Publications by authors named "Caroline Laurence"

Objective: The objective of this scoping review is to describe models of palliative care for under-served populations in high-income countries, defined as adults of culturally and linguistically diverse communities, low socioeconomic status, and/or residing in rural areas.

Introduction: Models of palliative care are processual, referring to the way palliative care services are delivered as people experience a condition, injury, or event. The aim of these models is to ensure people get the right care, at the right time, by the right team, in the right place.

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Background: In LMICs, including Indonesia, there is a rising burden of non-communicable diseases (NCDs) with a prevailing burden of infectious diseases, including among pregnant women. The Indonesian health system faces significant challenges to provide effective care for infectious diseases, and even more so, NCDs. This is concerning due to the greater vulnerability of pregnant women to complications caused by concomitant illnesses (NCDs and infectious diseases), and the need for complex, integrated healthcare between maternal care and other health services.

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Background: Chronic hepatitis B is a significant public health issue; however, there is limited understanding of the engagement in primary health care of Aboriginal people living with chronic hepatitis B (CHB).

Methods: To better understand the management of CHB, diagnostic reports and case note audits were conducted in six South Australian Aboriginal community controlled health services. The audits covered the initial assessment, CHB monitoring, and hepatocellular carcinoma screening.

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Introduction: Primary Health Care (PHC) gained considerable momentum in the past four decades and led to improved health outcomes across a wide variety of settings. In low-and middle-income countries (LMICs), national or large-scale Community Health Worker Programs (CHWPs) are considered as vehicles to incorporate PHC principles into healthcare provision and are an essential aspect of the PHC approach to achieve health for all and sustainable development goals. The success of CHWPs is rooted in the application of PHC principles.

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Objective: To assess the impact of different non-pharmaceutical interventions (NPIs) on COVID-19 cases across Victoria and South Australia.

Methods: Poisson regression models were fit to examine the effect of NPIs on weekly COVID-19 case numbers.

Results: Mask-wearing in Victoria had a pronounced lag effect of two weeks with an incidence rate ratio (IRR) of 0.

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Article Synopsis
  • The study aimed to explore how primary healthcare principles are integrated into community health worker (CHW) programs in low- and middle-income countries, focusing on their impact on health outcomes.
  • The researchers conducted a scoping review of 1280 papers, ultimately selecting 26 studies that highlighted the prevalence of universal health coverage and community participation, while intersectoral coordination was often lacking.
  • The findings suggest that while cultural acceptability is present in CHW programs by employing local community members, other critical factors like program effectiveness need further examination.
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Article Synopsis
  • The study highlights that in Indonesia, 'indirect' causes of maternal death, primarily due to companion illnesses like NCDs and infectious diseases, accounted for 23% of maternal deaths in 2010.
  • Analysis of data from 1990 to 2019 suggests a decrease in infectious diseases, apart from a rise in NCDs, with sexually transmitted infections being the most prevalent in 2019; projections indicate that diabetes and lower respiratory infections will continue to rise until 2030.
  • The findings urge Indonesian policymakers to adopt evidence-based strategies to mitigate the effects of these illnesses on pregnancy health outcomes.
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Objective: This scoping review aims to map the available literature on the application of primary health care principles as reflected in the implementation of national-level community health worker programs in low- and middle-income countries.

Introduction: There is extensive literature on how community health workers have been used to improve the health status of disadvantaged populations, especially in low- and middle-income countries. Established under the primary health care principles, national community health worker programs were expected to adopt and promote these principles to achieve improvements in health outcomes.

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Background: Family planning (FP) is among the important interventions that reduce maternal mortality. Poor quality FP service is associated with lower services utilisation, in turn undermining the efforts to address maternal mortality. There is currently little research on the quality of FP services in the private sector in Ethiopia, and how it compares to FP services in public facilities.

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Background: General practice nurses (GPNs) form an important component of the general practice workforce in Australia. Despite this, there is limited research on estimating their future supply. This study aims to estimate the future GPN supply and the impact of a range of policy and non-policy changes on workforce balances.

