Relevant bibliographies by topics / Primary care (Medicine) Australia

Academic literature on the topic 'Primary care (Medicine) Australia'

Author: Grafiati
Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Primary care (Medicine) Australia"

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Andersen, N. A. "Primary Care in Australia." International Journal of Health Services 16, no. 2 (April 1986): 199–212. http://dx.doi.org/10.2190/3l1k-c30d-j5af-2ajn.

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The Australian health care delivery system is reviewed in this article, with special comment on the implications of the financial components of the system and government concerns regarding costs and over-servicing. General practitioners' perception of their role is not significantly different from the expectation of patients, yet the reality may not match the idealized view. There are problems related to availability and there are developments which seem to pose some threat to the continuing care of patients. New developments have occurred in the way in which practice is organized which give an emphasis to continual availability over 24 hour periods, and these developments pose a challenge to the way in which doctors have organized their practices. Population features-Aborigines, migrants, and the elderly-present significant problems that are not always well met, and the concept of total patient care thereby suffers. The general practitioner's apparent failure to fill the expected role in co-ordination of services is discussed, as is the need for general practitioners to become more actively involved in health education and promotion. The hope for the future lies in the Family Medicine Programme of The Royal Australian College of General Practitioners, which represents a major attempt to provide appropriate vocational training for general practice.
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Dwyer, John M., and Stephen J. Duckett. "Restructuring primary health care in Australia." Medical Journal of Australia 205, no. 10 (November 2016): 435–36. http://dx.doi.org/10.5694/mja16.00554.

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Mak, Jason, and Renee Granger. "OP86 Exploring Public Utilization Data For Primary Care Education Programs." International Journal of Technology Assessment in Health Care 35, S1 (2019): 22. http://dx.doi.org/10.1017/s0266462319001417.

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IntroductionNPS MedicineWise delivers nationwide educational programs to improve quality use of medicines and medical tests in Australia. Targeted horizon scanning approaches are required to detect and address emerging challenges in the healthcare landscape such as overutilization and unexpectedly high expenditure on medicines and medical tests. Publicly available utilization and expenditure data from the Australian Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) may provide insights into identifying potential areas for intervention.MethodsFive financial years (2013-18) of publicly available PBS/MBS data was extracted from Australian Government websites and clustered according to medicine class, disease groups or anatomical therapeutic chemical classification (ATC). Usage and expenditure trends were explored with signals of potential inappropriate use identified as unusual spikes or changes.ResultsPBS data showed two fixed dose combination inhalers for respiratory conditions, three direct oral anticoagulants, four analgesics (including opioids) and two blood glucose lowering agents had high volume and expenditure growths in the 2016-17 financial year. Cholesterol-reducing medicines and anti-hypertensives also commonly had high utilisation growth. The highest growth classified by ATC level two codes were for urologicals. These signals were collated into themes of stroke prevention, cardiovascular, respiratory, pain management and type two diabetes. MBS data on pathology tests showed viral and bacterial testing had the highest growth, followed by vitamin B12 testing and vitamin D testing. Magnetic resonance imaging had the highest growth in expenditure and volume of services of the various imaging modalities and X-ray of the lower leg had the highest volume of services.ConclusionsSeveral medicines and medical tests were detected as possible targets for interventions based on high volume or expenditure growth. Themes identified from the data can then be further investigated and contextualized to inform topic areas for primary care education to support quality use of medicines and medical tests.
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Gunn, Jane M. "Should Australia develop primary care research networks?" Medical Journal of Australia 177, no. 2 (July 2002): 63–66. http://dx.doi.org/10.5694/j.1326-5377.2002.tb04667.x.

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Howe, Katrina, Siobhan Bourke, and Lloyd Sansom. "The extent to which off-patent registered prescription medicines are used for off-label indications in Australia: A scoping review." PLOS ONE 16, no. 12 (December 3, 2021): e0261022. http://dx.doi.org/10.1371/journal.pone.0261022.

