, from very different organisational contexts, to share or exchange knowledge. Opportunities to facilitate interaction; better understand each other's professional cultures and goals and also build collaborations are important to promote the use of research to inform and influence policy and practice. It is important to find ways in which such interactions between people can be facilitated, particularly as many stakeholders are not trained in the practice of knowledge exchange. Conferences are powerful, albeit temporary, clusters of contextualised knowledge exchange which facilitate low risk initial contacts and the ongoing development of collaborations. ItemPatients’ Experiences With Integrated Care: Possible Solutions(Primary Health Care Research and Information Service, 2012) Bywood, Petra TeresiaAt some time in their lives, most people will require health care services from multiple health care providers, whether it is for short-term unexpected ill-health, long-term chronic conditions, or co-morbidities that cross disciplines. Integration of health services is particularly important for people with chronic or complex conditions as they must negotiate a path that crosses various health care sectors. In 2011 PHCRIS undertook an abbreviated appraisal of evidence (Rapid Response) to address the following: - What types of initiatives have been implemented in Australia (or elsewhere) to integrate primary and acute health care? - How have these initiatives impacted on patients’ health outcomes and patients’ experience of their pathway through the health system? ItemFostering a culture of knowledge exchange(Primary Health Care Research and Information Service, 2013) Hagger, Christina; McIntyre, Ellen; Bywood, Petra TeresiaPHCRIS Research Fellow, Dr Christina Hagger presented at the 2nd Annual NHMRC Research Translation Faculty Symposium on 2 Oct 2013. This presentation titled Fostering a culture of knowledge exchange reports on the partners in the health care system, the role of knowledge exchange (KE), and how PHCRIS promotes an open culture of KE through a combined strategy of 'the People and the Portal'. ItemBaking an integration cake: Ingredients for fostering PHCOs' capacity for integration(Primary Health Care Research and Information Service, 2013) Brown, Lynsey; Oliver-Baxter, Jodie; Bywood, Petra TeresiaNational health reform has identified integrated care as a priority for the Australian health system. Enabling integration involves efforts at the macro (policy), meso (organisation) and micro (practitioner/patient) levels. Evidence suggests that at the meso level effective planning strategies, strong leadership, sufficient resources and shared goals are key ingredients in the recipe for integration. Using evidence from a rapid review of the peer-reviewed and grey literature, this presentation will examine integration as it relates to primary health care organisations. By synthesising sources for this review it was possible to identify challenges to integration at the meso level as relating to factors such as communication, stewardship, financing and resources. The mechanisms for successful integration were also evinced as factors such as engagement, partnerships, infrastructure and eHealth. This presentation will highlight the complexities of integration with emphasis on factors that can be addressed at the meso level to foster organisations’ capacity for integrated health care. ItemWhat is needed for integration of health services? Medicare Locals - A model for integrating primary health care(Primary Health Care Research and Information Service, 2013) Brown, Lynsey; Bywood, Petra Teresia; Katterl, Rachel; Cheffins, Tracey; Oliver-Baxter, JodiePrimary health care (PHC) is often the first level of contact individuals, families and communities have with the health system. National health reform in Australia has seen the introduction of Medicare Locals (MLs), PHC organisations charged with a number of objectives, one of which is improving the patient journey through developing integrated and coordinated services. Integration in this context refers to the health system’s ability to provide effective care as a person moves between different providers, with appropriate transfer of information and utilisation of resources. This qualitative study explored the perceptions of ML chief executive officers from around Australia regarding the operationalisation of integration in their local area. Analyses provided definitions of integration as connections across service providers and organisations, with emphasis on continuity of care. Many of the participants described the importance of partnerships between general practice and allied health with examples around psychological services and chronic disease management. The requisites (e.g., accessibility, infrastructure, incentives), building blocks (e.g., relationships, communication) and challenges (e.g., geography, culture, funding) of integration will be presented. Further, opportunities for the future will be discussed with emphasis on the value of multidisciplinary teams and applying population health approaches to support patients at a local level. ItemHow do integrated care initiatives impact on consumer experience?(Primary Health Care Research and Information Service, 2013) Bywood, Petra Teresia; Brown, Lynsey; Oliver-Baxter, JodiePurpose: This study explores how a knowledge exchange organisation has assisted its policy, practice, research and consumer stakeholders to cross borders in PHC. Theory: Knowledge exchange includes information management, linkage, capacity development, and support. Knowledge exchange bases its practice on exchanging information and knowledge in the most appropriate format with the right people at the most suitable time. Methods: We describe the knowledge exchange methods used by this organisation and illustrate how well they have been taken up by our stakeholders. Findings: In the 5 year period (2007-2011), this organisation has enhanced an extensive searchable website, convened 5 national conferences, produced weekly eBulletins and bi-monthly newsletters, published short papers on current PHC topics plus reviews on policy relevant issues, and created online fact sheets on how to carry out knowledge exchange. In addition, we have developed a publicly available online searchable register of research and researchers. Data show that these are accessed by all our stakeholder groups while evaluations indicate these have been useful. Discussion: While the results are encouraging, PHCRIS has the potential to improve what it does through more rigorous monitoring and evaluation as well as better engagement