Transformation to a Patient Centred Medical Home in an Urban Aboriginal Community Controlled Health Service: A Qualitative Study Using Normalisation Process Theory.

Rationale: The Patient-Centred Medical Home (PCMH) is a model of team-based care that is patient centred, coordinated, accessible, and focused on quality and safety. To learn how this model of healthcare works in an Indigenous primary health care setting in Australia, we explored the experiences of health staff in an urban Aboriginal Community Controlled Health Service (ACCHS) transitioning to an adapted model of a PCMH. Normalisation Process Theory (NPT) was applied to better understand factors enabling and inhibiting implementation of the PCMH, and the work required to deliver it.

Aboriginal and Torres Strait Islander community members' experiences of care in an urban Aboriginal Community Controlled Health Service transforming to a Patient Centred Medical Home.

Background Few studies have examined patient experiences of the Patient Centred Medical Home (PCMH). This qualitative study explores the experiences of patients of an urban Aboriginal Community Controlled Health Service during its transition to a model of a PCMH. Methods Twenty-eight community members who were registered as patients of an urban Aboriginal Community Controlled Health Service were purposively recruited to participate in yarning interviews.

Using predictive risk modelling to identify patients with hidden health needs in an Aboriginal and Torres Strait Islander health service.

Background And Objectives: In partnership with an Aboriginal and Torres Strait Islander community-controlled health service, we explored the use of a machine learning tool to identify high-needs patients for whom services are harder to reach and, hence, who do not engage with primary care.

Method: Using deidentified electronic health record data, two predictive risk models (PRMs) were developed to identify patients who were: (1) unlikely to have health checks as an indicator of not engaging with care; and (2) likely to rate their wellbeing as poor, as a measure of high needs.

Results: According to the standard metrics, the PRMs were good at predicting health checks but showed low reliability for detecting poor wellbeing.

Does use of GP and specialist services vary across areas and according to individual socioeconomic position? A multilevel analysis using linked data in Australia.

Objective: Timely access to primary care and supporting specialist care relative to need is essential for health equity. However, use of services can vary according to an individual's socioeconomic circumstances or where they live. This study aimed to quantify individual socioeconomic variation in general practitioner (GP) and specialist use in New South Wales (NSW), accounting for area-level variation in use.

Transformation to a patient-centred medical home led and delivered by an urban Aboriginal and Torres Strait Islander community, and association with engagement and quality-of-care: quantitative findings from a pilot study.

Background: The patient-centred medical home (PCMH) is a model of team-based primary care that is patient-centred, coordinated, accessible, and focused on quality and safety. In response to substantial population growth and increasing demand on existing primary care services, the Institute for Urban Indigenous Health (IUIH) developed the IUIH System of Care-2 (ISoC2), based on an international Indigenous-led PCMH. ISoC2 was piloted at an urban Aboriginal and Torres Strait Islander Community-Controlled Health Service in South-East Queensland between 2019-2020, with further adaptations made to ensure its cultural and clinical relevance to local Aboriginal and Torres Strait Islander people.

Understanding the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia: a realist review protocol.

Introduction: Chronic disease remains the leading cause of morbidity and mortality among Aboriginal and Torres Strait Islander peoples in Australia. Regular structured, comprehensive health assessments are available to Aboriginal and Torres Strait Islander people as annual health checks funded through the Medicare Benefits Schedule. This realist review aims to identify context-specific enablers and tensions and contribute to developing an evidence framework to guide the implementation of health checks in the prevention and early detection of chronic diseases for Aboriginal and Torres Strait Islander people.

Changes in general practice use and costs with COVID-19 and telehealth initiatives: analysis of Australian whole-population linked data.

Background: In response to the COVID-19 pandemic, general practice in Australia underwent a rapid transition, including the roll-out of population-wide telehealth, with uncertain impacts on GP use and costs.

Aim: To describe how use and costs of GP services changed in 2020 - following the COVID-19 pandemic and introduction of telehealth - compared with 2019, and how this varied across population subgroups.

Design And Setting: Linked-data analysis of whole-population data for Australia.