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Aim The aim of this scoping review was to determine the extent of off-patent prescription medicine use beyond registered indications in various Australian clinical settings. Method The review followed the Joanna Briggs Institute approach and reported using PRISMA Extension for Scoping Reviews. Online databases were used to identify published literature about off-patent registered prescription medicines used for off-label indications in Australian public hospital, community and primary healthcare settings. In addition, empirical data from the Queensland and the South Australian state-wide medicine formularies were screened for the same medication/off-label indication dyads identified in the literature, and other locally approved uses. Results Overall, fourteen studies were included, conducted in public hospitals (n = 11), palliative care units (n = 2) and the community setting (n = 1). There were 213 reports extracted from the literature describing off-patent registered prescription medicines used for off-label indications, representing 128 unique medication/off-label indication dyads and 32 different medicines. Of these, just five medication/off-label indication dyads were approved for use on both the Queensland and South Australian state-wide medicine formularies, with 12 others only approved for use in Queensland and 16 others only approved for use in South Australia. Further examination of these state-wide formularies demonstrated that the use of off-patent registered prescription medicines beyond registered indications is more extensive than has been reported to date in the literature. There were 28 additional medication/off-label indication dyads approved on the Queensland state-wide medicine formulary and 14 such examples approved for use in South Australia. Of these, just two medication/off-label indication dyads were approved for use on both formularies. Conclusion The extent to which off-patent registered prescription medicines have been repurposed in clinical settings for off-label indications in Australia is greater than previously reported in the literature. Usage and funded availability of certain medication/off-label indication dyads, varies across Australia. These results further expose the two tiered system of medicines regulation in Australia, and its impact on equity of access to medicines. Further research is required to support policy change to encourage submission of registration updates for off-patent prescription medicines.
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Lim, Renly, Luke Bereznicki, Megan Corlis, Lisa M. Kalisch Ellett, Ai Choo Kang, Tracy Merlin, Gaynor Parfitt, et al. "Reducing medicine-induced deterioration and adverse reactions (ReMInDAR) trial: study protocol for a randomised controlled trial in residential aged-care facilities assessing frailty as the primary outcome." BMJ Open 10, no. 4 (April 2020): e032851. http://dx.doi.org/10.1136/bmjopen-2019-032851.

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IntroductionMany medicines have adverse effects which are difficult to detect and frequently go unrecognised. Pharmacist monitoring of changes in signs and symptoms of these adverse effects, which we describe as medicine-induced deterioration, may reduce the risk of developing frailty. The aim of this trial is to determine the effectiveness of a 12-month pharmacist service compared with usual care in reducing medicine-induced deterioration, frailty and adverse reactions in older people living in aged-care facilities in Australia.Methods and analysisThe reducing medicine-induced deterioration and adverse reactions trial is a multicentre, open-label randomised controlled trial. Participants will be recruited from 39 facilities in South Australia and Tasmania. Residents will be included if they are using four or more medicines at the time of recruitment, or taking more than one medicine with anticholinergic or sedative properties. The intervention group will receive a pharmacist assessment which occurs every 8 weeks. The pharmacists will liaise with the participants’ general practitioners when medicine-induced deterioration is evident or adverse events are considered serious. The primary outcome is a reduction in medicine-induced deterioration from baseline to 6 and 12 months, as measured by change in frailty index. The secondary outcomes are changes in cognition scores, 24-hour movement behaviour, grip strength, weight, percentage robust, pre-frail and frail classification, rate of adverse medicine events, health-related quality of life and health resource use. The statistical analysis will use mixed-models adjusted for baseline to account for repeated outcome measures. A health economic evaluation will be conducted following trial completion using data collected during the trial.Ethics and disseminationEthics approvals have been obtained from the Human Research Ethics Committee of University of South Australia (ID:0000036440) and University of Tasmania (ID:H0017022). A copy of the final report will be provided to the Australian Government Department of Health.Trial registration numberAustralian and New Zealand Trials Registry ACTRN12618000766213.
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FURUKAWA, T. A., G. ANDREWS, and D. P. GOLDBERG. "Stratum-specific likelihood ratios of the General Health Questionnaire in the community: help-seeking and physical co-morbidity affect the test characteristics." Psychological Medicine 32, no. 4 (May 2002): 743–48. http://dx.doi.org/10.1017/s0033291702005494.

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Background. In evidence-based medicine, stratum-specific likelihood ratios (SSLRs) are now being increasingly recognized as a more convenient and generalizable method to interpret diagnostic information than an optimal cut-off and its associated sensitivity and specificity. We previously examined the SSLRs of the General Health Questionnaire (GHQ) in primary care settings. The present paper aims to examine if these SSLRs are generalizable to the community settings.Methods. The Composite International Diagnostic Interview (CIDI) and the GHQ were administered on a representative sample of the Australian population in the Australian National Survey of Mental Health and Well-Being. We first compared the SSLRs of GHQ in urban Australia with the estimates that we had previously obtained from the developed urban centres in the WHO Psychological Problems in General Health Care study. If the SSLRs in the community were found to differ significantly from those in the primary care, we sought for explanatory variables.Results. The SSLRs in urban Australia and in the urban centres in the WHO study were significantly different for three out of the six strata. When we limited the sample to those with physical problems who visited a health professional, however, the SSLRs in the Australian study were strikingly close to those observed for primary care settings.Conclusions. Different sets of SSLRs apply to primary care and general population samples. For general population surveys in developed countries, the results of the Australian National Survey represent the currently available best estimates. For developing countries or rural areas, the results are less definitive and an investigator may wish to conduct a pilot study.
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Hunter, Jennifer, Katherine Corcoran, Kerryn Phelps, and Stephen Leeder. "The Challenges of Establishing an Integrative Medicine Primary Care Clinic in Sydney, Australia." Journal of Alternative and Complementary Medicine 18, no. 11 (November 2012): 1008–13. http://dx.doi.org/10.1089/acm.2011.0392.

