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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.

Background In the Australian maternity system, general practitioners play a vital role in advising and directing prospective parents to maternity models of care. Optimising model of care discussions and the decision-making process avoids misaligning women with over or under specialised care, reduces the potential for disruptive care transitions and unnecessary healthcare costs, and is critical in ensuring consumer satisfaction. Current literature overwhelmingly focusses on women’s decision-making around model of care discussions and neglects the gatekeeping role of the General Practitioner (GP). This study aimed to explore and describe the factors influencing Australian GPs decision-making when referring pregnant women to maternity models of care. Methods This study used a qualitative descriptive approach. General practitioners (N = 12) with experience referring women to maternity models of care in Australia participated in a semi-structured interview. Interviews occurred between October and November 2021 by telephone or videoconference. Reflexive thematic analysis was facilitated by NVivo-12 data management software to codify and interpret themes from the data. Findings Two broad themes were interpreted from the data. The first theme entitled ‘GP Factors’, incorporated three associated sub-themes including ‘1) GPs Previous Model of Care Experience’, ‘2) Gaps in GP Knowledge’ and ‘3) GP Perception of Models of Care’. The second theme, entitled ‘Woman’s Factors’, encapsulated two associated sub-themes including the ‘4) Woman’s Preferences’ and ‘5) Access to Models’. Conclusions This study provides novel evidence regarding general practitioner perspectives of the factors influencing model of care decision-making and referral. Predominant findings suggest that gaps in GP knowledge regarding the available models of care are present and are largely informed by prior personal and professional experience. Most GPs described referring to models of care they perceive positively and centring their model of care discussions on the woman’s preferences and accessibility. The exploration and description of factors influencing model of care decisions provide unique insight into the ways that all stakeholders can experience access to a broader range of models of care including midwifery-led continuity of care models aligned with consumer-demand. In addition, the role of national primary health networks is outlined as a means to achieving this.

Objective HealthPathways is a web-based platform designed for use during a consultation to offer health professionals locally agreed information to support clinical and referral decision making. This study aimed to investigate whether access to specific HealthPathways pages in the North Coast New South Wales (NSW) region increased during specific critical events. High pageviews is used as a proxy for platform usefulness, and/or trust as a source of up-to-date information. Methods Data were extracted from Google Analytics from December 2015 to December 2021. Descriptive statistics were generated for the total number of pageviews for all pages by month and year (2015–2021); for the top 15 most viewed pages in 2019, February–March 2020 inclusive (early COVID-19 pandemic period), 10–24 March 2021 (North Coast NSW region local disaster declaration period) and 26 June–11 October 2021 (NSW COVID-19 lockdown period); and for monthly pageviews for the Influenza Immunisation pathway (2016–2021). Results Access to specific pages in HealthPathways increased alongside the occurrence of critical events affecting the region. Spikes in access to specific pages were seen during COVID-19 lockdown periods, during natural disasters, as well as during the annual influenza season. Conclusions HealthPathways is viewed as a useful and trusted source of information for health professionals in the North Coast NSW region. HealthPathways provides an opportunity for timely dissemination of information during critical events, including natural disasters and emergencies.

Abstract Background Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. Objective We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access. Methods In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis. Results We identified five major themes: (1) the ‘Significant Impact of CTS’ of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) ‘Waiting and Paying for Care’– the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of ‘Occupation and CTS Onset’ whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the ‘Information Scarcity’ of good information about CTS and the high relational and appraising work associated with using online resources; (5) ‘Negotiating Telehealth Perspectives’ where telehealth was valued if it meant earlier access for all despite the challenges it held for many. Conclusion Quality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care.

Introduction: Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. Methods: This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews with GPs and specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was used to derive key codes, then grouped into themes regarding participant experiences and perceptions. Results: Data analysis identified two major themes and several sub-themes. The major themes were variation in the uptake of TLCRP and enhancing coordinated care and communication. Discussion: Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Conclusion: Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service and may have wider relevance in other settings.

Therapeutic inertia, sometimes referred to as clinical inertia, has been defined as failure to initiate or intensify therapy when therapeutic goals are not reached. Lack of initiation or intensification of treatment according to clinical guidelines has been linked to suboptimal control of a range of chronic conditions. Clinician factors contributing to therapeutic inertia include knowledge gaps; discomfort with uncertainty about the diagnosis, therapeutic target, or evidence; concerns about the safety of treatment intensification; and time constraints. Patient characteristics that may be associated with therapeutic inertia include male sex, older age, lower life expectancy, multiple comorbidities and clinical parameters that are close to target. There may be reasons other than therapeutic inertia that explain apparent undertreatment. Apparent inertia in prescribing may be accompanied by appropriate actions, such as provision of lifestyle advice or interventions to promote adherence to existing medication. Some patients choose not to intensify treatment. Interventions to reduce therapeutic inertia include access to evidence-based treatment guidelines and point-of-care tools, preferably integrated with clinical record systems; clinician education including educational visits; reminders; clinical audits with feedback and reflection on practice; shared decision-making; prompting by patients; and ambulatory or home monitoring (e.g. ambulatory blood pressure monitoring).

