Here's why you cannot miss the 2011 PHC Research Conference
2
Meet our PHC Research
Conference sponsor 3
RHeaNA - Refugee Health
Network of Australia 3
Medicare Locals: inspiring, collaborative and solution oriented
4
Implementation of Primary Health Reform: Medicare Locals
4
RACGP’s National Standing
Committee - Research 5
New role: PHCRED Liaison
Officer 5
Centre of Excellence for
Indigenous primary care 6
APHCRI Update 6
PHCRED funded research 7-8 PHCRED Strategy: Research Capacity Building Initiative 9-14
Better health, safer care,
lower costs 19
Upcoming events 20
WebsiteWatch: Health Service
Research websites 19
Australian Association for
Academic Primary Care 18
Think Global! 18
Diffusion, spread and
sustainability of innovation 17 Adolescent Health: Embrace the Future, Better the World 17 Involving consumers in your
research 16
BookWatch: Writing your
journal article in 12 weeks 16 Advances in health outcomes
assessment 15
ReportWatch: A citizen’s
guide to health indicators 15
Editorial: Knowledge exchange
Ellen McIntyre, PHC RIS
Knowledge exchange has become a common buzz word and is often used interchangeably with knowledge translation, knowledge interaction, dissemination, diffusion and more. Essentially it is all about how we share information. It is about linking researchers and decision-makers. It is about facilitating interaction to better understand each other’s professional cultures and goals, to influence each other’s work, to forge new partnerships and to promote the use of evidence from research.
Knowledge exchange needs the right information, and the right people working on the right questions in the right manner such that the right solution is arrived at. It is certainly not a linear process and many other factors need to be considered other than the knowledge derived from research.
PHC RIS has been tasked to focus more on knowledge exchange and indeed we are excited about this challenge.
While we have been ‘doing’
knowledge exchange for quite some time we recognise that we can always do things better and look forward to consulting and working with you as we progress this further.
Over the years we have improved on ways to bring people together so that they can share their knowledge.
Of particular note is our annual PHC Research Conference and the upcoming 2011 Conference in Brisbane in July is looking to be an excellent
opportunity for knowledge
exchange (see p2 for more detail).
Our ROAR database that includes the profiles of PHC researchers in Australia has assisted many researchers and research users to contact and collaborate with other researchers who have expertise in a particular area.
Our eBulletin provides a wealth of information to keep people informed about what is happening in PHC. We encourage you to contribute by sharing your information through our on-line suggestion process at
<www.phcris.org.au/
publications/ebulletin/
suggestion.php>
PHC RIS is supporting capacity building in
knowledge exchange through our repertoire of tools to assist people to present their findings in the best way possible to those who need to know – the research users.
This has been done through our ‘how to’ infoBytes and Fact Sheets, all available on our website at
<www.phcris.org.au/
resources/>
PHC RIS Assist 1800 025 882 www.phcris.org.au
Volume 15, Issue 5 June 2011 ISSN 1832 620X
PHC RIS infonet
View the conference abstracts on-line
Visit www.phcris.org.au/conference/2011 Newsletter of the Primary Health Care
Research & Information Service
Inspirations, collaborations, solutions – here's why you cannot miss the 2011 PHC Research Conference
A SUMMARY OF SUBMITTED PAPERS AND POSTERS
Ellen McIntyre & Louise Baird, PHC RIS
The tables below provide summary information about what was submitted and by whom.
Number of abstracts in each topic area Preventive health
Education & training of the workforce Health care systems
Patient-centred care
Coordinated care of complex conditions Quality of care
Access & equity
Health literacy & self management Knowledge exchange & translation Research & evaluation methodology Building research capacity Response to local needs Improved workforce conditions Management of health information
57 46 37 35 34 33 31 23 22 19 15 11 6 5
Abstracts were submitted by (first authors):
Professors Associate Professors Doctors
Others (23 males, 111 females)
51 43 146 134
Number of authors that collaborated on the abstract
Nine authors or more Eight authors Seven authors Six authors Five authors Four authors Three authors Two authors One author
20 16 19 32 48 76 75 44 44
Funding source for the research came from:
University
Australian Government Department of Health and Ageing
NHMRC PHCRED State Health APHCRI RACGP ARC Regional Health Divisions Scholarship Other Unknown
60 48 45 38 37 12 7 6 5 3 111 1 1
The type of research submitted was:
Quantitative Qualitative
Mixed (qualitative and quantitative) Unknown
Descriptive Developmental Intervention Unknown
117 99 132 26 177 36 95 66
The research summarised in the abstracts was:
Completed Ongoing Unknown
257 112 5
Number of abstracts by state or country NSW QLD
VIC SA ACT TAS WA NT Overseas
117 80 78 22 21 15 13 5 23 All keynote speakers for 2011 are now confirmed:
Dr Dame Claire Bertschinger, Director for Diploma in Tropical Nursing, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine and Professor Kim Bennell,
Director of the multidisciplinary Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne
It is not too late to register – all information is available at
<www.phcris.org.au/conference/2011/>
6 The Rapid Response process: how to survive and prosper.
Our concurrent symposia are also not to be missed. With titles such as these, there is something for everyone:
1 The 5As of lifestyle interventions in primary health care
2 Optimising primary care management of hypertension in Australia: Insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure (Viper- BP) Study
3 Patient safety in primary health care
4 Breaking new ground in Australian Primary Health Care Reform:
APHCRI Centres of Research Excellence collaborations finding solutions to hard questions 5 Chronic disease self-management
(CDSM): A viable health care strategy for older Australians?
6 Today's medicare, tomorrow's world: the impact of population ageing on Medicare's chronic disease management and mental health care programs.
Ellen McIntyre & Louise Baird, PHC RIS
The Primary Health Care (PHC) Research Conference this year is shaping up to be another great first class event for the PHC research community. We received more abstracts than ever before – 374 in total (compared to 368 in 2010) – 310 for papers (we have 145 paper slots in the program) and posters (unlimited), 39 for the AAAPC distinguished paper, 15 for symposia (6 slots) and 11 for workshops (6 slots)
While our program is still being finalised, the workshops have been selected. You may find it hard to choose among the following:
1 Skills workshop: how to undertake a systematic review
2 When are you ready to do a phase III trial?
3 How can primary health care harness the opportunities of the digital media age?
4 An outcomes framework for comprehensive primary health care services and organisations
5 Practice-based and multi-
disciplinary networks: reservoirs for a decade of capacity building
PHC RIS infonet Page 3
Meet our PHC Research Conference sponsor
HealthInfoNet also encourages and supports information-sharing among practitioners, policy-makers and others working to improve Indigenous health.