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Grenvik, Ake. "Multidisciplinary Critical Care Medicine (CCM) in the USA." Prehospital and Disaster Medicine 1, S1 (1985): 116–18. http://dx.doi.org/10.1017/s1049023x00044058.

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A status report of CCM in different countries varies considerably. In the USA, resuscitation and intensive care were pioneered by anesthesiologists in the 1950s, but CCM evolved later as a multidisciplinary movement through the initiative of the Society of Critical Care Medicine (SCCM) starting in 1970. Recently, CCM has been introduced as a subspecialty of anesthesiology, internal medicine, pediatrics, and surgery. Australia has already, for a couple of years, had a primary specialty of intensive therapy, but there are two tracks, one in medicine and one in anesthesiology. In the Scandinavian countries, as well as in Italy, CCM is an integral part of anesthesiology, since intensive care was initiated there in the early 1950s by anesthesiologists. In several Ibero-Latin American nations, we find a primary specialty in intensive therapy.
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Clark, Alice, Andrew Gilbert, Deepa Rao, and Lorraine Kerr. "‘Excuse me, do any of you ladies speak English?’ Perspectives of refugee women living in South Australia: barriers to accessing primary health care and achieving the Quality Use of Medicines." Australian Journal of Primary Health 20, no. 1 (2014): 92. http://dx.doi.org/10.1071/py11118.

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Reforms to the Australian health system aim to ensure that services are accessible, clinically and culturally appropriate, timely and affordable. During the reform consultation process there were urgent calls from stakeholders to specifically consider the health needs of the thousands of refugees who settle here each year, but little is known about what is needed from the refugee perspective. Access to health services is a basic requirement of achieving the quality use of medicines, as outlined in Australia’s National Medicines Policy. This study aimed to identify the barriers to accessing primary health care services and explore medicine-related issues as experienced by refugee women in South Australia. Thirty-six women participated in focus groups with accredited and community interpreters and participants were from Sudan, Burundi, Congo, Burma, Afghanistan and Bhutan who spoke English (as a second language), Chin, Matu, Dari and Nepali. The main barrier to accessing primary health care and understanding GPs and pharmacists was not being able to speak or comprehend English. Interpreter services were used inconsistently or not at all. To implement the health reforms and achieve the quality use of medicines, refugees, support organisations, GPs, pharmacists and their staff require education, training and support.
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Dissertations / Theses on the topic "Primary care (Medicine) Australia"

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Bumgarner, D., K. Owens, J. Correll, W. T. Dalton, and Jodi Polaha. "Primary Behavioral Health Care in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6597.

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Polaha, Jodi. "ADHD in Primary Care." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6690.

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Polaha, Jodi. "Primary Care Behavioral Health." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6676.

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Dodd, Will. "Primary Care Cases." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/8930.

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Blackwelder, Reid B. "Primary Care Approach to Cough." Digital Commons @ East Tennessee State University, 2003. https://dc.etsu.edu/etsu-works/6994.

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Van, Sickle K., A. Beecham, and Jodi Polaha. "Training a Workforce for Primary Care." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6583.

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Polaha, Jodi, and Ivy Click. "Conducting Research in Primary Care Settings." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6752.

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Book Summary: Practice-Based Research shows mental-health practitioners how to establish viable and productive research programs in routine clinical settings. Chapters written by experts in practice-based research use real-world examples to help clinicians work through some of the most common barriers to research output in these settings, including lack of access to institutional review boards, lack of organizational support, and limited access to financial resources. Specialized chapters also provide information on research methods and step-by-step suggestions tailored to a variety of practice settings. This is an essential volume for clinicians interested in establishing successful, long-lasting practice-based research programs.
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Patel, Vaishal J. "MGH Internal Medicine Associates : primary care redesign." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/99015.

