Search

Abstract Introduction The COVID‐19 pandemic challenged primary care to rapidly innovate. In response, the Western Victorian Primary Health Network (WVPHN) developed a COVID‐19 online Community of Practice comprising general practitioners (GPs), practice nurses, pharmacists, aged care and disability workers, health administrators, public health experts, medical specialists, and consumers. This Experience Report describes our progress toward a durable organizational learning health system (LHS) model through the COVID‐19 pandemic crisis and beyond. Methods In March 2020, we commenced weekly Community of Practice sessions, adopting the Project ECHO (Extension of Community Health Outcomes) model for a virtual information‐sharing network that aims to bring clinicians together to develop collective knowledge. Our work was underpinned by the LHS framework proposed by Menear et al. and aligned with Kotter's eight‐step change model. Results There were four key phases in the development of our LHS: build a Community of Practice; facilitate iterative change; develop supportive organizational infrastructure; and establish a sustainable, ongoing LHS. In total, the Community of Practice supported 83 unique COVID‐19 ECHO sessions involving 3192 h of clinician participation and over 10 000 h of organizational commitment. Six larger sessions were run between March 2020 and September 2022 with 3192 attendances. New models of care and care pathways were codeveloped in sessions and network leaders contributed to the development of guidelines and policy advice. These innovations enabled WVPHN to lead the Australian state of Victoria on rates of COVID vaccine uptake and GP antiviral prescribing. Conclusion The COVID‐19 pandemic created a sense of urgency that helped stimulate a regional primary care‐based Community of Practice and LHS. A robust theoretical framework and established change management theory supported the purposeful implementation of our LHS. Reflection on challenges and successes may provide insights to support the implementation of LHS models in other primary care settings.

AIM: This study determined whether easily used guidelines and an electronic referral process could decrease the age of referral of suspected undescended testes (UDT). An online resource for primary medical practitioners was introduced for which the UDT guideline advises referral to paediatric surgery for testes not sitting spontaneously in the scrotum at three-months corrected age. METHOD: Data were collected prospectively for boys referred with UDT over a seven-year period (2012-2018), during which time agreed GP guidelines on the Community HealthPathways website for referral were introduced. Trends in the age at referral and age at orchidopexy were analysed. RESULTS: Complete data were obtained for 212 boys. Referral before age six months increased from 13% to 61%, and before 12 months from 48% to 78%. Orchidopexy by 12 months increased from 16% to 39%, and by 18 months from 48% to 74%, during the same period. Median age at orchidopexy for this 2012-2018 cohort was 21.6 months compared with 31.1 months from 1997-2007. DISCUSSION: These data demonstrate earlier referral of boys with UDT and earlier orchidopexy corresponded to the introduction of the GP Community HealthPathways website. A similar resource available in other regions or countries also might be expected to reduce the age of referral of suspected UDT from primary care providers.

AIM: The purpose of this study was to determine the utility of community-based imaging to reduce use of inpatient surgical resources and enforce social distancing at the outset of the COVID-19 pandemic. METHOD: A prospective evaluation of community-based CT for patients presenting to Christchurch general practitioners with acute abdominal pain from April to November 2020. Eligible patients were discussed with the on-call general surgical team, and then referred for CT abdomen rather than hospital assessment. The positivity rate of CT scans, the 30-day all-cause hospital admission rate, and the proportion of patients where community scanning altered management setting and the number of incidental findings, were all assessed. RESULTS: Of 131 included patients, 67 (51%) patients had a positive CT scan. Thirty-nine (30%) patients were admitted to hospital within 30 days, 34 (87%) of whom had a positive CT scan and were admitted under a surgical specialty. Ninety-two (70%) patients did not require hospital admission for their acute abdominal pain, thirty-three (35%) of whom had a positive CT scan. There were three deaths within 30 days of the community CT, and the setting of the community CT did not contribute to the death of any of the cases. Forty patients (30%) had incidental findings on CT, 10 (25%) of which were significant and were referred for further investigation. CONCLUSION: Community based abdominal CT scanning is a feasible option in the management of acute abdominal pain. While trialed in response to the initial nationwide COVID-19 lockdown in New Zealand, there may be utility for acute community-based CT scanning in regular practice.

