Improving outcomes for marginalised rural families through a care navigator program.

Issues Addressed: Health promotion programs are based on the premise that health and well-being is impacted by a person's living circumstances, not just factors within the health arena. Chronic health issues require integrated services from health and social services. Navigator positions are effective in assisting chronic disease patients to access services.

Risk of opioid misuse in people with cancer and pain and related clinical considerations: a qualitative study of the perspectives of Australian general practitioners.

Objective: To explore the perspectives of general practitioners (GPs) concerning the risk of opioid misuse in people with cancer and pain and related clinical considerations.

Design: A qualitative approach using semistructured telephone interviews. Analysis used an integrative approach.

How can communities and organisations improve their health literacy?

Definitions of health literacy have tended to focus on the abilities of patients and communities, rather than on the ability of the health system and its services to respond to patients' different levels of health literacy. However, health literacy is increasingly being recognised as part of a dynamic, two-way relationship, affected by both organisational factors (e.g.

Context matters for primary health care access: a multi-method comparative study of contextual influences on health service access arrangements across models of primary health care.

Background: Equitable access to primary health care (PHC) is an important component of integrated chronic disease management. Whilst context is known to influence access to PHC, it is poorly researched. The aim of this study was to determine the contextual influences associated with access arrangements in four Australian models of integrated PHC.

Impact Evaluation of a System-Wide Chronic Disease Management Program on Health Service Utilisation: A Propensity-Matched Cohort Study.

Background: The New South Wales Health (NSW Health) Chronic Disease Management Program (CDMP) delivers interventions to adults at risk of hospitalisation for five target chronic conditions that respond well to ambulatory care: diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure, and coronary artery disease. The intervention consists of two main components: (1) care coordination across sectors (acute, ambulatory, and community care from both public and private sectors) and clinical specialties, facilitated by program care coordinators, and (2) health coaching including management of lifestyle risk factors and medications and self-management. These components were broadly prescribed by the head office of NSW Health, which funded the program, and were implemented by regional health services (local health districts) in ways that best suited their own history, environment, workforce, and patient need.

Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations.

Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce. Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territories Results Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively.

Optimising the use of observational electronic health record data: Current issues, evolving opportunities, strategies and scope for collaboration.

Background: With increasing computerisation in general practice, national primary care networks are mooted as sources of data for health services and population health research and planning. Existing data collection programs - MedicinesInsight, Improvement Foundation, Bettering the Evaluation and Care of Health (BEACH) - vary in purpose, governance, methodologies and tools. General practitioners (GPs) have significant roles as collectors, managers and users of electronic health record (EHR) data.

Implementing guidelines to routinely prevent chronic vascular disease in primary care: the Preventive Evidence into Practice cluster randomised controlled trial.

Objective: To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease.

Setting: 32 urban general practices in 4 Australian states.

Randomisation: Stratified randomisation of practices.

Mechanisms underpinning interventions to reduce sexual violence in armed conflict: A realist-informed systematic review.

Sexual violence is recognised as a widespread consequence of armed conflict and other humanitarian crises. The limited evidence in literature on interventions in this field suggests a need for alternatives to traditional review methods, particularly given the challenges of undertaking research in conflict and crisis settings. This study employed a realist review of the literature on interventions with the aim of identifying the mechanisms at work across the range of types of intervention.

Factors influencing participation in a vascular disease prevention lifestyle program among participants in a cluster randomized trial.

Background: Previous research suggests that lifestyle intervention for the prevention of diabetes and cardiovascular disease (CVD) are effective, however little is known about factors affecting participation in such programs. This study aims to explore factors influencing levels of participation in a lifestyle modification program conducted as part of a cluster randomized controlled trial of CVD prevention in primary care.

Methods: This concurrent mixed methods study used data from the intervention arm of a cluster RCT which recruited 30 practices through two rural and three urban primary care organizations.

Do people with existing chronic conditions benefit from telephone coaching? A rapid review.

Objective: To examine the effectiveness of telephone-based coaching services for the management of patients with chronic diseases.

Methods: A rapid scoping review of the published peer reviewed literature, using Medline, Embase, CINAHL, PsychNet and Scopus. We included studies involving people aged 18 years or over with one or more of the following chronic conditions: type 2 diabetes, congestive cardiac failure, coronary artery disease, chronic obstructive pulmonary disease and hypertension.

What evidence exists for initiatives to reduce risk and incidence of sexual violence in armed conflict and other humanitarian crises? A systematic review.

Sexual violence is highly prevalent in armed conflict and other humanitarian crises and attracting increasing policy and practice attention. This systematic review aimed to canvas the extent and impact of initiatives to reduce incidence, risk and harm from sexual violence in conflict, post-conflict and other humanitarian crises, in low and middle income countries. Twenty three bibliographic databases and 26 websites were searched, covering publications from 1990 to September 2011 using database-specific keywords for sexual violence and conflict or humanitarian crisis.