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Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2015. In conjunction with the Leaders for Global Operations Program at MIT.
Thesis: S.M., Massachusetts Institute of Technology, Engineering Systems Division, 2015. In conjunction with the Leaders for Global Operations Program at MIT.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 105-107).
Internal Medicine Associates (IMA) is the largest primary care practice at Massachusetts General Hospital (MGH) with over 40 attending physicians, 60 residents, and 80 support staff that deliver care to more than 30,000 patients. The IMA is structured into seven pods that act independently to serve patients. Each pod consists of patient care providers and support staff that work collaboratively in a team structure. In particular, providers and medical assistants work closely together during the clinical session to meet patient needs. A lack of standardization in the practice's operations has contributed to inefficiencies that add to a sense of overload and burnout with the medical assistant staff A detailed study of providers' clinical schedules revealed that individual clinical sessions are highly variable in terms of the number of concurrent clinical sessions per pod, session length, and number of patient appointments booked during this time. Providers in the IMA are part-time and create their clinical schedules based on personal preference and coordination with their other MGH related commitments. Variability in the schedule arises from many systematic, predictable, and unpredictable sources. Additionally, as part of a teaching hospital, IMA supports the educational training of over 60 Internal Medicine residents who hold a varying number of clinical sessions per week, depending on specific requirements of their residency program. Coordinating and supporting provider presence consumes many resources, impacts medical assistant workload, and adds to variability within the practice. The project develops an optimization model to level-load the expected workload on medical assistants and other members of the medical care team by determining the clinic schedules of providers. The expected workload is measured by the number of concurrent sessions and expected number of patient visits per hour. The project has developed an optimization model to suggest changes to the clinic schedule. Specifically in Pod 2/3, by strategically shifting 19.5% of provider sessions, we can achieve an 83% improvement in variability, as measured by the difference between maximum and minimum expected workload. Similar results are modeled for all pods in the IMA. The team has identified a pilot pod to test the model and is
by Vaishal J. Patel.
M.B.A.
S.M.
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Polaha, Jodi. "Integrating Behavioral Health Into Primary Care." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6648.

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Polaha, Jodi. "Practice Transformation in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/6665.

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This session will describe the evolution of the Pediatric Primary Behavioral Health Model in one clinic including the integration of behavioral health and social services into a residency training clinic. The implementation strategy used to develop this model will be described.
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Books on the topic "Primary care (Medicine) Australia"

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B, Murray Richard, and Kimberley Aboriginal Medical Services' Council., eds. Aboriginal primary health care: An evidence-based approach. Melbourne: Oxford University Press, 1999.

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Britt, Helena. It's different in the bush: A comparison of general practice activity in metropolitan and rural areas of Australia, 1998-2000. [Canberra]: Australian Institute of Health and Welfare, 2001.

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Goroll, Allan H. Primary care medicine. Philadelphia: Lippincott, 2000.

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Goroll, Allan H. Primary care medicine. Philadelphia: Lippincott, 2006.

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1952-, Frank Robert G., ed. Primary care psychology. Washington, DC: American Psychological Association, 2003.

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Pagel, James F., and S. R. Pandi-Perumal, eds. Primary Care Sleep Medicine. Totowa, NJ: Humana Press, 2007. http://dx.doi.org/10.1007/978-1-59745-421-6.

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Pagel, James F., and S. R. Pandi-Perumal, eds. Primary Care Sleep Medicine. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1185-1.

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Isabel, Garcia-Gimeno, Jones Roger, and SpringerLink (Online service), eds. Primary Care English. Berlin, Heidelberg: Springer-Verlag Berlin · Heidelberg, 2008.

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K, Singleton Joanne, ed. Primary care. Philadelphia: Lippincott, 1999.

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Crowther, Christy L. Primary orthopedic care. 2nd ed. St. Louis, Mo: Mosby, 2004.

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Book chapters on the topic "Primary care (Medicine) Australia"

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Cundiff, David, and Mary Ellen McCarthy. "Primary Care." In The Right Medicine, 101–18. Totowa, NJ: Humana Press, 1994. http://dx.doi.org/10.1007/978-1-4612-0309-4_7.

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Idzik, Shannon. "Primary Care." In Encyclopedia of Behavioral Medicine, 1742. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-39903-0_137.

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Idzik, Shannon. "Primary Care." In Encyclopedia of Behavioral Medicine, 1535–36. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4419-1005-9_137.

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Idzik, Shannon. "Primary Care." In Encyclopedia of Behavioral Medicine, 1–2. New York, NY: Springer New York, 2016. http://dx.doi.org/10.1007/978-1-4614-6439-6_137-2.

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Idzik, Shannon. "Primary Care." In Encyclopedia of Behavioral Medicine, 1–2. New York, NY: Springer New York, 2017. http://dx.doi.org/10.1007/978-1-4614-6439-6_137-3.

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Creary, Ludlow, and Ernest Yen. "Primary Care Team." In Urban Family Medicine, 135–38. New York, NY: Springer New York, 1987. http://dx.doi.org/10.1007/978-1-4612-4624-4_17.

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Gambert, Steven. "Primary Care Physicians." In Encyclopedia of Behavioral Medicine, 1742–43. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-39903-0_138.