Association of individual-socioeconomic variation in quality-of-primary care with area-level service organisation: A multilevel analysis using linked data.

Rationale, Aims And Objectives: Ensuring equitable access to primary care (PC) contributes to reducing differences in health related to people's socioeconomic circumstances. However, there is limited data on system-level factors associated with equitable access to high-quality PC. We examine whether individual-level socioeconomic variation in general practitioner (GP) quality-of-care varies by area-level organisation of PC services.

Real price of health-experiences of out-of-pocket costs in Australia: protocol for a systematic review.

Introduction: Australians have substantial out-of-pocket (OOP) health costs compared with other developed nations, even with universal health insurance coverage. This can significantly affect access to care and subsequent well-being, especially for priority populations including those on lower incomes or with multimorbidity and chronic illness. While it is known that high OOP healthcare costs may contribute to poorer health outcomes, it is not clear exactly how these expenses are experienced by people with chronic illnesses.

Neurodegeneration in a novel invertebrate model system: Failed microtubule-mediated cell adhesion and unraveling of macroglia.

Neurodegenerative diseases are among the main causes of death in the United States, leading to irreversible disintegration of neurons. Despite intense international research efforts, cellular mechanisms that initiate neurodegeneration remain elusive, thus inhibiting the development of effective preventative and early onset medical treatment. To identify underlying cellular mechanisms that initiate neuron degeneration, it is critical to identify histological and cellular hallmarks that can be linked to underlying biochemical processes.

Progressivity of out-of-pocket costs under Australia's universal health care system: A national linked data study.

Background: In line with affordability and equity principles, Medicare-Australia's universal health care program-has measures to contain out-of-pocket (OOP) costs, particularly for lower income households. This study examined the distribution of OOP costs for Medicare-subsidised out-of-hospital services and prescription medicines in Australian households, according to their ability to pay.

Methods: OOP costs for out-of-hospital services and medicines in 2017-18 were estimated for each household, using 2016 Australian Census data linked to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefit Scheme (PBS) claims.

Homes and health in the Outer Hebrides: A social prescribing framework for addressing fuel poverty and the social determinants of health.

Health services are increasingly being reshaped with reference to addressing social determinants of health (SDoH), with social prescribing a prominent example. We examine a project in the Outer Hebrides that reshaped and widened the local health service, framing fuel poverty as a social determinant of health and mobilising a cross-sector support pathway to make meaningful and substantive improvements to islanders' living conditions. The 'Moving Together' project provided support to almost 200 households, ranging from giving advice on home energy, finances and other services, to improving the energy efficiency of their homes.

Study protocol: primary healthcare transformation through patient-centred medical homes-improving access, relational care and outcomes in an urban Aboriginal and Torres Strait Islander population, a mixed methods prospective cohort study.

Introduction: For over 40 years, Aboriginal and Torres Strait Islander Community-Controlled Health Services (ACCHS) in Australia have led strategic responses to address the specific needs of Aboriginal and Torres Strait Islander populations. Globally, there has been rapid growth in urban Indigenous populations requiring an adaptive primary healthcare response. Patient-centred medical homes (PCMH) are an evidenced-based model of primary healthcare suited to this challenge, underpinned by principles aligned with the ACCHS sector-relational care responsive to patient identified healthcare priorities.

Factors related to under-treatment of secondary cardiovascular risk, including primary healthcare: Australian National Health Survey linked data analysis.

Objective: To inform national evidence gaps on cardiovascular disease (CVD) preventive medication use and factors relating to under-treatment - including primary healthcare engagement - among CVD survivors in Australia.

Methods: Data from 884 participants with self-reported CVD from the 2014-15 National Health Survey were linked to primary care and pharmaceutical dispensing data for 2016 through the Multi-Agency Data Integration Project. Logistic regression quantified the relation of combined blood pressure- and lipid-lowering medication use to participant characteristics.

Aboriginal and Torres Strait Islander health checks: sociodemographic characteristics and cardiovascular risk factors.