Its free on-line yarning places allow people to share information, knowledge and experience across the country. The HealthInfoNet is a not-for-profit service which is funded primarily by the Department of Health and Ageing and based at Edith Cowan University in WA.
HealthInfoNet aims to inform practice and policy in Indigenous health by making the evidence base readily accessible via the internet at
<www.healthinfonet.ecu.edu.au>
Don’t forget to visit the HealthInfoNet stand at the PHC Research Conference.
bibliography with over 18 000 publications available as well as an on-line journal, the HealthBulletin.
There is an Overview of Australian Indigenous health status and reviews of most major health topics. The Overview and reviews are updated as new information becomes available.
Three great new reviews the HealthInfoNet was involved in were just recently added to the site.
1 Review of Indigenous Offender health (Apr 2011)
2 Review of Indigenous oral health (Apr 2011)
3 Review of volatile substance use among Indigenous people (Mar 2011).
The HealthInfoNet is helping to ‘close the gap’ in health between Indigenous and other Australians. It is a ‘one-stop info-shop’ for people interested in improving the health and wellbeing of Indigenous Australians. The
Tara Hoyne,
Australian Indigenous Health InfoNet &
Louise Baird, PHC RIS
PHC RIS is pleased to announce that the Australian Indigenous
HealthInfoNet is the satchel sponsor for the 2011 PHC Research Conference.
They will be providing the satchels as well as having a stand at the
Conference.
The Australian Indigenous
HealthInfoNet is a comprehensive web resource dedicated to Australian Indigenous health for those working or studying in the area of Indigenous health with a view to improving health out-comes and ‘closing the gap’.
The site is divided up into specific health topics which contain a review of the area, programs, policies and strategies, health promotion resources, publications and organisations. In addition there is an on-line
national focus, members translate the nationally determined best practice for their local population, considering the capacity of their service as well as the specific demographics and health needs of the local refugee community.
This sharing of solutions reduces the duplication of tasks such as the development of clinical protocols required to meet the health needs of the refugees settling in Australia.
Collaboration between the different providers of refugee health care will also enable future research to provide an evidence base for quality refugee healthcare.
RHeaNA provides the opportunity for rapid dissemination and distribution of information about the evolving issues in refugee health to those involved directly in health care delivery. This process enables each member to be continually involved in development of best practice for the delivery of refugee health care at a national level, while remaining locally responsive to the community they care for.
Our Aims:
1 To inform and support quality holistic health care for refugees in Australia.
2 To provide advice to policy-makers at Commonwealth and State/
Territory level on current and emerging issues in refugee health in Australia.
3 To provide a forum for exchange of information between providers of refugee health care and other relevant stakeholders across Australia.
4 To develop a research agenda and disseminate research findings.
RHeaNA will be holding a members only meeting at the PHC Research Conference and are very happy to welcome those who have an interest in refugee health to become members.
For more information please contact Dr Margaret Kay
Dr Margaret Kay,
Refugee Health Network of Australia
RHeaNA is a national network that was formed in 2009 with the purpose of working collaboratively to improve the health of persons of refugee-
background living in Australia. The health needs of refugees are complex and cross all disciplines of medicine.
The Network has a multidisciplinary focus and includes clinicians (medical practitioners, nurses and mental health workers), policy experts, health service managers and researchers from all states and territories in Australia. Many RHeaNA members work in primary health care, however, the Network draws on the expertise of specialists in the field of mental health, infectious disease, paediatrics and public health.
Until now, most refugee health services or providers of refugee health care have been isolated, with minimal capacity to communicate effectively with one another. RHeaNA provides the opportunity for members to
communicate, build partnerships and be responsive to emergent issues as they arise within the refugee health sector. While RHeaNA maintains a
RHeaNA - Refugee Health Network of Australia
PHC RIS infonet Page 3
Medicare Locals: inspiring, collaborative and solution oriented
opportunities that will become available through Medicare Locals.
We are shifting from a rigid health service sector to a health system that is opening up to ideas, services and processes that will fundamentally change a person’s interaction with this first line of care.
Importantly, collaboration will be a fundamental part of Medicare Locals.
In essence primary health care professionals, health care providers and community stakeholders, including for example Local Hospital Networks, the National Aboriginal Community Controlled Health Organisation (NACCHO) and PHC RIS, will over time develop a matrix of opportunities that will in turn improve patient access, reduce inequities in the system and improve the quality and safety of primary health care services across Australia.
Medicare Locals will be focused on developing solutions within the system to achieve these goals. Many of these solutions will come through shifting the focus away from acute care and
hospitals and toward primary health care and prevention – keeping people well, out of hospital, and participating in the community.
There will also be increased opportunities for working with the primary health care research
community. Medicare Locals will offer a much greater scope for developing and evaluating new models of care in population health planning, delivery and assessment, as well as in
undertaking grass roots research about primary health care.
AGPN looks forward to the outcomes of the 2011 PHC Research Conference–
Inspirations, collaborations, solutions - and is confident that Medicare Locals will be positioned as a fundamental component of the primary health care research community.
Dr Emil Djakic, AGPN Chair
As of July, Australia’s primary health care sector will embark on a new approach to this first line of care, through Medicare Locals. These new primary health care organisations will better coordinate local health services and over time improve the health outcomes for local communities.
Since the Federal Government released its National Health and Hospitals Network reforms in 2009, the Australian General Practice Network (AGPN) has been focused on delivering the primary health care components because the Network has been operating in this primary health care space for decades.
Working as a GP in rural and regional Australia, it’s an exciting time to be a part of these reforms. As Medicare Locals take hold and develop over time, the primary health care sector – whether consumers, GPs, nurses, allied health professionals, other carers or researchers - will be inspired by the
Implementation of Primary Health Reform: Medicare Locals
Melbourne, 13 May 2011
Attended by Ellen McIntyre, PHC RIS
Medicare Locals are set to be a major player in primary health reform in Australia. So it was no surprise that this Forum, convened by the National Primary and Community Health Network, was packed.
Tony Sherbon, Deputy CEO, Australian Government Health Reform Transition Office, provided the delegates with a comprehensive overview of the latest news on Medicare Locals. He
acknowledged that the process was complicated but the COAG Heads of Agreement – National Health Reform, signed on 13 February has made the process more focused, (see
<www.coag.gov.au/coag_meeting _outcomes/2011-02-13/>). In
essence, the health reform will create a unified national health and aged care
system that will have increased transparency and a renewed focus on primary health care. The soon to be announced National Performance and Accountability Framework will be pivotal in this reform since the indicators will drive performance.