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Idzik, Shannon. "Primary Care Providers." In Encyclopedia of Behavioral Medicine, 1743. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-39903-0_139.

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Gambert, Steven. "Primary Care Physicians." In Encyclopedia of Behavioral Medicine, 1536. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4419-1005-9_138.

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Idzik, Shannon. "Primary Care Providers." In Encyclopedia of Behavioral Medicine, 1537. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4419-1005-9_139.

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Conference papers on the topic "Primary care (Medicine) Australia"

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"Health Policy Reform Poor Rural Primary Health Care Delivery in Australia." In 2018 International Conference on Education, Psychology, and Management Science. Francis Academic Press, 2018. http://dx.doi.org/10.25236/icepms.2018.175.

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Desai, Rachit, and Carolyn McGregor. "Antenatal Care in Australia: Process Mapping to Visualise Resources and Care." In 2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC). IEEE, 2021. http://dx.doi.org/10.1109/embc46164.2021.9630582.

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"Clinical Medicine Undergraduates’ Reluctance to Engage in Primary Care." In 2020 International Conference on Social Sciences and Social Phenomena. Scholar Publishing Group, 2020. http://dx.doi.org/10.38007/proceedings.0001194.

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Nijland, Nicol, Karlijn Cranen, Stef F. F. Verlinden, Saskia M. Kelders, Henk Boer, and Julia E. W. C. van Gemert-Pijnen. "Computer Generated Self-Care Advice via Web-Based Triage of Complaints in Primary Care." In International Conference on eHealth, Telemedicine, and Social Medicine. eTELEMED 2009. IEEE, 2009. http://dx.doi.org/10.1109/etelemed.2009.17.

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Warren, Warren, and Freedman. "Interviewing expertise in primary care medicine: a knowledge-based support system." In Proceedings of the Twenty-Seventh Annual Hawaii International Conference on System Sciences. IEEE Comput. Soc. Press, 1994. http://dx.doi.org/10.1109/hicss.1994.323354.

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Warren, James R., Debra E. Warren, and Richard W. Freedman. "A knowledge-based patient data acquisition system for primary care medicine." In the second international conference. New York, New York, USA: ACM Press, 1993. http://dx.doi.org/10.1145/170088.170419.

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Martin, Matthew, and Randi Sokol. "Evaluation of a National Addiction Medicine Curriculum for Primary Care Physicians." In NAPCRG 50th Annual Meeting — Abstracts of Completed Research 2022. American Academy of Family Physicians, 2023. http://dx.doi.org/10.1370/afm.21.s1.4029.

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Wallis, Katharine, Susan Wells, Katrina Poppe, Vanessa Selak, and Ngaire Kerse. "57 In older people, the association between diabetes medication group and hypoglycaemia, cardiovascular disease, and mortality: prospective primary care-based cohort study 2010–2016." In Preventing Overdiagnosis Abstracts, December 2019, Sydney, Australia. BMJ Publishing Group Ltd, 2019. http://dx.doi.org/10.1136/bmjebm-2019-pod.70.

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Помыткина, Татьяна Евгеньевна, Татьяна Александровна Штернис, and Илья Игоревич Селин. "THE PROBLEM OF EMOTIONAL BURNOUT SYNDROME IN PRIMARY CARE PHYSICIANS." In Psychology, Sports science and Medicine (Психология. Спорт. Здравоохранение): сборник статей международной научной конференции (Санкт-Петербург, Октябрь 2022). Crossref, 2022. http://dx.doi.org/10.37539/221030.2022.94.41.007.

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В период пандемии COVID - 19 в 2020 году практическое здравоохранение столкнулось с проблемой синдрома эмоционального выгорания у работников амбулаторно - поликлинических учреждений, что в свою очередь привело к образованию кадрового дефицита. During the COVID -19 pandemic in 2020, practical healthcare faced the problem of emotional burnout among workers in outpatient clinics, which in turn led to the formation of a staffing shortage.
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d’Elia, Alexander, Lucy Frith, Mark Gabbay, Sarah Rodgers, Ciara Kierans, and Zoe Colombet. "P02 Artificial Intelligence and Health Inequities in Primary Care: A Scoping Review and Framework." In Society for Social Medicine Annual Scientific Meeting Abstracts. BMJ Publishing Group Ltd, 2022. http://dx.doi.org/10.1136/jech-2022-ssmabstracts.101.

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Reports on the topic "Primary care (Medicine) Australia"

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Harris, Daniel M., Stephen D. Tela, and Kris Truong. Provision and Use of Navy Medicine Primary Care: Empirical Background for Optimization. Fort Belvoir, VA: Defense Technical Information Center, August 2001. http://dx.doi.org/10.21236/ada402391.