Introduction Continuous quality improvement (CQI) initiatives are commonly used to enhance patient safety and quality of care. A novel South Australian Local Health Network (SALHN) Continuous Improvement Program (CIP009) has integrated a top-down model of executive-directed change initiatives, with a bottom-up approach of clinician designed interventions to address an organisational-wide goal of improved patient flow. This study evaluated the strengths and challenges of CIP009 implementation from the perspective of participants and deliverers. Methods A qualitative study was conducted in 2023/2024 to evaluate the implementation of CIP009 and 12 associated quality improvement projects. Semi-structured interviews and focus groups were conducted with key stakeholders (executives, coaches and CIP009 fellows) and guided by the Consolidated Framework for Implementation Research (CFIR). A document review and observations of CIP009 team meetings were also conducted. Data were analysed inductively using thematic analysis, then deductively mapped against the five CFIR domains. Results Thirty-one participants were interviewed individually or in focus groups, two presentation days and six team meetings were observed, and 78 documents were reviewed. Seven key themes were identified highlighting key challenges and strengths of CIP009 implementation within the SALHN setting. These included four key strengths: the CIP framework and culture (the flexible framework, common language, training, and a culture of flattened hierarchy); the benefits of support from a dedicated, internal improvement Faculty (wrap around support from coaches); the advantages of an enthusiastic team member disposition and incentives (vested interests to enhance workflow and patient outcomes); and effective teams and team composition (teams comprised of senior clinician change agents). Three key challenges included: workforce and organisation-level challenges (individual workloads, workforce capacity, and data access); team cohesion, logistics and stakeholder engagement challenges (issues in the way teams worked together); and training and support shortcomings (the training course, and the top-down nature of CIP009). Conclusion This evaluation identified that CIP009 was considered an effective multifaceted CQI program. The strengths of CIP009 support a learning health system (a data driven model, utilising systematic frameworks, with commitment from leadership, and a culture of continuous learning). Further integration of implementation science principles may support the program to overcome the key challenges identified. These findings will inform and guide improvement efforts within future iterations of CIP.

Background Formalised clinical pathways have become popular approaches to translate evidence into clinical recommendations, tailored for the local healthcare setting. In recent years, the HealthPathways platform has been used to implement a range of clinical and referral pathways in New Zealand and Australia. Despite widespread adoption, little is known of factors influencing the sustained use of HealthPathways in Australian general practice. Methods This qualitative study, conducted in three Melbourne Primary Health Network catchments, applied normalisation process theory to explore HealthPathways implementation. We conducted semi-structured interviews with 43 participants, including general practitioners (GPs), practice nurses, practice managers, Primary Health Network staff and key regional informants. Analysis combined inductive and deductive approaches. Results The findings suggest that although HealthPathways holds promise for enhancing clinical practice, its adoption and impact are currently limited due to low awareness and varied integration across Primary Health Network catchments. Recent medical graduates found it useful for helping patients access appropriate care. Adoption was influenced by peer recommendations and time constraints, although established GPs resisted change. Targeted education, effective promotion and improved monitoring systems were identified as crucial to facilitate wider and more effective use of HealthPathways, ultimately contributing to better patient care and streamlined clinical processes. Conclusion Although HealthPathways’ relative normalisation is evident, challenges in integration persist, requiring targeted strategies. Comprehensive promotion to GPs, standardisation across Australia and enhancing technical interoperability between digital interfaces is essential. Strong partnerships and feedback mechanisms can optimise HealthPathways’ impact on patient care, supporting the objectives of the Australian National Primary Health Care 10-year plan.

Perinatal depression is highly prevalent, yet there is a very low rate of treatment uptake and help-seeking. The MumSpace Initiative was funded by the Australian government to invest in digital stepped-care treatments and support for perinatal depression, to improve mental health outcomes and national access. This paper describes the reach of the MumSpace initiative as a one-stop shop offering perinatal depression treatments with a solid evidence base (MumMoodBooster programmes), supported by a prevention programme addressing modifiable risk factors through a smartphone application (MindMum) as well as evidence-based universal prevention programmes. We have brought together multi-skilled teams and a Perinatal Depression Consortium to deliver the programmes and address changing technology. The effectiveness of MumSpace was evaluated through systematic monitoring of consumer reach: data analysis of website traffic and resource uptake. MumSpace has successfully sustained engagement, attracting over 275,000 visits since its launch in 2017, with the number of visitors to the website increasing year on year. The central treatment tools, MumMoodBooster and Mum2BMoodBooster, have reached over 10,000 Australian women, largely through self-referral. Despite the development of a portal for direct clinician referral and monitoring, continuing challenges for implementation involve integrating digital treatments into traditional services and recruiting professionals to directly engage mothers.

