Moving from Interest to Engagement-Understanding the Research Capacity Building Needs of Rehabilitation Doctors.

Introduction: Doctors working in rehabilitation settings have specialized clinical skills and experience, but research activity may be constrained by time pressures and inadequate current skills. This means missed opportunities to contribute to the evidence-base for better clinical practice and outcomes for people living with disabling, chronic complex conditions. This research aimed to understand rehabilitation doctors' research needs, experience, and aspirations to enable future training initiatives that are tailored to their practice context.

Use and cost of Medicare Benefits Schedule and Pharmaceutical Benefits Scheme services following inpatient rehabilitation for acquired disability in Australia.

Objectives This study explored publicly funded health system and patient expenditure in the post-acute phase following discharge from inpatient acquired brain injury (ABI) or spinal cord injury (SCI) rehabilitation. The secondary aim was to explore sociodemographic and injury characteristics associated with high costs. Methods This was a prospective cohort study.

Perceived service adequacy and unmet need after discharge from brain injury rehabilitation.

Purpose: The present study aimed to quantify the perceived needs and adequacy of realised access to post-acute services in a sample of people with acquired brain injury in the first 6-months after discharge from inpatient rehabilitation. A secondary focus was the influence of access to funding and specialist transitional rehabilitation on unmet needs.

Materials And Methods: Participants were 51 adults with a median age of 50 (IQR 35-57) recruited from an inpatient rehabilitation unit in an Australian tertiary hospital.

Healthcare services for people with acquired disability in South-East Queensland, Australia: Assessing potential proximity and its association with service obstacles.

This study described access potential in South-East Queensland, to healthcare services commonly used by people with acquired disability; and investigated the association between service proximity and perceived service obstacles. First, we described accessibility by conducting a spatial analysis to create maps of potential accessibility to health services in South-East Queensland. Queensland statistical area level 2 (SA2) locations were combined with the residential locations of participants from a longitudinal cohort study involving people with ABI and SCI.

Planning with care complexity: Factors related to discharge delays of hospitalised people with disability.

Planning for discharge and supports beyond hospital for people with disability in Australia involves negotiation of complex care systems. The aims of this study were to examine how the individualised support pathway of the National Disability Insurance Scheme (NDIS) functioned for admitted people with disability who required funded support to leave hospital; and to explore the factors indicative of increased care complexity associated with delays. Retrospective chart reviews of people with disability were conducted.

Where to next? An exploration of patients with disability and complex needs who leave acute care hospitals via an interim discharge pathway.

Objective To examine the characteristics and circumstances of admitted patients with disability who require individualised supports to leave hospital and who experience interim discharge arrangements. Methods The study used a retrospective exploratory design. Medical chart reviews of patients with disability who required funded support to leave hospital were conducted.

The influence of personal factors, unmet need and service obstacles on the relationship between health service use and outcome after brain injury.

Background: This exploratory study aimed to: (i) examine the relationship between health service use and quality of life, psychological wellbeing, global function and participation after discharge from brain injury inpatient rehabilitation, and (ii) determine the influence of personal factors, unmet need for services and service obstacles on the relationship between service use and these outcomes.

Methods: Using a prospective cohort design, 41 adults with acquired brain injury (median age = 46 years; 71% male; 61% severe traumatic injury) were followed for 6-months after discharge from specialist brain injury inpatient rehabilitation. Service use was continuously recorded and obtained through data linkage methods, focusing on the use of: outpatient medical services, outpatient nursing, outpatient allied health; medical acute services; incidents of re-hospitalization; and transitional rehabilitation service use.

The effect of access to a designated interdisciplinary post-acute rehabilitation service on participant outcomes after brain injury.

This study aimed to determine the influence of participation in a designated acquired brain injury (ABI) transitional rehabilitation service (ABI TRS) on outcome, in the context of a historical comparison group (HIST). : A cohort study, with retrospective comparison. : 187 persons with ABI.

The Effect of Health Service Use, Unmet Need, and Service Obstacles on Quality of Life and Psychological Well-Being in the First Year After Discharge From Spinal Cord Injury Rehabilitation.

Objective: This study examined the effects of health and rehabilitation service use, unmet need for services, and service obstacles on health-related quality of life (HR QoL) and psychological well-being after discharge from spinal cord injury (SCI) rehabilitation.

Design: Prospective cohort study, with participants followed up at 6 and/or 12 months after discharge from SCI inpatient rehabilitation.

Setting: Community setting.

General practitioners' considerations when deciding whether to initiate end-of-life conversations: a qualitative study.

Background: End-of-life discussions often are not initiated until close to death, even in the presence of life-limiting illness or frailty. Previous research shows that doctors may not explicitly verbalize approaching end-of-life in the foreseeable future, despite shifting their focus to comfort care. This may limit patients' opportunity to receive information and plan for the future.

General practitioners' practical approach to initiating end-of-life conversations: a qualitative study.

Background: As doctors who provide care across the life-course, general practitioners (GPs) play a key role in initiating timely end-of-life discussions. Nonetheless, these discussions are often not initiated until close to death. Given the ageing of the population, GPs will be confronted with end-of-life care more often, and this needs to become a core skill for all GPs.

A qualitative follow-up study of diabetes patients' appraisal of an integrated diabetes service in primary care.

As the prevalence of type 2 diabetes continues to escalate, health system reform is seeking better patient outcomes through new models of care that aim to provide the most appropriate care when needed. Patients' experiences of service innovations can shed light on the successes and challenges of implementing change. This paper explores patients' views of a new model of integrated care for patients with type 2 diabetes.