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Smit, Amelia, Kate Dunlop, Nehal Singh, Diona Damian, Kylie Vuong, and Anne Cust. Primary prevention of skin cancer in primary care settings. The Sax Institute, August 2022. http://dx.doi.org/10.57022/qpsm1481.

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Overview Skin cancer prevention is a component of the new Cancer Plan 2022–27, which guides the work of the Cancer Institute NSW. To lessen the impact of skin cancer on the community, the Cancer Institute NSW works closely with the NSW Skin Cancer Prevention Advisory Committee, comprising governmental and non-governmental organisation representatives, to develop and implement the NSW Skin Cancer Prevention Strategy. Primary Health Networks and primary care providers are seen as important stakeholders in this work. To guide improvements in skin cancer prevention and inform the development of the next NSW Skin Cancer Prevention Strategy, an up-to-date review of the evidence on the effectiveness and feasibility of skin cancer prevention activities in primary care is required. A research team led by the Daffodil Centre, a joint venture between the University of Sydney and Cancer Council NSW, was contracted to undertake an Evidence Check review to address the questions below. Evidence Check questions This Evidence Check aimed to address the following questions: Question 1: What skin cancer primary prevention activities can be effectively administered in primary care settings? As part of this, identify the key components of such messages, strategies, programs or initiatives that have been effectively implemented and their feasibility in the NSW/Australian context. Question 2: What are the main barriers and enablers for primary care providers in delivering skin cancer primary prevention activities within their setting? Summary of methods The research team conducted a detailed analysis of the published and grey literature, based on a comprehensive search. We developed the search strategy in consultation with a medical librarian at the University of Sydney and the Cancer Institute NSW team, and implemented it across the databases Embase, MEDLINE, PsycInfo, Scopus, Cochrane Central and CINAHL. Results were exported and uploaded to Covidence for screening and further selection. The search strategy was designed according to the SPIDER tool for Qualitative and Mixed-Methods Evidence Synthesis, which is a systematic strategy for searching qualitative and mixed-methods research studies. The SPIDER tool facilitates rigour in research by defining key elements of non-quantitative research questions. We included peer-reviewed and grey literature that included skin cancer primary prevention strategies/ interventions/ techniques/ programs within primary care settings, e.g. involving general practitioners and primary care nurses. The literature was limited to publications since 2014, and for studies or programs conducted in Australia, the UK, New Zealand, Canada, Ireland, Western Europe and Scandinavia. We also included relevant systematic reviews and evidence syntheses based on a range of international evidence where also relevant to the Australian context. To address Question 1, about the effectiveness of skin cancer prevention activities in primary care settings, we summarised findings from the Evidence Check according to different skin cancer prevention activities. To address Question 2, about the barriers and enablers of skin cancer prevention activities in primary care settings, we summarised findings according to the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework for identifying important implementation considerations for novel interventions in healthcare settings and provides a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing a new activity or program. We assessed study quality using the National Health and Medical Research Council (NHMRC) levels of evidence. Key findings We identified 25 peer-reviewed journal articles that met the eligibility criteria and we included these in the Evidence Check. Eight of the studies were conducted in Australia, six in the UK, and the others elsewhere (mainly other European countries). In addition, the grey literature search identified four relevant guidelines, 12 education/training resources, two Cancer Care pathways, two position statements, three reports and five other resources that we included in the Evidence Check. Question 1 (related to effectiveness) We categorised the studies into different types of skin cancer prevention activities: behavioural counselling (n=3); risk assessment and delivering risk-tailored information (n=10); new technologies for early detection and accompanying prevention advice (n=4); and education and training programs for general practitioners (GPs) and primary care nurses regarding skin cancer prevention (n=3). There was good evidence that behavioural counselling interventions can result in a small improvement in sun protection behaviours among adults with fair skin types (defined as ivory or pale skin, light hair and eye colour, freckles, or those who sunburn easily), which would include the majority of Australians. It was found that clinicians play an important role in counselling patients about sun-protective behaviours, and recommended tailoring messages to the age and demographics of target groups (e.g. high-risk groups) to have maximal influence on behaviours. Several web-based melanoma risk prediction tools are now available in Australia, mainly designed for health professionals to identify patients’ risk of a new or subsequent primary melanoma and guide discussions with patients about primary prevention and early detection. Intervention studies have demonstrated that use of these melanoma risk prediction tools is feasible and acceptable to participants in primary care settings, and there is some evidence, including from Australian studies, that using these risk prediction tools to tailor primary prevention and early detection messages can improve sun-related behaviours. Some studies examined novel technologies, such as apps, to support early detection through skin examinations, including a very limited focus on the provision of preventive advice. These novel technologies are still largely in the research domain rather than recommended for routine use but provide a potential future opportunity to incorporate more primary prevention tailored advice. There are a number of online short courses available for primary healthcare professionals specifically focusing on skin cancer prevention. Most education and training programs for GPs and primary care nurses in the field of skin cancer focus on treatment and early detection, though some programs have specifically incorporated primary prevention education and training. A notable example is the Dermoscopy for Victorian General Practice Program, in which 93% of participating GPs reported that they had increased preventive information provided to high-risk patients and during skin examinations. Question 2 (related to barriers and enablers) Key enablers of performing skin cancer prevention activities in primary care settings included: • Easy access and availability of guidelines and point-of-care tools and resources • A fit with existing workflows and systems, so there is minimal disruption to flow of care • Easy-to-understand patient information • Using the waiting room for collection of risk assessment information on an electronic device such as an iPad/tablet where possible • Pairing with early detection activities • Sharing of successful programs across jurisdictions. Key barriers to performing skin cancer prevention activities in primary care settings included: • Unclear requirements and lack of confidence (self-efficacy) about prevention counselling • Limited availability of GP services especially in regional and remote areas • Competing demands, low priority, lack of time • Lack of incentives.
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Woods, Rachel, Alison Zhong, and Madelyn Vincent. Factors Associated with Influenza & Tdap Vaccine Uptake in Pregnant Patients at the UT Family Medicine Clinic in Memphis. University of Tennessee Health Science Center, 2021. http://dx.doi.org/10.21007/com.lsp.2020.0003.