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Article Synopsis
  • The study aimed to understand healthcare providers' perspectives on the challenges and supports for using the national family planning guideline in Amhara Region, Ethiopia.
  • Barriers to guideline use included lack of awareness, personal beliefs, reliance on traditional practices, limited access, and inadequate training, while facilitators included easy access, convenience, and incentives.
  • To ensure better implementation of the guideline, the study suggests enhancing training, addressing personal beliefs, increasing availability of the guidelines, and translating them into local languages.
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Several surveys of the general practice nurse (GPN) workforce have been undertaken in Australia over the last decade, but they have limitations, which mean that the workforce is not well-understood. The aim of this study is to describe the profile of the GPN workforce using the dataset available through the Australia Health Practitioner Registration Agency and to explore how it differs from the non-GPN nursing workforce, and if this workforce is changing over time. Data from labour force surveys conducted from 2012 to 2015 were used.

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Article Synopsis
  • Health workforce planning models are essential for estimating future GP requirements and guiding health policy decisions.
  • A simulation model was adapted to analyze the GP workforce in Western Australia, revealing a projected shortage of 493 full-time equivalent GPs by 2033, while South Australia may experience an oversupply.
  • The model also highlights how various scenarios, such as reduced international recruitment and changes in population projections, significantly impact GP supply, creating a tool for better workforce policy decisions.
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Background: Health workforce planning is based on estimates of future needs for and supply of health care services. Given the pipeline time lag for the training of health professionals, inappropriate workforce planning or policies can lead to extended periods of over- or under-supply of health care providers. Often these policy interventions focus on one determinant of supply and do not incorporate other determinants such as changes in population health which impact the need for services.

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Introduction: Over the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia.

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There is a shortage of medical practitioners able and/or willing to prescribe OST. This qualitative study investigated an alternative model of care where by pharmacists co-prescribed with an accredited doctor for OST patients. Semi-structured face-to-face interviews with 14 OST patients were conducted at a state government drug and alcohol clinic about their views on pharmacist prescribing OST for them.

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Background: Maternal mortality is noticeably high in sub-Saharan African countries including Ethiopia. Continuous nationwide systematic evaluation and assessment of the problem helps to design appropriate policy and strategy in Ethiopia. This study aimed to investigate the trends and causes of maternal mortality in Ethiopia between 1990 and 2013.

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Article Synopsis
  • Improving maternal health in Africa relies on effective family planning services, which require a focus on the quality of care provided to increase contraceptive use.
  • The systematic review analyzed 11 studies from 1990 to 2015, identifying key factors that influence service quality, including client satisfaction, provider competence, waiting times, and the structural aspects of health facilities.
  • Findings indicated that higher quality care is more likely in privately-owned facilities, but challenges remain, such as cost of services and provider workload impacting both access and the overall quality of care.
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The objective of this systematic review is to identify and synthesize the best available quantitative and qualitative evidence to understand the factors determining quality of care in family planning services in Africa.The review question for the quantitative component of the review is:What factors, including facility, provider and client characteristics, are associated with quality of care in family planning services in Africa?The review question for the qualitative component of the review is:What are client and provider experiences and/or perceptions of factors that affect quality of care in family planning services in Africa?

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Objective: Despite increases in Commonwealth funded general practice (GP) Registrar training positions, workforce trends continue to show geographical maldistribution. This study aimed to identify Registrar attributes which describe a cohort choosing to work in rural practice.

Design: Cross-sectional self-report questionnaire for socio-demographics, prior training, current training pathway, measures of personality and resilience.

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Background: In Australia, the approach to health workforce planning has been supply-led and resource-driven rather than need-based. The result has been cycles of shortages and oversupply. These approaches have tended to use age and sex projections as a measure of need or demand for health care.

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Objectives: To describe the personality profiles of International Medical Graduates (IMGs) undertaking General Practice (GP) training in Australia. A better understanding of the personal characteristics of IMGs may inform their training and enhance support for their vital contribution to the Australian rural workforce.

Design: Cross-sectional self-report questionnaires.

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Introduction: The ongoing rural doctor workforce shortage continues to stimulate interest in new strategies to alleviate the situation. Alongside increasingly promising approaches is the notion that attracting and nurturing the 'right' individuals may be paramount to achieving long-term success in recruitment and retention. This study compares the patterns of demographic and temperament and character trait profiles of general practice registrars in training across three Australian vocational training pathways: the Australian College of Rural and Remote Medicine independent rural pathway, and the rural and general pathways of Australian general practice training.

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Learning about interdisciplinary health approaches is important for students of health professions. Yet, interdisciplinary learning programs are sparse within primary health clinics. Larger health care complexes, such as superclinics in Australia, offer interdisciplinary learning opportunities for health, but also pose difficulties.

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Background: Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care providers.

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