Rural primary health care workers and research : what is their present capacity?

Aims & rationale/Objectives : The main objectives of this project were to:
- conduct an audit of research skills and experience of primary health care staff in nine south western Victorian not-for-profit agencies
- identify capacity for research in five pre-identified areas
- investigate unpublished research endeavours/innovative projects taking place in the linked community organisations.
Methods : A 9-item survey was developed and will be distributed to all primary health care staff at the nine agencies via the internal email system of each organisation. The survey was developed after consultation with several agency directors, to obtain an organisational perspective on research capacity issues. Staff were also invited to take part in informal focus groups exploring key themes.
Principal findings : This study is in progress, and is expected to be completed at the end of March, 2007. Expected findings are the identification of primary health care staff's capacity for research, and discussion of relevant organisational assistance which would develop their research skills or enable continued participation in research.
Discussion : Phase 2 of the Australian PHC Research, Evaluation and Development Strategy aims to support the development and expansion of the primary health care research workforce. Findings from the current study will support this goal by assisting rural primary health care workers to identify the training and support they need to undertake quality research. The data could also be used to: a) assist the consortium to identify common research interests; b) to inform the consortium regarding the potential for collective research efforts; and c) to support funding submissions from the consortium or from individual agencies.
Implications : These findings will help to inform improved strategic planning in relation to building research capacity. The data could also be used by participating agencies to support applications for research grant funding.
Presentation type : Poster
Session theme : Building research capacity

Investigation of overweight and obesity management in a rural primary health care setting

Background : The rural region of interest has one main central medical clinic and several smaller outlying clinics. The services available for weight management include dietetic services, community-based groups and bariatric surgery. At present, no formal area specific referral pathway exists for the treatment of overweight and obesity.
Aims & rationale/Objectives : To investigate general practitioners':
- assessment practices and experiences with overweight and obese clients
- experience of different treatment options for overweight and obesity
- perceived barriers to overweight and obesity management.
Methods : A self-administered survey will be sent to general practitioners within the region of interest. The survey was designed to investigate current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management. Participants will also be offered a brief interview to discuss the following topics; Usefulness of NHMRC's Overweight and Obesity Guidelines; barriers and frustrations of weight management, GP's and dietitian's roles in overweight and obesity treatment.
Principal findings : It is expected the principal findings will include details about methods used to determine overweight and obesity; factors considered when selecting patients for treatment; favoured treatment options of GPs; perceived barriers and frustrations of managing overweight and obese patients.
Discussion : Overweight and obesity are significant health issues in Australia, with recent data indicating more than 60% of Australian adults are affected (NHMRC, 2003). Studies have also suggested that the prevalence of overweight and obesity is higher in rural populations (Coulson, 2005). GPs have been recognised as an important contributor in the treatment of overweight and obesity (Campbell, 2000). There have been guidelines produced to assist GPs, however the extent to which guidelines are utilised or their perceived effectiveness have not yet been investigated.
Implications : It is thought that an investigation into current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management will provide valuable information to inform primary health care service provision and future quality improvement directions.
Presentation type : Poster
Session theme : Primary health care delivery

Providing quality mental health nursing in primary health care settings in Kenya : A discussion paper.

Kenya, a country of 38 million people in East Africa has about 75 Psychiatrists and 500 Psychiatric Nurses, the majority work in the private sector and mainly in urban areas. Mental illness is common in Kenya, however, specialist services are sparse and primary care struggles to cope, and this has been worsened by general health programs which have been slow to appreciate the significance of mental health. The World Health Organisation recommends that provision of good quality mental health care does not only involve increasing the number of health workers but changing the skill mix and developing new competencies among existing workers. Successful implementation of mental, neurological and substance abuse disorder services in Kenya will depend on nurses, who constitute majority of the workforce located in provinces, districts and community clinics.

This discussion paper will address s key workforce issues affecting the up-scaling of mental health services, and the delivery of quality mental health nursing care in primary health care settings in Kenya. Strategies to develop skills and competencies of new and existing personnel will be discussed.

Gender differences in financial barriers to primary health care in New Zealand

Gender differences in health status and use of health care services have been established in the developed world; less attention, however, has been paid to gender differences in financial barrier to primary health care. Such barrier, however, represent potentially avoidable mortality and morbidity. This paper aims to examine gender differences in financial barrier to primary health care in New Zealand.

Differences in primary health care delivery to Australia's Indigenous population : a template for use in economic evaluations

Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia’s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting.

Methods The ‘Indigenous Health Service Delivery Template’ has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS.

Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly.

Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing health inequities is a stated goal.

Primary health-care costs associated with special health care needs up to age 7 years: Australian population-based study.

We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN.

Empirical evidence of recall bias for primary health care visits

BACKGROUND: While it is common for an economic evaluation of health care to rely on trial participants for self-reported health service utilisation, there is variability in the accuracy of this data due to potential recall bias. The aim of this study was to quantify the level of recall bias in self-reported primary health care general practitioner (GP) visits following inpatient rehabilitation over a 12 month period.

METHODS: This report is a secondary analysis from a larger randomised control trial of an economic evaluation of additional Saturday inpatient rehabilitation. Participants were adults who had been discharged into the community following admission to an acute general rehabilitation hospital. Participants were asked to recall primary health care visits, including community GP visits, via a telephone questionnaire which was administered at 6 and 12 months following discharge from inpatient rehabilitation. Participants were asked to recall health service utilisation over each preceding 6 month period. The self-reported data were compared to equivalent claims data from the national insurer, over the same period.

RESULTS: 751 participants (75% of the full trial) with a mean age of 74 years (SD 13) were included in this analysis. Over the 12 month period following discharge from rehabilitation there was an under-reporting of 14% in self-reported health service utilisation for GP visits compared to national insurer claims data over the same period. From 0 to 6 months following discharge from rehabilitation, there was an over-reporting of self-reported GP visits of 35% and from 7 to 12 months there was an under-reporting of self-reported GP visits of 36%, compared to national insurer claims data over the same period. 46% of patients reported the same or one number difference in self-reported GP visits between the 0 to 6 and the 7 to 12 month periods.

CONCLUSION: Based on these findings we recommend that an economic evaluation alongside a clinical trial for an elderly adult rehabilitation population include a sensitivity analysis that inflates self-reported GP visits by 16% over 12 months. However caution is required when utilising self-reported GP visits as the data may contain periods of both over and under reporting. Where general practitioner visits are expected to vary significantly between intervention and control groups we recommend that administrative data be included in the trial to accurately capture resources for an economic evaluation.

A square peg in a round hole? Approaches to incorporating lifestyle counselling into routine primary health care

Few studies have explored how lifestyle counselling can be integrated into routine practice for primary health care (PHC) clinicians working outside general practice. This paper describes the feasibility of models of lifestyle counselling developed for PHC clinicians working in community health services and the congruence with routine practice. Action research methods were used to develop and implement models of lifestyle counselling in three community health teams. Following a six-month implementation period, semi-structured interviews were conducted with a purposeful sample of participants (n = 30) to explore the appropriateness of implementing risk factor management models in practice. Models were considered appropriate if they fitted the clinician’s philosophy of practice, were relevant to existing work tasks, could easily be integrated into workflow and were perceived as being acceptable to the client. The approach to service delivery and team priorities were also important in influencing which models suited particular teams. Models of lifestyle counselling for PHC clinicians outside general practice should be tailored to the clinicians’ and teams’ way of working and thus may need to be discipline-specific. Engaging PHC clinicians and teams is important in developing models that are acceptable and feasible in everyday practice.