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INTRODUCTION: Given the increased risk for infections among pregnant patients and newborns, vaccination against influenza (>50,000,000 annual US cases affecting all ages) and pertussis (>15,000 annual US cases disproportionately affecting newborns) are recommended among pregnant patients in order to protect them and their babies via passive immunity to cover a newborn’s window of vaccine ineligibility. Though flu and Tdap vaccination rates among pregnant patients have been trending upwards nationally, there is still room for improvement to achieve optimal rates. OBJECTIVES: The primary objectives were to study factors that affect the vaccination rates at the University of Tennessee Family Medicine Clinic at Memphis (UTFMC-M), compare those rates with national pregnancy flu/Tdap vaccination rates, and to generate recommendations based off observed factors associated with vaccine uptake to improve flu/Tdap vaccination rates in UTFMC-M pregnant patients. METHODS: This was a retrospective chart review of UTFMC-M patients who were pregnant from September 1, 2019-April 24, 2020 (included 2019-2020 flu season) (n=465). Variables studied included demographic data (race, age, insurance), immunization history (vaccine status, history of physician encouragement), and prenatal history (parity, number of prenatal visits, trimester at first visit, high risk clinic (HRC) admittance status). Vaccination status was based on ACIP recommendations (Flu shot eligible = any gestational age; Tdap eligible = ≥27 weeks). Positive HRC admittance was noted for patients with ≥2 visits to the UTFMC-M HRC, a clinic that specializes in high risk pregnant patient care. RESULTS: The patient sample was predominantly black (84.3%) and insured by Medicaid programs (88%). Among eligible UTFMC-M pregnant patients, 50.1% were flu-vaccinated (n=465); 73.8% were Tdap-vaccinated (n=317); and 52.1% were Flu+Tdap-vaccinated (n=317). No significant associations were found between vaccine uptake and HRC status, parity, and age. However, statistically significant relationships were found between vaccine uptake and physician encouragement (positive relationship with flu shot: X2(1, N = 465) =131, p < 0.001, Tdap: X2 (6, N = 465) =476, p < 0.001), number of prenatal visits (flu shot group median 8 visits, Tdap group median 9 visits vs. unvaccinated group median 4 visits; p < 0.001), and early trimester age at first prenatal visit (X2(6, N = 465) =47.635 , p CONCLUSION: 2019-2020 UTFMC-M vaccination rates were on par with 2018-2019 US flu vaccine rates and higher than 2018-2019 US Tdap and Flu+Tdap rates. There were statistically significant relationships between vaccine uptake at UTFMC-M and physician encouragement, number of prenatal visits, and early trimester age at first prenatal visit but no significant relationships with UTFMC-M HRC admittance, parity, or age. Recommendations following from our observations to address further vaccine rate improvement include: continue vaccine encouragement, continue booking multiple visits (8 for flu, 9 for Tdap), prioritize Tdap vaccine higher for late trimester intake patients, and focus on flu vaccine encouragement and education.
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Leavy, Michelle B., Costas Boussios, Robert L. Phillips, Jr., Diana Clarke, Barry Sarvet, Aziz Boxwala, and Richard Gliklich. Outcome Measure Harmonization and Data Infrastructure for Patient-Centered Outcomes Research in Depression: Final Report. Agency for Healthcare Research and Quality (AHRQ), June 2022. http://dx.doi.org/10.23970/ahrqepcwhitepaperdepressionfinal.