Presentations from SA, Vic and NSW State Health Departments further outlined the challenges and
opportunities in working with Medicare Locals and establishing Local Hospital Networks alongside GP Super Clinics, Community Health Centres, allied health practitioners and more. Richard Matthews from NSW suggested we need to define the endgame and then determine what infrastructure we need to achieve this.
David Butt, CEO, Australian General Practice Network, stated in his presentation that Medicare Locals would build on what the Divisions have been doing. This would include population planning, focus on health inequalities, fund-holding,
commissioning services, and possibly
service provision, something that was disputed by several delegates.
Several Divisions of General Practice described how they were planning the transition to the new Medicare Locals.
Their enthusiasm and the extensive planning that has already happened was encouraging although it was noted that early expectations need to be realistic.
Question time interspersed the presentations, enabling many to highlight concerns and raise the many issues that accompany such a major change in health.
Sincere thanks to the Australian Institute of Primary Care and Ageing and National Primary and Community Health Network for bringing the primary health care players together.
Presentations are available at
<www.latrobe.edu.au/aipca/
pchnetwork/national.htm>
PHC RIS infonet Page 5
RACGP’s National Standing Committee - Research
the RACGP research unit is visible and consulted on major issues of concern to GPs in relation to research and ethics
general practice research is valued and promoted by health
organisations through adequate funding and building partnerships with like-minded funding
organisations
promote opportunities for external funding bodies (private and public) to invest in priority areas for general practice/primary health care research through the RACGP research foundation
lobby for better career paths for mid-career primary care researchers.
The NSC-R is also highly proactive in current issues affecting general practice research. Issues recently addressed include lobbying to improve the ERA ranking of primary care research journals, contributing to the Australian Family Physician Research Viewpoint series; exploring the delivery and implementation of the RACGP
curriculum on critical thinking and research at the regional training provider level; and lobbying for registrars to be able to combine research higher degrees with general practice training.
For further details visit the website at
<www.racgp.org.au/nsc/> or contact Marie on 03 8344 9723 or
Email [email protected]
Dr Marie Pirotta,
Chair NSC-R & PHCRED Research Fellow, University of Melbourne
The major roles of the Royal Australian College of General Practitioners (RACGP) National Standing Committee – Research (NSC-R) include the development of general practice research capacity, lobbying on behalf of GP researchers, setting standards for best research practice, and facilitating and encouraging publishing and dissemination of research. NSC-R also advises RACGP Council about research matters.
The current NSC-R has four working parties – research culture and profile, RACGP funding for research, research training, and academic careers. Some of the current tasks of these parties include that:
GPs obtain effective training and support in research design and critical thinking and RACGP promotes research literacy in general practice
Strategy: Phase Three 2010-14, I jumped at the opportunity. I saw it as a chance to improve my understanding of the role of quality research evidence in health policy development around primary health care systems, services and practice.
I am located at APHCRI in Canberra and my main work is as a 'knowledge broker'. ‘Knowledge brokers’ are ‘in- between-ers’ that link decision makers, with researchers facilitating their interaction so that they are better able to understand each other’s goals and professional cultures, influence each other’s work, forge new partnerships, and promote the use of research based evidence in decision making.
Over the next year I will work to facilitate greater interpersonal links between primary health care (PHC) researchers and DoHA policy officers to ensure PHC research is relevant, readily accessible and useful for departmental policy makers.
I am due to finish my placement at APHCRI in March 2012 and am hopeful the opportunity will be available for another DoHA policy maker for the next 12 month period.
You can contact Peter on 02 6125 7485 or Email [email protected] For more information on the
PHCRED Strategy see
<www.phcris.org.au/phcred/>
Peter McInnes, APHCRI
Peter McInnes is the Primary Health Care Research, Evaluation and Development (PHCRED) Liaison Officer located at the Australian Primary Health Care Research Institute (APHCRI).
I have had a long involvement with researchers and their research over my 12 years in the Australian Government Department of Health and Ageing (DoHA). In DoHA I worked across a range of policy and program areas including public health law reform, genetics policy and Aboriginal and Torres Strait Islander Health data development and program evaluation.
Most recently I worked in budget and primary health care reform
implementation coordination.
When a seconded position was created for a DoHA officer to work with APHCRI and PHC RIS as a liaison officer to further the purpose of the PHCRED
New role: PHCRED Liaison Officer
Dr Marie Pirotta
Peter McInnes
Centre of Excellence for Indigenous primary care intervention research in chronic disease
skills and support to contribute to their communities’ needs in chronic disease into the future.
These objectives will be achieved through explicit capacity development and knowledge translation strategies, delivered within the context of three key research projects:
A Developing a Model of Chronic Disease Care for Indigenous Australians – The Kanyini Chronic Care Model (CCM).
B Building better systems of chronic disease care involving innovative trials in family-based chronic disease prevention and care (The Danila Dilba Project) and Electronic Decision Support Tools.
C Extending our emerging yet pioneering research on the interplay between psychosocial factors such as chronic stress and depression on the burden and management of chronic diseases in Aboriginal communities in order to develop future
interventions in co-morbid chronic disease.
Our proposed Centre for Research Excellence represents the next stage in our innovative primary care research network, at a time of significant health system reform and chronic disease policy development. Chronic disease in Indigenous Australians remains a pivotal target; a key opportunity to develop responsive health policy that delivers improved cost-effective prevention, early detection, and management.
More information is available on the APHCRI website at
<www.anu.edu.au/aphcri/>
Alex Brown, Executive Director, Baker IDI Central Australia
The Kanyini Vascular Collaboration (KVC) represents a network of leading Aboriginal and non-Aboriginal
researchers, Aboriginal Medical Services, community members and policy-advisors aiming to achieve health system reform to improve outcomes for Indigenous people with chronic disease.
The stated objectives of the new Centre for Research Excellence (CRE) are:
1 to improve the quality of care, quality of life and outcomes of chronic disease
2 examine the impact, utility and effectiveness of the federal government’s ‘Closing the Gap’
chronic disease package elements within partner primary care services, with a view to maximizing benefit for patients and informing policy development
3 develop a cadre of Indigenous primary care researchers with the
and primary care services, and to identify gaps in meeting the needs of local communities
developing a national performance measurement system for primary health care.
While other countries have initiated reforms in these areas, they will be new to Australia. Overseas experiences need to be understood and their adaptation to the Australian context carefully worked through.
There is a widely expressed view that primary health care reform has ‘failed’
because there is insufficient detail, eg.
in relation to Medicare Locals. Far from being a ‘failure’, these gaps should be seen as an exciting opportunity to participate fully in the reform process.