A multifaceted intervention to reduce inappropriate polypharmacy in primary care: research co-creation opportunities in a pilot study.

Co-creation (or co-design) represents the highest form of stakeholder engagement, but it can be infeasible to co-create with all stakeholders through all stages of a research project. The choice of stakeholders for co-design will depend on the study purpose and context of change. For this deprescribing pilot study, general practitioners were recognised as a critical gateway for co-creation, with patients' perspectives of the deprescribing process to be assessed in the evaluation of the pilot.

Making sense of change: patients' views of diabetes and GP-led integrated diabetes care.

Background: Health system reform is directed towards better management of diabetes. However, change can be difficult, and patients' perspectives are a key aspect of implementing change.

Objective: This study investigated patients' perceptions and experiences of type 2 diabetes (T2DM), self-care and engagement with GP-led integrated diabetes care.

Challenges of user-centred assistive technology provision in Australia: shopping without a prescription.

Purpose: People with disability have a right to assistive technology devices and services, to support their inclusion and participation in society. User-centred approaches aim to address consumer dissatisfaction and sub-optimal outcomes from assistive technology (AT) provision, but make assumptions of consumer literacy and empowerment. Policy discourses about consumer choice prompt careful reflection, and this paper aims to provide a critical perspective on user involvement in assistive technology provision.

A new model of integrated primary-secondary care for complex diabetes in the community: study protocol for a randomised controlled trial.

Background: A new model of complex diabetes care is provided by a multidisciplinary team which incorporates general practitioner (GP) Clinical Fellows supported by an Endocrinologist and diabetes educator within a community-based general practice setting. This study evaluates the health and clinical benefits of the new model of care, assesses the acceptability of the model to patients, GPs and other health professionals, and examines the cost-effectiveness of the model.

Methods/design: The study is an open, non-inferiority randomised controlled trial with data collected at baseline, 6 and 12 months.

'The onus is on me': primary care patient views of Medicare-funded team care in chronic disease management in Australia.

Background And Objective: This study investigated the views of primary care patients in receipt of Medicare-funded team care for chronic disease management (CDM) in Australia.

Design: A qualitative study using a repeat in-depth interview design.

Participants And Setting: Twenty-three patients (17 female), aged 32-89, were recruited over a six-month period from two purposively selected general practices: one urban and one regional practice in Queensland, Australia.

Social processes that can facilitate and sustain individual self-management for people with chronic conditions.

Recent shifts in health policy direction in several countries have, on the whole, translated into self-management initiatives in the hope that this approach will address the growing impact of chronic disease. Dominant approaches to self-management tend to reinforce the current medical model of chronic disease and fail to adequately address the social factors that impact on the lives of people with chronic conditions. As part of a larger study focused on outcomes following a chronic disease, this paper explores the processes by which a chronic disease self-management (CDSM) course impacted on participants.

Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care.

Objective: To critically examine utilisation of the 13 allied health services provided through Medicare Chronic Disease Management program and related general practitioner (GP) care planning initiatives.

Methods: Statistics generated from national billing data from July 2005 to June 2009 were extracted from Medicare data and compared by profession, State or Territory and population.

Results: Most services grew over 4 years although nationally consistent service levels were not found for any allied health provider profession.

Unravelling the concept of consumer preference: implications for health policy and optimal planning in primary care.

Accounting for consumer preference in health policy and delivery system design makes good economic sense since this is linked to outcomes, quality of care and cost control. Probability trade-off methods are commonly used in policy evaluation, marketing and economics. Increasingly applied to health matters, the trade-off preference model has indicated that consumers of health care discriminate between different attributes of care.

Impact of Enhanced Primary Care on equitable access to and economic efficiency of allied health services: a qualitative investigation.

Objective: To evaluate new pathways to access allied health services introduced by the Enhanced Primary Care/Chronic Disease Management (EPC/CDM) initiative that may both increase or decrease equity to and efficiency in access.

Design: A qualitative study consisting of semi-structured in-depth interviews with a purposively selected group of allied health practitioners. PARTICIPANTS AND SETTING.

Does Enhanced Primary Care enhance primary care? Policy-induced dilemmas for allied health professionals.

One aim of Medicare's Enhanced Primary Care (EPC) initiative is to encourage multidisciplinary care of patients with chronic disease by funding five allied health treatment sessions per patient per year. In many cases, the number of funded treatments is far less than standard clinical practice indicates, particularly when the five visits are shared between service providers. We believe clinical outcomes may be compromised by adhering to the funded hours, and inequity of outcome may arise based on socioeconomic status and the ability of patients to pay.

The Intensive Care Unit liaison nurse: towards a clear role description.

In Australia, Intensive Care Unit (ICU) liaison nurses, have recently emerged as a group of nurse practitioners whose goal is to enhance the transition from the ICU to the ward. Internationally, there has been little uniformity in the roles or functions undertaken by these specialist nurses, a factor that has made evaluation of the role difficult. In order to develop a clearer role description that could be used to test for effectiveness, this paper reports on a qualitative study of the context, and activities undertaken by the six known ICU liaison nurses in Australia.

Incorporation of environmental factors into outcomes research.

In health and disability arenas, it is increasingly being recognized that removing or modifying environmental factors can have a greater influence over outcomes than many individually focused interventions. In 2001, the World Health Organization endorsed a major revision of its framework for assessing and classifying health, disability and handicap, conceptualizing intervention and assessing outcome. This framework, the International Classification of Functioning, Disability and Health (ICF), is now defined by its recognition of the impact of environmental and personal factors on body function and structure, activities and participation in disablement.