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Objective. The objective of this project was to demonstrate the feasibility and value of collecting harmonized depression outcome measures in the patient registry and health system settings, displaying the outcome measures to clinicians to support individual patient care and population health management, and using the resulting measures data to support patient-centered outcomes research (PCOR). Methods. The harmonized depression outcome measures selected for this project were response, remission, recurrence, suicide ideation and behavior, adverse effects of treatment, and death from suicide. The measures were calculated in the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, and displayed on the registry dashboards for the participating pilot sites. At the conclusion of the data collection period (March 2020-March 2021), registry data were analyzed to describe implementation of measurement-based care and outcomes in the primary care and behavioral health care settings. To calculate and display the measures in the health system setting, a Substitutable Medical Apps, Reusable Technology (SMART) on Fast Healthcare Interoperability Resource (FHIR) application was developed and deployed at Baystate Health. Finally a stakeholder panel was convened to develop a prioritized research agenda for PCOR in depression and to provide feedback on the development of a data use and governance toolkit. Results. Calculation of the harmonized outcome measures within the PRIME Registry and PsychPRO was feasible, but technical and operational barriers needed to be overcome to ensure that relevant data were available and that the measures were meaningful to clinicians. Analysis of the registry data demonstrated that the harmonized outcome measures can be used to support PCOR across care settings and data sources. In the health system setting, this project demonstrated that it is technically and operationally feasible to use an open-source app to calculate and display the outcome measures in the clinician’s workflow. Finally, this project produced tools and resources to support future implementations of harmonized measures and use of the resulting data for research, including a prioritized research agenda and data use and governance toolkit. Conclusion. Standardization of outcome measures across patient registries and routine clinical care is an important step toward creating robust, national-level data infrastructure that could serve as the foundation for learning health systems, quality improvement initiatives, and research. This project demonstrated that it is feasible to calculate the harmonized outcome measures for depression in two patient registries and a health system setting, display the results to clinicians to support individual patient management and population health, and use the outcome measures data to support research. This project also assessed the value and burden of capturing the measures in different care settings and created standards-based tools and other resources to support future implementations of harmonized outcome measures in depression and other clinical areas. The findings and lessons learned from this project should serve as a roadmap to guide future implementations of harmonized outcome measures in depression and other clinical areas.
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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.

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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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Leavy, Michelle B., Danielle Cooke, Sarah Hajjar, Erik Bikelman, Bailey Egan, Diana Clarke, Debbie Gibson, Barbara Casanova, and Richard Gliklich. Outcome Measure Harmonization and Data Infrastructure for Patient-Centered Outcomes Research in Depression: Report on Registry Configuration. Agency for Healthcare Research and Quality (AHRQ), November 2020. http://dx.doi.org/10.23970/ahrqepcregistryoutcome.

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Background: Major depressive disorder is a common mental disorder. Many pressing questions regarding depression treatment and outcomes exist, and new, efficient research approaches are necessary to address them. The primary objective of this project is to demonstrate the feasibility and value of capturing the harmonized depression outcome measures in the clinical workflow and submitting these data to different registries. Secondary objectives include demonstrating the feasibility of using these data for patient-centered outcomes research and developing a toolkit to support registries interested in sharing data with external researchers. Methods: The harmonized outcome measures for depression were developed through a multi-stakeholder, consensus-based process supported by AHRQ. For this implementation effort, the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, each recruited 10 pilot sites from existing registry sites, added the harmonized measures to the registry platform, and submitted the project for institutional review board review Results: The process of preparing each registry to calculate the harmonized measures produced three major findings. First, some clarifications were necessary to make the harmonized definitions operational. Second, some data necessary for the measures are not routinely captured in structured form (e.g., PHQ-9 item 9, adverse events, suicide ideation and behavior, and mortality data). Finally, capture of the PHQ-9 requires operational and technical modifications. The next phase of this project will focus collection of the baseline and follow-up PHQ-9s, as well as other supporting clinical documentation. In parallel to the data collection process, the project team will examine the feasibility of using natural language processing to extract information on PHQ-9 scores, adverse events, and suicidal behaviors from unstructured data. Conclusion: This pilot project represents the first practical implementation of the harmonized outcome measures for depression. Initial results indicate that it is feasible to calculate the measures within the two patient registries, although some challenges were encountered related to the harmonized definition specifications, the availability of the necessary data, and the clinical workflow for collecting the PHQ-9. The ongoing data collection period, combined with an evaluation of the utility of natural language processing for these measures, will produce more information about the practical challenges, value, and burden of using the harmonized measures in the primary care and mental health setting. These findings will be useful to inform future implementations of the harmonized depression outcome measures.
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