Background After decades of debate, Australian general practitioners (GPs) are being integrated into disaster health management (DHM) systems. Objective This article outlines the evolving integration of GPs into DHM in Australia and discusses key DHM concepts and systems GPs need to know. Discussion The aim of disaster response is a unified efficient whole-of-health response based on a multidisciplinary pre-planned, pre exercised system. Each discipline must have a clear understanding of how the system works and where they fit within the response. GPs’ link to the DHM system is through the local Primary Health Network that links to the broader disaster health response through the local health service areas. This article outlines the evolving integration of GPs into DHM in Australia. Although there is a long way to go before there is full integration of GPs consistently across all local health service areas, without linkage to the broader disaster response, GPs risk being unsupported, isolated and less effective in their response.

Background Climate change means that disasters such as bushfires, heatwaves, storms and floods are becoming more frequent and severe, and thus having greater impact on general practices and communities. Objective To provide a concise introduction to disaster planning for those who are new to Australian general practice or to general practice ownership. Discussion The Standards for General Practice, published by The Royal Australian College of General Practitioners (RACGP), provide guidance on business continuity, including during disasters. As part of practice accreditation, practices are required to prepare a disaster plan, which should be based on local research regarding likelihood of hazard or disaster scenarios, and contain information on disaster coordination and communication and an emergency contact list. Planning should also involve preparation of an emergency kit, provisions for different hazards, practising the disaster plan and clear communications to trigger the disaster response. Plans should be rapidly implemented during disasters and reviewed following disaster events

Abstract Objectives To assess the effectiveness and safety of the new clinical pathway for patients presenting to an ED with AF, incorporating community next‐working‐day follow‐up and more specific clinician guidance around medication prescribing. Methods A before‐and‐after, retrospective cohort study comparing patients presenting to Christchurch ED with acute uncomplicated AF in the year before (‘hospital‐based’ follow‐up) and after (‘community‐based’ follow‐up) implementation of a new AF management approach. The ‘community’ pathway replaced hospital‐based review with a next‐day community follow‐up and introduced more specific anticoagulation recommendations. Results A total of 1065 patients met inclusion criteria, with 531 presenting during the ‘hospital‐based’ pathway period and 534 during the ‘community’ pathway period. The spontaneous reversion rate was approximately 61% in both cohorts. Following the implementation of the community pathway, there was no increase in cardioversions (16.6% vs 20%, difference 3.5% [95% CI −1.4 to 8.3]), admission rates (32.8% vs 32.2%, difference − 0.6% [95% CI −6.4 to 5.3]), or AEs (60‐day all‐cause mortality 1.3% vs 0.9%, difference − 0.7% [95% CI −2.3 to 1]). Attendance at a follow‐up AF clinic improved from 92.9% to 98.1% (difference 5.2% [95% CI 0.7–9.7]). Clinician adherence to anticoagulation guidelines increased by 7% (95% CI 1.6–12.4). Conclusions A ‘rate‐and‐wait’ strategy for managing acute uncomplicated AF continues to allow a significant proportion of patients to self‐revert to sinus rhythm, without requiring hospital admission or cardioversion procedures. Transitioning to an off‐site, community AF clinic is both safe and effective, demonstrating increased clinic attendance and improved adherence to anticoagulation guidelines.

Objective To assess the effectiveness of a multicomponent waitlist optimisation strategy on the proportion of patients overdue to be seen for a neurosurgical (spinal pain) outpatient service at an Australian public hospital. Study design An interrupted time series study in the outpatient department of a tertiary referral hospital in New South Wales, Australia. Methods We implemented and evaluated nine waitlist optimisation strategies. We compared a Pre-implementation phase (January 2015–January 2016), a Implementation phase (February 2016–December 2017), and a Post-implementation phase (January 2018–January 2020). We included data from all adults who had been referred for neck and back pain. We used three outcomes of interest; they were: (i) the proportion of patients overdue to be seen (based on their triage category) for a given month, (ii) the proportion of patients that were waiting longer than one year for an initial appointment each month and (iii) the total neurosurgical waitlist number. Results We included data from 11,520 unique individuals who had a mean age of 54 years (SD 17), 51 % (5900) were female, and 8·8 % (1004) identified as Aboriginal and/or Torres Strait Islander. Across the three phases, there were 26,928 monthly data points Pre-implementation, 36,009 Implementation, and 15,326 Post-implementation. The trend in the proportion of patients overdue to be seen in the Post-Implementation phase was 7 % lower (OR 0·93 [95 % CI 0·89, 0·97]) compared to Pre-implementation. Conclusion The waitlist optimisation strategies tested in this study led to a large reduction in the proportion of patients overdue to be seen on the neurosurgical waitlist. The tested strategies can be used by other services to address extended waits in outpatient services.