The primary health care research community is uniquely placed to contribute to a successful process of reform. They are best placed to identify the evidence to guide the next steps, to advise on how the
performance of primary health care can be measured, and to participate in the ongoing evaluation and refinement of the reforms.
The Australian Primary Health Care Research Institute (APHCRI) is a national network that has a specific mandate to link to policy makers and researchers and to provide research evidence relevant to the reform process. However, the challenge and opportunities extend well beyond the APHCRI network. All those with an interest in improving primary health care in Australia have the potential to contribute.
More information is available on the APHCRI website at
<www.anu.edu.au/aphcri/>
Robert Wells, Director, APHCRI
The meeting of the Council of Australian Governments (COAG) held in February 2011 established the broad directions for health reform in Australia for the coming decade. With a detailed reform process in the acute sector agreed by COAG, the focus for reform will shift to primary health care.
Key features of that reform will include:
continuation of establishing GP Super Clinics as models of integrated primary health care
building a national network of primary health care organisations (Medicare Locals) to ensure improved access to After Hours care, better coordination of acute
APHCRI update: Research to underpin primary health care reform
Page 7 PHC RIS infonet
PHCRED funded research
the Sydney Metropolitan Area. Over 1 000 patients completed a
questionnaire that collected details of their smoking, nutrition, alcohol and physical activity (SNAP) risk factors, their readiness to change and basic information on their medical history and current medications. Patients completed a blood test (lipids and glucose) and a GP visit that included assessment of the Cardiovascular Absolute Risk (intervention group) or a health check (control group). Follow-up was achieved for over 85% of patients and only one GP withdrew from the study.
In the intervention group, moderate and high risk patients (those with a CVAR of greater than 10%) were significantly more likely to receive lifestyle advice (for nutrition and weight management) than patients in the control group. Modelling of medication management suggests that substantial over-prescribing of
antihypertensives and lipid lowering drugs occurs if management decisions are based on single risk factors and that management based on CVAR should result in substantially lower rates of prescription of lipid lowering
THE FEASIBILITY AND IMPACT OF CARDIOVASCULAR
ABSOLUTE RISK ASSESSMENT IN GENERAL PRACTICE
Elizabeth Denney-Wilson &
Mark Harris Research Fellow P: 02 9385 1511
E: [email protected]
Cardiovascular Absolute Risk (CVAR) assessment is a simple, yet
comprehensive method of assessing a patient’s probability of suffering a cardiovascular event over a five year period by recognising the compounding effect of multiple risk factors including smoking, high lipids and blood pressure, age and sex. Based on recommended guidelines, patients are then managed according to their CVAR rather than the traditional method of managing single risk factors.
The Absolute Risk Trial (ART) aimed to evaluate the impact of Absolute CVAR assessment in general practice. It enrolled 36 GPs from 34 practices in
The CRP&T aims to improve access to general practice for Aboriginal people through a supporting cultural and clinical ‘care partnership’ involving general practice, community-controlled health agencies and Divisions of General Practice. It uses a staged approach to embed four levels of clinical re-design activities (community, reception, consulting room, professional organisations) according to the practice’s readiness.
The CRP&T was pilot-tested in Melbourne. A number of ‘care partnerships' emerged within the framework adopted. Preliminary findings were positive, highlighting roles, responsibilities, strengths and tensions within the partnerships. There was increased identification of
Aboriginal patients. The CRP&T appeared well-accepted by providers and patients. A GP said, “After reading the Toolkit, I visited the local
Aboriginal medical service to see how we can work together for my patients.
I also paid attention to services on my way home and had no idea there were
so many different Aboriginal services in my area.”
The CRP&T provided a platform for Divisions to engage with health services. A Close the Gap Project officer said “The Toolkit is a useful resource and it provides a framework for the Division’s Closing the Gap work.
For the general practices in the care partnership, it has been pivotal in facilitating networking and sharing ideas about how to close the gap for Aboriginal patients”.
Challenges identified to date include GP/staff shortage, staff continuity/
cohesion, heavy workload, leadership to implement changes, competing priorities and agendas within the health financing framework.
A current pilot is underway in NSW.
The next phase is a multi-centre effectiveness trial in Victoria and NSW planned for 2012.
ENGAGING COMPETENTLY WITH OUR ABORIGINAL PATIENTS
Dr Phyllis Lau Research Fellow P: 03 8344 9042 E: [email protected]
Prof Siaw-Teng Liaw Professor/Director E: siaw-teng.liaw
@sswahs.nsw.gov.au
The research team at University of Melbourne and University of New South Wales recently pilot-tested a Cultural Respect Program & Toolkit (CRP&T) developed closely with the Victorian Aboriginal community, in particular the Victorian Aboriginal Community Controlled Health Organisation and Victorian Aboriginal Health Service.
Elizabeth Denney-Wilson & Mark Harris
and antihypertensive drugs in younger lower risk patients.
We found that GP uptake of CVAR was mixed; some GPs found the software very useful for patient education and used it on patients outside of the trial and reported that they would continue using the software. Others found it too time consuming and not a good fit with their usual practice. Overcoming this by incorporating preventive care tools like CVAR into medical software and including reminders to offer preventive care is crucial for widespread adoption.
breakdown in communication between communities and regional hospital where births occurred for most women.
We identified women were culturally insecure during pregnancy and birth.
We also found there was little
consistent support and information for district medical officers or general practitioners with regard to managing complicated pregnancies.
We have been working closely with the Department in the NT who have used our findings to help inform major improvement to the system and are using the final year of the study to evaluate this extensive work. Findings have been reported back to local women at regular intervals who are seeing some major changes to the system of care as a result of the study.
births occurred in community,
bypassing the planned health services;
we conducted 61 in depth interviews with key stakeholders; did 120 hours of observation in Royal Darwin Hospital and remote clinics; identified more than 200 indicators that can be used to measure and monitor improvement in health system performance around maternal infant health and refined these to make them specific for remote maternity care with Aboriginal women.
We also collected ethnographic data, including 12 narratives of women and their families who did not use the health system for births, and the (longitudinally) collected stories of seven women and their families who have received conventional care from early pregnancy until their infants were 12 months old.
We found the care woman received was fragmentary, which was a major problem and created risk of medical error and social and emotional distress when women arrived in ‘town’. We found the Patient Assisted Travel Scheme is problematic with a ‘lot of waste in the system’. We found the method used to organise their health services were varied considerably between Community A and B. We identified incomplete or incorrect postnatal discharge summaries and the
1+1 = A HEALTHY START TO LIFE
Lesley Barclay, Professor and Director Yu Gao, Research Fellow
P: 02 6620 7231
E: [email protected]
Between 2007 and 2011 we conducted an NHMRC funded project: 1+1 = A Healthy Start to Life Project: Targeting the year before and the year after birth in Aboriginal children in remote areas.