with our stakeholders. ItemMedicare Locals: A model for integration in primary health care(Primary Health Care Research and Information Service, 2013) Bywood, Petra Teresia; Brown, Lynsey; Katterl, RachelObjective: Australian Medicare Locals (MLs) have been established to improve the patient’s journey through the health care system by facilitating integrated services that meet the local community’s needs. How MLs are expected to achieve better integration is not clearly defined. This absence of a clear definition is reflected in the literature, where a multitude of definitions exist. The main objective of this study was to explore MLs’ understanding of integrated care, how they planned to integrate services across primary health and acute care sectors, and identify the challenges faced by MLs as agents for integration. Methods: Five CEOs from the first round of 19 established MLs agreed to participate in semi-structured telephone interviews. Participants represented MLs from different States and Territories, ranging from metropolitan to rural and remote areas. Interview transcripts were analysed using a thematic approach. Lessons learned: ML CEOs identified several key themes in their interviews, including: variation in understanding of integration; tension between competition and collaboration in service delivery; patient-centred care as a key principle; barriers and enablers to integration; impact of historical factors; and need for ongoing resources to sustain integration efforts. Implications: This project enabled participants to contribute their knowledge and experience to an analysis of a key building block of the Australian health reform agenda. The variation across MLs regarding their understanding of integration, challenges and ways to operationalise integration may assist other primary health care organisations and policy makers to develop effective implementation strategies for integrated care. ItemPromising initiatives for integrated service delivery(Primary Health Care Research and Information Service, 2013) Bywood, Petra Teresia; Oliver-Baxter, Jodie; Brown, LynseyObjective: Health service users require local services that meet their needs, are connected and easy to navigate. Delivering well integrated and coordinated health care services is challenging. This review aimed to identify integrated care initiatives that improved outcomes for health service users. Methods: A pragmatic literature review was undertaken using a range of electronic databases, websites and grey literature sources. Lessons learned: Diverse models of integrated care have been established across Australia. The most promising initiatives include: Primary Care Partnerships, community-oriented primary health care centres, GP Super Clinics and comprehensive primary health care approaches. The key mechanisms underlying these initiatives are effective communication and support; appropriate structural arrangements, use of technology and tailoring of services to meet local needs. However, many challenges remain, including limited evidence of effectiveness; limited integration with hospitals; poor alignment with other service boundaries; and lack of appropriate measures to evaluate integration efforts. Implications: While evidence from integrated health service delivery projects has demonstrated improved outcomes, experiences and satisfaction for patients, upstream policies and organisational/system initiatives are also needed to enable effective and efficient integrated care at the service delivery level. ItemGetting your findings into practice: tackling knowledge exchange and research translation(Primary Health Care Research and Information Service, 2014) Hagger, ChristinaPHCRIS Senior Research Fellow and Knowledge Exchange Manager, Dr Christina Hagger, presented an online session on Getting your findings into practice: Tackling knowledge exchange and research translation during Research Week 2014 - a GPET initiative with plenary sessions and workshops run online between 28 February and 7 March 2014 ItemConnecting to the PHC Network(Primary Health Care Research and Information Service, 2014) Oliver-Baxter, Jodie; Dixon, KathrynA presentation given as part of the inaugral Knowledge Exchange Capacity Building Workshop for Higher Degree Students. This workshop took place as a satellite event to the 2014 Primary Health Care Research Conference in Canberra on 22 July, the aim of the event was to encourage a philosophy of knowledge exchange early in researchers’ careers. It included information on resources and tools to help students with planning, conducting and disseminating research. It created opportunities for networking with student colleagues from around Australia, and offered delegates the chance to speak with more experienced researchers, as well as gain an insight into knowledge exchange and how they might apply such a framework in their research. ItemInformation sharing & exchange(Primary Health Care Research and Information Service, 2014) Brown, LynseyA presentation given as part of the inaugral Knowledge Exchange Capacity Building Workshop for Higher Degree Students. This workshop took place as a satellite event to the 2014 Primary Health Care Research Conference in Canberra on 22 July, the aim of the event was to encourage a philosophy of knowledge exchange early in researchers’ careers. It included information on resources and tools to help students with planning, conducting and disseminating research. It created opportunities for networking with student colleagues from around Australia, and offered delegates the chance to speak with more experienced researchers, as well as gain an insight into knowledge exchange and how they might apply such a framework in their research. ItemPatients’ Experiences With Integrated Care: Possible Solutions(Primary Health Care Research and Information Service, 2012) Bywood, Petra TeresiaAt some time in their lives, most people will require health care services from multiple health care providers, whether it is for short-term unexpected ill-health, long-term chronic conditions, or co-morbidities that cross disciplines. Integration of health services is particularly important for people with chronic or complex conditions as they must negotiate a path that crosses various health care sectors. In 2011 PHC RIS undertook an abbreviated appraisal of evidence (Rapid Response) to address the following: - What types of initiatives have been implemented in Australia (or elsewhere) to integrate primary and acute health care? - How have these initiatives impacted on patients’ health outcomes and patients’ experience of their pathway through the health system?