Abstract Background Lung cancer remains a significant public health problem and a leading cause of cancer‐related mortality worldwide. The delays in the diagnosis of lung cancer are more pronounced for rural and regional Australians compared to their urban counterparts. Implementing an online HealthPathway is one way to reduce delays in the diagnosis of lung cancer. Aim The Townsville Lung Cancer Referral Pathway (TLCRP) was implemented to guide local general practitioners (GPs) in the referral process of people with suspected lung cancer. The aim of the study was to compare the time interval from initial GP consultation of the person with suspected lung cancer to the first specialist referral and from the first specialist referral to the initial specialist appointment, before and after implementation of TLCRP. Other lung cancer service outcomes were also compared between the pre‐ and post‐implementation groups. Methods A retrospective cohort study of 316 participants was conducted, and descriptive statistical analysis of the data was used to discern any difference in timelines and other clinical outcomes in the pre‐pathway implementation group compared to the post‐pathway implementation group. Results The time interval from initial GP presentation to initial referral to specialist appointment was significantly reduced in the post‐pathway group (15 days) compared to the pre‐pathway group (8 days, P = 0.03). However, the time interval from GP referral to initial appointment with a specialist increased in the post‐pathway group (15 and 20 days, P = 0.03). Many of the Cancer Australia lung cancer optimal care pathway referral guidelines were not met. Only 40% of the pre‐pathway group and 34% of the post‐pathway group were seen in the specialist clinic within 2 weeks of GP referral. Significant proportions of patients in both groups did not have chest x‐rays ordered by the GP, and the proportion of participants who were appropriately referred to the respiratory clinic did not improve after implementation of TLCRP (76% and 72%). Nearly 30% of participants in both groups were diagnosed after emergency presentation. Conclusions TLCRP improved the time interval from initial GP consultation to specialist referral, thus meeting its primary objective. However, better strategies are required to improve other timelines and meet Cancer Australia's lung cancer optimal care pathway guidelines.

BACKGROUND Familial hypercholesterolemia (FH) is a common and treatable inherited condition of cholesterol metabolism that increases cardiovascular health risk. Less than 10% of people with FH have been detected and few receive recommended treatment. OBJECTIVE We report on the development of a national implementation strategy for enhancing the detection of FH in Australia. METHODS A modified intervention mapping study was conducted, through workshops to identify barriers and facilitators of FH detection, models for detection and their objectives. Practical implementation strategies were selected using a constructivist analysis and summaries of the strategies were disseminated for feedback. A case study showcase was used to monitor strategy implementation. RESULTS Potential models for FH detection were identified, including (1) use of pathology lab reports and recall; (2) screening in general practice, pharmacy, and Aboriginal Community Controlled Health Organizations; (3) screening in cardiovascular inpatients, outpatients, and rehabilitation; (4) universal screening; and (5) centralized coordination of primary-tertiary shared care. Implementation strategies were selected for each model to support their operationalization into routine care. A list of general implementation strategies was also produced that could support multiple models for FH detection. CONCLUSION We identified multiple FH detection models and strategies that would support implementation across Australia. Centralized coordination of a primary-tertiary shared care model was described as a promising approach for integrating index case detection with family cascade testing. We provide a set of implementation recommendations for policy and practice to enhance the detection of FH in Australia.

Abstract Mapping, identifying and reducing unwarranted healthcare variation is integral to improving the appropriateness of care – minimising wasteful or unnecessary care and redirecting care to those who could benefit most (J Eval Clin Pract 26: 687–696, 2020). The Australian Atlas of Healthcare Variation series has examined variation in healthcare use since 2015. The findings reported in the Atlas series have led to important system changes. National safety and quality standards, mandatory for all hospitals and day procedure services, now require health service organisations to monitor and investigate variation and address unwarranted variation. Clinical care standards have been developed for clinical conditions in which the Atlas series has identified considerable variation. But the overuse of low-value care and underuse of high-value care persists, as suggested by the marked variation the Atlas series continues to uncover. We must now develop an approach that systematically links reporting of data and investigation of variation with a suite of responses to address unwarranted variation. This paper focuses on efforts to reduce low value-care, so that resources can be redirected to supporting high-value care as well as reducing waste and cutting carbon emissions from health care (Med J Aust 216: 67–68, 2022).