The 1+1 study was designed prior to this time with Aboriginal elders from two communities. Our goal was to improve maternal and infant health for remote dwelling Aboriginal families in two large remote communities in the Top End of the Northern Territory (NT), Australia. We are investigating how services can be better designed to increase community involvement in improving early detection of problems and increase the effectiveness of multidisciplinary practice during pregnancy and the year after birth.
Our researchers undertaking PhDs and honours work audited 750 matched mother/infant pairs’ records, analysed 32 mother and baby’s records and interviewed many of these whose
PHCRED funded research
investigating occupational therapy private practices in rural and remote Australia to better understand how practices can be viable in these areas.
Occupational therapy (OT) private practitioners will be surveyed about where they provide services, what services they provide, how they operate their practices, their opinions about private occupational therapy practice and demographic information.
The study will provide new information that can inform policy and service access for people in regional and remote Australia. People living in these areas have poorer health and access to health services than people in major cities. Moreover, the health and workers compensation systems in their current forms rely on an
interrelationship of public and private medical and allied health providers.
Investigating the work of existing OT private practices in regional and remote areas will inform us of service provision and gaps and make an important contribution to addressing health, access and equity issues for both practitioners and consumers in these areas. Judith intends to enrol in a PhD, for which this study will provide background information.
Judith Merritt & Frances Boreland
BROKEN HILL DEPARTMENT OF RURAL HEALTH
UNIVERSITY OF SYDNEY
Frances Boreland
PhD Candidate/Research Fellow P: 08 8080 1279
E: [email protected] Introducing our 2011 RDP
Judith Merritt, a local occupational therapist and Allied Health Academic, has commenced her Researcher Development Placement with the Broken Hill University Department of Rural Health. Her project is
PHCRED Strategy: Research Capacity Building Initiative
One of the local reference groups
Page 9 PHC RIS infonet
PHCRED Strategy: Research Capacity Building Initiative
stimulates clinical practice. One candidate explained that she now probes during interviews with her clients.
…the process of in-depth
interviewing that I have used in my RDP project has encouraged me to dig deeper all the time in my verbal discussions and questioning with clients. By trying to get maximum understanding and information from ‘clients’ assists me to deliver information/education with the greatest impact for their individual needs. (Amanda)
Another RDP candidate emphasised how she has become more critical of literature.
I am more selective and critical in thinking when reviewing articles that promote change within the work area. I am more judgemental in reflection of appropriateness of article promoting change. Accuracy and ethical application to situation has given me more confidence in decision-making. (Helen)
When faced with clinical problems, using research skills helps to problem- solve.
[I] think analytically – what is the core of the problem? Look at alternative solutions; make predictions about which solution may be best; go to the literature to find evidence to support chosen strategy; make decisions, which are based on analysis and evidence; be prepared to justify decisions when others may question your strategy.
(Emma)
All the RDPs agreed that having
‘thinking time’ is important for problem solving in clinical practice. Translation of research knowledge into clinical practice has helped in the process of achieving better clinical outcomes.
UNIVERSITY DEPARTMENT OF RURAL HEALTH & RURAL CLINICAL SCHOOL – NORTHERN NSW
UNIVERSITY OF NEWCASTLE
Dr Karin Fisher Research Supervisor P: 02 6767 8462
E: [email protected] Translating RDP Training into Clinical Practice
The Researcher Development Program (RDP) candidates at the University Department of Rural Health (UDRH) &
Rural Clinical School (RCS) – Northern NSW were recently asked how they translated the research skills they have acquired into their clinical practice. The following is an excerpt of their
reflections.
They agreed that an academic environment and strong mentoring provides exposure to new ideas that
PHC research knowledge. Networks, through their various structures and membership, effectively ‘embody’ the research capacity building effort, providing a platform for the creation of knowledge, expertise and
organisational memory. Despite the importance of research networks, they are not guaranteed funding as part of the PHCRED Phase 3 funding cycle and there are no obvious alternative funding sources.
To this aid, NSWPHC are conducting a workshop on 14 July at the PHC Research Conference entitled, Practice- based and multi-disciplinary research networks: reservoirs for a decade of research capacity building, which aims to showcase achievements; engage with stakeholders; and launch a dialogue to identify how to continue to build on their achievements.
Part 1: Showcase and policy update seminar: The opening session will provide delegates with information and awareness building around practice- based and multi-disciplinary networks in NSW and beyond. This session will:
a include an international guest speaker with network expertise
b showcase achievements of practice- based and multi-disciplinary networks (nationally)
c update participants regarding the current policy environment at federal and state levels.
Part 2: Debate and discussion forum:
Delegates including policy-makers will be invited to discuss and give feedback on practice-based and multi-
disciplinary research networks and what they heard in Part 1 of the workshop.
A core set of recommendations will be taken forward following the
Conference. Depending on
developments following the workshop, NSWPHC may host a follow-up forum in Sydney in September/October 2011 for a number of participants actively involved in research networks.
NSW PRIMARY HEALTH CARE (NSWPHC) RESEARCH
CAPACITY BUILDING PROGRAM
UNIVERSITY OF NEW SOUTH WALES
Jacqueline Schroeder State Coordinator P: 02 9385 1502 E: [email protected] The Future Sustainability of Practice-based and Multi- disciplinary Research Networks:
the NSWPHC Consortium strategic direction for the final year of the RCBI
In 2011, the NSWPHC Consortium will shift the focus of the state-wide program from research capacity building more broadly to future sustainability of research networks.
Practice-based and multi-disciplinary research networks have been established over the last decade to meet research capacity building objectives, including connecting, growing and up-skilling PHC
researchers and expanding the body of
PHCRED Strategy: Research Capacity Building Initiative
The first step will be to commence a research higher degree in 2012.
My RDP project aims to describe emerging integrated primary health care services (IPHCS) in Australia including GP Super Clinics, the HealthOne initiative in NSW and GP-Plus initiative in SA. This is a mixed methods study, underpinned by a qualitative paradigm. The methods consist of case studies informed by documentation and interviews with IPHCS leaders and policy-makers. The purpose of the case studies will be to describe several IPHCSs that represent the major models currently in various stages of development in Australia. The project will develop knowledge about the range and types of models, their structure, what they hope to achieve, and who is involved and their funding.
So far, I have developed a study protocol, conducted a literature review and I am currently in the process of developing the questionnaire survey and coordinating the ethics
applications. I am looking forward to the next stage of the project where I will be conducting interviews, setting up a database, and commencing the analysis.