Abstract Background Australian cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk assessment, but less than half of eligible patients have the required risk factors recorded due to fragmented implementation over the last decade. Co-designed decision aids for general practitioners (GPs) and consumers have been developed that improve knowledge barriers to guideline-recommended CVD risk assessment and management. This study used a stakeholder consultation process to identify and pilot test the feasibility of implementation strategies for these decision aids in Australian primary care. Methods This mixed methods study included: (1) stakeholder consultation to map existing implementation strategies (2018-20); (2) interviews with 29 Primary Health Network (PHN) staff from all Australian states and territories to identify new implementation opportunities (2021); (3) pilot testing the feasibility of low, medium, and high resource implementation strategies (2019-21). Framework Analysis was used for qualitative data and Google analytics provided decision support usage data over time. Results Informal stakeholder discussions indicated a need to partner with existing programs delivered by the Heart Foundation and PHNs. PHN interviews identified the importance of linking decision aids with GP education resources, quality improvement activities, and consumer-focused prevention programs. Participants highlighted the importance of integration with general practice processes, such as business models, workflows, medical records and clinical audit software. Specific implementation strategies were identified as feasible to pilot during COVID-19: (1) low resource: adding website links to local health area guidelines for clinicians and a Heart Foundation toolkit for primary care providers; (2) medium resource: presenting at GP education conferences and integrating the resources into audit and feedback reports; (3) high resource: auto-populate the risk assessment and decision aids from patient records via clinical audit software. Conclusions This research identified a wide range of feasible strategies to implement decision aids for CVD risk assessment and management. The findings will inform the translation of new CVD guidelines in primary care. Future research will use economic evaluation to explore the added value of higher versus lower resource implementation strategies.

ABSTRACT Introduction People with dementia of all ages have a human right to equal access to quality health care. Despite evidence regarding its effectiveness, many people living with dementia are unable to access rehabilitation for promoting function and quality of life. Conducted in Australia, this study was designed to (1) explore barriers to access to dementia rehabilitation and (2) identify solutions that improve access to rehabilitation. Methods People living with dementia ( n  = 5) and care partners ( n  = 8) and health professionals ( n  = 13) were recruited nationally. Experience‐based codesign across three virtual workshops was used to understand barriers and design solutions to improve access to rehabilitation treatments. Socio‐ecological analyses, using the Levesque Access to Health care framework, were applied to findings regarding barriers and to aid selection of solutions. Results There was high attendance (92.3%) across the three workshops. Barriers were identified at a user level (including lack of knowledge, transport, cost and difficulty navigating the health, aged care and disability sectors) and health service level (including health professional low dementia knowledge and negative attitudes, inequitable funding models and non‐existent or fragmented services). Solutions focused on widespread dementia education and training, including ensuring that people with dementia and their care partners know about rehabilitation therapies and that health professionals, aged care and disability co‐ordinators know how to refer to and deliver rehabilitation interventions. Dementia care navigators, changes to Australia's public funding models and specific dementia rehabilitation programmes were also recommended. Conclusions Barriers to accessing rehabilitation for people with dementia exist at multiple levels and will require a whole‐community and systems approach to ensure change. Patient or Public Contribution People with living experience (preferred term by those involved) were involved at two levels within this research. A Chief Investigator living with dementia was involved in the design of the study and writing of the manuscript. People with living experience, care partners and service providers were participants in the codesign process to identify barriers and design potential solutions.

Purpose HealthPathways is an online decision support portal, primarily aimed at General Practitioners (GPs), that provides easy to access and up to date clinical, referral and resource pathways. It is free to access, with the intent of providing the right care, at the right place, at the right time. This case study focuses on the experience and learnings of a HealthPathways program in metropolitan Sydney during the COVID-19 pandemic. It reviews the team's program management responses and looks at key factors that have facilitated the spread and scale of HealthPathways. Design/methodology/approach Available data and experiences of two HealthPathways program managers were used to recount events and aspects influencing spread and scale. Findings The key factors for successful spread and scale are a coordinated response, the maturity of the HealthPathways program, having a single source of truth, high level governance, leadership, collaboration, flexible funding and ability to make local changes where required. Originality/value There are limited published articles on HealthPathways. The focus of spread and scale of HealthPathways during COVID-19 is unique.