Abstract Background In response to the well-documented fragmentation within its mental health system, Australia has witnessed recently rapid expansion in the availability of digital mental health care navigation tools. These tools focus on assisting consumers to identify and access appropriate mental health care services, the proliferation of such varied web-based resources risks perpetuating further fragmentation and confusion for consumers. There is a pressing need to systematically assess the characteristics, comprehensiveness, and validity of these navigation tools, especially as demand for digital resources continues to escalate. Objective This study aims to identify and describe the current landscape of Australian digital mental health care navigation tools, with a focus on assessing their comprehensiveness, identifying potential gaps, and the extent to which they meet the needs of various stakeholders. Methods A comprehensive infoveillance approach was used to identify Australian digital mental health care navigation tools. This process involved a systematic web-based search complemented by consultations with subject matter experts. Identified navigation tools were independently screened by 2 authors, while data extraction was conducted by 3 authors. Extracted data were mapped to key domains and subdomains relevant to navigation tools. Results From just a handful in 2020, by February 2024 this study identified 102 mental health care navigation tools across Australia. Primary Health Networks (n=37) and state or territory governments (n=21) were the predominant developers of these tools. While the majority of navigation tools were primarily designed for consumer use, many also included resources for health professionals and caregivers. Notably, no navigation tools were specifically designed for mental health care planners. Nearly all tools (except one) featured directories of mental health care services, although their functionalities varied: 27% (n=27) provided referral information, 20% (n=21) offered geolocated service maps, 12% (n=12) included diagnostic screening capabilities, and 7% (n=7) delineated care pathways. Conclusions The variability of navigation tools designed to facilitate consumer access to mental health services could paradoxically contribute to further confusion. Despite the significant expansion of digital navigation tools in recent years, substantial gaps and challenges remain. These include inconsistencies in tool formats, resulting in variable information quality and validity; a lack of regularly updated service information, including wait times and availability for new clients; insufficient details on program exclusion criteria; and limited accessibility and user-friendliness. Moreover, the inclusion of self-assessment screening tools is infrequent, further limiting the utility of these resources. To address these limitations, we propose the development of a national directory of mental health navigation tools as a centralized resource, alongside a system to guide users toward the most appropriate tool for their individual needs. Addressing these issues will enhance consumer confidence and contribute to the overall accessibility, reliability, and utility of digital navigation tools in Australia’s mental health system.

Background Community HealthPathways are clinical decision support tools, combining evidence-based guidelines with local service and referral information, collaboratively developed and collated by primary care and hospital clinicians. HealthPathways is being implemented throughout Australia, New Zealand and the UK, and often plays a role in supporting local service redesign and integrated care. Objective This article summarises the background and benefits of community HealthPathways and provides tips to support decision making in the consulting room. The article highlights the influence a community of clinicians can have on service redesign through developing and publishing HealthPathways. Discussion Clinical information-seeking is often done during consultations, and having access to evidence-based, decision support tools like HealthPathways can facilitate consistency of best practice clinical care across jurisdictions and streamline referrals to local health services. Through the process of collaboration, HealthPathways supports integration of health services. Knowledge about the structure of HealthPathways and how to find information is useful for busy clinicians to aid decision support at the point of care.

Falls present a major, growing and neglected public health problem with devastating consequences for older individuals, their families and health care systems. The recently published World guidelines for falls prevention and management for older adults: a global initiative1 (Guidelines) is a comprehensive document that provides extensive recommendations with additional background materials available on an accompanying website. The Guidelines is a consensus document informed by systematic reviews and a Delphi process. This body of work demonstrates that much is known about what works in falls prevention but there is considerable complexity. The main message is that most falls occur due to a loss of balance while upright or walking, and the most important intervention to prevent this is exercise. Rare causes such as cardioinhibitory syncope are also described. The Guidelines includes important messages about the older person's perspective, and which interventions are effective in hospitals and residential aged care facilities. The Guidelines1 explicitly states that although we know what interventions are effective, we still need to know how best to implement these interventions in our busy health systems. This perspective article aims to provide a digestible version of the most important points from the Guidelines that may be applied in general health and medical settings. For some of the points, we have added our interpretation of additional scientific information that is relevant to a clinical audience. Some solutions need to be implemented outside of our health systems, such as through community awareness, promotion of lifelong exercise, and provision of safe accessible environments. Following the Guidelines structure, which highlights the importance of tailored intervention rather than a detailed assessment, this article first discusses effective interventions and thereafter addresses assessment.