Objective: To quantify Aboriginal and Torres Strait Islander health check claims in Australian adults in relation to sociodemographic and health characteristics, including prior cardiovascular disease (CVD) and CVD risk factors.

Methods: The study involved analysis of baseline data (2006-2009) from the Sax Institute's 45 and Up Study, involving 1753 Aboriginal and Torres Strait Islander adults in New South Wales, Australia, linked to Medicare Benefits Schedule (MBS) hospital and death data (to December 2015). The outcome was a claim for receiving a Medicare-funded Health Assessment for Aboriginal and Torres Strait Islander People (MBS item 715) in the 2 years before December 2015.

Education-related inequalities in cause-specific mortality: first estimates for Australia using individual-level linked census and mortality data.

Background: Socioeconomic inequalities in mortality are evident in all high-income countries, and ongoing monitoring is recommended using linked census-mortality data. Using such data, we provide the first estimates of education-related inequalities in cause-specific mortality in Australia, suitable for international comparisons.

Methods: We used Australian Census (2016) linked to 13 months of Death Registrations (2016-17).

Experiences of pregnant mothers using a social media based antenatal support service during the COVID-19 lockdown in the UK: findings from a user survey.

Objectives: The COVID-19 pandemic has seen unprecedented restrictions on face-to-face healthcare encounters. This has led to an increase in the use of online healthcare resources by service users. Pregnant women have always been a group particularly motivated to seek out information online.

Comparison of radiography and computed tomography to evaluate fractures of the canine tarsus.

Detection and accurate classification of traumatic tarsal fractures are important for identifying cases requiring surgical intervention. The aim of this prospective, experimental, methods comparison study was to directly compare the accuracy, sensitivity, and specificity of tarsal computed tomography (CT), ten-view and two-view digital radiographs for detecting traumatic fractures of the canine tarsus. The working hypothesis was that tarsal fractures would be detected with higher accuracy, sensitivity, and specificity using CT imaging compared to radiography, and a ten-view would be superior to a two-view radiographic study.

Undiagnosed diabetes from cross-sectional GP practice data: an approach to identify communities with high likelihood of undiagnosed diabetes.

Objectives: To estimate undiagnosed diabetes prevalence from general practitioner (GP) practice data and identify areas with high levels of undiagnosed and diagnosed diabetes.

Design: Data from the North-West Adelaide Health Survey (NWAHS) were used to develop a model which predicts total diabetes at a small area. This model was then applied to cross-sectional data from general practices to predict the total level of expected diabetes.

General practitioner (family physician) workforce in Australia: comparing geographic data from surveys, a mailing list and medicare.

Background: Good quality spatial data on Family Physicians or General Practitioners (GPs) are key to accurately measuring geographic access to primary health care. The validity of computed associations between health outcomes and measures of GP access such as GP density is contingent on geographical data quality. This is especially true in rural and remote areas, where GPs are often small in number and geographically dispersed.

Social exclusion, deprivation and child health: a spatial analysis of ambulatory care sensitive conditions in children aged 0-4 years in Victoria, Australia.

Recent Australian policy initiatives regarding primary health care focus on planning services around community needs and delivering these at the local area. As in many other countries, there has also been a growing concern over social inequities in health outcomes. The aims of the analysis presented here were firstly to describe small area variations in hospital admissions for ambulatory care sensitive conditions (ACSC) among children aged 0-4 years between 2003 and 2009 in the state of Victoria, Australia, and secondly to explore the relationship of ACSC hospitalisations with socio-economic disadvantage using a comparative analysis of the Child Social Exclusion (CSE) index and the Composite Score of Deprivation (CSD).

Measures of social deprivation that predict health care access and need within a rational area of primary care service delivery.

Objective: To develop a measure of social deprivation that is associated with health care access and health outcomes at a novel geographic level, primary care service area.

Data Sources/study Setting: Secondary analysis of data from the Dartmouth Atlas, AMA Masterfile, National Provider Identifier data, Small Area Health Insurance Estimates, American Community Survey, Area Resource File, and Behavioural Risk Factor Surveillance System. Data were aggregated to primary care service areas (PCSAs).