I’m happy to be working with a supervisor with a wealth of knowledge of the field, who is providing me with a rich and rewarding learning experience.
A goal for me this year will be to push against time constraints and publish the findings in a journal.
RESEARCH CENTRE OF PRIMARY HEALTH CARE AND EQUITY
UNIVERSITY OF NEW SOUTH WALES
Jacqueline Schroeder
Research Associate (Researcher Development Program)
P: 02 9385 1502
E: [email protected] UNSW 2011 Researcher Development Program (RDP) I am fortunate to be in the final round of RDP recipients for what I am aware has been a rich and rewarding experience for many before me. My educational background is in Social Inquiry and my interest is in comprehensive primary health care services. The RDP experience provides me with the opportunity to bridge the divide between a coordination role, as part of the PHCRED Program, and a research career in primary health care.
My project will be focusing on the type of language assessments used with urban Aboriginal preschoolers. I will be looking at the richness and quality of assessment information gained from non-standardised assessment methods versus assessment information gained from standardised assessments that are commonly used by speech pathologists. I will also be exploring the use of non-standard English amongst urban Aboriginal preschoolers, which may have an impact on how they perform in standardised speech and language assessments.
The RDP has provided me with formal research training opportunities and an opportunity to work with
knowledgeable researchers who have been supportive along every step of the process so far. The RDP has also provided me with time to dedicate to research, a luxury which is hard to come by in the clinical setting. I have the time to thoroughly explore existing research surrounding my topic, and plan my project to answer my research question.
Over the next eight months I will be working on collecting and analysing data for my project and producing a paper for publication. I’m incredibly excited to see what results are found and to present this information to my colleagues.
CENTRE FOR HEALTH EQUITY TRAINING, RESEARCH AND EVALUATION
UNIVERSITY OF NEW SOUTH WALES
Erin Miller
Research Associate (Researcher Development Program)
P: 02 9612 0779 E: [email protected] UNSW 2011 Researcher Development Program (RDP) My RDP experience at the Centre for Health Equity Training, Research and Evaluation has been a wonderfully rewarding learning opportunity.
I have been fortunate enough to have been given the opportunity to come up with a research question and design my own project, utilising my background in speech pathology. My project is part of a bigger study, The Gudaga Study, which is a birth cohort study of Aboriginal infants in an urban environment.
RDP Erin Miller
Page 11 PHC RIS infonet
PHCRED Strategy: Research Capacity Building Initiative
in anthropology and has taught medical anthropology at the University of Sydney.
I will not be attending the annual Primary Health Care Research Conference but am pleased to announce that the Youth Health Research Interest Group (YHRIG), a multidisciplinary research network supported by our PHCRED Program, will be presenting its annual Breakfast Session. This year's session is entitled Research-inspired solutions for youth health guided by youth input:
examples from the field. YHRIG's new chairperson, Dr Melissa Kang, and former chairperson Dr Carol Kefford, will facilitate the session along with other YHRIG members.
Our three RDP fellows are making pleasing progress on their research projects, and all submitted abstracts for the conference. Alex McLaren is continuing the research project that she commenced last year, An
Evaluation of the Primary Health Atlas.
Marika Franklin's project concerns Siblings as secondary patients: an
investigation into health practitioners' perceptions of the needs of adolescents and young adults (AYAs) with a sibling diagnosed with cancer. The title of Karen Hutchinson's research project is Delving deeper into living with a chronic and complex neurological disability: the patients' story.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF SYDNEY
Dr Raechelle Rubinstein PHCRED Coordinator P: 02 9556 7200 E: amanda.rossobuckton
@sydney.edu.au
PHCRED Program Update
After more than five years as PHCRED Coordinator, I will be leaving the University of Sydney's Program in early May. It has been a pleasure getting to know so many of you during this time.
Dr Amanda Rosso-Buckton will be taking over from me as Coordinator.
She has an interesting background in the health sector. She trained and worked as a psychiatric nurse in a broad range of public hospital clinical settings before becoming a Clinical Nurse Specialist in psychiatric admission areas and relieving in management positions. She has a PhD
Gaining an understanding of why Aboriginal and Torres Strait Islander young people, 17-22 year old, stop inhalant use (Leigh-Anne Pokino) This study seeks to identify strategies that young people consider may decrease the uptake of sniffing and contribute to sniffers ceasing the habit.
It focuses on the social determinants of health.
Evaluation of diabetes shared care community clinic (Jenny Morcom) This is an evaluation of the benefits and drawbacks of an integrated and innovation model of diabetes care delivery in general practices. The study focuses on the impact of the
introduction of innovative models of chronic disease management on general practice staff, visiting specialists and patients.
Managing the general practice teaching load: A study of the features which may facilitate multi-level teaching in urban general practice (Dr Margaret Henderson)
This study seeks to identify features of general practices that facilitate work- integrated learning. It will contribute to
an understanding of successful integrated learning approaches in general practice settings.
All fellows will submit a paper for publication which will outline their key findings and the ways in which their research contributes to the primary health care priority areas.
For further information please contact the UQ PHCRED Coordinator Dr Tina Janamian at [email protected].
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF QUEENSLAND
Dr Tina Janamian PHCRED Coordinator P: 0413 174 797
PHCRED Fellows at the University of Queensland in 2011
In this final year of PHCRED, the University of Queensland is focused on concluding the program on a high note.
We have invested in four enthusiastic novice research fellows. Their proposed projects cover a diversity of research questions and address a range of primary health care priority areas, namely:
The state of health of Indigenous women at their initial antenatal visit (Dr Clare Maher)
This study aims to gain a deeper understanding of enablers and barriers to access to antenatal care. It focuses on exploring the social determinants of health.
PHCRED Strategy: Research Capacity Building Initiative
directly related to improving the primary care of patients.
In the CFS study I am assisting in gathering and analysing information from patients on the symptoms they experience and the types of treatment they use. We aim to develop clearer clinical guidelines and treatment protocols by focusing on what patients themselves have to say about the impact their illness is having on their daily lives. We are also investigating what they believe are the causes of CFS and what they hope quality research can achieve. This has been particularly interesting as my previous involvement in research has come from the clinician’s or health administrator’s perspective rather than the patient’s.
Existing CFS guidelines are heavily debated and the most common issue that patients raise is that when they visit a GP with their concerns, especially with severe and persistent fatigue, they are often dismissed and fail to receive the help they require.
At this stage, it is exciting to get strong feedback from patients and try to discover more clues that could lead to better diagnosis. My concern is that many patients are spending a significant amount on treatments that may or may not be helpful, so it would be wonderful to determine the most effective treatments that are tailored to the individual needs of each patient.