The impact of a brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial).

Background: The risk factors for chronic disease, smoking, poor nutrition, hazardous alcohol consumption, physical inactivity and weight (SNAPW) are common in primary health care (PHC) affording opportunity for preventive interventions. Community nurses are an important component of PHC in Australia. However there has been little research evaluating the effectiveness of lifestyle interventions in routine community nursing practice.

A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care.

Background: Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care.

Methods: An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken.

Routine use of clinical management guidelines in Australian general practice.

Significant gaps remain between recommendations of evidence-based guidelines and primary health care practice in Australia. This paper aims to evaluate factors associated with the use of guidelines reported by Australian GPs. Secondary analysis was performed on a survey of primary care practitioners which was conducted by the Commonwealth Fund in 2009: 1016 general practitioners responded in Australia (response rate 52%).

Building research capacity in south-west Sydney through a Primary and Community Health Research Unit.

The Primary and Community Health Research Unit was established in 2010 in south-west Sydney to build research capacity in primary and community health services and help generate evidence to underpin clinical activities. In 2011, six project teams participated in a 12-month researcher mentoring program, undertaking projects in quality improvement and service evaluation. Project teams were linked with academic mentors and participated in four research skill development workshops covering research design, research ethics, statistical analysis and academic writing.

A cluster randomised controlled trial of vascular risk factor management in general practice.

Objective: To evaluate the impact of a lifestyle intervention in Australian general practice to reduce the risk of vascular disease.

Design, Setting And Participants: Stratified cluster randomised controlled trial among 30 general practices in New South Wales from July 2008 to January 2010. Patients aged 40-64 years were invited to participate.

Clients' experience of brief lifestyle interventions by community nurses.

Lifestyle modification interventions in primary health care settings are an important means of addressing lifestyle risk factors. An essential factor for the success of lifestyle advice is the client's acceptance. Lifestyle interventions offered in general practice are well accepted by clients.

Predictors of primary care referrals to a vascular disease prevention lifestyle program among participants in a cluster randomised trial.

Background: Cardiovascular disease accounts for a large burden of disease, but is amenable to prevention through lifestyle modification. This paper examines patient and practice predictors of referral to a lifestyle modification program (LMP) offered as part of a cluster randomised controlled trial (RCT) of prevention of vascular disease in primary care.

Methods: Data from the intervention arm of a cluster RCT which recruited 36 practices through two rural and three urban primary care organisations were used.

What predicts patient-reported GP management of smoking, nutrition, alcohol, physical activity and weight?

This study aimed to describe patient-reported management of behavioural risk factors in Australian general practice. Six hundred and ninety-eight eligible patients from 30 general practices in two rural and three urban Divisions of General Practice responded to a mailed invitation to participate and completed a questionnaire. Data were analysed using univariate and multi-level multivariate methods.

Is there scope for community health nurses to address lifestyle risk factors? the community nursing SNAP trial.

Background: This paper examines the opportunity and need for lifestyle interventions for patients attending generalist community nursing services in Australia. This will help determine the scope for risk factor management within community health care by generalist community nurses (GCNs).

Methods: This was a quasi-experimental study conducted in four generalist community nursing services in NSW, Australia.

Satisfaction with referral relationships between general practice and allied health professionals in Australian primary health care.

Chronic diseases require a multidisciplinary approach to provide patients with optimal care in general practice. This often involves general practitioners (GPs) referring their patients to allied health professionals (AHPs). The Team-link study explored the impact of an intervention to enhance working relationships between GPs and AHPs in general practice regarding the management of two chronic diseases: diabetes and ischaemic heart disease (IHD) or hypertension.

Collaboration across private and public sector primary health care services: benefits, costs and policy implications.

Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care.

Socio-demographic factors, behaviour and personality: associations with psychological distress.

Background: Anxiety, psychological distress and personality may not be independent risk factors for cardiovascular disease; however they may contribute via their relationship with unhealthy lifestyle behaviours. This study aimed to examine the association between psychological distress, risk behaviours and patient demographic characteristics in a sample of general practice patients aged 40-65 years with at least one risk factor for cardiovascular disease.

Design: Cross-sectional analytic study.

Multidisciplinary Team Care Arrangements in the management of patients with chronic disease in Australian general practice.

Objective: To explore factors associated with the frequency of multidisciplinary Team Care Arrangements (TCAs) and the impact of TCAs on patient-assessed quality of care in Australian general practice.

Design And Setting: Data were collected as part of a cluster randomised controlled trial conducted in 60 general practices in New South Wales, the Australian Capital Territory and Victoria between July 2006 and June 2008. Multilevel logistic regression analysis evaluated factors associated with the frequency of TCAs recorded in the 12 months after baseline, and multilevel multivariable analysis examined the association between TCAs and patient-assessed quality of chronic illness care, adjusted for patient and practice characteristics.