FACULTY OF HEALTH SCIENCES
& MEDICINE
BOND UNIVERSITY
Samantha Johnston
PHCRED Novice Research Fellow P: 07 5595 4492
Improving primary care of patients with Chronic Fatigue Syndrome I have always been interested in health, especially in improving the way treatment is administered and the delivery of health care services in general. I was therefore very excited to join the research team at Bond
University to work on a Chronic Fatigue Syndrome (CFS) study as a PHCRED Novice Research Fellow. My
background is in biomedical science and I recently completed a Masters in Public Health and a Masters in Health Economics at the University of Queensland. This is my first project
I am currently involved with several Chronic Fatigue syndrome (CFS)/
Myalgic Encephalitis (ME) studies at Bond including a large immunological study involving CFS cohorts from the Darling Downs and the Gold Coast regions. This study is unique in many ways but it is personally appealing as it involves ongoing communication with the participants. My role includes the design, distribution, collation and analyses of completed patient questionnaires, storing information, and maintaining the study databases.
I am currently writing two ethics applications for future CFS projects and will be recruiting patients for these studies.
As a study liaison between participants and the chief investigators, I keep participants informed of their laboratory results and encourage participants to actively engage with the researchers through feedback sessions, regular newsletters and email contact.
This ongoing dialogue with participants is invaluable in formulating future projects and it provides the
participants with a supportive forum to voice their opinions and concerns about
their illness. It also provides some hope that their condition is not being overlooked by clinicians and
researchers, a concern that is often raised by those suffering from this debilitating condition. The
establishment of an immunological diagnostic marker of CFS/ME therefore is of utmost importance to sufferers and their General Practitioners, as it would provide both with measurable evidence of disease, and remove the uncertainty and stigma associated with the syndrome.
FACULTY OF HEALTH SCIENCES
& MEDICINE
BOND UNIVERSITY
Jillian Parkes
PHCRED Novice Research Fellow P: 07 5595 4492
E: [email protected] Chronic Fatigue Syndrome research: the impact on social functioning
Since 2010 I have been working as a Novice Research Fellow at PHCRED Bond University. I am a Human Genetics Society of Australasia (HGSA) certified Genetic Counsellor (Master of Genetic Counselling with Honours, GU), and my background also includes science (Bachelor of Applied Science, QUT), and general nursing. I initially developed an interest in primary care whilst working on secondment from Qld Health as a Genetic Counsellor in a community health setting in NSW.
Jillian Parkes
Page 13 PHC RIS infonet
PHCRED Strategy: Research Capacity Building Initiative
to improve experiences by offering a
‘home follow-up’ service. The NSF contacted stroke-survivors at scheduled intervals after returning home to assess how they were coping;
providing further support where appropriate.
The UDRH was approached to evaluate this service which it completed as a PHCRED initiative. A qualified primary health care professional (Jane Brodie) was recruited to work on the project as part of our PHCRED mini research apprenticeship program. The project aimed to provide a study population profile as well as conduct semi- structured interviews to gain an understanding of how useful
community-dwelling stroke-survivors found the service.
The data underscores how complex and far-reaching the effects of stroke are. It is clear that the work of the NSF is needed and valued by those
interviewed, particularly phone calls up to six months post-discharge.
Interviewees identified a lack of support in areas such as pre-stroke risk factor identification and post- stroke specialist services, as well as (sometimes) general practice. They had low expectations of community care and relied on family support. The data also suggest the importance of ensuring that the stoic attitude of some males and rural people in particular is accounted for: they may be more likely to underestimate their own care needs.
The NSF is using the report to define its future directions and build business cases and evidence for stroke support services across Australia. Jane Brodie is presenting the study at the Smart Strokes 2011 Conference on 4-5 August in Surfers Paradise.
UNIVERSITY DEPARTMENT OF RURAL HEALTH
UNIVERSITY OF TASMANIA
Erica Bell,
Jane Brodie & Sarah Brinckman
Deputy Director P: 03 6226 7377
'You tough it out': aftercare for stroke patients
‘You tough it out’ is a common sentiment among stroke-survivors returning to their homes, a 2010 report by Tasmania’s University Department of Rural Health (UDRH) has found.
Australians experience up to 48 000 strokes each year. Stroke-survivors and carers consistently report difficulty reintegrating into the community and dissatisfaction with post-stroke services. The National Stroke Foundation (Tasmania) (NSF) sought
Lesley Hawes also works at General Practice Victoria. She manages the Limited Adverse Occurrence Screening program (LAOS). This is an
independent peer review program of adverse events which have occurred in small rural hospitals which employ local GPs as Visiting Medical Officers (VMOs). The LAOS program enables records of adverse events to be sent to independent GP peer reviewers, who are also VMOs, in different geographic areas. Lesley’s project will evaluate the GP peer reviewers’ perspectives of the LAOS program.
Dentist Andre Priede’s area of interest is oral health and diabetes, and during his PHCRED fellowship he will develop and distribute a survey that investigates oral health knowledge and behaviour among adults with type 1 diabetes. Andre currently works in the Undergraduate Clinic of the Royal Dental Hospital, as a civilian dentist at HMAS Cerberus, and part-time in the Oral Health Promotion Unit for Dental Health Services Victoria.
This year we have also funded the research training of five additional novice researchers who are undertaking primary care research, including three Honours students. This
is the first time the Department of General Practice has offered an Honours year; their work will be featured in the next edition!
DEPARTMENT OF GENERAL PRACTICE
UNIVERSITY OF MELBOURNE
Assoc Prof Meredith Temple-Smith Director of Research Training
P: 03 8344 3371 E: m.temple-smith
@unimelb.edu.au Meet our 2011 RDP Fellows This Department is funding several novice researchers in 2011.
Shelley Walker, a nurse with a degree in community development, has been funded for a second year to develop her RDP project on young peoples’ views on sexting into a Master of Primary Health Care.
Emma Barnard has a background in public health and currently coordinates a state-wide GP alcohol education program at General Practice Victoria.
Her PHCRED research project is a qualitative study examining how women with hepatitis C engage with General Practice in terms of their ongoing management and care.
Lesley Hawes
Emma Barnard Shelley Walker
Andre Priede
from South Australia, the Northern Territory and the Greater Green Triangle (Victoria) to share their research in a collegiate environment.
Short presentation sessions of 15 minutes allow more than 20 researchers to present their current work.
The Conference dinner at the Adelaide Zoo will be an opportunity for PHCRED researchers past and present to look back on the journey of the RCBI program over the years and to reflect on the new primary health care landscape of Medicare Locals, primary health care reform, eHealth and improvement in service delivery.
Don't miss the opportunity to be part of this important primary health care research event.
The Conference is affordable at $110 registration fee for the two days and the Conference dinner; additional
dinner tickets are $55 each. The venue for the Conference is the Education Development Centre located on the fringe of the CBD - take the tram along North Terrace.
The Deadline for abstracts has now been extended to 30 June. For up to date information on the Conference program - workshops and key speakers as well as registration details please go to the PHCRED Tri-State web site:
<www.phcredtristate.org.au/
conference>
Ed: After over two years as PHCRED Tri-State Coordinator Elena is leaving the PHCRED Program. She will be replaced by Marnie Joyce. We wish Elena well in her new venture.
PHCRED TRI-STATE
FLINDERS UNIVERSITY
Elena DiBez
PHCRED Tri-State Coordinator P: 08 7221 8535
E:[email protected] The 2011 PHCRED Tri-State Conference will be held
15-16 September in Adelaide this year.
Ten years of research capacity building will be celebrated and organisers are hoping to attract interest from the broader primary health care sector:
health professionals, GPs, researchers, consumers, students, policy makers and health educators.
PHCRED Directors from the five University Departments: Spencer Gulf Rural Health School, Centre for Remote Health, Greater Green Triangle
University Department of Rural Health (Deakin and Flinders University), University of Adelaide and Flinders University, have been invited to talk about the highlights of their research programs.
Apart from key speaker sessions the focus of the Tri-State Conference has traditionally been to allow researchers
PHCRED Strategy: Research Capacity Building Initiative
PHCRED WA – a collaboration between the University of Western Australia, the University of Notre Dame, Australia and the Combined Universities Centre for Rural Health – organised for experts across a range of areas to play host to medical students, encouraging them to ask questions about their future career pathways and share their lived experiences.
Students’ responses to this unique event were encouraging.
Just wanted to say thank you for organising the GP Career Pathways event tonight. I found it quite useful as a student. Overall I came in with vague ideas and
expectations and came out with a clearer picture of what career options there are in general practice, so thank you and the experts at the tables.
Very informative, I found out a lot of new info.
Receiving positive feedback from activities we have targeted to build capacity in early career health professionals is not just ego boosting but also an affirmation to the good work that we currently do within the PHCRED Strategy.
PHCRED WA
COMBINED UNIVERSITIES CENTRE FOR RURAL HEALTH UNIVERSITY OF
WESTERN AUSTRALIA
Lyn Brun
PHCRED Coordinator P: 08 9956 0200 E: lyn.brun
@cucrh.uwa.edu.au
General Practice Careers Careers and coffee were a unique blend which drew medical students together from across Perth to engage in conversations on Career Pathways in General Practice.
Based on the World Cafe idea of gathering around tables and engaging in discussions on a particular topic,
PHC RIS infonet Page 15
ReportWatch: A citizen’s guide to health indicators
Collecting information that will enable the effectiveness of PHC services to be evaluated and provide assistance in planning health interventions requires development of performance indicators that are both meaningful and usable by health professionals. The Health Council of Canada developed A citizen’s guide to health indicators to assist with this task. It provides an introduction to health indicators: what they are, where they come from, and how they can
influence health care decisions and policies.
The citizen’s guide provides an outline of Canada’s health indicator framework and indicates what they can measure (eg. health system performance, health disparities, community and health system characteristics). Also included are the requisites of a good health indicator, an overview of the strengths and weaknesses of particular types of indicators and a section on ‘Health indicators at work’ that provides real life examples of health indicators in practice (eg. how indicators can be used to consider the quality of care in nursing homes and to stimulate quality improvement). A raft of links to on-line interactive resources from where you can find and work with health indicators may also be of benefit.
The full guide is free to download at
<www.healthcouncilcanada.ca>
Reference: Health Council of Canada.
(2011). A Citizen’s Guide to Health Indicators. Toronto: Health Council of Canada.
Belinda Lunnay, PHC RIS
This guide to health indicators provides an understanding of how health statistics are developed and how they can be used to make informed decisions about health.
In Australia, the past decade has seen tremendous interest in the concept of health indicators, particularly within the framework of health care reform.
Many sub-disciplines within health aim to develop national key performance indicators capable of surveying and reporting on the population’s health, and importantly, monitoring the performance of our health care system.
Of particular relevance to the primary health care (PHC) sector is that the potential capabilities of PHC performance indicators to provide a comprehensive picture of the PHC sector is not well suited or accessible to PHC providers. This is due in part to the scarcity of good quality data on care provision and information systems to support data collection, analysis and reporting at the clinician, health service and policy levels.
biomarkers of disease→ symptoms→
functional implications of impairments→ general health outcomes. The best measures are those that use a combination of these domains (for example, the HR-QOL).
However this may not necessarily be found within a single measurement instrument. The use of multiple domains of evidence supports the case more comprehensively and
convincingly.
In his research, Dr Ware follows the simple idea that “patients are the experts on what they are able to do and how they feel”. He adds that generic measures (such as general wellbeing, eg. “Overall, how would you rate your health during the past 4 weeks?”) can provide extremely complimentary, useful and predictive information, and should be applied to all health outcome studies. He demonstrated this by asking the audience whether a walk test on a treadmill (requiring patient to stop when experiencing pain) provides a
valid indicator of pain and quality of life impact for a particular patient.
Dr Ware also mentioned the
importance of addressing the needs of different audiences. For example, data on the mobility or flexibility of a limb may be important to policy makers, but for others (eg. the patient’s GP) determining the patient’s experience may be just as important. It is also necessary to consider the practical significance of the data being used.
Practical and statistical significance do not always point to the same
conclusions when it comes to the real life significance of results.
Dr Ware concluded with the hope that health outcomes will become
standardised throughout the world to enable appropriate comparisons between different populations.
For more information about Dr Ware’s research see <http://jwrginc.com/>
HEALTH OUTCOMES SEMINAR SERIES WITH DR JOHN WARE
Adelaide, 5 May 2011
Attended by Bradley Smith, Belinda Lunnay & Rachel Katterl, PHC RIS
Dr John Ware, Professor and Chief, Outcomes Measurement Science at the University of Massachusetts Medical School, a world authority on healthcare outcomes assessment (and developer of the SF-36 general health survey), visited Adelaide in May as part of a national health outcomes seminar series. Dr Ware focused on the application and interpretation of patient reported health outcome measures, as well as the implications for current practice.
The underlying theme of the seminar was the principle that health outcomes should be measured on a continuum (over four domains) in order to cover everything from clinical to generic information. The domains include
